SCHIZOPHRENIA
DR SEIF JUMA ABAS
MD
1
Learning tasks
• Define Schizophrenia
• Explain aetiology and risk factors of
Schizophrenia
• Outline the epidemiology of Schizophrenia
• Explain clinical features of Schizophrenia
2
Learning tasks…
• Establish provisional and differential
diagnosis of Schizophrenia
• Describe the Pre referral treatment of
Schizophrenia
• Provide follow-up services of
Schizophrenia
Schizophrenia
• Schizophrenia is a group of major
functional psychotic disorders
characterized by disturbances in thinking,
perception, mood and behavior
• It is characterized by impaired ability to
monitor reality, resulting in altered mood,
thinking, language, perceptions, behavior,
and interpersonal interactions
Aetiology
• The exact cause of schizophrenia is
unknown
• Research suggests a combinations of
physical, genetic, psychological and
environmental factors can make a person
more likely to develop the conditions
Risk factors
• Genetic – Family history of schizophrenia
• Environmental risk like various perinatal
problems including pre-term labour and fetal
hypoxia
• Cannabis use is also a risk factor
• Imbalances in neurotransmitters (Excess in
dopamine)
Epidemiology
• Schizophrenia occurs throughout the
world.
• The prevalence of schizophrenia (ie, the
number of cases in a population
approaches 1%
• Slightly more men are diagnosed with
schizophrenia than women
Types of Schizophrenia
There are several types of schizophrenia:
• Paranoid type: Where delusions and
hallucinations are present but thought
disorder, disorganized behavior, and
affective flattening are absent
– characterized mainly by delusions of
persecution, feelings of passive or active
control and feelings of interference
Types of Schizophrenia…
• Disorganized (hebephrenic) type: Where
thought disorder and flat affect are present
together
• Catatonic type: The subject may be almost
immobile or exhibit agitated purposeless
movement
– Symptoms can include catatonic stupor and
waxy flexibility
Types of Schizophrenia…
• Undifferentiated type: Psychotic symptoms
are present but the criteria for paranoid,
disorganized, or catatonic types have not
been met
• Residual type: Where positive symptoms
are present at a low intensity only
Clinical Features
• At least two of the following core psychotic
features should be present for ≥ 6 months
Positive symptoms:
– Hallucinations - Sensory experiences
that occur in the absence of
environmental stimulation
o Hallucinations are commonly auditory
Clinical Features…
– Delusions - beliefs that are contrary to
reality
o Persecutory delusions are common
– Disorganized speech
– Grossly disorganized or catatonic
behavior
– See Handout 28.1 on clinical features of
Schizophrenia
Diagnosis
• A diagnosis of schizophrenia is based on
the presence of above mentioned
symptoms, coupled with social or
occupational dysfunction for at least six
months in the absence of another
diagnosis that would better account for the
presentation.
Differential Diagnosis
• Infections like HIV, neuropsyphilis and
brain abscess
• Brief psychotic disorder- delusions lasts
for less 1 month
• Delirium due to medical conditions like
sepsis, endocrine disorders
• Space occupying lesions like Brain tumors
and subdural hematoma
Differential Diagnosis…
• Alcoholic hallucinosis
• Drug abuse – Stimulants and
hallucinogens like Amphetamine/ khat
(miraa, mirungi)/ cocaine
• Metabolic diseases like electrolyte
imbalances e.g hyponatremia
• Mood disorders like mania
Investigations
• No laboratory investigations can confirm
schizophrenia, but the following can be
done as routine and for ruling out organic
causes of symptoms
– Hemoglobin
– SR
– Widal test
– Blood slide for malaria
Investigations…
– Urinalysis
– HIV Test
– Syphilis test
– Lumbar puncture for CSF analysis
Treatment
• Anti –psychotic drug treatment
– Chlorpromazine 50 – 100mg IM in acute
phase followed by maintenance dose of up to
400mg orally in divided dose per day.
– Haloperidol 5-15mg/day IM in acute phase
followed by maintenance dose of up to 5-15
mg orally in divided dose per day.
– Injection Diazepam 10 – 20mg IV stat to calm
the patient.
Treatment
• Anti-psychotics give side effects of extra
pyramidal system such as
– Tremors
– Tongue protrusion
– Stiffness of the neck and rigidity
• These side effects are controlled by
– Tablet Artane (trihexyphenidyl)
• Refer to hospital whereby patient is
observed in a special secured ward
Treatment
Non pharmacological
• Psychotherapy is also widely
recommended and used in the treatment
of schizophrenia
• Cognitive behavioral therapy (CBT) is
used to target specific symptoms and
improve related issues such as self-
esteem, social functioning, and insight.
Treatment …
• Another approach is cognitive remediation,
a technique aimed at remediating the
neurocognitive deficits sometimes present
in schizophrenia.
• Rehabilitation is mandatory if the patient is
in danger to himself or to his family or to
the community at large.
Treatment …
• Family therapy or education, which
addresses the whole family system of an
individual with a diagnosis of
schizophrenia, has been consistently
found to be beneficial, at least if the
duration of intervention is longer-term.
Follow-up
• Patient on Schizophrenia treatment should
be followed up for side effects of
antipsychotics including extra pyramidal
side effects such as tremors
• Patients should be counseled on
adherence to non pharmacological
management
Key Points
• Schizophrenia is a group of major
functional psychotic disorders
characterized by disturbances in thinking,
perception, mood and behavior
• Clinical features of Schizophrenia are
mainly divided into positive and negative
symptoms
Key Points
• A diagnosis of schizophrenia is based on
the presence of pyschotic symptoms,
coupled with social or occupational
dysfunction for at least six months
• Treatment involves pharmacological and
non pharmacological approaches
Key Reference
• Braunwald & Fauci (2001). Harrison’s
principles of internal medicine 15th Ed.
Oxford: McGraw Hill
• Davidson, S (2006). Principles and
practice of medicine 20th Ed. Churchill:
Livingstone.
• Kumar & Clark (2003) Textbook of clinical
medicine. Churchill: Livingstone.
Key Reference
• Douglas Model (2006): Making sense of
Clinical Examination of the Adult patient. 1st
Ed. Hodder Arnold
• Longmore, M., Wilkinson, I., Baldwin, A., &
Wallin, E. (2014). Oxford handbook of
clinical medicine. Oxford
• Macleod, J. (2009). Macleod's clinical
examination. G. Douglas, E. F. Nicol, & C. E.
Robertson (Eds.). Elsevier Health Sciences.
27
Key Reference
• Nicholson N., (1999), Medicine of Non-
communicable diseases in adults. AMREF
• Stuart and Saunders (2004): Mental health
Nursing principles and practice. 1st Ed.
Mosby
• Swash, M., & Glynn, M. (2011).
Hutchison's clinical methods: An
integrated approach to clinical practice.
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