This document provides information about schizophrenia from the Department of Psychiatry at Charles University in Prague. It defines schizophrenia, describes its prevalence and typical age of onset. It discusses the work of key researchers in the field like Kraepelin, Bleuler, and Schneider. It outlines the diagnostic criteria according to ICD-10, describes positive and negative symptoms, and lists different subtypes of schizophrenia including paranoid, hebephrenic, and catatonic schizophrenia.

1. SchizophreniaSchizophrenia
Department of PsychiatryDepartment of Psychiatry
11stst
Faculty of MedicineFaculty of Medicine
Charles University, PragueCharles University, Prague
Head: Prof. MUDr. Jiří Raboch, DrSc.Head: Prof. MUDr. Jiří Raboch, DrSc.
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2. DefinitionDefinition
 The schizophrenic disorders are characterized inThe schizophrenic disorders are characterized in
general by fundamental and characteristicgeneral by fundamental and characteristic distortions ofdistortions of
thinking and perception, and affectsthinking and perception, and affects that arethat are
inappropriate or blunted. Clear consciousness andinappropriate or blunted. Clear consciousness and
intellectual capacity are usually maintained althoughintellectual capacity are usually maintained although
certain cognitive deficits may evolve in the course ofcertain cognitive deficits may evolve in the course of
time.time.
 The most important psychopathological phenomenaThe 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 inhallucinatory voices commenting or discussing the patient in
the third personthe third person
• thought disorders and negative symptoms.thought disorders and negative symptoms. Brought to you by

3. SchizophreniaSchizophrenia
 Schizophrenia occurs with regular frequencySchizophrenia occurs with regular frequency
nearly everywhere in the world in 1 % ofnearly everywhere in the world in 1 % of
population and begins mainly in young agepopulation and begins mainly in young age
(mostly around 16 to 25 years).(mostly around 16 to 25 years).
 Schizophrenia is defined bySchizophrenia is defined by
• a group of characteristic positive and negativea group of characteristic positive and negative
symptomssymptoms
• deterioration in social, occupational, or interpersonaldeterioration in social, occupational, or interpersonal
relationshipsrelationships
• continuous signs of the disturbance for at least 6continuous signs of the disturbance for at least 6
monthsmonths
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4. HistoryHistory
 Emil KraepelinEmil Kraepelin: This illness develops relatively early in: This illness develops relatively early in
life, and its course is likely deteriorating and chronic;life, and its course is likely deteriorating and chronic;
deterioration reminded dementiadeterioration reminded dementia („Dementia praecox“(„Dementia praecox“),),
but was not followed by any organic changes of thebut was not followed by any organic changes of the
brain, detectable at that time.brain, detectable at that time.
 Eugen BleulerEugen Bleuler: He renamed Kraepelin’s dementia: He renamed Kraepelin’s dementia
praecox aspraecox as schizophreniaschizophrenia (1911); he recognized the(1911); he recognized the
cognitive impairment in this illness, which he named ascognitive impairment in this illness, which he named as
a „splittinga „splitting““ of mind.of mind.
 Kurt SchneiderKurt Schneider: He emphasized the role of psychotic: He emphasized the role of psychotic
symptoms, as hallucinations, delusions and gave themsymptoms, as hallucinations, delusions and gave them
the privilege ofthe privilege of „the first rank symptoms”„the first rank symptoms” even in theeven in the
concept of the diagnosis of schizophrenia.concept of the diagnosis of schizophrenia.
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5. 4 A (Bleuler)4 A (Bleuler)
 Bleuler maintained, that for the diagnosis ofBleuler maintained, that for the diagnosis of
schizophrenia are most important the following fourschizophrenia 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” andThese groups of symptoms, are called „four A’ s” and
Bleuler thought, that they are „primary” for thisBleuler thought, that they are „primary” for this
diagnosis.diagnosis.
