Schizophrenia - etiology, symptoms and treatment

Schizophrenia

1. SchizophreniaSchizophrenia
Department of PsychiatryDepartment of Psychiatry
11
stst
Faculty of Medicine Faculty of Medicine
Charles University, PragueCharles University, Prague
Head: Prof. MUDr. Jiří Raboch, DrSc.Head: Prof. MUDr. Jiří Raboch, DrSc.

2. DefinitionDefinition

The schizophrenic disorders are characterized in The schizophrenic disorders are characterized in
general by fundamental and characteristic general by fundamental and characteristic distortions distortions
of thinking and perception, and affectsof thinking and perception, and affects that are that are
inappropriate or blunted. Clear consciousness and inappropriate or blunted. Clear consciousness and
intellectual capacity are usually maintained although intellectual capacity are usually maintained although
certain cognitive deficits may evolve in the course of certain cognitive deficits may evolve in the course of
time. time.

The most important psychopathological phenomena The most important psychopathological phenomena
includeinclude
•thought echothought echo
•thought insertion or withdrawalthought insertion or withdrawal
•thought broadcastingthought broadcasting
•delusional perception and delusions of controldelusional perception and delusions of control
•influence or passivityinfluence or passivity
•hallucinatory voices commenting or discussing the patient in hallucinatory voices commenting or discussing the patient in
the third personthe third person
•thought disorders and negative symptoms.thought disorders and negative symptoms.

3. SchizophreniaSchizophrenia

Schizophrenia occurs with regular Schizophrenia occurs with regular
frequency nearly everywhere in the world frequency nearly everywhere in the world
in 1 % of population and begins mainly in in 1 % of population and begins mainly in
young age (mostly around 16 to 25 young age (mostly around 16 to 25
years).years).

Schizophrenia is defined by Schizophrenia is defined by
•a group of characteristic positive and negative a group of characteristic positive and negative
symptomssymptoms
•deterioration in social, occupational, or deterioration in social, occupational, or
interpersonal relationshipsinterpersonal relationships
•continuous signs of the disturbance for at least continuous signs of the disturbance for at least
6 months6 months

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

5. 4 A (Bleuler)4 A (Bleuler)

Bleuler maintained, that for the diagnosis of Bleuler maintained, that for the diagnosis of
schizophrenia are most important the following four schizophrenia are most important the following four
fundamental symptoms:fundamental symptoms:
•affective bluntingaffective blunting
•disturbance of associationdisturbance of association (fragmented thinking) (fragmented thinking)
•autismautism
•ambivalenceambivalence (fragmented emotional response) (fragmented emotional response)

These groups of symptoms, are called „four A’ s” These groups of symptoms, are called „four A’ s”
and Bleuler thought, that they are „primary” for and Bleuler thought, that they are „primary” for
this diagnosis.this diagnosis.

The other known symptoms, hallucinations, The other known symptoms, hallucinations,
delusions, which are appearing in schizophrenia delusions, which are appearing in schizophrenia
very often also, he used to call as a “secondary very often also, he used to call as a “secondary
symptoms”, because they could be seen in any symptoms”, because they could be seen in any
other psychotic disease, which are caused by quite other psychotic disease, which are caused by quite
different factors — from intoxication to infection or different factors — from intoxication to infection or
other disease entities.other disease entities.

6. Course of IllnessCourse of Illness

Course of schizophrenia:Course of schizophrenia:
•continuous without temporary improvementcontinuous without temporary improvement
•episodic with progressive or stable deficitepisodic with progressive or stable deficit
•episodic with complete or incomplete remission episodic with complete or incomplete remission

Typical stages of schizophrenia:Typical stages of schizophrenia:
•prodromal phaseprodromal phase
•active phaseactive phase
•residual phaseresidual phase

7. Clinical PictureClinical Picture

Diagnostic manuals: Diagnostic manuals:
•lCD-10lCD-10 („International Classification of Disease“, WHO) („International Classification of Disease“, WHO)
•DSM-IVDSM-IV („Diagnostic and Statistical Manual“, APA) („Diagnostic and Statistical Manual“, APA)

