Schizophrenia

and
other psychotic disorder
Intern Dr.Aakriti puri
Department of psychiatry
introduction
• Eugen Bleuler coined term schizophrenia
• Clinical syndrome of disruptive psychopathology that involves
cognition, emotion, perception ,and behavior .
• 4As of Eugen Bleuler
o Association
o Affect disturbance
o Autism
o Ambivalence
• Kurt Schneider 1st rank symptoms
• Audible thoughts /echo
• Voices discussing about patient
• Voices comenting on ones action

• Thought insertion
• Thought withdrawl
• Thought broadcast

• Made impulse
• Made feelings
• Made acts

• Delusional perception
• Somatic passivity
epidemiology
• Gender
• equally prevalent in men and women.
• onset of schizophrenia is earlier for men(10-25)
• Female (25-30),(40)
• Prognosis poor in male.

• Seasonality of Birth: born in the winter or early spring,

,influenza

• Maternal Factors: “Complications during delivery, maternal malnutrition”

• Early Life Experiences: childhood trauma,
• Urban Upbringing.
• Cannabis.
• Cognitive Deficits
ETIOLOGY
BIOCHEMICAL FACTORS
• The Dopamine Hypothesis: results from too much dopaminergic
activity.

• Serotonin. excess
• Norepinephrine
• GABA(decreased)
• Glutamate
• Acetylcholine
Genetic factors :
among biological relative ,twins
Age of father >60
Neuropathology
• Cerebral Ventricles: (CT) scans of patients consistently shown lateral
and third ventricular enlargement and some reduction in cortical
volume.
• Reduced Symmetry:There is a reduced symmetry in several brain
areas in schizophrenia,
• Limbic System: role in controlling emotions,postmortem brain
samples shown decrease in the size amygdala, the hippocampus, and
the Parahippocampal gyrus.
• Prefrontal Cortex
• Thalamus. volume shrinkage or neuronal loss in particular subnuclei,
• Basal Ganglia and Cerebellum
• odd movements can include an awkward gait, facial grimacing, and
stereotypies
• Huntington disease, Parkinson disease
• Psychosocial Theories
• disease of the brain, parallel diseases of other organs (e.g.,
myocardial infarctions, diabetes) whose courses are affected by
psychosocial stress.
Psychoanalytic Theories.
• Sigmund Freud thought that schizophrenia resulted from
developmental fixations early in life.
• defects in ego development, such defects contributed to the
symptoms of schizophrenia.

Learning Theories.
• the poor interpersonal relationships because of poor models for
learning during childhood.
Icd 10
• F20 Schizophrenia
• F20.0 Paranoid schizophrenia
F20.1 Hebephrenic schizophrenia
• F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
• F20.4 Post-schizophrenic depression
• F20.5 Residual schizophrenia
F20.6 Simple schizophrenia
F20.8 Other schizophrenia
F20.9 Schizophrenia, unspecified
• F21 Schizotypal disorder
• F22 Persistent delusional disorders
• F23 Acute and transient psychotic disorders
• F24 Induced delusional disorder
• F25 Schizoaffective disorders
• F28 Other nonorganic psychotic disorders
• F29 Unspecified nonorganic psychosis
Clinical feature

Premorbid sign and symptoms “positive, negative, and cognitive.”

In premorbid history patient had sizoid or

sizotypal personality (quiet, passive and
introverted)
Exclusion of social activities
OCD
 POSITIVE SYMPTOMS

Bizarre behavior
Delusions Clothing and behavior
Hallucinations Persecutory delusions Social and sexual behavior
Auditory hallucinations Delusions of jealousy Aggressive behavior
Voices commenting Delusions of guilt or sin Repetitive or stereotyped behavior
Voices conversing Grandiose delusions
Somatic or tactile Religious delusions
hallucinations Somatic delusions
Olfactory hallucinations Delusions of reference Positive formal thought
Visual hallucinations Delusions of being controlled disorder
Delusions of mind reading Derailment
Thought broadcasting Tangentiality
Thought insertion Incoherence
Thought withdrawal Illogicality”
 Negative symptoms
• Affective flattening or blunting • Alogia
• “Unchanging facial expressions Poverty of speech
• Decreased spontaneous movement Poverty of content of speech
• Paucity of expressive gesture Blocking
• Poor eye contact Increased latency of response
• Affective nonresponsivity
• Avolition—apathy
• Inappropriate affect
Grooming and hygiene
• Lack of vocal inflections
Impersistence at work or school
Physical anergia”

.
• Anhedonia—asociality
Recreational interests and activities
Sexual interest and activities
Intimacy and closeness
Relationships with friends

• Attention
Social inattentiveness
Inattentiveness during testing
Cognitive Symptoms

• Impairments in Normal Cognitive Functions

• impairments of attention, working memory, and executive
functioning.

