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Schizophrenia 123
- 7. • SCHIZOPHRENIA - derived from the Greekword “Skhizein” meaning “tosplit”,and “phren” meaning “mind” • common, chronic and frequently devastating neuropsychiatric disorder, affecting about 1% of the world’s general population. • among the ten leading causes of disability worldwide.
- 8. 1. Major depression 2. Alcohol use 3. Road traffic accidents 4. Schizophrenia 5. Self inflicted injuries 6. Bipolar disorder 7. Drug use
- 11. • • • • • • •
- 16. GENETICPREDISPOSITION • Concept of genetic pruning • Increased rate among the biological relatives • One parent - 46% • Both parents - 52% • Monozygotictwins–Concordancerateof50%
- 18. BIOCHEMICALFACTORS DOPAMINE HYPOTHESIS: Excessive dopamine release in patients with schizophrenia has been linked tothe severity of positive psychotic symptoms NOREPHINEPHRINE HYPOTHESIS: Anhedonia –the impaired capacity for emotional gratification and the decreased ability to experience pleasure –has long been noted to be a prominent feature of schizophrenia.
- 20. BRAINMETABOLISM: Studies using resonance spectroscopy, found that patients with schizophrenia had lower levels of phosphomonoester and inorganic phosphate and higher levels of phosphodiester than a control group.
- 21. • Hippocampus, amygdala, parahippocamp. –Smaller in affected twin (statictrait) –Disordered hippocampal pyramidal cells –Also in entorhinal, cingulate, parahippocampal cortex
- 22. • Shrinkage of cerebellar vermis • Thicker corpus callosum • Frontal lobes –Abnormal neuronal migration in one study –Dendrites have fewer spines –But no major structural abnormalities –Measures of frontal function impaired
- 25. FEATURES OF PSYCHOSIS: 1. Delusion 2. Hallucination 3. Disorganised Speech 4. Disorganised behavior 5. Catatonic state
- 26. 1.Positive (things that start to happen) 2.Negative (things that stop happening) 3.Cognitive (related to processing information) Mainly classified into three broad categories:
- 27. 1. Hallucinations : • Sensations that appear real but are created by mind • Could affect all the senses • These might tell them what to do, warn them of danger. • The voices might talk to each other. 2. Delusions : • An idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument • It is a distortion of reality. • These are beliefs that seem strange and are easy to prove wrong. • Can be of various types 3. Disorganizedspeech : • Have a hard time organizing their thoughts. • They might not be able to follow along when you talk to them. • Words come out all jumbled and not make sense. • Can also have trouble concentrating 4. Disorganized behaviour 5. Catatonic state • Abnormality of movement and behaviour arising from a disturbed mental state
- 28. TYPESOFHALLUCINATIONS • AUDITORY : Hearing voices : • VISUAL: Seeing things : • OLFACTORY: Smell things that aren't there : • GUSTATORY: False sense of taste : • TACTILE: Feel things that don't exist :
- 29. TYPESOF DELUSIONS • Delusion of Persecution • Delusions of Reference• • Delusions of Grandeur • Delusions of Erotomania • Delusion of Somatomania • Delusion of Infidelity
- 30. DISORGANIZEDSPEECH: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
- 31. DISORGANIZEDBEHAVIOUR: 1. Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. 2. Disorganized behavior appears as: 1. Adecline in overall daily functioning 2. Unpredictable or inappropriate emotional responses 3. Behaviors that appear bizarre and have no purpose 4. Lack of inhibition and impulse control
- 32. Negative Symptoms represent the absence or diminution of normal intellectual function • AFFECT Schizophrenics have flat(lack of expression), blunt(severe reduction in intensity) or inappropriate (incongruent with situation) affect • ALOGIA It is characterised by poverty of speech,a reduction in the amount of speech, speech content,blocking or late replies.
- 33. • AVOLITION It is the loss of motivation • ASOCIALITY It is the diminished interest in, motivation for, and appreciation of social interactions with others, like family and friends • APHEDONIA It is the inability to feel pleasure in normally pleasurable activities
- 34. 1. Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed 2. They include the following: • Poor “executive functioning” • Trouble focusing or paying attention • Problems with “working memory”
- 36. • Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or expressjoy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
- 38. • There are five types ofschizophrenia: 1. Catatonic – little to no movement, possibly a vegetative state 2. Disorganized – disorganized thinking, flat effect, inappropriate emotions or behavior 3. Paranoid –delusions, hallucinations, false beliefs of grandeur 4. Residual –negative symptoms often remain such as flat effect or a refusal to talk 5. Undifferentiated – does not fit in one of the above categories
- 41. E) Change in personal behaviors
- 45. Domains* Symptoms Severity Environmental influences Functional Impairments including cognitive deficits. Socio- occupational Impairment Roleperformance Subjective experiences like the “Quality of Life” Treatment related influences *adapted from New oxford textbook of psychiatry, pg596
- 46. A tool for all psychiatric examinations
- 52. PHENOTHIAZINES •Chlorpromazine BUTYROPHENONES •Haloperidol THIOXANTHENES •Flupenthixol
- 53. EFFECTIVENESS OF TYPICALS/First Generation (FGAs) Effective in acute phase and as maintenance therapy 80% Respond Positive symptoms (hallucinations, delusions, thought disorder) No effect on negative symptoms 20 % treatment-resistant 50%-80% non-compliance
- 54. 1. Dopamine blockade –EPS (TD), raised prolactin levels (sexual side effects, menstural problems, galactorrhoea) 2. Anticholinergic – dry mouth, urinary etc 3. Postural hypotension 4. Sedation 5. Weight gain
- 55. 1. Clozapine 2. Remoxipride 3. Risperidone 4. Sertindole 5. Olanzapine 6. Quetiapine 7. Amisulpiride 8. Zotepine 9. Ziprasidone 10.Aripiprazole An antipsychotic that does not cause EPS at therapeutic doses
- 56. Evidence of association between metabolic disturbances and the use of atypical antipsychoitics The ‘metabolic syndrome’ include: Obesity Diabetes Dyslipidemia
- 57. •ECTisnot the primary treatment of choiceforschizophrenia •The indications of ECT include:- •1.Catatonic Stupor 2.Uncontrolled Catatonic Excitement 3.Acute exacerbation not controlled with drugs 2.Severe side-effects with drugs in the presence ofschizophrenia Usually 8-12 ECT’Sare needed administered 2-3 times aweek.
- 67. REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION
- 74. AVISION FOR SCHIZOPHRENIAOVERTHE NEXT DECADE
- 75. Schizophrenia - Spectrum of Dysfunctions Affecting cognitive, emotional, and behavioral domains Positive, negative, and disorganized symptom clusters Several Bio-Psycho-Social Variables are Involved Diagnosed according to the ICD 10 criteria Management includes antipsychotics, along with psychosocial interventions Successful Treatment Rarely Includes Complete Recovery Genetic therapy is the way ahead