Schizophrenia2

SCHIZOPHRENIASCHIZOPHRENIA

HISTORY OF SCHIZOPHRENIAHISTORY OF SCHIZOPHRENIA

Emil KraepelinEmil Kraepelin – uses the term demence – uses the term demence precox to emphasized the distinct pattern of precox to emphasized the distinct pattern of dementia in early onset.dementia in early onset.

Eugen Bleuler Eugen Bleuler – coined the term – coined the term schizophrenia. He chose the term schisms schizophrenia. He chose the term schisms between thought, emotion, and behavior in between thought, emotion, and behavior in patients with this disorderpatients with this disorder

Eugen Bleuler 4 A’s of Eugen Bleuler 4 A’s of schizophreniaschizophrenia

Associational disturbancesAssociational disturbances AffectAffect Autism Autism AmbivalenceAmbivalence

EPIDEMIOLOGYEPIDEMIOLOGY

Lifetime prevalence rate is Lifetime prevalence rate is 1%1% EquallyEqually prevalent in men and women prevalent in men and women Onset is Onset is earlier in menearlier in men than in women than in women The peak age of onset is The peak age of onset is 10 to 2510 to 25 for men and for men and 25 to 35 25 to 35

years for womenyears for women About About 3 – 10%3 – 10% of women present this illness of women present this illness after age after age

40.40. 90%90% of schizophrenia in treatment is of schizophrenia in treatment is between 15 to 55 between 15 to 55

years old.years old. Onset of schizophrenia Onset of schizophrenia before age 10 or after age 60 is before age 10 or after age 60 is

extremely rareextremely rare

EPIDEMIOLOGYEPIDEMIOLOGY

In the northern hemisphere, including the US, In the northern hemisphere, including the US, persons with schizophrenia are more often persons with schizophrenia are more often born in the months of born in the months of January to April.January to April. In In southern hemisphere, it is between southern hemisphere, it is between July to July to SeptemberSeptember

Ireland Ireland have an unusual high prevalence of have an unusual high prevalence of schizophrenia.schizophrenia.

First degree biological relatives have a First degree biological relatives have a 10x 10x greater risk for developing the disease.greater risk for developing the disease.

EPIDEMIOLOGYEPIDEMIOLOGY

Persons with schizophrenia have a higher Persons with schizophrenia have a higher mortality rates from accidents and natural mortality rates from accidents and natural causes than the general population.causes than the general population.

Suicide is the leading cause of mortality.Suicide is the leading cause of mortality. Persons who have realistic awareness of the Persons who have realistic awareness of the

deteriorative effects of the illness, deteriorative effects of the illness, hopelessness, excessive dependence on hopelessness, excessive dependence on treatment or loss of faith in treatment increases treatment or loss of faith in treatment increases the risk of suicide.the risk of suicide.

EPIDEMIOLOGYEPIDEMIOLOGY

Schizophrenic patients are in the low Schizophrenic patients are in the low socioeconomic status of life.socioeconomic status of life. Downward drift hypothesisDownward drift hypothesis – that affected – that affected

persons move into, or failed to rise out of, persons move into, or failed to rise out of, low socioeconomic status of lifelow socioeconomic status of life

Social causation hypothesisSocial causation hypothesis – proposes that – proposes that stresses experienced by low socioeconomic stresses experienced by low socioeconomic groups contribute to the development of groups contribute to the development of schizophreniaschizophrenia

ETIOLOGYETIOLOGY

Stress Diathesis ModelStress Diathesis Model NeurobiologyNeurobiology

Dopamine hyperactivityDopamine hyperactivity SerotoninSerotonin Neuropeptides - cholecystokinin and Neuropeptides - cholecystokinin and

neurotensinneurotensin Genetic factorsGenetic factors Psychosocial FactorsPsychosocial Factors

Subtypes of schizophreniaSubtypes of schizophrenia

Paranoid typeParanoid type Disorganized typeDisorganized type Catatonic typeCatatonic type Undifferentiated typeUndifferentiated type Residual typeResidual type

Auditory hallucinations, such as hearing voices Delusions, such as believing a co-worker wants to poison you

Anxiety Anger

Aloofness Violence

Verbal confrontations Patronizing manner

Suicidal thoughts and behavior

SIGNS AND SYMPTOMS OF PARANOID SCHIZOPHRENIA

Paranoid typeParanoid type

In paranoid schizophrenia, delusions are In paranoid schizophrenia, delusions are often focused on the perception that often focused on the perception that you're being singled out for harm. Your you're being singled out for harm. Your brain misinterprets experiences and you brain misinterprets experiences and you hold on to these false beliefs despite hold on to these false beliefs despite evidence to the contrary evidence to the contrary

