Schizophrenia

1. SCHIZOPHRENIASCHIZOPHRENIA

2. HISTORY OF SCHIZOPHRENIAHISTORY OF SCHIZOPHRENIA
The word "schizophrenia" is less than 100 The word "schizophrenia" is less than 100
years old. However the disease was first years old. However the disease was first
identified as a discrete mental illness by identified as a discrete mental illness by
Dr. Dr. Emile Emile KraepelinKraepelin in the 1887 and the in the 1887 and the
illness itself is generally believed to have illness itself is generally believed to have
accompanied mankind through its history. accompanied mankind through its history.

3. HISTORY OF SCHIZOPHRENIAHISTORY OF SCHIZOPHRENIA
Written documents that identify Schizophrenia Written documents that identify Schizophrenia
can be traced to the old Pharaonic Egypt, as far can be traced to the old Pharaonic Egypt, as far
back as the second millennium before Christ. back as the second millennium before Christ.
Depression, dementia, as well as thought Depression, dementia, as well as thought
disturbances that are typical in schizophrenia are disturbances that are typical in schizophrenia are
described in detail in the Book of Hearts. The described in detail in the Book of Hearts. The
Heart and the mind seem to have been Heart and the mind seem to have been
synonymous in ancient Egypt. The physical synonymous in ancient Egypt. The physical
illnesses were regarded as symptoms of the illnesses were regarded as symptoms of the
heart and the uterus and originating from the heart and the uterus and originating from the
blood vessels or from purulence, fecal matter, a blood vessels or from purulence, fecal matter, a
poison or demons. poison or demons.

4. HISTORY OF SCHIZOPHRENIAHISTORY OF SCHIZOPHRENIA
At one point, all people who were considered At one point, all people who were considered
"abnormal," whether due to mental illness, "abnormal," whether due to mental illness,
mental retardation, or physical deformities, were mental retardation, or physical deformities, were
largely treated the same. Early theories largely treated the same. Early theories
supposed that mental disorders were caused by supposed that mental disorders were caused by
evil possession of the body, and the appropriate evil possession of the body, and the appropriate
treatment was then exorcising these demons, treatment was then exorcising these demons,
through various means, ranging from innocuous through various means, ranging from innocuous
treatments, such as exposing the patient to treatments, such as exposing the patient to
certain types of music, to dangerous and certain types of music, to dangerous and
sometimes deadly means, such as releasing the sometimes deadly means, such as releasing the
evil spirits by drilling holes in the patient's skull. evil spirits by drilling holes in the patient's skull.

5. HISTORY OF SCHIZOPHRENIAHISTORY OF SCHIZOPHRENIA
One of the first to classify the mental One of the first to classify the mental
disorders into different categories was the disorders into different categories was the
German physician, German physician, Emile Emile KraepelinKraepelin. Dr. . Dr.
Kraepelin used the term "dementia Kraepelin used the term "dementia
praecox" for individuals who had praecox" for individuals who had
symptoms that we now associate with symptoms that we now associate with
schizophrenia. schizophrenia.

6. HISTORY OF SCHIZOPHRENIAHISTORY OF SCHIZOPHRENIA
The Swiss psychiatrist, Eugen Bleuler, coined the The Swiss psychiatrist, Eugen Bleuler, coined the
term, "schizophrenia" in 1911. He was also the term, "schizophrenia" in 1911. He was also the
first to describe the symptoms as "positive" or first to describe the symptoms as "positive" or
"negative." Bleuler changed the name to "negative." Bleuler changed the name to
schizophrenia as it was obvious that Krapelin's schizophrenia as it was obvious that Krapelin's
name was misleading as the illness was not a name was misleading as the illness was not a
dementia (it did not always lead to mental dementia (it did not always lead to mental
deterioration) and could sometimes occur late as deterioration) and could sometimes occur late as
well as early in life. well as early in life.

7. HISTORY OF SCHZOPHRENIAHISTORY OF SCHZOPHRENIA
The word "schizophrenia" comes from the The word "schizophrenia" comes from the
Greek roots schizo (split) and phrene Greek roots schizo (split) and phrene
(mind) to describe the fragmented (mind) to describe the fragmented
thinking of people with the disorder. His thinking of people with the disorder. His
term was not meant to convey the idea of term was not meant to convey the idea of
split or multiple personality. split or multiple personality.