Clinical picture of schizophrenia is according to lCD-Clinical picture of schizophrenia is according to lCD-
10, defined from the point of view of the presence 10, defined from the point of view of the presence
and expression of primary and/or secondary and expression of primary and/or secondary
symptoms (at present covered by the terms symptoms (at present covered by the terms
negative and positive symptoms)negative and positive symptoms)::
•tthe he negative symptomsnegative symptoms are represented by cognitive are represented by cognitive
disorders, having its origin probably in the disorders of disorders, having its origin probably in the disorders of
associations of thoughts, combined with emotional blunting associations of thoughts, combined with emotional blunting
and small or missing production of hallucinations and and small or missing production of hallucinations and
delusionsdelusions
•tthe he positive positive symptomsymptom are characterized by the presence of are characterized by the presence of
hallucinations and delusionshallucinations and delusions
•tthe division is not quite strict and lesser or greater mixture he division is not quite strict and lesser or greater mixture
of symptoms from these two groups are possibleof symptoms from these two groups are possible

8. Positive and Negative SymptomsPositive and Negative Symptoms
NegativeNegative PositivePositive
AlogiaAlogia HallucinationsHallucinations
Affective flatteningAffective flattening DelusionsDelusions
Avolition-apathyAvolition-apathy Bizarre behaviourBizarre behaviour
Anhedonia-asocialityAnhedonia-asociality Positive formal thought Positive formal thought
disorderdisorder
Attentional impairmentAttentional impairment
Andreasen N.C., Roy M.-A., Flaum M.: Positive and negative symptoms. In:
Schizophrenia, Hirsch S.R. and Weinberger D.R., eds., Blackwell Science, pp. 28-45, 1995

9. The Criteria of DiagnosisThe Criteria of Diagnosis
For the For the diagnosis of schizophreniadiagnosis of schizophrenia is necessary is necessary

presence of one very clear symptom presence of one very clear symptom - - from point a) to d)from point a) to d)

or the presence of the symptoms from at least two groups or the presence of the symptoms from at least two groups - -
from point e) to h)from point e) to h)
for one month or more:for one month or more:
a)a)the hearing of own thoughts, the feelings of thought the hearing of own thoughts, the feelings of thought
withdrawal, thought insertion, or thought broadcastingwithdrawal, thought insertion, or thought broadcasting
b)b)the delusions of control, outside manipulation and influence, the delusions of control, outside manipulation and influence,
or the feelings of passivity, which are connected with the or the feelings of passivity, which are connected with the
movements of the body or extremities, specific thoughts, movements of the body or extremities, specific thoughts,
acting or feelings, delusional perceptionacting or feelings, delusional perception
c)c)hallucinated voices, which are commenting permanently the hallucinated voices, which are commenting permanently the
behavior of the patient or they talk about him between behavior of the patient or they talk about him between
themselves, or the other types of hallucinatory voices, themselves, or the other types of hallucinatory voices,
coming from different parts of bodycoming from different parts of body
d)d)permanent delusions of different kind, which are permanent delusions of different kind, which are
inappropriate and unacceptable in given cultureinappropriate and unacceptable in given culture

10. The Criteria of DiagnosisThe Criteria of Diagnosis
e)e)the lasting hallucination of every formthe lasting hallucination of every form
f)f)blocks or intrusion of thoughts into the flow of thinking and blocks or intrusion of thoughts into the flow of thinking and
resulting incoherence and irrelevance of speach, or resulting incoherence and irrelevance of speach, or
neologismsneologisms
g)g)catatonic behaviorcatatonic behavior
h)h)„„the negative symptoms”, for instance the expressed apathy, the negative symptoms”, for instance the expressed apathy,
poor speech, blunting and inappropriatness of emotional poor speech, blunting and inappropriatness of emotional
reactionsreactions
i)i)expressed and conspicuous qualitative changes in patient’s expressed and conspicuous qualitative changes in patient’s
behavior, the loss of interests, hobbies, aimlesness, behavior, the loss of interests, hobbies, aimlesness,
inactivity, the loss of relations to others and social inactivity, the loss of relations to others and social
withdrawalwithdrawal

