Neurobyology Respons

Schizophrenia
&
Other Psychotic Disorder

Dr Sabar P S, SpKJ
I. Schizophrenia

- It’s Chronic
- Debilitating mental disorder
- Characterized:
1. loss of touch with reality
2. disturbance of though, behavior, appearance &
speech
3. abnormal afect &
4. social withdrawal
 Syndromes of Schizophrenia

Positive Symptoms Negative Symptoms

(Type I) (Type II)
Delutions Affective flattening/blunting
Hallucinations Poverty of speech or
speech content
Blocking
Poor Grooming
Disorganized Symptoms Lack of motivation
(Type III) Anhedonia
though disorder Social withdrawal
Disorganized speech &
behavior
Cognitive defects
Attention deficits
Course

- 3 phases
- 1. prodromal: occur prior to the first psychotic
episode
include: a. avoidance of social activities
b. physical complaints
c. new interest in religion, the
occult or philosophy
2. psychotic phase: loses touch reality
3. residual phase: in touch reality but does not
behave normally
 Prognosis
• Downhill course over years
• Suicide is common in patients with schizophrenia
• The prognosis is better & the suicide risk is lower, if
the patients is older at onset of illness
married
has social relationships
female
has a good employment history
has mood symptoms
has positive symptoms
has few relapses
Etiology
1. Genetic
Group:
the general population 1%
child who has one schizophrenic or sibling 12%
child who has two schizophrenic parents 40%
monozygotic twin of a schizophrenic person 50%
2. Chromosome 6, 8 & 13
3. No social or environmental factor causes
Neural pathology
1. Anatomy
a. abnormalities of the frontal lobe
b. lateral & third ventricle enlargement

2. Neurotransmitter & other abnormalities

a. excessive dopaminergic activity
excessive number of dopamine receptors
excessive concentration of dopamine
hypersensitivity of receptors dopamine
b. serotonin hyperactivity

3. Eye movement are abnormal

 Subtypes DSM-IV TR
• Disorganized: - poor grooming & disheveled personal
appearance
- inappropriate emotional respon,
disinhibition
- onset before 25 years of age

• Catatonic: - stupor or agitation, lack of coherent

speech
- bizzare posturing (waxy flexibility)
- rare since the introduction of
antipsychotic agents
 Con’t
• Paranoid:
- delusions of persecution
- better functioning & older age at onset than other
subtypes

• Undifferentiated:
- characteristic of more than one subtype

• Residual:
- one previous schizophrenic episode
- subsequent residual symptoms but no
psychotic symptoms
Differential Diagnosis

• Medical ilnesses
• Medications
• Psychiatric illnesses
 Treatment
• Pharmacologic treatments
 antipsychotic agents
typical
atypical

• Psychological treatments, including individual,

family & group psychoterapy are useful to provide
long-term support & to foster compliance with the
drug regimen
Other psychotic disorders
Brief psychotic disorder

Characteristic
symptoms lasting > 1 day but < 1 month
often precipitating psychosocial factors

Prognosis
50%-80% recover completely
 Con’t (2)

Schizophreniform disorder
Schizoaffective disorder

Characteristics
symptoms lasting 1 – 6 months
symptoms of a mood disorder as well as psychotic symptoms

Prognosis
33% recover completely
Lifelong social & occupational impairment (somewhat higher
overall level of functioning than schizophrenia)
 Con’t (3)

Delusional disorder

Characteristics
Fixed, persistent, nonbizzare delusional
system

Prognosis
50% recover completely
many have relatively normal social &
occupational functioning