7. • SCHIZOPHRENIA - derived from the Greekword “Skhizein”
meaning “tosplit”,and “phren” meaning “mind”
• common, chronic and frequently devastating
neuropsychiatric disorder, affecting about 1% of the world’s
general population.
• among the ten leading causes of disability worldwide.
8. 1. Major depression
2. Alcohol use
3. Road traffic
accidents
4. Schizophrenia
5. Self inflicted injuries
6. Bipolar disorder
7. Drug use
16. GENETICPREDISPOSITION
• Concept of genetic pruning
• Increased rate among the biological relatives
• One parent - 46%
• Both parents - 52%
• Monozygotictwins–Concordancerateof50%
17.
18. BIOCHEMICALFACTORS
DOPAMINE HYPOTHESIS:
Excessive dopamine release in patients with schizophrenia has been
linked tothe severity of positive psychotic symptoms
NOREPHINEPHRINE HYPOTHESIS:
Anhedonia –the impaired capacity for emotional gratification and the
decreased ability to experience pleasure –has long been noted to be a
prominent feature of schizophrenia.
21. • Hippocampus, amygdala, parahippocamp.
–Smaller in affected twin (statictrait)
–Disordered hippocampal pyramidal cells
–Also in entorhinal, cingulate,
parahippocampal cortex
22. • Shrinkage of cerebellar
vermis
• Thicker corpus callosum
• Frontal lobes
–Abnormal neuronal
migration in one
study
–Dendrites have fewer
spines
–But no major
structural
abnormalities
–Measures of frontal
function impaired
23.
24.
25. FEATURES OF PSYCHOSIS:
1. Delusion
2. Hallucination
3. Disorganised Speech
4. Disorganised behavior
5. Catatonic state
26. 1.Positive (things that start to happen)
2.Negative (things that stop happening)
3.Cognitive (related to processing
information)
Mainly classified into three
broad categories:
27. 1. Hallucinations :
• Sensations that appear real but are created by mind
• Could affect all the senses
• These might tell them what to do, warn them of danger.
• The voices might talk to each other.
2. Delusions :
• An idiosyncratic belief or impression maintained despite being
contradicted by reality or rational argument
• It is a distortion of reality.
• These are beliefs that seem strange and are easy to prove wrong.
• Can be of various types
3. Disorganizedspeech :
• Have a hard time organizing their thoughts.
• They might not be able to follow along when you talk to them.
• Words come out all jumbled and not make sense.
• Can also have trouble concentrating
4. Disorganized behaviour
5. Catatonic state
• Abnormality of movement and behaviour arising from a
disturbed mental state
28. TYPESOFHALLUCINATIONS
• AUDITORY : Hearing voices :
• VISUAL: Seeing things :
• OLFACTORY: Smell things that aren't there :
• GUSTATORY: False sense of taste :
• TACTILE: Feel things that don't exist :
29. TYPESOF DELUSIONS
• Delusion of Persecution
• Delusions of Reference•
• Delusions of Grandeur
• Delusions of Erotomania
• Delusion of Somatomania
• Delusion of Infidelity
30. DISORGANIZEDSPEECH:
• Loose associations – Rapidly shifting from topic to
topic, with no connection between one thought and the
next.
• Neologisms – Made-up words or phrases that only
have meaning to the patient.
• Perseveration – Repetition of words and statements;
saying the same thing over and over.
• Clang – Meaningless use of rhyming words (“I said the
bread and read the shed and fed Ned at the head").
31. DISORGANIZEDBEHAVIOUR:
1. Schizophrenia disrupts goal-directed activity, causing
impairments in a person’s ability to take care of him or
herself, work, and interact with others.
2. Disorganized behavior appears as:
1. Adecline in overall daily functioning
2. Unpredictable or inappropriate emotional
responses
3. Behaviors that appear bizarre and have no
purpose
4. Lack of inhibition and impulse control
32. Negative Symptoms represent the absence or diminution of
normal intellectual function
• AFFECT
Schizophrenics have flat(lack of expression), blunt(severe reduction
in intensity) or inappropriate (incongruent with situation) affect
• ALOGIA
It is characterised by poverty of speech,a reduction in the amount
of speech, speech content,blocking or late replies.
33. • AVOLITION
It is the loss of motivation
• ASOCIALITY
It is the diminished interest in, motivation for, and
appreciation of social interactions with others, like
family and friends
• APHEDONIA
It is the inability to feel pleasure in normally
pleasurable activities
34. 1. Cognitive symptoms are subtle and are often
detected only when neuropsychological tests are
performed
2. They include the following:
• Poor “executive functioning”
• Trouble focusing or paying attention
• Problems with “working memory”
35.
36. • Social withdrawal
• Hostility or suspiciousness
• Deterioration of personal
hygiene
• Flat, expressionless gaze
• Inability to cry or expressjoy
• Inappropriate laughter or crying
• Depression
• Oversleeping or insomnia
• Odd or irrational statements
• Forgetful; unable to concentrate
• Extreme reaction to criticism
• Strange use of words or way of
speaking
37.
38. • There are five types ofschizophrenia:
1. Catatonic – little to no movement, possibly a vegetative
state
2. Disorganized – disorganized thinking, flat effect,
inappropriate emotions or behavior
3. Paranoid –delusions, hallucinations, false beliefs of
grandeur
4. Residual –negative symptoms often remain such as flat
effect or a refusal to talk
5. Undifferentiated – does not fit in one of the above
categories
55. 1. Clozapine
2. Remoxipride
3. Risperidone
4. Sertindole
5. Olanzapine
6. Quetiapine
7. Amisulpiride
8. Zotepine
9. Ziprasidone
10.Aripiprazole
An antipsychotic that does not
cause EPS at therapeutic doses
56. Evidence of association between metabolic
disturbances and the use of atypical antipsychoitics
The ‘metabolic syndrome’ include:
Obesity
Diabetes
Dyslipidemia
57. •ECTisnot the primary treatment of choiceforschizophrenia
•The indications of ECT
include:-
•1.Catatonic Stupor
2.Uncontrolled Catatonic Excitement
3.Acute exacerbation not
controlled with drugs
2.Severe side-effects with drugs
in the presence ofschizophrenia
Usually 8-12 ECT’Sare needed
administered 2-3 times aweek.
75. Schizophrenia - Spectrum of Dysfunctions
Affecting cognitive, emotional, and behavioral
domains
Positive, negative, and disorganized symptom
clusters
Several Bio-Psycho-Social Variables are Involved
Diagnosed according to the ICD 10 criteria
Management includes antipsychotics, along with
psychosocial interventions
Successful Treatment Rarely Includes Complete
Recovery
Genetic therapy is the way ahead