 The other known symptoms, hallucinations, delusions,The other known symptoms, hallucinations, delusions,
which are appearing in schizophrenia very often also,which are appearing in schizophrenia very often also,
he used to call as a “secondary symptoms”, becausehe used to call as a “secondary symptoms”, because
they could be seen in any other psychotic disease,they could be seen in any other psychotic disease,
which are caused by quite different factors — fromwhich are caused by quite different factors — from
intoxication to infection or other disease entities.intoxication to infection or other disease entities.
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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 remissionepisodic with complete or incomplete remission
 Typical stages of schizophrenia:Typical stages of schizophrenia:
• prodromal phaseprodromal phase
• active phaseactive phase
• residual phaseresidual phase
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7. Clinical PictureClinical Picture
 Diagnostic manuals:Diagnostic manuals:
• lCD-10lCD-10 („International Classification of Disease“, WHO)(„International Classification of Disease“, WHO)
• DSM-IVDSM-IV („Diagnostic and Statistical Manual“, APA)(„Diagnostic and Statistical Manual“, APA)
 Clinical picture of schizophrenia is according to lCD-10,Clinical picture of schizophrenia is according to lCD-10,
defined from the point of view of the presence anddefined from the point of view of the presence and
expression of primary and/or secondary symptoms (atexpression of primary and/or secondary symptoms (at
present covered by the terms negative and positivepresent covered by the terms negative and positive
symptoms)symptoms)::
• tthehe negative symptomsnegative symptoms are represented by cognitive disorders,are represented by cognitive disorders,
having its origin probably in the disorders of associations ofhaving its origin probably in the disorders of associations of
thoughts, combined with emotional blunting and small orthoughts, combined with emotional blunting and small or
missing production of hallucinations and delusionsmissing production of hallucinations and delusions
• tthehe positivepositive symptomsymptom are characterized by the presence ofare characterized by the presence of
hallucinations and delusionshallucinations and delusions
• tthe division is not quite strict and lesser or greater mixture ofhe division is not quite strict and lesser or greater mixture of
symptoms from these two groups are possiblesymptoms from these two groups are possible
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8. 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 thoughtPositive 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
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9. The Criteria of DiagnosisThe Criteria of Diagnosis
For theFor the diagnosis of schizophreniadiagnosis of schizophrenia is necessaryis necessary
 presence of one very clear symptompresence of one very clear symptom -- from point a) to d)from point a) to d)
 or the presence of the symptoms from at least two groupsor the presence of the symptoms from at least two groups -- fromfrom
point e) to h)point e) to h)
for one month or more:for one month or more:
a)a) the hearing of own thoughts, the feelings of thought withdrawal,the hearing of own thoughts, the feelings of thought withdrawal,
thought insertion, or thought broadcastingthought insertion, or thought broadcasting
b)b) the delusions of control, outside manipulation and influence, or thethe delusions of control, outside manipulation and influence, or the
feelings of passivity, which are connected with the movements offeelings of passivity, which are connected with the movements of
the body or extremities, specific thoughts, acting or feelings,the body or extremities, specific thoughts, acting or feelings,
delusional perceptiondelusional perception
c)c) hallucinated voices, which are commenting permanently thehallucinated voices, which are commenting permanently the
behavior of the patient or they talk about him betweenbehavior of the patient or they talk about him between
themselves, or the other types of hallucinatory voices, comingthemselves, or the other types of hallucinatory voices, coming
from different parts of bodyfrom different parts of body
d)d) permanent delusions of different kind, which are inappropriate andpermanent delusions of different kind, which are inappropriate and
unacceptable in given cultureunacceptable in given culture
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10. The Criteria of DiagnosisThe Criteria of Diagnosis
e)e) the lasting hallucination of every formthe lasting hallucination of every form
f)f) blocks or intrusion of thoughts into the flow of thinking andblocks or intrusion of thoughts into the flow of thinking and