8. HISTORY OF SCHIZOPHRENIAHISTORY OF SCHIZOPHRENIA
Henri laborit used chlorpromazine as Henri laborit used chlorpromazine as
anesthetic in his surgical cases.anesthetic in his surgical cases.
Laborit goaded his brother-in-law, Pierre Laborit goaded his brother-in-law, Pierre
Deniker, a psychiatrist who used it in his Deniker, a psychiatrist who used it in his
patients.patients.
Chlorpromazine was the first antipsychotic Chlorpromazine was the first antipsychotic
approved by the USFDA in 1954 for approved by the USFDA in 1954 for
mental illness mental illness

12. FACTS ABOUT SCHIZOPHRENIAFACTS ABOUT SCHIZOPHRENIA
About 150 of every 100,000 persons About 150 of every 100,000 persons
will develop schizophrenia. will develop schizophrenia.
Schizophrenia affects men and Schizophrenia affects men and
women equally women equally
About 1% of the population suffers About 1% of the population suffers
from schizophrenia. from schizophrenia.
About 75% of patients developed About 75% of patients developed
schizophrenia between the ages of schizophrenia between the ages of
15-25. 15-25.

13. SYMPTOMSSYMPTOMS
Changes in work performance Changes in work performance
Disordered thinking Disordered thinking
Talking in nonsense Talking in nonsense
Hallucinations and delusions Hallucinations and delusions
Unusual perceptions Unusual perceptions
Changes in social relationships Changes in social relationships

14. PSYCHOSOCIAL FACTORSPSYCHOSOCIAL FACTORS
Life/Health Changes:Life/Health Changes: Environmental effects, such as viral infections that Environmental effects, such as viral infections that
changed the body’s chemistry or a highly stressful situation, may trigger changed the body’s chemistry or a highly stressful situation, may trigger
susceptibility to the illness. susceptibility to the illness.
Family History:Family History: There is an 8-18% chance of children, with one parent There is an 8-18% chance of children, with one parent
who is schizophrenic, to develop the illness. In children with two parents who is schizophrenic, to develop the illness. In children with two parents
who are schizophrenic, there is a 15-50% risk. who are schizophrenic, there is a 15-50% risk.
Genetics: Genetics: Genetic combinations could result in a person not having certain Genetic combinations could result in a person not having certain
enzymes or fully developed nerves; both of which could lead to the illness. enzymes or fully developed nerves; both of which could lead to the illness.
Developmental Problems:Developmental Problems: In some schizophrenic patients, the prefrontal In some schizophrenic patients, the prefrontal
cortex in the brain may have developed abnormally, thus leading to the cortex in the brain may have developed abnormally, thus leading to the
disturbances in thought patterns. disturbances in thought patterns.
Illness:Illness: Autoimmune illness and viral infections may combine with genetics Autoimmune illness and viral infections may combine with genetics
to cause schizophrenia. to cause schizophrenia.
Medication:Medication: Use of medication may interfere with the brain’s production of Use of medication may interfere with the brain’s production of
dopamine. Schizophrenia sufferers may be extra sensitive to dopamine, or dopamine. Schizophrenia sufferers may be extra sensitive to dopamine, or
may produce too much of it. may produce too much of it.

16. Coronal MR scans from a normal comparison subject (left), and chronic
schizophrenic (right). Note increase in CSF in right amygdala-hippocampal complex.
(image courtesy of Harvard University Schizophrenia Project

17. Variability maps are similar in both groups with highest variability in the posterior horns (NC =
normal controls, SZ = schizophrenic patients). Increases in LH ventricle length and volume were
determined. The color bar encodes the root mean square magnitude of variability in millimeters

18. Displacement maps show the magnitude of displacement (mm) between schizophrenic
patients and normal controls as represented by the color bar for the lateral ventricles
and corpus callosum. A significant vertical displacement of the lateral ventricles in
schizophrenic patients reflects a bilateral increase in ventricular volume, and
corresponds to the displacement of the corpus callosum

19. Mapping Brain Tissue Loss in Adolescents with Schizophrenia. This map reveals the
3-dimensional profile of gray matter loss in the brains of teenagers with early-onset
schizophrenia, with a region of greatest loss in the temporal and frontal brain regions that
control memory, hearing, motor functions, and attention. Using novel image analysis
algorithms, dramatic reductions in the profiles of gray matter were detected, based on a
database of 96 images from schizophrenic patients scanned repeatedly with MRI. The parallel
extraction of anatomical models from all patients in the image database required 60 CPU
hours, when running in parallel on an SGI RealityMonster with 32 internal CPUs. [Image by
Paul Thompson, Christine Vidal, Judy Rapoport, and Arthur Toga].