Diagnosis of Diagnosis of acute schizophorm disorderacute schizophorm disorder (F23.2) – if the (F23.2) – if the
conditions for diagnosis of schizophrenia are fulfilled, but conditions for diagnosis of schizophrenia are fulfilled, but
lasting less than one monthlasting less than one month

Diagnosis of Diagnosis of schizoaffective disorderschizoaffective disorder (F25) - if the (F25) - if the
schizophrenic and affective symptoms are developing schizophrenic and affective symptoms are developing
together at the same timetogether at the same time

11. F20-F29 F20-F29 Schizophrenia, Schizotypal Schizophrenia, Schizotypal
and Delusional Disorders and Delusional Disorders
F20 F20 SchizophreniaSchizophrenia
F20.0 F20.0 Paranoid schizophrenia Paranoid schizophrenia
F20.1 Hebephrenic schizophrenia F20.1 Hebephrenic schizophrenia
F20.2 Catatonic schizophrenia F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia F20.3 Undifferentiated schizophrenia
F20.4 Post-schizophrenic depression F20.4 Post-schizophrenic depression
F20.5 Residual schizophrenia F20.5 Residual schizophrenia
F20.6 Simple schizophrenia F20.6 Simple schizophrenia
F20.8 Other schizophrenia F20.8 Other schizophrenia
F20.9 Schizophrenia, unspecified F20.9 Schizophrenia, unspecified

12. F20-F29 F20-F29 Schizophrenia, Schizotypal Schizophrenia, Schizotypal
and Delusional Disordersand Delusional Disorders
F21 F21 Schizotypal disorderSchizotypal disorder

F22 F22 Persistent delusional disordersPersistent delusional disorders
F22.0 F22.0 Delusional disorder Delusional disorder
F22.8 F22.8 Other persistent delusional disorders Other persistent delusional disorders
F22.9 F22.9 Persistent delusional disorder, unspecified Persistent delusional disorder, unspecified

F23 F23 Acute and transient psychotic disordersAcute and transient psychotic disorders
F23.1 F23.1 Acute polymorphic psychotic disorder with Acute polymorphic psychotic disorder with
symptoms of schizophrenia symptoms of schizophrenia
F23.2 F23.2 Acute schizophrenia-like psychotic disorder Acute schizophrenia-like psychotic disorder
F23.3 F23.3 Other acute predominantly delusional Other acute predominantly delusional
psychotic disorders psychotic disorders
F23.8 F23.8 Other acute and transient psychotic disorders Other acute and transient psychotic disorders
F23.9 F23.9 Acute and transient psychotic disorder, Acute and transient psychotic disorder,
unspecified unspecified

13. F20-F29 F20-F29 Schizophrenia, Schizotypal Schizophrenia, Schizotypal
and Delusional Disordersand Delusional Disorders
F24 F24 Induced delusional disorderInduced delusional disorder

F25 F25 Schizoaffective disordersSchizoaffective disorders
F25.0 F25.0 Schizoaffective disorder, manic type Schizoaffective disorder, manic type
F25.1 F25.1 Schizoaffective disorder, depressive type Schizoaffective disorder, depressive type
F25.2 F25.2 Schizoaffective disorder, mixed type Schizoaffective disorder, mixed type
F25.8 F25.8 Other schizoaffective disorders Other schizoaffective disorders
F25.9 F25.9 Schizoaffective disorder, unspecified Schizoaffective disorder, unspecified

F28 F28 Other nonorganic psychotic disorders Other nonorganic psychotic disorders

F29 F29 Unspecified nonorganic psychosisUnspecified nonorganic psychosis

14. F20.0 Paranoid Schizophrenia F20.0 Paranoid Schizophrenia

Paranoid schizophreniaParanoid schizophrenia is characterized is characterized
mainly by delusions of persecution, mainly by delusions of persecution,
feelings of passive or active control, feelings of passive or active control,
feelings of intrusion, and often by feelings of intrusion, and often by
megalomanic tendencies also. The megalomanic tendencies also. The
delusions are not usually systemized too delusions are not usually systemized too
much, without tight logical connections much, without tight logical connections
and are often combined with hallucinations and are often combined with hallucinations
of different senses, mostly with hearing of different senses, mostly with hearing
voices. voices.