resulting incoherence and irrelevance of speach, or neologismsresulting incoherence and irrelevance of speach, or neologisms
g)g) catatonic behaviorcatatonic behavior
h)h) „„the negative symptoms”, for instance the expressed apathy,the negative symptoms”, for instance the expressed apathy,
poor speech, blunting and inappropriatness of emotional reactionspoor speech, blunting and inappropriatness of emotional reactions
i)i) expressed and conspicuous qualitative changes in patient’sexpressed and conspicuous qualitative changes in patient’s
behavior, the loss of interests, hobbies, aimlesness, inactivity, thebehavior, the loss of interests, hobbies, aimlesness, inactivity, the
loss of relations to others and social withdrawalloss of relations to others and social withdrawal
 Diagnosis ofDiagnosis of acute schizophorm disorderacute schizophorm disorder (F23.2) – if the(F23.2) – if the
conditions for diagnosis of schizophrenia are fulfilled, but lastingconditions for diagnosis of schizophrenia are fulfilled, but lasting
less than one monthless than one month
 Diagnosis ofDiagnosis of schizoaffective disorderschizoaffective disorder (F25) - if the schizophrenic(F25) - if the schizophrenic
and affective symptoms are developing together at the same timeand affective symptoms are developing together at the same time
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11. F20-F29F20-F29 Schizophrenia, SchizotypalSchizophrenia, Schizotypal
and Delusional Disordersand Delusional Disorders
F20F20 SchizophreniaSchizophrenia
F20.0F20.0 Paranoid schizophreniaParanoid schizophrenia
F20.1 Hebephrenic schizophreniaF20.1 Hebephrenic schizophrenia
F20.2 Catatonic schizophreniaF20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophreniaF20.3 Undifferentiated schizophrenia
F20.4 Post-schizophrenic depressionF20.4 Post-schizophrenic depression
F20.5 Residual schizophreniaF20.5 Residual schizophrenia
F20.6 Simple schizophreniaF20.6 Simple schizophrenia
F20.8 Other schizophreniaF20.8 Other schizophrenia
F20.9 Schizophrenia, unspecifiedF20.9 Schizophrenia, unspecified Brought to you by

12. F20-F29F20-F29 Schizophrenia, SchizotypalSchizophrenia, Schizotypal
and Delusional Disordersand Delusional Disorders
F21F21 Schizotypal disorderSchizotypal disorder
F22F22 Persistent delusional disordersPersistent delusional disorders
F22.0F22.0 Delusional disorderDelusional disorder
F22.8F22.8 Other persistent delusional disordersOther persistent delusional disorders
F22.9F22.9 Persistent delusional disorder, unspecifiedPersistent delusional disorder, unspecified
F23F23 Acute and transient psychotic disordersAcute and transient psychotic disorders
F23.1F23.1 Acute polymorphic psychotic disorder withAcute polymorphic psychotic disorder with
symptoms of schizophreniasymptoms of schizophrenia
F23.2F23.2 Acute schizophrenia-like psychotic disorderAcute schizophrenia-like psychotic disorder
F23.3F23.3 Other acute predominantly delusional psychoticOther acute predominantly delusional psychotic
disordersdisorders
F23.8F23.8 Other acute and transient psychotic disordersOther acute and transient psychotic disorders
F23.9F23.9 Acute and transient psychotic disorder, unspecifiedAcute and transient psychotic disorder, unspecified
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13. F20-F29F20-F29 Schizophrenia, SchizotypalSchizophrenia, Schizotypal
and Delusional Disordersand Delusional Disorders
F24F24 Induced delusional disorderInduced delusional disorder
F25F25 Schizoaffective disordersSchizoaffective disorders
F25.0F25.0 Schizoaffective disorder, manic typeSchizoaffective disorder, manic type
F25.1F25.1 Schizoaffective disorder, depressive typeSchizoaffective disorder, depressive type
F25.2F25.2 Schizoaffective disorder, mixed typeSchizoaffective disorder, mixed type
F25.8F25.8 Other schizoaffective disordersOther schizoaffective disorders
F25.9F25.9 Schizoaffective disorder, unspecifiedSchizoaffective disorder, unspecified
F28F28 Other nonorganic psychotic disordersOther nonorganic psychotic disorders
F29F29 Unspecified nonorganic psychosisUnspecified nonorganic psychosis
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14. F20.0 Paranoid SchizophreniaF20.0 Paranoid Schizophrenia
 Paranoid schizophreniaParanoid schizophrenia is characterized mainlyis characterized mainly
by delusions of persecution, feelings of passiveby delusions of persecution, feelings of passive
or active control, feelings of intrusion, andor active control, feelings of intrusion, and
often by megalomanic tendencies also. Theoften by megalomanic tendencies also. The
delusions are not usually systemized too much,delusions are not usually systemized too much,
without tight logical connections and are oftenwithout tight logical connections and are often
combined with hallucinations of differentcombined with hallucinations of different
senses, mostly with hearing voices.senses, mostly with hearing voices.
