Schizophrenia

INTRODUCTION:
  • Schizophrenia is a disorder of thoughts
  • Eugene Bleuler coined the term schizophrenia
  • Maximum heritability is seen in Schizophrenia
  • Ages of 16 and 30
  • Males tend to show symptoms at a slightly younger age than females
  • 1 percent of all adults, globally
  • The prevalence of schizophrenia is approximately >1% worldwide.
  • Incidence rate of schizophrenia ranges from 0.10 to 0.70(0.5%)
  • Incidence of schizophrenia in India is 1 -5%
ETIOLOGY:
  • Genetic inheritance
  • Chemical imbalance in the brain
  • Dopamine, serotonin
  • Family relationships
  • Environmental factors
  • Trauma before birth and viral infections, Stressful experiences
  • Drug induced schizophrenia
  • Marijuana and LSD, cannabis ,steroids and stimulants,Amphetamine(symptoms similar like paranoid schizophrenia)
SYMPTOMS:
  • Positive symptoms - also known as psychotic symptoms. For example, delusions and hallucinations
  • . Negative symptoms - these refer to elements that are taken away from the individual. For example, absence of facial expressions or lack of motivation.
  • Cognitive symptoms - these affect the person's thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
  • Perseveration :Persistent and inappropriate repetition of the same thoughts
  • Emotional symptoms - Passivity phenomenon (Inappropriate emotions)
  1. Made feeling or affect
  2. Made impulses
  3. Made volition or acts
  4. Somatic passivity
  5. Lack of motivation (avolition)
  6. Deficits in smooth-pursuit eye movements,
  7. Poor expression of emotions
  • Social withdrawal,Poor personal care,Decreased interest in sex
  • Neologism : A newly coined word that no one heared or may even not exist
  • Unawareness of illness & Waxy flexibility
  • Split personality
  • Gradual onset of suspiciousness
  • Van Gogh Syndrome features i.e. self-mutilation
  • Catatonia
  • The presence of one of these Schneider's first rank symptoms (SFRS) absence of intoxication, brain injury or clear affective illness is suggestive of schizophrenia Thought alienation phenomenon (Formal thought disorder) is the primary disturbance
  • Thought withdrawl
  • Thought insertion
  • Thought diffusion or broadcasting
  1. Eugen Bleuler's fundamental symptoms of schizophrenia
  2. Ambivalence: Severe inability to decide for or against
  3. Autism : Withdrawl into self
  • Affect disturbance : Inappropriate or incongruent affect
  • Associations : loosening of thought associations leading to word salad/ flight of ideas/ thought disorder.
  • lCD-10

Negative Positive
Alogia Hallucinations
Audible thoughts
Voices heard arguing
Voices commenting on one's action (3rd person hallucination)
Responds first to treatment
Affective flattening Delusions The delusions included in the first rank symptoms of schizophrenia are primary delusions also known as autoconthous delusions.
Delusion of reference
Avolition-apathy Bizarre behaviour
Anhedonia-asociality Positive formal thought disorder
Attentional impairment
DIAGNOSTIC CRITERIA:
  • Have at least two of the following typical symptoms:
  1. delusions
  2. disorganized or catatonic behavior
  3. disorganized speech
  4. hallucinations
  • negative symptoms that are present for much of the time during the last 4 weeks
  • Experience considerable impairment in the ability to attend school, carry out their work duties, or carry out everyday tasks.
  • Have symptoms that persist for 6 months or more.
  • Certain tests will be ordered to rule out other illnesses and conditions that may trigger schizophrenia-like symptoms, such as:
  1. Blood tests - in cases where drug use may be a factor a blood test may be ordered. Blood tests are also done to exclude physical causes of illness.
  2. Imaging studies - to rule out tumors and problems in the structure of the brain.
  3. CT: Shows lateral and third ventricular enlargement and some degree of reduction in cortical volume
  • EEG: Increased sensitivity to activation procedures, decreased a-activity, and increased 7- and 8-activity
  • Psychological evaluation
Exam Question
  • Lateral and third ventricle enlargement ,Deficits in smooth-pursuit eye movements,Increased incidence of abnormally slow electroencephalogram tracings are seen in schizophrenia 3rd person auditory hallucination,Inappropriate emotions,Formal thought disorder & incongruent affect are seen in schizophrenia
  • Neurotransmitter which is implicated in both positive and negative symp­toms in schizophrenia is Dopamine
  • 0.5% is the incidence rate of schizophrenia in general population
  • Schizophrenia and depression both have Social withdrawal,Poor personal care,Decreased interest in sex, suicidal tendencies
  • Schizophrenia is a disorder of thoughts
  • Split personality,Systemized delusion & Third person hallucination are the features that is suggestive of Schizophrenia rather than organic psychosis
  • Maximum heritability is seen in Schizophrenia I
  • Incidenceof schizophrenia in India is 1 -5%
  • Eugen Bleuer's fundamental symptoms include Ambivalence,Autism and Affect disturbance
  • Schneider's first rank symptoms (SFRS ) is seen in schizophrenia
  • The primary disturbance in schizophrenia is Formal Thought Disorder
  • Waxy flexibility,Delusion of reference & Formal thought disorder are characterstics of schizophrenia
  • Auditory Hallucination & Catatonia is seen in schizophrenia
  • Van Gogh Syndrome is seen in schizophrenia
  • Schizophrenia mostly occurs in Adolescents
  • Auditory Hallucination in schizophrenia respond earliest to treatment
  • Gradual onset of suspiciousness, muttering and smiling without clear reason, decreased socialization, violent outbursts, and lack of interest in studies ,blunt affect, thought broadcast, a relatively preserved cognition, impaired judgment and insight are suggestive symptoms of schizophrenia
  • Neologism is characteristically seen in schizophrenia
  • Perseveration is Persistent and inappropriate repetition of the same thoughts Characteristic of schizophrenia
  • Four A's of schizophrenia was described by Eugen Bleuler's
  • Drugs abuse with symptoms similar like paranoid schizophrenia are seen in Amphetamine
Don't Forget to Solve all the previous Year Question asked on Schizophrenia