Schizophernia case presentation

case presentation on schizophernia with discussion

1. Case Presentation on Schizophernia Presenter : Dr Shubham Sadh 3 rd Year PG Scholar Guide: Dr Suhas Kumar Shetty Professor

2. Vital Data Name : ABC Age : 33 yrs Sex : M ale Address : Religion : Hindu Education: Post Graduation Occupation : business Marital status: Unmarried

3. PRESENT ILLNESS loss of interest, lethargy and marked reduction in physical and mental well being since 6-7 years.

4. HISTORY OF PRESENT ILLNESS Informer – patient A 33 year old male c/o marked reduction in physical and mental well being since 7years. Acc. To patient he was belittled by his sisters and school mates for being obese which reduced his self esteem and started performing poor in school works, from childhood itself he started developing a feeling of being left alone and was not able to tolerate even small bullying.

5. Later on he started feeling that all the people he came across are talking about him behind his back. He also comments that people outside doesn’t have manners. After completing pre-degree and PGDC he started working as a trainee at auditory office but left the job after 6 months with a feeling of insecurity and joined a coffee trading company but couldn’t hold on that job either. Later on he joined family business helping his father. During the period of his pre degree he consulted a psychiatrist at NIMHANS in 2008 as he was feeling some kind of sexual abusement done on him by his father and sister.

6. He also complaints that he is intolerable to traffic and noise. Informer – father Acc. To his father he was the young child of a non- consaginous parents with two elder sisters both unmarried. He was apparently healthy till his 8 th standard. Later his school performance started becoming poor and he showed less enthusiasm in all the other activities. Once his father remembers an incident that he stood near the window and started abusing people walking outside saying that they all intend to harm him.

7. Then he was taken to a psychiatrist and was under treatment thereafter. His studies improved thereafter and suddenly one evening he shouted at his father that his sister has been abusing him each night but on a realistic account his sister was not at their home. Later he lost interest in all activities and appear anxious all the time. He was admitted here for better treatment of his present condition.

8. PAST HISTORY N/H/O DM, HTN, infectious diseases, Disease related to eye, ear & dental, head injury or surgery, meningitis. FAMILY HISTORY His grand father had some sort of psychiatric illness details of which are not known. TREATMENT HISTORY Tab.Topaz 100mg OD Tab. Schizopin 100mg BD Not Underwent any ayurvedic treatments before

9. PERSONAL HISTORY Appetite – good Bowel – Regular (1-2/day) Micturition – (6-7 times/day) Straw colored urine Sleep – reduced Habits – Nil Allergy – For dust Diet - vegetarian

10. Vital Signs BP - 130/90mmHg Temperature – 98.6 o F Pulse rate- 84/min Respiratory rate – 16/min

11. GENERAL EXAMINATION Built: well built, obese Nourishment: Well nourished Pallor : absent Icterus : absent Cyanosis: absent Clubbing: absent Lymphadenopathy : absent Edema: absent Facies : Normal

12. Systemic examination RS – NVBS heard, no additional sounds CVS – S1,S2 heard, no murmur/clicks GIT – Soft, non tender, no organomegaly, tympanic note on percussion.

13. Mental Status Examination General appearance & behaviour : well built, obese, pt. looks anxious, unhygienic, inappropriate dressing. Attitude towards examine was partially attentive. Their was no eye contact, partially impaired comprehension. Rapport was built only after repeated interrogations. Speech – spontanity noticed, pt. replies soon before the question is finished. Rate: Rapid Vol : audible

14. Mood and Affect: Subjective Affect: lethargic, reduced interest in all activities Objective Affect: same Mood was anxious Thought: Stream of Thought: social in appearance Content: loosing his charm day by day, world is dangerous since 6years.

15. Perception: sister and father trying to harass and abuse him. Cognition: consciousness: present attention: less concentration: intact intelligence: impaired Insight: Grade 2(awareness of being ill)

16. Judgement : impaired

17. Differential Diagnosis- Modern Sciences Bipolar affective disorder Delusional disorder Depression Mental disorders secondary to general medical conditions Schizoaffective disorder Kaphavruta vyana Kampavata Guruta sarva gaatranam Sarva sandhiasthi ruja Gati sanga Vamabhaga samarambhatatoaparam Nrityaneeva chalati Beebhatsa mukha chesta Nidraya kampavarjita Karapadatala kampa Dehabhramana dukhite Nidra bhanga Mati ksheena

18. Diagnosis: Paranoid schizophrenia

19. SCHIZOPHRENIA Schizophrenia occurs with regular frequency nearly everywhere in the world in 1 % of population and begins mainly in young age (mostly around 16 to 25 years). Schizophrenia is defined by a group of characteristic positive and negative symptoms deterioration in social, occupational, or interpersonal relationships continuous signs of the disturbance for at least 6 months

20. History Emil Kraepelin : This illness develops relatively early in life, and its course is likely deteriorating and chronic; deterioration reminded dementia („Dementia praecox“), but was not followed by any organic changes of the brain, detectable at that time. Eugen Bleuler : He renamed Kraepelin’s dementia praecox as schizophrenia (1911); he recognized the cognitive impairment in this illness, which he named as a „splitting “ of mind. Kurt Schneider : He emphasized the role of psychotic symptoms, as hallucinations, delusions and gave them the privilege of „the first rank symptoms” even in the concept of the diagnosis of schizophrenia.