Disturbances of affect, volition and Disturbances of affect, volition and
speech, and catatonic symptoms, are speech, and catatonic symptoms, are
either absent or relatively inconspicuous. either absent or relatively inconspicuous.

15. F20.1 Hebephrenic SchizophreniaF20.1 Hebephrenic Schizophrenia

Hebephrenic schizophreniaHebephrenic schizophrenia is characterized by is characterized by
disorganized thinking with blunted and disorganized thinking with blunted and
inappropriate emotions. It begins mostly in inappropriate emotions. It begins mostly in
adolescent age, the behavior is often bizarre. There adolescent age, the behavior is often bizarre. There
could appear mannerisms, grimacing, inappropriate could appear mannerisms, grimacing, inappropriate
laugh and joking, pseudophilosophical brooding and laugh and joking, pseudophilosophical brooding and
sudden impulsive reactions without external sudden impulsive reactions without external
stimulation. There is a tendency to social isolation.stimulation. There is a tendency to social isolation.

Usually the prognosis is poor because of the rapid Usually the prognosis is poor because of the rapid
development of "negative" symptoms, particularly development of "negative" symptoms, particularly
flattening of affect and loss of volition. Hebephrenia flattening of affect and loss of volition. Hebephrenia
should normally be diagnosed only in adolescents should normally be diagnosed only in adolescents
or young adultsor young adults..

Denoted also as Denoted also as disorganized schizophreniadisorganized schizophrenia

16. F20.2 Catatonic SchizophreniaF20.2 Catatonic Schizophrenia

Catatonic schizophreniaCatatonic schizophrenia is characterized is characterized
mainly by motoric activity, which might be mainly by motoric activity, which might be
strongly increased (hypekinesis) or strongly increased (hypekinesis) or
decreased (stupor), or automatic obedience decreased (stupor), or automatic obedience
and negativism. and negativism.

We recognize two forms:We recognize two forms:
•productive formproductive form — which shows catatonic — which shows catatonic
excitement, extreme and often aggressive excitement, extreme and often aggressive
activity. activity. TreatmentTreatment by neuroleptics or by by neuroleptics or by
electroconvulsive therapy.electroconvulsive therapy.
•stuporose formstuporose form — characterized by general — characterized by general
inhibition of patient’s behavior or at least by inhibition of patient’s behavior or at least by
retardation and slowness, followed often by retardation and slowness, followed often by
mutism, negativism, fexibilitas cerea or by mutism, negativism, fexibilitas cerea or by
stupor. The consciousness is not absent. stupor. The consciousness is not absent.

17. F20.3 Undifferentiated F20.3 Undifferentiated
SchizophreniaSchizophrenia

Psychotic conditions meeting the general Psychotic conditions meeting the general
diagnostic criteria for schizophrenia but diagnostic criteria for schizophrenia but
not conforming to any of the subtypes in not conforming to any of the subtypes in
F20.0-F20.2, or exhibiting the features of F20.0-F20.2, or exhibiting the features of
more than one of them without a clear more than one of them without a clear
predominance of a particular set of predominance of a particular set of
diagnostic characteristics.diagnostic characteristics.

This subgroup represents also the former This subgroup represents also the former
diagnosis of diagnosis of atypical schizophreniaatypical schizophrenia..

18. F20.4 Postschizophrenic F20.4 Postschizophrenic
DepressionDepression

A depressive episode, which may be A depressive episode, which may be
prolonged, arising in the aftermath of a prolonged, arising in the aftermath of a
schizophrenic illness. Some schizophrenic schizophrenic illness. Some schizophrenic
symptoms, either symptoms, either „„positivepositive““ or or „„negativenegative““, ,
must still be present but they no longer must still be present but they no longer
dominate the clinical picture. dominate the clinical picture.