 Disturbances of affect, volition and speech, andDisturbances of affect, volition and speech, and
catatonic symptoms, are either absent orcatatonic symptoms, are either absent or
relatively inconspicuous.relatively inconspicuous.
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15. F20.1 Hebephrenic SchizophreniaF20.1 Hebephrenic Schizophrenia
 Hebephrenic schizophreniaHebephrenic schizophrenia is characterized by disorganizedis characterized by disorganized
thinking with blunted and inappropriate emotions. It beginsthinking with blunted and inappropriate emotions. It begins
mostly in adolescent age, the behavior is often bizarre.mostly in adolescent age, the behavior is often bizarre.
There could appear mannerisms, grimacing, inappropriateThere could appear mannerisms, grimacing, inappropriate
laugh and joking, pseudophilosophical brooding and suddenlaugh and joking, pseudophilosophical brooding and sudden
impulsive reactions without external stimulation. There is aimpulsive reactions without external stimulation. There is a
tendency to social isolation.tendency to social isolation.
 Usually the prognosis is poor because of the rapidUsually the prognosis is poor because of the rapid
development of "negative" symptoms, particularly flatteningdevelopment of "negative" symptoms, particularly flattening
of affect and loss of volition. Hebephrenia should normallyof affect and loss of volition. Hebephrenia should normally
be diagnosed only in adolescents or young adultsbe diagnosed only in adolescents or young adults..
 Denoted also asDenoted also as disorganized schizophreniadisorganized schizophrenia
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16. F20.2 Catatonic SchizophreniaF20.2 Catatonic Schizophrenia
 Catatonic schizophreniaCatatonic schizophrenia is characterized mainlyis characterized mainly
by motoric activity, which might be stronglyby motoric activity, which might be strongly
increased (hypekinesis) or decreased (stupor),increased (hypekinesis) or decreased (stupor),
or automatic obedience and negativism.or automatic obedience and negativism.
 We recognize two forms:We recognize two forms:
• productive formproductive form — which shows catatonic— which shows catatonic
excitement, extreme and often aggressive activity.excitement, extreme and often aggressive activity.
TreatmentTreatment by neuroleptics or by electroconvulsiveby neuroleptics or by electroconvulsive
therapy.therapy.
• stuporose formstuporose form — characterized by general inhibition— characterized by general inhibition
of patient’s behavior or at least by retardation andof patient’s behavior or at least by retardation and
slowness, followed often by mutism, negativism,slowness, followed often by mutism, negativism,
fexibilitas cerea or by stupor. The consciousness isfexibilitas cerea or by stupor. The consciousness is
not absent.not absent. Brought to you by

17. F20.3 UndifferentiatedF20.3 Undifferentiated
SchizophreniaSchizophrenia
 Psychotic conditions meeting the generalPsychotic conditions meeting the general
diagnostic criteria for schizophrenia butdiagnostic criteria for schizophrenia but
not conforming to any of the subtypes innot conforming to any of the subtypes in
F20.0-F20.2, or exhibiting the features ofF20.0-F20.2, or exhibiting the features of
more than one of them without a clearmore than one of them without a clear
predominance of a particular set ofpredominance of a particular set of
diagnostic characteristics.diagnostic characteristics.
 This subgroup represents also the formerThis subgroup represents also the former
diagnosis ofdiagnosis of atypical schizophreniaatypical schizophrenia..
