Schizophrenia Awareness
Dr. Rakesh [Link] M.D. (Psy.)
Medical Superintendent
Hospital For Mental Health
Vadodara
9825453224
Dr. Rakesh Shah M.D.(Psy.)
Phillipe Pinel
Phillipe Pinel liberating mentally ill
Stigma
“The stigma is harder to deal
with than the illness itself”
Joanne Verbanic
Founder, Schizophrenics Anonymous
Stigma Hurts
Awareness Program
Global burden of
diseases
very high
due to
mental disorders
all over the world
Schizophrenia: Some Figures
• Lifetime prevalence: About 1%
• 10-15% cases end in suicide.
• Illness of young and adolescents.
• M:F = 1:1, equally affected.
• More in lower socio-economic groups.
Schizophrenia
is
Disabling
Most mentally ill ,
after treatment
can lead useful lives.
Diagnosis
Diagnostic criteria (DSM-IV)
Patient must have 2 or more of following
symptoms for at least one month out of
continuous disturbances of six months:
• Delusion
• Hallucination
• Disorganized speech
• Grossly disorganized or catatonic behaviour
• Negative symptoms
Diagnostic criteria (DSM-IV)
Symptoms must
• cause impairment in social and occupational
functioning
• not be due to some drug or general medical
disease
Clinical features
• Onset : acute or insidious.
• Clinical features :
Positive Disorganization
Negative Cognitive
Positive Symptoms: Delusions
False but firm, fixed belief which cannot be
corrected :
• Logical argument,
• Giving proof of wrongness of belief
• Not shared by people in the same socio-
cultural background
• Two or more voices
talking about
patient in third
person
• Running
commentary
• Hearing one’s own
thoughts spoken
aloud
Disorganization :
Speech Behaviour
Negative Symptoms
• Social withdrawal / Apathy
• Poverty of speech ( Alogia)
• Flat or blunted emotions
• Anhedonia : Lack of pleasure or
interest
Cognitive Symptoms
Impairment of :
• Memory
• Attention
• Judgement
• Executive function/ planning
Types of schizophrenia
• Paranoid
• Catatonic
• Disorganized
• Undifferentiated
• Residual
Aetiology
Aetiology
• Biological,
• Psychological,
• Social
Heredity
Changes in Dopamine and Serotonin
Alcohol and
Addicting Drug
May precipitate
schizophrenia
Treatment
Most mentally ill need not live in mental
hospitals, rather they should be treated at
their doorsteps.
With regular and proper treatment
many people with schizophrenia
can lead
a normal routine life
Treatment definitely improves Quality of Life
Hospitalization
• Non-cooperative,
• Aggressive, violent
• Suicidal
Schizophrenia
is treatable
Most of the therapeutic effects are observed
in first 6 – 8 weeks of therapy
Effects of Antipsychotics
• No dependence potential
• Specific to target core symptoms
• Maintenance medication prevents relapse
• Drug compliance a major issue
• Treatment duration:
May be required for 2 – 5 years/ indefinite
period, as per clinical condition
Typical Antipsychotics
• Chlorpromazine
• Haloperidol
• Trifluperazine
• Thioridazine
• Pimozide
• Fluphenazine
Atypical Antipsychotics
Significant advantage : no EPS, Improved
negative symptoms , improved QOL
• Currently available important APDs-
-
• Clozapine
• Olanzapine
• Risperidone
• Ziprasidone
• Quetiapine
Common Side effects
• Dryness of mouth
• Blurring of vision
• Constipation
• Urinary retention
• Sedation
• wt. increase
Acute Dystonic Reactions
• May occur in first few week , especially
with high doses
• Torticollis, retrocollis, protrusion of tongue,
opisthotonos, occulogyric crisis
• Reversible
Drug induced parkinsonism
• Muscle rigidity, tremors at rest, loss of
facial expression, akinesia, muscular inco-
ordination etc.
• Usually responds to anti-parkinsonism
drugs e.g. benztropine
Akathisia
• Anxiety along with restlessness
• Patient not able to sit or stand still
• Can be treated or minimized by :
Propranolol, Diazepam
Tardive Dyskinesia
• Occurs in at least 20 – 40% of patient treated
• >50 years of age, increased incidences
• Usually irreversible
• Characterized by repeated involuntary sucking &
smacking of lips, abnormal jaw movements,
darting, pushing and twisting of tongue
• No effective treatment but lowering of drug dose
may help
Neuroleptic Malignant Syndrome
• Rare but serious side effect.
• May appear early in the treatment.
• Temperature control disturbances.
• Muscle rigidity,, diaphoresis, tachycardia,
autonomic dysregulation, decreased
consciousness and confusion
Schizophrenia : Outcome
10%
Full Recovery
20%
Recovery +Re-
lapse
35% Recovery
Incomplete
35%
Deterioration
Mentally ill need
your understanding, treatment
and support
Expressed Emotions
• Hostility
• Critical Comments Relapse
• Overinvolvement
Myths
or
Realities?
Myth
Marriage is not the treatment of
Schizophrenia
Mental disorders are NOT
Caused by supernatural forces
Mental disorders are
Not caused by
effects of planets
You do not get mental illness
simply by living with
a mentally ill person.
Myth
Schizophrenia patients are
violent
Reality
Most acts of violence are
committed by so called
sane people
Myth
He does not give ups his thoughts
Reality
The thoughts do not remain in patients’ control
In fact the thoughts start controlling the patient
Myth
Electro convulsive therapy (E.C.T.)
damages the brain and is
painful to the patient
Reality
ECT is effective, safe, economic treatment
especially in catatonic patients and who
have prominent mood symptoms
Everyone can help!
Conclusions
• Severe , disabling brain disorder
• Clinical manifestations
• Duration at least 6 months
• Impairment functioning
• Medication reduces manifestations
• Reduce stigma
Questions?
