- It is most common Psychotic Disorder
- 50% of patients in all Mental Hospital Admission.
It is Greek Word
- Schizo – Split
- Phrenic – Mind
- Split Mind
Definition
- It is a functional Psychosis
- Disturbances in Thinking, Emotion, Volition & Perception.
- Clear Consciousness
Epidemiology
- Prevalent in all cultures and all part of the world
- 3 to 4 / 1000 in any community
- 1 % of general population in lifetime
- 2/3 of cases 15 – 30 yrs
- Lower Social Classes
Etiology
Biological
Psychological
Social
Biological
- Genetic Factors
Monozygotic twin of Schizophrenic - 47
Child of Two Schizophrenic Parents - 40
Dizygotic twin of a Schizophrenic Parents - 12
- Bio Chemical Factors
Dopamine Hypothesis (Dopamine)
Transmethylation Hypothesis (Abnormal Transmethylation of Catecholamines)
Indolamine Hypothesis (Defect in metabolism of Indolamine – Serotonin)
Psychological
- Withdrawn and Social Contact
- Ego Boundary Disturbances
Social & Environmental
- Family with lot of conflict
- Communication of parents with Children
- Low Social Class
Positive Symptoms
Clinical Features
Negative Symptoms
Positive Symptoms
- Delusions
- Hallucinations
- Aggression
- Agitation
- Suspiciousness
- Hostility
- Excitement
- Grandiosity
- Conceptual Disorganization
Negative Symptoms
- Apathy
- Withdrawal
- Avolition
- Blunted Affect
- Stereotyped Thinking
- Artificial Gestures
- Lack of Spontaneity
Thought Disturbance
Condensation – Ideas are mixed, not necessarily logical
Displacement – Associated Idea, not correct one
Symbolisation – Abstract thoughts are replaced by concrete ones.
Over Inclusive Thinking – Irrelevant thoughts are incorporated into the speech.
- Neolologism
Incoherence and Mutism
- Thought Block
- Delusion – Disturbance content of thought
- Delusions of Persecutions
- Delusions of Grandeur
Austism
- Slow Progressive withdrawal from reality
Volitional Disturbance
- Deterioration in will power, drive and ambition
- Apathy – Self Neglect
Affect Disturbances
- Flattening or Blunt affect
Perceptional Disturbances
- Hallucinations
Behavioral Changes
Withdrawal Changes
↓
Withdrawal from reality into fantasy
↓
Increase Apathy
↓
Stupor or Catatonic Stupor
Reverse – Catatonic Excitement
- Echolalia, Echopraxia, Negativism
- Poor Personal Hygiene
- Lack of Insight
Types of Schizophrenia
1. Paranoid
2. Hebephrenic
3. Catatonic
4. Residual
5. Undifferentiated
6. Simple
Paranoid Schizophrenia
- Persecutory or Grandiose Delusions together with associated jealous
- Hallucinations
- Unfocussed Anxiety, Anger, Argumentativeness and Violence
- Doubts about Gender Identity
Hebephrenic Schizophrenia
- Incoherence and Flat, Incongruous or Silly Effect
- 15 – 25 Years
- Extreme Social Impairment, Poor Pre morbid Personality, Early Insidious Onset and a Chronic Course without Significant remissions.
Catatonic Schizophrenia
- Psychomotor Disturbance
- Catatonic Stupor or Rigidity
- Catatonic Excitement
- Catatonic Posturing
- Negativism
Residual Schizophrenia
- Atleast one episode of Schizophrenia in the past but without Prominent Psychotic Symptoms at present.
- Emotional Blunting, Social Withdrawal, Eccentric Behaviour, Illogical Thinking & Loosening Associations.
Undifferentiated Schizophrenia
- Prominent Psychotic Symptoms that cannot be classified in any Category
Simple Schizophrenia
- Insidious Onset, Progressive Development of Odd Behaviour, Wandering Tendency, Self-Absorbed, Idle and Aimless Activity
Course of Illness
Sub chronic
- Less than 2 years at least 6 Months
- From the beginning patient show signs of Illness more or less continuously
Chronic
- Duration > 2 Years
Good Prognosis
- Later Onset, Precipitating Factors, Acute Onset, Pre morbid personality, Affective (Depression) Symptoms, Paranoid Catatonic, Married, Family History of Mood Disorders, Good Support Care, Positive Symptoms
Management
1. Somatic (Physical Therapies)
a. Antipsychotic Medications
b. ECT
2. Psychological Treatment
a. Hospitalisation
b. Psychotherapy
c. Rehabilitation – Social, Vocational
d. Aftercare – Day Treatment, Halfway Homes
e. Education about the Illness for Patients and families
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