schizophrenia.pptx and its classification

content deals with schizophrenia

1. INTRODUCTION Eugen Bleuler in 1911 renamed dementia as schizophrenia. He recognized that schizophrenia consist of a group of disorder. He described the 4 primary symptom Autism Ambivalence Affect disturbance Association disturbance

2. Schizophrenia Schizophrenia is a major mental illness. In this all the components of the mind of the individual is affected, destroying his entire personality and sometimes making him unfit for life. Not only that but in schizophrenia there may be a disconnection between what the person is thinking and what he is feeling. For e.g. when we describe a sad event in our life such as the death of a close relative, our feeling becomes sad which is shown in our face and by the tone of our voice. But a patient with schizophrenia may laugh while describing sad events. This is called as incongruous affect. The patient also has strange beliefs and unusual perceptions.

3. Epidemiology Around 1% of the world population is affected with schizophrenia. The incidence of schizophrenia is about 1/1000. The onset of schizophrenia occurs usually later in females and often runs a more benign course, as compared to males. The male to female incidence is approximately equal.

4. Incidence: It is most common of all psychiatric disorders. Equally prevalent in men & women 2\3 rd of cases are in age group 15-30 yrs

5. Epidemiology Monozygotic twins - 47% Dizygotic twins - 12% Siblings/ parents - 12% Child of one schizophrenic parent - 12% Child of both schizophrenic parents - 40%

6. Definition Schizophrenia is a psychotic condition characterized by a disturbance in the emotions ,violitions& faculties in the presence of clear consciousness which usually lead to social withdrawal -Sreevani

7. Etiology Genetic factors – DiGeorge syndrome (22q11.2 deletion syndrome )others Biochemical factors-dopamine pathways Psychological factors- trauma,metabolic disorder Social factors-lower social economic

8. ICD AND DSM 6A20-ICD-11 CODE FOR SCHIZOPHRENIA 295.90- DSM 5 CODE FOR SCHIZOPHRENIA

9. DIAGNOSIS BRIEF PSYCHATRIC RATING SCALE COGNITIVE DEFICITS IN SCHIZOPHRENIA-STROOP TEST - TRAIL MAKING TEST PERSONALITY RELATED PROBLEMS-RORSCHACH INKBLOT TEST CT SCAN –VENTRICULAR ENLARGEMENT PET SCAN – INCEREASED D2 RECPETOR

10. A/C TO ICD 11 THINKING PEREPTION SELF EXPERINCE COGNITION AFFECT BEHAVIOUR

11. Pathophysiology Neuroanatomy: prefrontal cortex enlarged lat. ventricle ed metabolism ed volume hippocampus ed volume

12. Pathophysiology Neurochemistry: Dopamine: dopamine excess hippocampus positive symptoms dopamine deficiency prefrontal lobe negative symptoms

13. Pathophysiology Neurochemistry: Glutamate Acetyl choline Serotonin

14. CLASSIFICATIONS 1.PARANOID SCHIZOPHRENIA Delusion of persecution Delusion of jealousy Delusion of grandiosity Hallucinatory voice Auditory hallucination

15. 2.DISORGANISED SCHIZOPHRENIA MARKED THOUGHT DISODER EMOTIONAL DISTURBANCE EXTREME SOCIAL WITHDRAWAL

16. 3.CATATONIC SCHIZOPHRENIA Excited catatonia Stuporous catatonia Catatonia altering between excitement & stupor

17. 4.Residual & latent schizophrenia Emotional blunting Eccentric behavior illogical thinking social withdrawal Loosening of association

18. 5.Undifferentiated schizophrenia Diagnosed when no subtype are present or features of more than one subtype are present

19. 6.Simple schizophrenia Negative symptoms of residual schizophrenia

20. 7. Post schizophrenic depression Develop within 12 months of acute episode of schizophrenia Increased risk of suicide

21. CLINICAL FEATURES 1.Thought & speech disorder Autistic thinking Loosening of association Thought blocking Neologism Mutism Poverty of speech Poverty of ideation Echolalia Delusion

22. 2.Disorder of perception 3 Disorder of affect 4 Disorder of motor behaviour 5.Negative symptoms 6 Miscellaneous

23. Treatment . Most of the patients do not require hospitalisation. The usual indications for (a) For diagnostic purposes. (b) For stabilization of medication. (c) For grossly disorganized and inappropriate behaviour, including the inability to take care of basic needs such as food, clothing and shelter. (d) For patients safety because of suicidal or homicidal ideas.

24. Antipsychotic Medication Antipsychotic medications have revolutionized the treatment of schizophrenia. Minimum length of antipsychotic trial is 4-6 weeks in adequate dosages. If unsuccessful a drug from a different group should be tried. Patients should be maintained at the lowest possible effective dosage for 6 months to 1 year for the first episode, for 1 to 2 years for the subsequent episodes, and for indefinite period for repeated episodes or persistent symptoms. Depot preparations with long duration of action are used in patients who are irregular with their medication.

25. Electroconvulsive therapy Usually 6-8 ECTs are needed, given biweekly. Indications for ECT include: (i) Catatonic stupor. (ii) Uncontrolled catatonic excitement. (iii) Acute exacerbation not controlled with drugs. (iv) Severe side effects with drugs, in presence of untreated schizophrenia.

26. Psychosocial treatment Education of the patient and especially the family regarding the nature of illness, its course and treatment. Group therapy is particularly aimed at teaching problem solving, and communication skills. It is usually conducted in a form, which is known as ‘social skills training package’. Family therapy : Apart from education, family is also given social skills training to enhance communication and decrease family tensions

27. Psychosocial treatment (iv) Milieu therapy includes treatment in a living, learning or working environment ranging from inpatient psychiatric unit to day-care hospitals and halfway homes. Individual psychotherapy is usually of supportive nature. Cognitive behaviour therapy is useful. Psychosocial rehabilitation is used, usually along with milieu therapy. This includes activity therapy, to develop the work habit, training in a new vocation or retraining in a previous skill, vocational guidance, job placement, sheltered employment or self-employment, & occupational therapy.

28. Prognosis The course and prognosis of schizophrenia is better in the developing countries like India, than in developed countries. Almost 50% patients show complete or near complete recovery, and only 18% showed severe disability with only 9% needing institutionalisation or long term hospitalisation. We should watch for depression and suicidal ideation in recovering schizophrenics to prevent unnecessary loss of life. Depression if it occurs should be treated aggressively.

29. LETS CHECK YOUR KNOWLEDGE QUESTION HOUR

30. Ram Singh a quiet person is behaving strangely for a few days. One day in public he tore off his clothes and was behaving as if he is not concerned with any thing. He refuses to do any work and has to be forcibly taken to hospital.

31. Shyam Singh is known to be a friendly person has been noted to be quiet and withdrawn for the last few weeks. He has stopped taking care of his personal hygiene or taking his bath. He does not speak to others even when spoken to and does not bother about his appearance. He sits in one pose for a long time without doing anything.

32. KV Oraon believes that his friends are plotting against him. He thinks that they are trying to kill him and are discussing how to go about it. He becomes aggressive and attacks his friends. He also complains to the police that people are trying to harm him. When the police try to counsel him that no such plot is there he accuses the police of being in league with his enemies

33. Mrs Kavita a young housewife has suddenly started laughing and crying without reason. She does not do her house jobs, speaks to herself and says that a bhoot has taken possession over her body. Her family members take her to the tantrik in order to cure her.

34. IDENTIFY THE PERSON WITH PARANOID SHIZOPHRENIA

35. FILM BASED ON SCHIZOPHRENIA 15 PARK AVENUE

36. Thank you