Schizophrenia

• 1. History of Schizophrenia Benedict Morel A French Psychiatrist, had used the term "dmence prcoce" for deteriorated patients whose illness began in adolescence.

2. Emil Kraepelin Translated "dmence prcoce" into "dementia precox", that emphasized the distinct cognitive process (dementia) and early onset (precox) of the disorder. Dementia precox is described as a long term deteriorating course, hallucinations and dellusions. 3. Eugen Bleuler Replaced the term "dementia precox" and first coined the term "schizophrenia". He chose the term to express the presence of schisms between thought, emotion and behavior in patients with disorder. He developed the Four As (associations, affect, autism and ambivalence) as a summary for the symptoms of schizophrenia. 4. Adolf Meyer He is the founder of psychobiology. According to him Schizophrenia and other mental disorders are reactions to life stresses and called the syndrome as schizophrenic reaction. 5. Harry Stack Sullivan He founded the interpersonal psychoanalytic school and emphasized that social isolation as a cause and symptom of schizophrenia. 6. Ernst Kretschmer According to him, schizophrenia occurs more often to people with asthenic (slender, lightly muscled physiques), athletic or dysplastic types body rather than people with pyknic (short, stocky physiques). 7. Gabriel Langfeldt He classified major psychotic symptoms into two groups, true schizophrenia and schizophrenia like psychosis. True schizophrenia is described with several factors such as insidious onset, feelings of derealization and depersonalization, autism and emotional blunting. 8. Karl Jaspers A psychiatrist and philosopher who developed existential psychoanalysis. His work paved the way toward trying to understand the psychological meaning of schizophrenic signs and symptoms such as delusions and hallucinations. 9. What is schizophrenia? Schizophrenia is a mental illness that interferes with a persons ability to think clearly, manage emotions, make decisions, and relate to others. Most people living with schizophrenia have hallucinations and delusions, meaning they hear or, less commonly, see things that arent there and believe things that are not real or true. 10. Epidemiology The lifetime prevalence of schizophrenia in the United States is about 1 percent which means 1 person in 100 develop schizophrenia during their life time. Incidence is higher for persons born in urban areas of industrialized nations. Schizophrenia is found in all societies and geographical areas and incidence prevalence rates are roughly equal worldwide. 0.05 percent of the total population in US is treated for schizophrenia in any single year and only about half of all patients with schizophrenia obtain treatment, inspite of the severity of the disorder. 11. A. Gender and age Schizophrenia is equally prevalent in men and women however they differ in the onset and course of illness. Onset is earlier in men than in women. More than half of male schizophrenia patients are admitted to psychiatric hospital before age 25 while only 1/3 of female schizophrenia patients are admitted . The peak age for men is 10-25 years old while for women is 25-35 years old. Onset of schizophrenia rarely happens before age 10 or after age 60. Men are more like to be impaired by negative symptoms than women and that women have better social functioning than men. When onset occurs after 45 it is considered as late 12. B. Reproductive Factors The use of psychotherapeutic drugs, the open- door policies in hospitals, the deinstitutionalization in state hospitals, the emphasis on rehabilitation and community based patients have all led to increase in marriage and fertility rates among persons with schizophrenia. First degree biological relatives of person with schizophrenia have a 10 times greater risk for developing than the general population. 13. C. Suicide Risk Leading cause of mortality in persons suffering from schizophrenia. 15 percent of people with schizophrenia die because of suicide attempt. Mortality is especially high in young age people 14. D. Substance Use 1. Cigarette smoking 3/4 of schizophrenia patients smoke cigarettes. Cigarette smoking is associated with the use of high dosages of antipsychotic drugs because cigarette smoking increases the metabolism of this drugs. However cigarette smoking can also be a form of self-medication based on recent studies, it has effect on nicotine receptors in the brain that reduce the perception of outside stimuli such as noise that's why it decrease hallucinations. 15. 2. Other Substances 30-50% of people with schizophrenia has alcohol abuse or alcohol dependence. 15-25% are because of cannabis 5-10% are because of cocaine Patients report that they use this substance to obtain pleasure and combat their anxiety and depression. D. Substance Use 16. The class will be divided into groups. A group will have different representatives to answer each question and construct the jumbled letters. The questions will be about etiology of Schizophrenia. If you know the answer, you have to follow some instructions before raising your hand. READY? 