These depressive states are associated These depressive states are associated
with an increased risk of suicide. with an increased risk of suicide.

19. F20.5 Residual SchizophreniaF20.5 Residual Schizophrenia

AA chronic stage in the development of chronic stage in the development of
schizophrenia with clear succession from schizophrenia with clear succession from
the initial stage with one or more episodes the initial stage with one or more episodes
characterized by general criteria of characterized by general criteria of
schizophrenia to the late stage with long-schizophrenia to the late stage with long-
lasting negative symptoms and lasting negative symptoms and
deterioration (not necessarily irreversible).deterioration (not necessarily irreversible).

20. F20.6 Simple SchizophreniaF20.6 Simple Schizophrenia

Simple schizophrenia is characterized by Simple schizophrenia is characterized by
early and slowly developing initial stage early and slowly developing initial stage
with growing social isolation, withdrawal, with growing social isolation, withdrawal,
small activity, passivity, avolition and small activity, passivity, avolition and
dependence on the others.dependence on the others.

The patients are indifferent, without any The patients are indifferent, without any
initiative and volition. There is not initiative and volition. There is not
expressed the presence of hallucinations expressed the presence of hallucinations
and delusions.and delusions.

21. F21 F21 Schizotypal disorderSchizotypal disorder

According to lCD-10 this disorder is According to lCD-10 this disorder is
characterized by eccentric behavior and by characterized by eccentric behavior and by
deviations of thinking and affectivity, deviations of thinking and affectivity,
which are similar to that occurring in which are similar to that occurring in
schizophrenia, but without psychotic schizophrenia, but without psychotic
features and expressed symptoms of features and expressed symptoms of
schizophrenia of any type.schizophrenia of any type.

22. F22 Persistent Delusional F22 Persistent Delusional
DisordersDisorders

Includes a variety of disorders in which Includes a variety of disorders in which
long-standing delusions constitute the long-standing delusions constitute the
only, or the most conspicuous, clinical only, or the most conspicuous, clinical
characteristic and which cannot be characteristic and which cannot be
classified as organic, schizophrenic or classified as organic, schizophrenic or
affective. affective.

Their origin is probably heterogeneous, Their origin is probably heterogeneous,
but it seems, that there is some relation to but it seems, that there is some relation to
schizophrenia.schizophrenia.

23. F22.0 F22.0 Delusional DisorderDelusional Disorder

A disorder characterized by the A disorder characterized by the
development of one delusion or of the development of one delusion or of the
group of similar related delusions, which group of similar related delusions, which
are persisting unusually long, very often are persisting unusually long, very often
for the whole life. for the whole life.

Other psychopathological symptoms — Other psychopathological symptoms —
hallucinations, intrusion of thoughts etc. hallucinations, intrusion of thoughts etc.
are not present and are excluding this are not present and are excluding this
diagnosis. diagnosis.

It begins usually in the middle age.It begins usually in the middle age.

24. F23 F23 Acute and Transient Acute and Transient
Psychotic DisordersPsychotic Disorders

The criteria should be the following The criteria should be the following
features:features:
•acute beginning (to two weeks)acute beginning (to two weeks)
•presence of typical symptoms (quickly presence of typical symptoms (quickly
changing “polymorphic symptoms”)changing “polymorphic symptoms”)
•presence of typical schizophrenic symptoms.presence of typical schizophrenic symptoms.

Complete recovery usually occurs within a Complete recovery usually occurs within a
few months, often within a few weeks or few months, often within a few weeks or
even days.even days.

The disorder may or may not be The disorder may or may not be
associated with acute stress, defined as associated with acute stress, defined as
usually stressful events preceding the usually stressful events preceding the
onset by one to two weeks. onset by one to two weeks.