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18. F20.4 PostschizophrenicF20.4 Postschizophrenic
DepressionDepression
 A depressive episode, which may beA depressive episode, which may be
prolonged, arising in the aftermath of aprolonged, arising in the aftermath of a
schizophrenic illness. Some schizophrenicschizophrenic illness. Some schizophrenic
symptoms, eithersymptoms, either „„positivepositive““ oror „„negativenegative““,,
must still be present but they no longermust still be present but they no longer
dominate the clinical picture.dominate the clinical picture.
 These depressive states are associatedThese depressive states are associated
with an increased risk of suicide.with an increased risk of suicide.
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19. F20.5 Residual SchizophreniaF20.5 Residual Schizophrenia
 AA chronic stage in the development ofchronic stage in the development of
schizophrenia with clear succession fromschizophrenia with clear succession from
the initial stage with one or more episodesthe initial stage with one or more episodes
characterized by general criteria ofcharacterized by general criteria of
schizophrenia to the late stage with long-schizophrenia to the late stage with long-
lasting negative symptoms andlasting negative symptoms and
deterioration (not necessarily irreversible).deterioration (not necessarily irreversible).
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20. F20.6 Simple SchizophreniaF20.6 Simple Schizophrenia
 Simple schizophrenia is characterized bySimple schizophrenia is characterized by
early and slowly developing initial stageearly and slowly developing initial stage
with growing social isolation, withdrawal,with growing social isolation, withdrawal,
small activity, passivity, avolition andsmall activity, passivity, avolition and
dependence on the others.dependence on the others.
 The patients are indifferent, without anyThe patients are indifferent, without any
initiative and volition. There is notinitiative and volition. There is not
expressed the presence of hallucinationsexpressed the presence of hallucinations
and delusions.and delusions.
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21. F21F21 Schizotypal disorderSchizotypal disorder
 According to lCD-10 this disorder isAccording to lCD-10 this disorder is
characterized by eccentric behavior and bycharacterized by eccentric behavior and by
deviations of thinking and affectivity,deviations of thinking and affectivity,
which are similar to that occurring inwhich are similar to that occurring in
schizophrenia, but without psychoticschizophrenia, but without psychotic
features and expressed symptoms offeatures and expressed symptoms of
schizophrenia of any type.schizophrenia of any type.
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22. F22 Persistent DelusionalF22 Persistent Delusional
DisordersDisorders
 Includes a variety of disorders in whichIncludes a variety of disorders in which
long-standing delusions constitute thelong-standing delusions constitute the
only, or the most conspicuous, clinicalonly, or the most conspicuous, clinical
characteristic and which cannot becharacteristic and which cannot be
classified as organic, schizophrenic orclassified as organic, schizophrenic or
affective.affective.
 Their origin is probably heterogeneous,Their origin is probably heterogeneous,
but it seems, that there is some relation tobut it seems, that there is some relation to
schizophrenia.schizophrenia.
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23. F22.0F22.0 Delusional DisorderDelusional Disorder
 A disorder characterized by theA disorder characterized by the
development of one delusion or of thedevelopment of one delusion or of the
group of similar related delusions, whichgroup of similar related delusions, which
are persisting unusually long, very oftenare 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 thisare not present and are excluding this
diagnosis.diagnosis.
 It begins usually in the middle age.It begins usually in the middle age.
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24. F23F23 Acute and TransientAcute and Transient
Psychotic DisordersPsychotic Disorders
 The criteria should be the following features:The criteria should be the following features:
• acute beginning (to two weeks)acute beginning (to two weeks)
• presence of typical symptoms (quickly changingpresence of typical symptoms (quickly changing
“polymorphic symptoms”)“polymorphic symptoms”)
• presence of typical schizophrenic symptoms.presence of typical schizophrenic symptoms.
 Complete recovery usually occurs within a fewComplete recovery usually occurs within a few
months, often within a few weeks or even days.months, often within a few weeks or even days.
 The disorder may or may not be associatedThe disorder may or may not be associated
with acute stress, defined as usually stressfulwith acute stress, defined as usually stressful
events preceding the onset by one to twoevents preceding the onset by one to two
weeks.weeks.
