Schizophrenia symptoms and treatment .ppt

A ppt describing the defintion , prevalence . etiology and symptoms and management

1. SchizophreniaSchizophrenia

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 affectof thinking and perception, and affect that are that are
inappropriate or blunted. inappropriate or blunted.

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
timetime

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.

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. 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

8. 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

9. 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

10. 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. The feelings of passive or active control. 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.

11. 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 and sudden impulsive reactions laugh and joking and sudden impulsive reactions
without external stimulation. There is a tendency to without external stimulation. There is a tendency to
social isolation.social isolation.

Denoted also as Denoted also as disorganized schizophreniadisorganized schizophrenia

12. 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.

13. 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..

14. 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.schizophrenic illness.


These depressive states are associated These depressive states are associated
with an increased risk of suicide. with an increased risk of suicide.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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

20. 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

21. 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.

22. 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.

23. 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, thioridazine
droperidole, flupentixol, fluphenazine,
haloperidol, melperone, oxyprothepine,
penfluridol, perphenazine, pimozide,
trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine,
quetiapine, risperidone, sertindole, sulpiride