Schizophernia Clinical Case Presentation

Clinical Case Report writing guide for Schizophernia

1. Schizophrenia: Understanding the Mind’s Fracture Presented By: Dr. Sadia Ghazi Medical College

2. Introduction Schizophrenia is a chronic psychotic disorder with at least two of the following for 1 month (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms) that affects ~1% of the global population. Leads to significant disability and social/occupational dysfunction. Duration : Continuous signs for 6 months From some disease is chronic, for others there are periods of exacerbation & remission, and for some it can be one time occurrence. Illness affects perceptions, cognition, and affect

3. Most Common Symptoms Hallucinations Delusions Disorganized Speech Bizarre Behavior 01 03 02 04 05 06 Inappropriate Affect Confusion/ Disorientation

4. Hallucinations Auditory are most common form of hallucinations associated with psychosis Voices – generally taunting or saying negative things to person Command hallucinations – Hallucinations which tell the individual to perform certain tasks Visual , olfactory, and sensory hallucinations can be associated with neurological disorders, occasionally with genuine psychosis, or may be feigned.

5. Fixed, false beliefs that individual holds despite evidence to contrary Can be bizarre or non-bizarre Content may include a variety of themes (e.g. persecutory, referential, somatic, religious, or grandiose) Persecutory delusions are most common – being tormented, tricked, spied on, subjected to ridicule Delusions

6. Inappropriate Affect Laughing at inappropriate times Labile Affect – up and down rapidly Smiling or silly facial expression without any apparent reason

7. Disorganized Speech/Thinking Loose Associations – ping ponging from one subject to another with no clear string of thoughts connecting the two Tangential – responses to questions only remotely related to question at hand Word salad – incomprehensible, disorganized, incoherent speech.

8. Bizarre Behavior Disheveled Dress inappropriately (multiple layers of clothing) Putting tin foil in strategic places Engaging in purposeless behavior repeatedly Catatonia Can ’ t seem to hold and recall concepts after repeated instruction Can ’ t remember date, location despite repeated prompts Can ’ t recall who you are

9. Confusion/Disorientation Can ’ t seem to hold and recall concepts after repeated instruction Can ’ t remember date, location despite repeated prompts Can ’ t recall who you are

10. Rule out Differential Diagnosis Psychosis due to medical disorder? Psychosis due to medication? Psychosis due to drug/alcohol intoxication or withdrawal? Psychotic depression or mania? Psychosis of schizophrenia? Delusional disorder?

11. Presenting Features Positive symptoms: Delusions, hallucinations Negative symptoms: Avolition, anhedonia, alogia Cognitive deficits: Attention, memory, executive dysfunction

12. Etiology Genetic: COMT, DISC1 Environmental: Cannabis, trauma, urban living Neurodevelopmental : Prenatal infections, birth complications Neurochemical : Dopamine, glutamate, GABA imbalance

13. 1- Hypofrontality (reduced prefrontal activity ) 2- Impaired DMN connectivity 3- Grey matter loss in PFC, temporal lobes, hippocampus 4- Reduced dendritic spine density Effects on Brain - Physiology & Pathology

14. CT and MRI Findings CT : Ventricular enlargement, cortical atrophy MRI: Decreased volume in hippocampus, PFC Thalamic shrinkage White matter changes (DTI)

15. Treatment Protocol Acute Phase: Hospitalization, initiate antipsychotics Stabilization Phase: Medication titration, psychosocial support Maintenance Phase: CBT, family therapy, rehabilitation

16. Pharmacology & Mode of Action Typical Antipsychotics: D2 receptor antagonism (e.g., haloperidol ) Atypical Antipsychotics: D2 + 5-HT2A antagonism (e.g., risperidone, olanzapine ) Emerging : NMDA modulators, partial D2 agonists (aripiprazole)

17. Neurotransmitters & Receptors Involved Dopamine: Mesolimbic (hyperactivity): Positive symptoms Mesocortical (hypoactivity): Negative & cognitive symptoms Serotonin (5-HT2A): Modulates dopamine Glutamate (NMDA): Hypofunction theory GABA : Reduced inhibitory tone Acetylcholine : Nicotinic receptor involvement

18. Conclusion Schizophrenia is a complex neurodevelopmental disorder . Multifactorial etiology, chronic course, disabling impact . Early diagnosis and comprehensive treatment improve outcomes.

19. References Owen MJ et al. Lancet 2016;388(10039):86-97 . Howes OD, Kapur S. Schizophr Bull 2009;35(3): 549-62. van Os J, Kapur S. Lancet 2009;374(9690): 635-45. Green MF et al. Nat Rev Neurosci 2015;16(10): 620-631. Tandon R et al. Schizophr Res 2010;122(1-3):1-23.

20. Case Discussion