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25. F24 Induced Delusional DisorderF24 Induced Delusional Disorder
 A delusional disorder shared by two or more peopleA delusional disorder shared by two or more people
with close emotional links. Only one of the peoplewith close emotional links. Only one of the people
suffers from a genuine psychotic disorder; thesuffers from a genuine psychotic disorder; the
delusions are induced in the other(s) and usuallydelusions are induced in the other(s) and usually
disappear when the people are separated.disappear when the people are separated.
 The psychotic disorder of the dominant member ofThe psychotic disorder of the dominant member of
this dyad is mainly, but not necessarily, ofthis dyad is mainly, but not necessarily, of
schizophrenic type. The original delusions ofschizophrenic type. The original delusions of
dominant member and his partner are usuallydominant member and his partner are usually
chronic, either persecutory or megalomanic.chronic, either persecutory or megalomanic.
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26. F25 Schizoaffective DisordersF25 Schizoaffective Disorders
 Episodic disorders in which both affective andEpisodic disorders in which both affective and
schizophrenic symptoms are prominentschizophrenic symptoms are prominent ((during theduring the
same episode of the illness or at least during few dayssame episode of the illness or at least during few days))
but which do not justify a diagnosis of eitherbut which do not justify a diagnosis of either
schizophrenia or depressive or manic episodes.schizophrenia or depressive or manic episodes.
 Patients suffering from periodic schizoaffectivePatients suffering from periodic schizoaffective
disorders, especially with manic symptoms, havedisorders, especially with manic symptoms, have
usually good prognosis with full remissions without anyusually good prognosis with full remissions without any
remaining defects.remaining defects.
 They are divided in different subgroups:They are divided in different subgroups:
• F25.0 Schizoaffective disorder, manic typeF25.0 Schizoaffective disorder, manic type
• F25.1 Schizoaffective disorder, depressive typeF25.1 Schizoaffective disorder, depressive type
• F25.2 Schizoaffective disorder, mixed typeF25.2 Schizoaffective disorder, mixed type
• F25.8 Other schizoaffective disordersF25.8 Other schizoaffective disorders
• F25.9 Schizoaffective disorder, unspecifiedF25.9 Schizoaffective disorder, unspecified
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27. Genetics of SchizophreniaGenetics of Schizophrenia
 Many psychiatric disorders areMany psychiatric disorders are
multifactorial (caused by the interaction ofmultifactorial (caused by the interaction of
external and genetic factors) and from theexternal and genetic factors) and from the
genetic point of view very oftengenetic 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
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28. Etiology of SchizophreniaEtiology of Schizophrenia
 The etiology and pathogenesis ofThe etiology and pathogenesis of
schizophrenia is not knownschizophrenia is not known
 It is accepted, that schizophrenia is „theIt is accepted, that schizophrenia is „the
group of schizophrenias“ which origin isgroup of schizophrenias“ which origin is
multifactorial:multifactorial:
• internal factors – genetic, inborn, biochemicalinternal factors – genetic, inborn, biochemical
• external factors – trauma, infection of CNS,external factors – trauma, infection of CNS,
stressstress
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29. Etiology of Schizophrenia -Etiology of Schizophrenia -
Dopamine HypothesisDopamine Hypothesis
 The most influential and plausible are the hypotheses, based on theThe most influential and plausible are the hypotheses, based on the
supposed disorder of neurotransmission in the brain, derived mainly fromsupposed disorder of neurotransmission in the brain, derived mainly from
1.1. the effects of antipsychotic drugs that have in common the ability tothe effects of antipsychotic drugs that have in common the ability to
inhibit the dopaminergic system by blocking action of dopamine in theinhibit the dopaminergic system by blocking action of dopamine in the
brainbrain
2.2. dopamine-releasing drugs (amphetamine, mescaline, diethyl amide ofdopamine-releasing drugs (amphetamine, mescaline, diethyl amide of
lysergic acid - LSD) that can induce state closely resembling paranoidlysergic acid - LSD) that can induce state closely resembling paranoid
schizophreniaschizophrenia
 Classical dopamine hypothesis of schizophreniaClassical dopamine hypothesis of schizophrenia: Psychotic symptoms are: Psychotic symptoms are
related to dopaminergic hyperactivity in the brain. Hyperactivity ofrelated to dopaminergic hyperactivity in the brain. Hyperactivity of
dopaminergic systems during schizophrenia is result of increaseddopaminergic systems during schizophrenia is result of increased
sensitivity and density of dopamine D2 receptors in the different parts ofsensitivity and density of dopamine D2 receptors in the different parts of
the brain.the brain.
