Schizophrenia (Psychotic condition)

Schizophrenia is a chronic psychiatric disorder. People with this disorder experience distortions of reality, often experiencing delusions or hallucinations.

The exact cause of schizophrenia isn't known, but a combination of genetics, environment and altered brain chemistry and structure may play a role.

Schizophrenia is characterised by thoughts or experiences that seem out of touch with reality, disorganised speech or behaviour and decreased participation in daily activities. Difficulty with concentration and memory may also be present.
Treatment is usually lifelong and often involves a combination of medications, psychotherapy and coordinated speciality care services.

1. PRESENTED BY
MR.B.KALYANKUMAR MSC(N)
Schizophrenia

2. Introduction
Thewordschizophreniacoinedin1908bythe
swisspsychiatristEugenbleuler.Itisderived
fromtheGreekwordsSchizo(SPLIT)andphren
(MIND).

3. Definition
Schizophreniaisaseverebraindisorder
characterizedbyadisturbanceinthinking,
emotions,volitionswhichusuallyleadstosocial
withdrawal.

4. Incidence
About15%ofnewadmissionsinmentalhospitals
areSchizophrenicpatients.Schizophreniais
equallyprevalentinmenandwomen.Thepeak
agesofonsetare15to25yearsformenand25to
35yearsforwomen.Thediseaseismorecommon
inlowersocioeconomicgroups.

5. Etiology
Biological
theories
Psychodynamic
theories
Vulnerability-
stress model
Social factors

6. I. Biochemical theories
Anexcessofdopaminedependentneuronal
activityinthebrainmaincausesofschizophrenia.
Otherbiochemicalhypothesis:Theseinclude
abnormalitiesintheneurotransmitternor-
epinephrine,serotonin,acetylcholineandgamma
aminobutyricacid(GABA)andneuroregulators
suchasprostaglandinsandendorphins.

7. Neurostructuraltheories:Prefrontalcortexand
limbiccortexmayneverfullydevelopedinthe
brainsofpersonswithschizophrenia.Computed
tomography(CT)andMagneticresonanceimaging
(MRI)studiesofbrainstructureshows-Decreased
brainvolume,largerlateralandthirdventricles,
atrophyinthefrontallobeofcerebellumand
limbicstructures.

8. Genetictheories:Morecommonamongpeople
bornofconsanguineousmarriages.

9. Prenatalriskfactors:Multiplenongeneticfactors
influencethedevelopmentofschizophrenia.

10. II. Psychodynamic theories
Developmentaltheories:Accordingtofreud,
thereisregressiontothestageofpsychosexual
development,withtheuseofDefencemechanisms
ofdenial,projectionandreactionformation.The
individualhavepooregoboundaries,inadequate
egodevelopment,superegodominance.

11. Family theories:
Doubleblindcommunication:Parentsconveytwo
ormoreconflictingandincompatiblemessageat
thesametime.

12. III. Social factors
Studieshaveshownthatschizophreniaismore
prevalentinareasofhighsocialmobilityand
disorganization,especiallyamongmembersof
verylowsocialclasses.Stressfullifeeventsalsocan
precipitatethedisease.

13. Psychopathology
Genetic
predisposition
Environmental social and
psychological factors
Neurodevelopmental abnormalities and target
features
Brain dysfunction, improper balance of chemicals
Schizophrenia

14. Clinical features
Symptoms of schizophrenia may appear suddenly or
develop gradually overtime. Tension, inability to
concentrate, insomnia, withdrawal.
Bleuler’sfour A’s:
Affective disturbance
Autistic thinking
Ambivalence
Associative looseness.

15. Positive and negative symptoms
Positive
Delusions
Hallucinations
Excitement
Suspiciousness
Possible suicidal
tendencies
Negative
Apathy
Attentionalimpairment
Alogia

16. Clinical types
1.Paranoid
2.Hebephrenic
3.Catatonic
4.Residual
5.Undifferentiated
6.Simple
7.Post-schizophrenic depression

17. 1.Paranoidschizophrenia:Thewordparanoid
meansdelusional,itisthemostcommonformof
schizophrenia,characterizedbyfollowingfeatures..
Delusion of persecution
Delusion of jealousy
Delusion of grandiosity
Hallucinatory voices

18. 2.Hebephrenicschizophrenia:Itisassociated
withpoorpremorbidpersonality.Essentialfeatures
includeMarkedthoughtdisorder,severelooseningof
associationsand extremesocialimpairment.
Recoveryclassicallyneveroccursandithasoneof
theworstprognosisamongallthesubtypes.

19. 3.Catatonicschizophrenia:Disturbanceof
motorbehaviour,thismaytaketheformofa
catatonicstuporandcatatonicexcitement.
Clinicalfeaturesofcatatonicstupor:
Mutism-Absenceofspeech
Rigidity-Maintenanceofrigidpostureagainst
effortstobemoved
Stupor-Doesnotreacttohissurroundings.


20. Echolalia-Repetition of words
Echopraxia-Repetition of actions observed
Ambitendency-A conflict to do or not to do

21. 4.Residualschizophrenia:Symptomsinclude
emotionalblunting,socialwithdrawaland
looseningofassociations.
5.Undifferentiatedschizophrenia:Itis
diagnosedeitherwhenfeaturesofnosubtypeare
fullypresent.

22. 6. Simple schizophrenia: It is characterized by
early and insidious onset. It differs from Residual
schizophrenia, in that there never has been an
episode with all the typical psychotic symptoms. The
prognosis is very poor.
7. Post-schizophrenic depression:Depressive
features develop in the presence of residual or active
features of schizophrenia and are associated with an
increased risk of suicide.

23. Diagnosis
Mentalstatusexamination,psychiatryhistoryand
carefulclinicalobservation.Officialdiagnosisis
basedonICD10criteria.
Investigations:NoDiagnostictestdefinitely
confirmschizophrenia,testmyorderedruleto
ruleoutdisordersthatcausepsychosis,including
vitamindeficiencies,uremia,thyrotoxicosisand
electrolyteimbalances.
CTscanandMRI.

24. Treatment modalities
Conventionalantipsychoticsand atypical
antipsychotics.
Conventionalantipsychotics:
Chlorpromazine300-1500mg/dayoral;50-100
mg/dayIM
Haloperidol25-50mg/dayoral;5-20mg/dayIM
Trifluoperazine15-60mg/dayoral;1-5mg/dayIM

25. Atypical antipsychotics:
Clozapine25-450 mg/day oral
Risperidone2-10 mg/day oral
Olanzapine10-20 mg/day oral
Quetiapine150-750 mg/day oral
Other drugs:
i.Anti depressants
ii.Mood stabilizers
iii.benzodiazepines

26. Electroconvulsivetherapy
Psychologicaltherapies:
I.GroupTherapy
II.Behaviourtherapy
III.SocialSkilltraining
IV.Cognitivetherapy
V.Familytherapy
VI.Psychosocialrehabilitation

27. Nursing management
Datamaybeobtainedfromfamilymembersotherpeople
familiarwiththepatientandalsofromoldrecords.A
nursingassessmentincludesinformationregardingany
previousincidenceofmentalillnessorpsychoticepisodes
observebehaviourpattern
Identifythetypeofdisturbancethepatientis
experiencing
Askthepatientaboutfeelingswhilethoughtalterations
areevident
Assessspeechpatternsassociatedwiththedelusions.
Determineanysuicidalintentorrecentattemptsthat
mayhavebeenmade.

28. Summary
Conclusion