Schizophrenia - Overview of this common psychiatric disorder
Date: Monday, December 12 @ 17:54:03 IST
Topic: Psychiatry


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- 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- Withdrawn and Social Contact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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