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30. Etiology of Schizophrenia -Etiology of Schizophrenia -
Contemporary ModelsContemporary Models
 Dopamine hypothesis revisitedDopamine hypothesis revisited: various: various
neurotransmitter systems probably takes place in theneurotransmitter systems probably takes place in the
etiology of schizophrenia (norepinephric, serotonergic,etiology of schizophrenia (norepinephric, serotonergic,
glutamatergic, some peptidergic systems); based onglutamatergic, some peptidergic systems); based on
effects of atypical antipsychotics especially.effects of atypical antipsychotics especially.
 Contemporary models of schizophreniaContemporary models of schizophrenia conceptualize itconceptualize it
as a neurocognitive disorder, with the various signsas a neurocognitive disorder, with the various signs
and symptoms reflecting the downstream effects of aand symptoms reflecting the downstream effects of a
more fundamental cognitive deficit:more fundamental cognitive deficit:
• the symptoms of schizophrenia arise from “cognitivethe symptoms of schizophrenia arise from “cognitive
dysmetria” (Nancy C. Andreasen)dysmetria” (Nancy C. Andreasen)
• concept of schizophrenia as a neurodevelopmental disorderconcept of schizophrenia as a neurodevelopmental disorder
(Daniel R. Weinberger)(Daniel R. Weinberger)
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31. Etiology of Schizophrenia -Etiology of Schizophrenia -
Neurodevelopmental ModelNeurodevelopmental Model
 Neurodevelopmental modelNeurodevelopmental model supposes insupposes in
schizophrenia the presence of “silent lesion” in theschizophrenia the presence of “silent lesion” in the
brain, mostly in the parts, important for thebrain, mostly in the parts, important for the
development of integration (frontal, parietal anddevelopment of integration (frontal, parietal and
temporal), which is caused by different factorstemporal), which is caused by different factors
(genetic, inborn, infection, trauma...) during very(genetic, inborn, infection, trauma...) during very
early development of the brain in prenatal or earlyearly development of the brain in prenatal or early
postnatal period of life.postnatal period of life.
 It does not interfere too much with the basic brainIt does not interfere too much with the basic brain
functioning in early years, but expresses itself infunctioning in early years, but expresses itself in
the time, when the subject is stressed bythe time, when the subject is stressed by
demands of growing needs for integration, duringdemands of growing needs for integration, during
formative years in adolescence and youngformative years in adolescence and young
adulthood.adulthood. Brought to you by

32. Treatment of SchizophreniaTreatment of Schizophrenia
 The acute psychotic schizophrenic patients willThe acute psychotic schizophrenic patients will
respond usually to antipsychotic medication.respond usually to antipsychotic medication.
 According to current consensus we use in the firstAccording 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 appearancebecause their use is not complicated by appearance
of extrapyramidal side-effects, or these are muchof extrapyramidal side-effects, or these are much
lower than with classical antipsychotics.lower than with classical antipsychotics.
conventional
antipsychotics
(classical
neuroleptics)
chlorpromazine, chlorprotixene, clopenthixole,
levopromazine, periciazine, thioridazine
droperidole, flupentixol, fluphenazine,
fluspirilene, haloperidol, melperone,
oxyprothepine, penfluridol, perphenazine,
pimozide, prochlorperazine, trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine,
quetiapine, risperidone, sertindole, sulpiride
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33. This platform has been started byThis platform has been started by
Parveen Kumar Chadha with theParveen Kumar Chadha with the
vision that nobody should suffervision that nobody should suffer
the way he has suffered becausethe way he has suffered because
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