25. F24 Induced Delusional Disorder F24 Induced Delusional Disorder

A delusional disorder shared by two or A delusional disorder shared by two or
more people with close emotional links. more people with close emotional links.
Only one of the people suffers from a Only one of the people suffers from a
genuine psychotic disorder; the delusions genuine psychotic disorder; the delusions
are induced in the other(s) and usually are induced in the other(s) and usually
disappear when the people are separated.disappear when the people are separated.

The psychotic disorder of the dominant The psychotic disorder of the dominant
member of this dyad is mainly, but not member of this dyad is mainly, but not
necessarily, of schizophrenic type. The necessarily, of schizophrenic type. The
original delusions of dominant member original delusions of dominant member
and his partner are usually chronic, either and his partner are usually chronic, either
persecutory or megalomanic.persecutory or megalomanic.

26. F25 Schizoaffective Disorders F25 Schizoaffective Disorders

Episodic disorders in which both affective and Episodic disorders in which both affective and
schizophrenic symptoms are prominent schizophrenic symptoms are prominent ((during the during the
same episode of the illness or at least during few same episode of the illness or at least during few
daysdays)) but which do not justify a diagnosis of either but which do not justify a diagnosis of either
schizophrenia or depressive or manic episodes. schizophrenia or depressive or manic episodes.

Patients suffering from periodic schizoaffective Patients suffering from periodic schizoaffective
disorders, especially with manic symptoms, have disorders, especially with manic symptoms, have
usually good prognosis with full remissions without usually good prognosis with full remissions without
any remaining defects.any remaining defects.

They are divided in different subgroups:They are divided in different subgroups:
•F25.0 Schizoaffective disorder, manic type F25.0 Schizoaffective disorder, manic type
•F25.1 Schizoaffective disorder, depressive type F25.1 Schizoaffective disorder, depressive type
•F25.2 Schizoaffective disorder, mixed type F25.2 Schizoaffective disorder, mixed type
•F25.8 Other schizoaffective disorders F25.8 Other schizoaffective disorders
•F25.9 Schizoaffective disorder, unspecifiedF25.9 Schizoaffective disorder, unspecified

27. Genetics of SchizophreniaGenetics of Schizophrenia

Many psychiatric disorders are Many psychiatric disorders are
multifactorial (caused by the interaction of multifactorial (caused by the interaction of
external and genetic factors) and from the external and genetic factors) and from the
genetic point of view very often genetic point of view very often
polygenically determined.polygenically determined.

Relative risk for schizophrenia is around:Relative risk for schizophrenia is around:
•1% for normal population1% for normal population
•5.6% for parents5.6% for parents
•10.1% for siblings10.1% for siblings
•12.8% for children12.8% for children

28. Etiology of SchizophreniaEtiology of Schizophrenia

The etiology and pathogenesis of The etiology and pathogenesis of
schizophrenia is not knownschizophrenia is not known

It is accepted, that schizophrenia is It is accepted, that schizophrenia is
„the group of schizophrenias“ which „the group of schizophrenias“ which
origin is multifactorial:origin is multifactorial:
•internal factors – genetic, inborn, internal factors – genetic, inborn,
biochemicalbiochemical
•external factors – trauma, infection of external factors – trauma, infection of
CNS, stressCNS, stress

29. Etiology of Schizophrenia - Etiology of Schizophrenia -
Dopamine HypothesisDopamine Hypothesis

The most influential and plausible are the The most influential and plausible are the
hypotheses, based on the supposed disorder of hypotheses, based on the supposed disorder of
neurotransmission in the brain, derived mainly fromneurotransmission in the brain, derived mainly from
1.1.the effects of antipsychotic drugs that have in common the the effects of antipsychotic drugs that have in common the
ability to inhibit the dopaminergic system by blocking ability to inhibit the dopaminergic system by blocking
action of dopamine in the brainaction of dopamine in the brain
2.2.dopamine-releasing drugs (amphetamine, mescaline, dopamine-releasing drugs (amphetamine, mescaline,
diethyl amide of lysergic acid - LSD) that can induce state diethyl amide of lysergic acid - LSD) that can induce state
closely resembling paranoid schizophreniaclosely resembling paranoid schizophrenia