21. 4 A (Bleuler) Bleuler maintained, that for the diagnosis of schizophrenia are most important the following four fundamental symptoms: affective blunting disturbance of association (fragmented thinking) autism ambivalence (fragmented emotional response) These groups of symptoms, are called „four A’ s” and Bleuler thought, that they are „primary” for this diagnosis. The other known symptoms, hallucinations, delusions, which are appearing in schizophrenia very often also, he used to call as a “secondary symptoms”, because they could be seen in any other psychotic disease, which are caused by quite different factors — from intoxication to infection or other disease entities.

22. Causes of Schizophrenia No one knows the exact cause of schizophrenia, but multiple possible factors have been discovered Genetics appear to play a part; someone is more likely to develop schizophrenia if they have an identical twin with schizophrenia than if they have a fraternal twin with schizophrenia Women infected with the influenza virus during their pregnancy are more likely to give birth to children who will develop the disorder Schizophrenics’ brains also contain larger fluid-filled areas than their healthy brain counterparts

23. The left brain is diagnosed with schizophrenia. The brain on the right is healthy. The schizophrenic’s fluid-filled areas are larger. Johan and Ad van Bennekom are identical twins, both diagnosed with schizophrenia.

24. Types of Schizophrenia There are five types of schizophrenia: Catatonic – little to no movement, possibly a vegetative state Disorganized – common archetype of schizophrenia; disorganized thinking, flat effect, inappropriate emotions or behavior Paranoid – common archetype of schizophrenia; delusions, hallucinations, false beliefs of grandeur Residual – long-term schizophrenia where most symptoms have disappeared, negative symptoms (detractions from normal behavior) often remain such as flat effect or a refusal to talk Undifferentiated – does not fit in one of the above categories because the patient suffers from symptoms of multiple types

25. Schizophrenic Delusions A delusion is a false belief Some common schizophrenic delusions include: Being cheated Being harassed Being poisoned Being spied upon Being plotted against Most delusions are very grandiose and involve the patient at the center of some large plot or scheme

26. Schizophrenic Hallucinations A hallucination is a nonexistent stimulus that is perceived as real The most common schizophrenic hallucination is hearing voices, however the patient may also have visual hallucinations where they see a person or object that does not exist Hallucinated voices often interact with the patient: By commenting on their behavior By ordering them to do things By warning of impending dangers By talking to other voices about the patient

27. COURSE OF ILLNESS Course of schizophrenia: continuous without temporary improvement episodic with progressive or stable deficit episodic with complete or incomplete remission Typical stages of schizophrenia: prodromal phase active phase residual phase

28. Clinical Picture Diagnostic manuals: lCD-10 („International Classification of Disease“, WHO) DSM-IV („Diagnostic and Statistical Manual“, APA) Clinical picture of schizophrenia is according to lCD-10, defined from the point of view of the presence and expression of primary and/or secondary symptoms (at present covered by the terms negative and positive symptoms) : t he negative symptoms are represented by cognitive disorders, having its origin probably in the disorders of associations of thoughts, combined with emotional blunting and small or missing production of hallucinations and delusions t he positive symptom are characterized by the presence of hallucinations and delusions

29. Positive and Negative Symptoms Negative Positive Alogia Hallucinations Affective flattening Delusions Avolition -apathy Bizarre behaviour Anhedonia-asociality Positive formal thought disorder Attentional impairment

30. Treating Schizophrenia Antipsychotic drugs have been effective in treating the symptoms of schizophrenia Unfortunately, these drugs can also have some mild side effects including drowsiness, weight gain, jitters, movement problems, and muscle contractions A possible long-term side effect of antipsychotic drugs is a condition called tardive dyskinesia where patients will develop uncontrollable movements Another treatment is atypical antipsychotic drugs which have less side effects and can better treat patients not treated effectively by the normal drugs Therapy and counseling are also effective in improving behavior as well as creating a system of support for the patient in their family and friends

31. Famous People With Schizophrenia John Nash – Nobel Prize winner Syd Barret – guitarist for Pink Floyd Mary Todd Lincoln – wife of Abraham Lincoln

32. Nash’s two main delusions as seen in the movie

33. CONCLUSION Early detection and treatment has the best results/response to treatment. Per patients, once you have schizophrenia you have it for life. The best you can hope for is control.

34. “If you talk to God, you are praying; if God talks to you, you have schizophrenia” THANK YOU