20. Value of Early Diagnosis and Value of Early Diagnosis and
Treatment in SchizophreniaTreatment in Schizophrenia
Patients with long DUP (delayed untreated psychosis) had a worse Patients with long DUP (delayed untreated psychosis) had a worse
outcome regarding the severity level of positive symptoms, of outcome regarding the severity level of positive symptoms, of
general symptoms and social disability general symptoms and social disability
Longer DUP results partly from a pattern of symptoms and social Longer DUP results partly from a pattern of symptoms and social
functioning which reduces concern by the sufferer and relevant functioning which reduces concern by the sufferer and relevant
others. DUP's relationship to outcome is strongest in the initial others. DUP's relationship to outcome is strongest in the initial
months of psychosis. This has implications for targeting early months of psychosis. This has implications for targeting early
intervention.intervention.
Earlier diagnosis of schizophrenia improves results of Earlier diagnosis of schizophrenia improves results of
treatmenttreatment
The DUP prior to first psychiatric admission adversely affects the The DUP prior to first psychiatric admission adversely affects the
long-term outcome in schizophrenia. The findings underline the long-term outcome in schizophrenia. The findings underline the
importance of establishing health service programs for early importance of establishing health service programs for early
detection and treatment of schizophrenic patients with the aim to detection and treatment of schizophrenic patients with the aim to
shorten the DUP and to consequently improve the course and shorten the DUP and to consequently improve the course and
outcome of schizophrenic patients.outcome of schizophrenic patients.

21. SYMPTOMS OF SCHIZOPHRENIASYMPTOMS OF SCHIZOPHRENIA
HALLUCINATIONSHALLUCINATIONS
BIZARRE DELUSIONSBIZARRE DELUSIONS
DISORGANIZED SPEECHDISORGANIZED SPEECH
GROSSLY DISORGANIZED BEHAVIOR OR GROSSLY DISORGANIZED BEHAVIOR OR
CATATONIC BEHAVIORCATATONIC BEHAVIOR
NEGATIVE SYMPTOMSNEGATIVE SYMPTOMS

22. TYPES OF SCHIZOPHRENIATYPES OF SCHIZOPHRENIA
Paranoid schizophreniaParanoid schizophrenia a person feels extremely a person feels extremely
suspicious, persecuted, grandiose, or experiences a suspicious, persecuted, grandiose, or experiences a
combination of these emotions. combination of these emotions.
Disorganized schizophreniaDisorganized schizophrenia a person is often incoherent a person is often incoherent
but may not have delusions. but may not have delusions.
Catatonic schizophreniaCatatonic schizophrenia a person is withdrawn, mute, a person is withdrawn, mute,
negative and often assumes very unusual postures. negative and often assumes very unusual postures.
Residual schizophreniaResidual schizophrenia a person is no longer delusion or a person is no longer delusion or
hallucinating, but has no motivation or interest in life. hallucinating, but has no motivation or interest in life.
These symptoms can be most devastating. These symptoms can be most devastating.

23. POSITIVE vs NEGATIVE SYMPTOMSPOSITIVE vs NEGATIVE SYMPTOMS
POSITIVEPOSITIVE
–HallucinationsHallucinations
–DelusionsDelusions
–Disorganized thinkingDisorganized thinking
–agitationagitation
NEGATIVE NEGATIVE
SYMPTOMSSYMPTOMS
–LACK OF DRIVELACK OF DRIVE
–SOCIAL WITHDRAWALSOCIAL WITHDRAWAL
–APATHYAPATHY
–EMOTIONAL EMOTIONAL
UNRESPONSIVENESSUNRESPONSIVENESS

24. DISORGANIZED TYPE OF SCHIZOPHRENIA

25. CATATONIC SCHIZOPHRENIA