“Suicide. Suicide is the single leading cause of premature death among people with schizophrenia.”
Diagnostic criteria
• Two (or more) of the following, each present for a significant portion of time
during a 1- month period (or less if successfully treated). At least one of these
must be delusions, hallucinations, or disorganized speech:
Delusions
Hallucinations
Disorganized speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative symptoms (i.e., diminished emotional expression or avolition)
• Continuous signs of the disturbance persist for at least six months. This 6-
month period must include at least 1 month of symptoms (or less if successfully
treated) that meet the above criteria (i.e., active phase symptoms) and may
include periods of prodromal or residual symptoms. During these prodromal or
residual periods, the signs of the disturbance may be manifested only be
negative symptoms or by two or more symptoms listed above present in an
attenuated form.
• For a significant portion of time since the onset of the disturbance, level
of functioning in one or more major areas, such as work, interpersonal
relations, or self-care is markedly below the level achieved prior to the
onset (or when the onset is in childhood or adolescence, there is a
failure to achieve expected level of interpersonal, academic, or
occupational functioning).

• Schizoaffective disorder and depressive or bipolar disorder with

psychotic features have been ruled out.
• The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition.

• There is a history of autism spectrum disorder or a communication

disorder of childhood onset, the additional diagnosis of schizophrenia is
made only if prominent delusions or hallucinations, in addition to the
other required symptoms of schizophrenia, are also present for at least
1 month (or less if successfully treated).
 prognosis

Positive Prognostic Factors Poor Prognostic Factors

• Acute onset • Insidious onset
• Female sex • Childhood or adolescent
• Living in a developed onset
country • Poor premorbid
functioning
• Cognitive impairment
Treatment
• hospitalization :
• indicated for diagnostic purposes, for stabilization of medications, for
patients’ safety because of suicidal or homicidal ideation,

• grossly disorganized or inappropriate behavior, including the inability to take

care of basic needs such as food, clothing, and shelter.

• Short stays of 4 to 6 weeks are just as effective as long-term hospitalizations,

pharmacotherapy
pharmacotherapy
Other Somatic Treatments

ECT
• as effective as antipsychotic medications and more effective than
psychotherapy.
• supplementing antipsychotic medications with ECT is more effective
than antipsychotic medications alone

.transcranial magnetic stimulation (TMS) or transcranial direct current

stimulation (tDCS): may be useful for treating hallucinations or negative
symptoms
• Psychosocial Therapy
• better adherence to therapy, less negative symptoms, and better overall
functioning.
• include a variety of methods to increase social abilities, self-sufficiency,
practical skills, and interpersonal communication in schizophrenia patients.
• develop social and vocational skills for independent living.
• “Cognitive Behavioral Therapy:
• to improve cognitive distortions, reduce distractibility, and correct errors in
judgment.
• . The approach generally incorporates cognitive restructuring, self-
monitoring, “and graded coping skills.
• Social Skills Training
• also called behavioral skills therapy
• other noticeable symptoms : poor eye contact, unusual delays in response,
odd facial expressions, lack of spontaneity in social situations, and inaccurate
perception or lack of perception of emotions in other people
• . addresses these behaviors through the use of videotapes of others and the
patient, role-playing in therapy, and homework assignments for practicing the
specific skills.
• Art Therapy.
• cognitive training is a behavioral therapy that attempts to improve cognitive
processes.
• “Vocational Therapy and Supported Employment.
• help patients regain old skills or develop new ones.
• sheltered workshops, job clubs, and part-time or transitional employment
programs.”
Other psychotic disorder
Schizoaffective Disorder • features of both schizophrenia and mood disorders”
• Meets criteria for a major depressive or manic episode
• Meets criteria for Schizophrenia

Schizophreniform Disorder • symptoms are short term, lasting at least 1 month but less than 6
months.
• then return to their baseline level of functioning.”

Acute and Transient psychotic <1 month on average, sudden onset

disorder/brief Remission is full
more often among younger patients (20s and 30s) than among older
patients

Delusional Disorder • exhibits one or more delusions of at least 1 month’s duration

• No marked functional impairment
.
Thank you