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SCHIZOPHRENIA
HISTORICAL OVERVIEW
Emil Kraeplin:- He classified mental illness as
a) Manic depressive illness
b) Dementia Praecox :- emphasise the distinct
cognitive decline (dementia) & early onset of disorder
(praecox)
DEFINITION
Schizophrenia is a group of mental
disorders that is characterised by
disturbances in thinking, mood and
affect with a disorganized personality
EPIDEMIOLOGY
1. Schizophrenia affects around 0.30.7%
of people at some point in their life.
2. It occurs 1.4times more frequently in
males than females and typically
appears earlier in men. The peak ages
of onset are 25 years for males and 27
years for females.
COURSE OF
SCHIZOPHRENIA
SCHIZOPHRENIA F20
F20
F20.0
F20.1
F20.2
F20.3
F20.4
F20.5
F20.6
F20.8
F20.9
Schizophrenia
Paranoid schizophrenia
Hebephrenic schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Post-schizophrenic depression
Residual schizophrenia
Simple schizophrenia
Other schizophrenia
Schizophrenia, unspecified
TYPES
1. Paranoid type: The word paranoid means delusional.
Paranoid schizophrenia is the most common type of
schizophrenia. Delusions or auditory hallucinations
are present, but thought disorder, disorganized
behavior, or affective flattening are not. Delusions are
persecutory and/or grandiose, but in addition to
these, other themes such as jealousy, religiosity, or
somatizationmay also be present.
2. Disorganized type: Namedhebephrenic
schizophreniain the ICD. It has an early and insidious
onset and is often associated with poor pre-morbid
personality. Where thought disorder and flat affect are
present together and extreme social impairment is
present.
3. Catatonic type: Catatonic schizophrenia is
characterized by marked disturbance of motor
behaviour. This may take the form of catatonic
stupor, catatonic excitement and catatonia
CAUSES
1.
2.
CLINICAL PICTURE
Autistic Thinking
Thought Blocking
Neologism
Poverty of Speech
Delusions
Loosening of Association
Disorders of Perception
7. Hallucinations Auditory & Visua
Disorders of Affect
8. Apathy
9. Emotional Blunting
10.Anhedonia
POSITIVE SYMPTOMS
Those that appear to reflect an excess
or distortion of normal functions.
Positive symptoms are those that have
a positive reaction from some
treatment. In other words, positive
symptoms respond to treatment.
Hallucinations. Distortions or
exaggerations of perception in any of
the senses.
NEGATIVE SYMPTOMS
Those that appear to reflect a diminution
or loss of normal functions.
POSITIVE SYMPTOMS
NEGATIVE SYMPTOMS
Hallucinations
Alogia
Delusions
Avolition
Bizzare Behaviour
Flattening of Affect
Anhedonia
Attentional Impairment
SCHIZOPHRENIA
TREATMENT
Therapeutic Goals
1. Minimise Symptoms
2. Minimise Side-Effects
3. Prevent Relapse
4. Maximise Function
5. Recovery
Types of Treatment
1. Biological Treatment
A) Pharmacotherapy
B) ECT
C) Deep Brain Stimulation
2. Psychological /Psychotherapeutic Treatment
TYPES OF DRUG
TREATEMENT
1. AntiPsychotics
a) First Generation Antipsychotics
b) Second Generation Antipsychotics
c) Third Generation Antipsychotics
2. Adjunctive Medications
a) Lithium Carbonate
b) Anti-Depressants
c) Anti-Convulsants
d) Benzodiazepines
3. Other Medications
a) Anti-Parkinsons
b) Beta- Blockers
IPS GUIDELINE
RECOMMENDATIONS
Therapy include 3 phases
1. Acute Phase:- ( Goal- Symptom Reduction,
Improvement of Functioning)
2. Post-Acute Phase or Continuation Phase:- (GoalConsolidation of remission, Relapse Prevention). It
usually lasts 6 months
3. Stable Phase or Maintenance Phase:- (Improving or
maintaining functioning or prevention of recurrence)
Choice of Drug depends upon
1. Side-Effect Profile
2. Response Pattern
3. Patient preferences and Cost
4. Preferred Route of Administration
DURATION OF TREATMENT
It should be individualised. The suggested
guidelines are:1. First Episode Patients:- 1-2 yrs of
maintenance
2. Patient with several episode or
exacerbation :- >/ 5 yrs of maintenance
3. Patient with h/o aggression or suicide :Indefinite Period even life long
ECT
Schizophrenia itself is not a
primary indication for ECT.
The indications for ECT in schizophrenia
are :1. Catatonic Stupor
2. Uncontrolled Catatonic Excitement
3. Acute Exacerbations not controlled
with drug
4. Severe side-effects with drugs in
presence of untreated or resistant
schizophrenia
5. Risk of suicide, homicide or physical
assault
PSYCHOLOGICAL THERAPIES
1. Group Therapy
2. Behaviour Therapy
3. Family Therapy
4. Social Skill Training
5.Rehabilitation
CASE SCENARIO
Mr. Ali aged 26 yr male, admitted in psychiatric ward on
18-1-15 is a diagnosed case of paranoid schizophrenia
since 5 yrs. On asking, client often gives delusional
description about self and others.
On conversation client verbalises that You have to rule
the world, because you cannot trust anyone. He always
maintain a in-secured position saying that people are
planning to kill him.
Clients relative complained that he often gets irritated
on asking him to brush or bath. Also verbalised that client
gives odd description of self and others
On examination, general appearance of client was found
to be unkempt, inadequate hygiene with evidence of body
odour and dirty , delusional thinking and derealisation
was identified.