17. The limbic system, the frontal cortex, cerebellum, and the basal ganglia are interconnected so that the dysfunction in one area may involve a primary pathological process in another. Touch the nose of the person right next to the person at your right. Neurobiology 18. Schizophrenia results from too much dopaminergic activity. The efficacy and the potency of antipsychotic drugs (dopamine receptor antagonists) are correlated with their ability to act as antagonists of the dopamine D2 receptor. Drugs that increase dopaminergic activity, notably amphetamine are psychotomimetic. Pinch your cheeks and say Im so cute Dopamine Hypothesis 19. A person has specific vulnerability (diathesis) that when acted on by a stressful influence allows the symptoms of schizophrenia to develop. The diathesis or the stress can be biological or environmental or both. The biological basis of a diathesis can be shaped by influenced by substance abuse, psychosocial stress and trauma. Put your tongue out and say MISSISSIPPI Stress- Diathesis Model 20. brains of patients with schizophrenia have lateral and third ventricular enlargement and some reduction in cortical volume, abnormal cerebral asymmetry and change in brain density. Consistent with a decrease in the usual amount of brain tissue in affected patients.Raise the left hand of the person whos right next to your left. Computed Tomography 21. Controls the emotions. This area of the brain is proved to be the most fertile for neuropathological studies of schizophrenia. Schizophrenia patients have shown decrease in the size of the region including the amygdala, the hippocampus, and parahippocampal gyrus and also found out that there is disorganization of neurons in the hippocampus. Under the NeuropathologyTouch your toes, knees your shoulder and your head while singing the song. Limbic System 22. Involved in the control of movement. Patients with schizophrenia show odd movements even in the absence of medication induced movements disorders. Also under Neurobiology Basal Ganglia and Cerebellum Tap the shoulder of fifth person from your left and say you always have my shoulder 23. Industrialization and urbanization are involved in the causes of schizophrenia. Dance oppa gangnam style Social Theories 24. According to psychoanalytic theory of Sigmund Freud, he postulated that ego defect affects the interpretation of reality and the control of inner drives such as sex and aggression. According to learning theorists, children who later have schizophrenia learn irrational reactions and way of thinking by imitating parents who have their own significant emotional problems. Psychosocial Theories Remove your shoes and raise it 25. Tecgeni ortfacs A person is like to have schizophrenia when other members of the family have the disorder. Monozygotic twins gave the highest concordance rate. In studies, of adopted monozygotic twins, twins reared by adoptive parents are seen to have schizophrenia at the same rate as their twin siblings brought by their biological parents. Clap three times and close your eyes Genetic Factors 26. Inability to follow moving visual target accurately. Eye movement is trait marker for people with schizophrenia, according to the recent studies, 50 - 85 patients with schizophrenia are reported to have abnormal eye movement. Hold your nose with your left hand while answering the question. Eye Movement Dysfunction 27. Schizophrenia like psychoses have been reported to occur more frequently than expected in patient with complex partial seizures, especially seizures involving the temporal lobes Under applied electrophysiology Touch your left ear with your right hand and raise your left hand. Complex Partial Epilepsy 28. Symptoms and Diagnosis DSM-IV TR Diagnostic Criteria for Schizophrenia A. Characteristic symptoms: Two or more of the following each present for a significant portion of time during 1 month period or less if successfully treated: 1. delusions 2. hallucinations 3. disorganized speech (frequent derailment or incoherence) 4. grossly disorganized catatonic behavior 5. Negative symptoms, affective flattening, alogia or avolition 29. DSM-IV TR Diagnostic Criteria for Schizophrenia B. Social/Occupational dysfunction: Significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations or self care are markedly below level achieved prior to the onset. C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6 months period include at least 1 month of symptoms. D. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance or a general medical condition 30. Diagnostic Criteria for Schizophrenia Subtypes A. Paranoid Type - A type of schizophrenia in which the following criteria are met: Preoccupation with one or more delusions or frequents auditory hallucinations. None of the following is prominent: disorganized speech, disorganized or catatonic behavior or flat or inappropriate affect. B. Disorganized Type - A type of schizophrenia in which the following criteria are met: All of the following are prominent Disorganized speech Disorganized behavior Flat or inappropriate affect. 31. Diagnostic Criteria for Schizophrenia Subtypes C. Catatonic Type - A type of schizophrenia in which the clinical picture is dominated by at least two of the following: Motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor Excessive motor activity (that is apparently purposeless and not influenced by external stimuli. Extreme negativism(an apparently motiveless resistance to all instructions or maintenance of rigid posture against attempts to be moved) or mutism peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate bizarre postures), stereotyped movements prominent mannerisms or prominent grimacing echolalia or echopraxia 32. Diagnostic Criteria for Schizophrenia Subtypes D. Undifferentiated Type - A type of schizophrenia in which symptoms that meet criterion A are present but the criteria are not met for the paranoid or catatonic type. E. Residual Type - A type of schizophrenia in which the following criteria are met. Absence of prominent delusions, hallucinations, disorganized speech and grossly disorganized or catatonic behavior. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in criterion A