Paranoid typeParanoid type

you may believe that the government is you may believe that the government is monitoring every move you make or that monitoring every move you make or that a co-worker is poisoning your lunch. You a co-worker is poisoning your lunch. You may also have delusions of grandeur — may also have delusions of grandeur — the belief that you can fly, that you're the belief that you can fly, that you're famous or that you have a relationship famous or that you have a relationship with a famous person with a famous person

Paranoid typeParanoid type

Delusions can result in aggression or violence if Delusions can result in aggression or violence if you believe you must act in self-defense against you believe you must act in self-defense against those who want to harm you. those who want to harm you.

These voices may talk either to you or to each These voices may talk either to you or to each other. The voices are usually unpleasant. They may other. The voices are usually unpleasant. They may give a running critique of what you're thinking or give a running critique of what you're thinking or doing, or they may harass you about real or doing, or they may harass you about real or imagined faults. Voices may also command you to imagined faults. Voices may also command you to do things that can be harmful to yourself or to do things that can be harmful to yourself or to others. When you have paranoid schizophrenia, others. When you have paranoid schizophrenia, these voices seem real. You may talk to or shout at these voices seem real. You may talk to or shout at the voices. the voices.

Disorganized TypeDisorganized Type

Disorganized schizophrenia is characterized by Disorganized schizophrenia is characterized by illogical and incoherent thoughts and behaviors. illogical and incoherent thoughts and behaviors.

Disorganized schizophrenia is considered a more Disorganized schizophrenia is considered a more severe type of schizophrenia because you may be severe type of schizophrenia because you may be unable to carry out routine daily activities, such as unable to carry out routine daily activities, such as bathing and meal preparation. With disorganized bathing and meal preparation. With disorganized schizophrenia, others may not be able to schizophrenia, others may not be able to understand what you're saying. Also, frustration understand what you're saying. Also, frustration and agitation may cause you to lash out. and agitation may cause you to lash out. Disorganized schizophrenia is sometimes known Disorganized schizophrenia is sometimes known as hebephrenic schizophrenia. as hebephrenic schizophrenia.

Disorganized type Disorganized type symptomssymptoms

Disorganized thinking.Disorganized thinking. With disorganized With disorganized thinking, you can't form logical or coherent thinking, you can't form logical or coherent thoughts. This disorganization is also thoughts. This disorganization is also noticeable in your speech patterns. You may noticeable in your speech patterns. You may not be able to stay on track in a conversation, not be able to stay on track in a conversation, instead jumping from one unrelated idea to instead jumping from one unrelated idea to another. Your disorganized speaking is so another. Your disorganized speaking is so severe that it may appear garbled and severe that it may appear garbled and unintelligible to others, and you may make up unintelligible to others, and you may make up words. These same disorganized patterns are words. These same disorganized patterns are evident in your written communication evident in your written communication

Disorganized type Disorganized type symptomssymptoms

Grossly disorganized behavior.Grossly disorganized behavior. The The disorganized behavior of this type of disorganized behavior of this type of schizophrenia is severe and causes significant schizophrenia is severe and causes significant impairment in your ability to function in regular impairment in your ability to function in regular daily activities. You may not be able to bathe, daily activities. You may not be able to bathe, dress appropriately or prepare meals, for dress appropriately or prepare meals, for instance. You may have unprovoked agitation instance. You may have unprovoked agitation or confrontations, wear many layers of clothes or confrontations, wear many layers of clothes on a warm day, appear disheveled or engage on a warm day, appear disheveled or engage in sexual behavior in public in sexual behavior in public

Disorganized symptomsDisorganized symptoms

Absent or inappropriate emotional Absent or inappropriate emotional expression.expression.

When you lack emotional expression (flat affect), When you lack emotional expression (flat affect), your face appears blank. You don't make eye your face appears blank. You don't make eye contact or display common body language. contact or display common body language. Although you may occasionally show some Although you may occasionally show some emotion, your range of expression is usually very emotion, your range of expression is usually very limited. Sometimes you may have emotions that limited. Sometimes you may have emotions that are inappropriate to the situation, such as acting are inappropriate to the situation, such as acting silly or laughing loudly during a serious event.silly or laughing loudly during a serious event.