Classical dopamine hypothesis of schizophreniaClassical dopamine hypothesis of schizophrenia: :
Psychotic symptoms are related to dopaminergic Psychotic symptoms are related to dopaminergic
hyperactivity in the brain. Hyperactivity of hyperactivity in the brain. Hyperactivity of
dopaminergic systems during schizophrenia is result dopaminergic systems during schizophrenia is result
of increased sensitivity and density of dopamine D2 of increased sensitivity and density of dopamine D2
receptors in the different parts of the brain.receptors in the different parts of the brain.

30. Etiology of Schizophrenia - Etiology of Schizophrenia -
Contemporary ModelsContemporary Models

Dopamine hypothesis revisitedDopamine hypothesis revisited: various : various
neurotransmitter systems probably takes place in neurotransmitter systems probably takes place in
the etiology of schizophrenia (norepinephric, the etiology of schizophrenia (norepinephric,
serotonergic, glutamatergic, some peptidergic serotonergic, glutamatergic, some peptidergic
systems); based on effects of atypical systems); based on effects of atypical
antipsychotics especially.antipsychotics especially.

Contemporary models of schizophreniaContemporary models of schizophrenia
conceptualize it as a neurocognitive disorder, conceptualize it as a neurocognitive disorder,
with the various signs and symptoms reflecting with the various signs and symptoms reflecting
the downstream effects of a more fundamental the downstream effects of a more fundamental
cognitive deficit:cognitive deficit:
•the symptoms of schizophrenia arise from “cognitive the symptoms of schizophrenia arise from “cognitive
dysmetria” (Nancy C. Andreasen)dysmetria” (Nancy C. Andreasen)
•concept of schizophrenia as a neurodevelopmental concept of schizophrenia as a neurodevelopmental
disorder (Daniel R. Weinberger)disorder (Daniel R. Weinberger)

31. Etiology of Schizophrenia - Etiology of Schizophrenia -
Neurodevelopmental ModelNeurodevelopmental Model

Neurodevelopmental modelNeurodevelopmental model supposes in supposes in
schizophrenia the presence of “silent lesion” in the schizophrenia the presence of “silent lesion” in the
brain, mostly in the parts, important for the brain, mostly in the parts, important for the
development of integration (frontal, parietal and development of integration (frontal, parietal and
temporal), which is caused by different factors temporal), which is caused by different factors
(genetic, inborn, infection, trauma...) during very (genetic, inborn, infection, trauma...) during very
early development of the brain in prenatal or early early development of the brain in prenatal or early
postnatal period of life. postnatal period of life.

It does not interfere too much with the basic brain It does not interfere too much with the basic brain
functioning in early years, but expresses itself in functioning in early years, but expresses itself in
the time, when the subject is stressed by the time, when the subject is stressed by
demands of growing needs for integration, during demands of growing needs for integration, during
formative years in adolescence and young formative years in adolescence and young
adulthood.adulthood.

32. Treatment of SchizophreniaTreatment of Schizophrenia

The acute psychotic schizophrenic patients will The acute psychotic schizophrenic patients will
respond usually to antipsychotic medication.respond usually to antipsychotic medication.

According to current consensus we use in the first According to current consensus we use in the first
line therapy the newer atypical antipsychotics, line therapy the newer atypical antipsychotics,
because their use is not complicated by appearance because their use is not complicated by appearance
of extrapyramidal side-effects, or these are much of extrapyramidal side-effects, or these are much
lower than with classical antipsychotics.lower than with classical antipsychotics.
conventional
antipsychotics
(classical
neuroleptics)
chlorpromazine, chlorprotixene, clopenthixole,
levopromazine, periciazine, thioridazine
droperidole, flupentixol, fluphenazine,
fluspirilene, haloperidol, melperone,
oxyprothepine, penfluridol, perphenazine,
pimozide, prochlorperazine, trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine,
quetiapine, risperidone, sertindole, sulpiride