SCHIZOPHRENIA
DR MASUDI
INTRODUCTION
Schizophrenia is the psychotic disorder in which the psychotic
symptoms last longer than 6 months .
Schizophrenia is the most common psychotic disorder characterized
by delusion, hallucination and thought process disturbance.
Schizophrenia is the most psychotic disorder and the most likely
cause for in patient hospitalization.
EPIDEMIOLOGY
Schizophrenia affect approximately 1% of the population
It is equally prevalent in men and women
The peak age of disease in men is 15-25 years old and women is 25-
35 years old.
People with schizophrenia are more likely to be in lower social
economic group.
ETIOLOGY OF SCHIZOPHRENIA
Stressful environment
Dopamine hypothesis suggest increase in dopamine activities bring
schizophrenia
Genetic basis
Vitamin deficiency
SIGNS & SYMPTOMS OF
SCHIZOPHRENIA
Positive Symptoms
DELUSION : False beliefs that are not based in reality
HALLUCINATION : Involving seeing or hearing things that don't exist
DISORGANIZED SPEECH & THINKING : Effective communication can
be impaired and answers to questions may be partially or completely
unrelated
CATATONIA : Purposeless abnormal motor activity or aggressive
behavior
SIGNS & SYMPTOMS OF
SCHIZOPHRENIA
Cognitive Symptoms
POOR EXECUTIVE FUNCTIONING : Unability to understand
information to make decisions
POOR WORKING MEMORY : Unability to use information immediately
after learning
SIGNS & SYMPTOMS OF
SCHIZOPHRENIA
Negative Symptoms
FLAT AFFECT : Reduced expression of emotions via facial expression
or voice tone
ALOGIA : Reduced speech
AVOLITION : Inability to begin & sustain activities
ANHEDONIA : Inability to experience pleasure
ASOCIALITY : Withdrawal from social contacts
Reluctance to perform everyday tasks
Schneider’s Ranks of Symptoms and
Criteria for Diagnosis of Schizophrenia
Schneider’s first rank symptoms of schizophrenia are symptoms which, if
present are strongly suggestive of schizophrenia
Schneider’s First Rank Symptoms of Schizophrenia include
Auditory hallucination
Hearing thought spoken aloud or hearing voices referring to himself/herself,
made in the third person auditory hallucination in the form of commentary
Thought insertion
Thought withdrawal
Thought broadcast: one’s thought being made known to others
Schneider’s Ranks of Symptoms
and Criteria for Diagnosis of
Schizophrenia
Schneider’s Second Rank Symptoms of Schizophrenia
Secondary delusion: false beliefs which arises from some preceding
morbid experiences
Second person auditory hallucinations
Visual, tactile hallucinations
Blunting affect
Formal thought disorder
Catatonic symptoms
DIAGNOSTIC CRITERIA OF
SCHIZOPHRENIA
A. 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 (1 ), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or
avolition).
DIAGNOSTIC CRITERIA OF
SCHIZOPHRENIA
B. For a significant portion of the 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 failure to achieve expected level of
interpersonal, academic, or occupational functioning).
DIAGNOSTIC CRITERIA OF
SCHIZOPHRENIA
C. Continuous signs of the disturbance persist for at least 6 months.
This 6-month period must include at least 1 month of symptoms (or
less if successfully treated) that meet Criterion A (i.e., active-phase
symptoms) and may include periods of prodromal or residual
symptoms
D. The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition.
DIFFERENTIAL DIAGNOSIS OF
SCHIZOPHRENIA
Substance induced psychosis
Personality disorder
Major depressive disorder
Bipolar disorder
TREATMENT OF SCHIZOPHRENIA
Non pharmacology
CBT
Social skills training
Pharmacological treatment
We use ant psychotic drug
First generation ant psychotic drug
Second generation ant psychotic drug
First generation ant psychotic drug
Chlorpromazine(CPZ) 200mg -1000mg/day
Haloperidol 2mg -20mg/day
Second generation ant psychotic drug
Olanzapine 5mg -20 mg /day
Risperidone 2mg- 16mg/day
SIDE EFFECT OF ANT PSYCHOTIC
DRUG
Extrepyramidal symptoms which include
Akathisia(a movement disorder that makes it hard for you to stay
still. It causes an urge to move that you can't control)
Parkinsonism(A disorder of the central nervous system that affects
movement, often including tremors)
Neuroleptic malignant syndrome(is a life-threatening idiosyncratic
reaction to antipsychotic drugs characterized by fever, altered mental
status, muscle rigidity, and autonomic dysfunction.)
Tardive dyskinesia(is a disorder that involves involuntary movements)
Treatment of extrapyramidal symptoms is artane 2mg -5mg/day