Other symptoms of Other symptoms of disorganized typedisorganized type

Having beliefs not based on reality Having beliefs not based on reality (delusions) (delusions)

Seeing or hearing things that don't exist Seeing or hearing things that don't exist (hallucinations), especially voices (hallucinations), especially voices

Grimacing Grimacing Odd postures Odd postures Trouble functioning at school or work Trouble functioning at school or work Social isolation Social isolation Clumsy, uncoordinated movementsClumsy, uncoordinated movements

Risk factorsRisk factors

Having a family history of schizophrenia Having a family history of schizophrenia Exposure to viruses while in the womb Exposure to viruses while in the womb Malnutrition while in the womb Malnutrition while in the womb Stressful life circumstances Stressful life circumstances Trauma or abuse during childhood Trauma or abuse during childhood Older paternal age Older paternal age Taking psychoactive drugs during Taking psychoactive drugs during

adolescence adolescence

Catatonic typeCatatonic type

a chronic mental illness in which reality is a chronic mental illness in which reality is interpreted abnormally (psychosis). interpreted abnormally (psychosis). Catatonic schizophrenia includes Catatonic schizophrenia includes extremes of behavior. At one extreme of extremes of behavior. At one extreme of catatonic schizophrenia, you're unable to catatonic schizophrenia, you're unable to speak, move or respond. At the other, speak, move or respond. At the other, you have overexcited or hyperactive you have overexcited or hyperactive motion motion

Catatonic type symtomsCatatonic type symtoms

Physical immobilityPhysical immobility Excessive mobilityExcessive mobility Extreme resistanceExtreme resistance Peculiar movementsPeculiar movements Mimicking speech or movementMimicking speech or movement

Undifferentiated typeUndifferentiated type

A form of schizophrenia that is A form of schizophrenia that is characterized by a number of characterized by a number of schizophrenic symptoms such as schizophrenic symptoms such as delusion(s), disorganized delusion(s), disorganized behavior, disorganized speech, flat behavior, disorganized speech, flat affect, or hallucinations but does not affect, or hallucinations but does not meet the criteria for any other type of meet the criteria for any other type of schizophrenia.schizophrenia.

Residual TypeResidual Type

A form of schizophrenia that is A form of schizophrenia that is characterized by a previous diagnoses of characterized by a previous diagnoses of schizophrenia, but no longer having any schizophrenia, but no longer having any of the prominent psychotic of the prominent psychotic symptoms. There are some remaining symptoms. There are some remaining symptoms of the disorder however, such symptoms of the disorder however, such as eccentric behavior, emotional as eccentric behavior, emotional blunting, illogical thinking, or social blunting, illogical thinking, or social withdrawal.withdrawal.

Positive symptoms of Positive symptoms of schizophreniaschizophrenia

HallucinationsHallucinations DelusionsDelusions Bizaare behaviorBizaare behavior Positive formal thought disorderPositive formal thought disorder

DerailmentDerailment TangentialityTangentiality IncoherenceIncoherence IllogicalityIllogicality CircumstatialityCircumstatiality Pressure of speechPressure of speech Distractible speechDistractible speech clangingclanging

Negative symptoms of Negative symptoms of schizophreniaschizophrenia

Affective flatteningAffective flattening AlogiaAlogia Avolition-ApathyAvolition-Apathy Anhedonia-asocialityAnhedonia-asociality AttentionAttention

Good prognostic feature of Good prognostic feature of schizophreniaschizophrenia

Late onsetLate onset Obvious precipitating stressorsObvious precipitating stressors Acute onsetAcute onset Mood disorder symptomsMood disorder symptoms MarriedMarried Family history of mood disorderFamily history of mood disorder Good support systemGood support system Positive symptomsPositive symptoms

Poor prognostic feature of Poor prognostic feature of SchizophreniaSchizophrenia

Young onsetYoung onset No precipitating stressorNo precipitating stressor Insidious onsetInsidious onset Withdrawn, autistic behaviorWithdrawn, autistic behavior Single, divorced or widowedSingle, divorced or widowed Family history of schizophreniaFamily history of schizophrenia Neurological signs and symptomsNeurological signs and symptoms History of perinatal traumaHistory of perinatal trauma No remissions in three yearsNo remissions in three years Many relapsesMany relapses History of assaultiveness History of assaultiveness

TREATMENTTREATMENT

HospitalizationHospitalization For diagnostic purposesFor diagnostic purposes For stabilization of medicationsFor stabilization of medications For patient’s safety because of suicidal or or For patient’s safety because of suicidal or or

homicidal ideationhomicidal ideation For grossly disorganized or inappropriate behavior For grossly disorganized or inappropriate behavior Establishing an effective association between Establishing an effective association between

patients and community support systempatients and community support system

TREATMENTTREATMENT

Biological therapiesBiological therapies Psychosocial therapiesPsychosocial therapies Vocational therapyVocational therapy

THE ENDTHE END