BS 11BS 11

Schizophrenia

And

Other psychotic disorders

Schizophrenia

And

Other psychotic disorders

Schizophrenia Schizophrenia

Basically means that the person has lost touch with reality in some way, shape or form.

It is a chronic > 6 months, debilitating mental disorder

Peak age of onset 15 – 25 yrs for men, 25 – 35 yrs in women

Equally in men & women, in all cultures & ethnic groups

Has intact memory, and is oriented to person, place & time

Basically means that the person has lost touch with reality in some way, shape or form.

It is a chronic > 6 months, debilitating mental disorder

Peak age of onset 15 – 25 yrs for men, 25 – 35 yrs in women

Equally in men & women, in all cultures & ethnic groups

Has intact memory, and is oriented to person, place & time

Symptoms Symptoms

1. Positve sym: are additional to expected behavior – includes hallucinations, delusions, agitation & talkativeness

respond well with traditional antipsychotic agents

Negative sym: are missing from expected behavior – lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming & poor speech content

respond well with Atypical antipsychotics

1. Positve sym: are additional to expected behavior – includes hallucinations, delusions, agitation & talkativeness

respond well with traditional antipsychotic agents

Negative sym: are missing from expected behavior – lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming & poor speech content

respond well with Atypical antipsychotics

Course

It has 3 phases 1. Prodromal: symptoms occuring prior to 1st

psychotic episode – avoidance of social activities, physical complaints, new interest in religion, the occult / philosophy

2. Psychotic: pt loses touch with reality – disorders of perception, thought content, thought processes & form of thought

3. Residual: (period between psychotic episodes) – back to reality, but social withdrawal & peculiar thinking

Course

It has 3 phases 1. Prodromal: symptoms occuring prior to 1st

psychotic episode – avoidance of social activities, physical complaints, new interest in religion, the occult / philosophy

2. Psychotic: pt loses touch with reality – disorders of perception, thought content, thought processes & form of thought

3. Residual: (period between psychotic episodes) – back to reality, but social withdrawal & peculiar thinking

Perception Illusion

hallucination

Misperception of real stimuli

False sensory perception

Mistaking a shadow for someone.

Hearing voices

Thought content Delusion False belief Feeling of being followed by FBI

Thought processes

Impaired abstraction

Neologism

Lack of object relationship

Inventing words

Says eating

Medocrat

Form of thought Loose

association

Tangentiality

Shift of ideas from one topic to another

Getting farther away from one point

Health to basket ball

From his health to brothers health

Prognosis Prognosis

Usually repeated psychotic episodes – chronic downhill course over years – stabilizes in midlife

Suicidal tendency common – 50% attempt - 10% succeed

Prognosis is better if pt is older, married, has social relationship, female with positive symptoms

Usually repeated psychotic episodes – chronic downhill course over years – stabilizes in midlife

Suicidal tendency common – 50% attempt - 10% succeed

Prognosis is better if pt is older, married, has social relationship, female with positive symptoms

Etiology Etiology

Not known 1. Genetic factors –

2. Other factors: Season of birth: cold season – Jan - April - probable viral infections to mothers during 2nd trimester

Not known 1. Genetic factors –

2. Other factors: Season of birth: cold season – Jan - April - probable viral infections to mothers during 2nd trimester

general population ………….. – 1%having 1 schizophrenic parent / sibling – 12%Having 2 schizophrenic parent …… - 40%Having monozygotic schizophrenic twin – 50%

Neural pathologyNeural pathology

1. Anatomy abnormalities in frontal lobe functions -

reduced glucose meta as seen in PET Lateral & 3rd Vent enlargement / abnormal

cerebral symmetry / changes in density of brain

1. Anatomy abnormalities in frontal lobe functions -

reduced glucose meta as seen in PET Lateral & 3rd Vent enlargement / abnormal

cerebral symmetry / changes in density of brain

Neurotransmitters & other abnormalitis:

Excessive dopaminergic activities – excessive no of dopamine receptors, excessive concentration of dopamine – amphetamine & cocaine cause psychotic symps – elevated levels of homovanillic acid (HVA) – a metabolite of dopamine in pts serum

Serotonin hyperactivity

Eye movement: poor smooth visual pursuit – in schizophrenic pts and in their relatives

Neurotransmitters & other abnormalitis:

Excessive dopaminergic activities – excessive no of dopamine receptors, excessive concentration of dopamine – amphetamine & cocaine cause psychotic symps – elevated levels of homovanillic acid (HVA) – a metabolite of dopamine in pts serum

Serotonin hyperactivity

Eye movement: poor smooth visual pursuit – in schizophrenic pts and in their relatives

As per Diagnostic & Statistical Manual of Mental disorders IV Edn (DSM-IV) – 5 typesAs per Diagnostic & Statistical Manual of

Mental disorders IV Edn (DSM-IV) – 5 types

1.Disorganized Poor grooming, inappropriate emotional response, disinhibition – onset before 25 yrs of age

2.Catatonic Stupor / agitation / lack of coherant speech, bizarre posturing (waxy Flexibility)

3.Paranoid Delusions of persecution – older age of onset

4.Undifferentiated Characteristics of more than one type

5.Residual One previous episode & subsequent residual symptoms with no psychotic symptoms

Differential diagnosisDifferential diagnosis

Medical illnesses Medications Psychiatric illnesses

Medical illnesses Medications Psychiatric illnesses

Treatment Treatment

antipsychotic medication, Cognitive-Behavioural Therapy Family and Group Therapy Psychodynamic therapies

antipsychotic medication, Cognitive-Behavioural Therapy Family and Group Therapy Psychodynamic therapies

Typical Antipsychotics Atypical Antipsychotics

Chlorpromazine (Largactil)

Droperidol (Droleptan, Thalamonal)

Flupenthixol (Depixol, Fluanxol)

Fluphenazine (Modecate, Moditen, Motipress, Motival)

Haloperidol (Haldol, Serenace)

Thioridazine (Melleril)

Trifluoperazine (Stelazine, Parstelin)

Zuclopenthixol (Clopixol)

Clozapine (Clozaril)

Olanzapine

Risperidone

Other psychotic disordersOther psychotic disorders

Brief psychotic disorder Schizophreniform disorder Schizoactive disorder Shared delusional disorder

Brief psychotic disorder Schizophreniform disorder Schizoactive disorder Shared delusional disorder

Disorder Characteristics prognosis

Schizophrenia Psychotic & residual symptoms lasting for > 6 months

Lifelong, social & occupational impairment

Brief psychotic disorder

Psychotic symptoms lasting for > 1 day, but < 1 month – often precipitating social factors

50% - 80% recover completely

Schizophrenifom disorder

Schizoaffective disorder

Psychotic & residual symptoms lasting 1 – 6 months

Symptoms of mood disorder + psychotic symptom

33% recover completely

Lifelong social & occupational impairment

Delusional disorder

fixed, persistant, nonbizare delusional system – paranoid in persecutory / romantic in erotomanic type

50% recover completely

Shared delusional disorder

Delusion in a close relative shared by this person

10 – 40% recover completely