SHIZOPHRENIA

Causes distorted and bizarre thoughts, perception, movements, emotions and behavior. It cannot be defined as a single illness rather schizophrenia is a thought of as a syndrome or a disease process with many different varieties and symptoms much like the varieties of cancer

SCHIZPHRENIA

A mbivalence

A ssociated looseness

D elusions

E chopraxia

F light of ideas

H allucinations

I deas of reference

P erseveration

POSITIVE OR HARD SYMPTOMS

Having mixed or contradictory beliefs/feelings

AMBIVALENCE

poorly/fragmented thoughts and ideas

ASSOCIATED LOOSENESS

fixed false beliefs that is not based on reality

DELUSIONS

Imitations of movement/gesture or another person

ECHOPRAXIA

Continues flow of verbalization, jumping rapidly from one topic or another

FLIGHT OF IDEAS

False expression that have special meaning for the person

IDEAS OF REFERENCE

Verbal repetition of sentences, words or phrase resisting to change the topic

PERSEVERATION

L ack of volition

A logia

B lunted affect

A nhedonia

C atatonia

F lat affect

A pathy

NEGATIVE OR SOFT SYMPTOMS

absence of will, ambition to take action

Lack of volition

reduced speech output; poverty speech

ALOGIA

restricted range of emotional feeling, tone or mood

BLUNTED AFFECT

Loss of pleasurable feelings

ANHEDONIA

reduced movement; motionless

CATATONIA

Absence of any facial expression

FLAT AFFECT

Feelings of indifference towards people, event and activities

APATHY

**P-** RODROMAL PHASE

**A-** CTIVE PHASE

**R**- ESIDUAL TYPE

TYPICAL STAGES OF SCHIZOPHRENIA

**P-** ARANOID TYPE

**D-** ISORGANIZED TYPE (HEBEPHRENIC)

**C-** ATATONIC TYPE

**U-** UNDIFFERENTIATED TYPE (ATYPICAL SCHIZOPHRENIA)

**R-** ESIDUAL TYPE

SUBTYPES OF SCHIZOPHRENIA

• Characterized by persecutory or grandiose delusions and hallucinations.

• Do not show disorganized behavior

• Best prognosis of all type

• High familial link than other types

• Intact cognitive skills and affect

PARANOID TYPE

• Characterized by grossly inappropriate or flat affect, incoherence and marked disruption of behavior and speech.

• Chronic or lack of remissions, develop early

DISORGANIZED TYPE (HEBEPHRENIC)

• Characterized by marked psychomotor disturbances either motionless or excessive motor activity.

• Tends to be severe and rare

CATATONIC BEHAVIOR

• Characterized by mixed schizophrenic symptoms of other types along with disturbances of thought, affect and behavior

• Major symptoms symptoms of schizophrenia

UNDIFFERENTIATED TYPE

• Characterized by at least one previous, though not a current episode; social withdrawal , flat affect, and looseness of association

• still shows “left over” symptoms

RESIDUAL TYPE

\-          Continuous without temporary improvement

\-          Episodic with progressive or stable deficit

\-          Episodic with complete or incomplete remission

Course of schizophrenia

1\.     **T**wo of the following for most of 1 month:

\-          Delusions

\-          Hallucinations

\-          Disorganized speech

\-          Grossly disorganized or catatonic behavior

\-          Negative symptoms

2\.     **M**arked social or occupational dysfunction

3\.     **D**uration of at least 6 months of persistent symptoms

4\.     **S**ymptoms of schizoaffective & mood disorder are ruled out

5\.     **S**ubstance abuse & medical conditions are ruled out as etiological



**TMDS2 DE HA DE GRO NE**

DSM-IV diagnostic criteria for schizophrenia

is also used in the treatment of schizophrenia, but may be useful when catatonia or prominent affective symptoms are present.

Electroconvulsive Therapy (ECT

\-          Chlorpromazine

\-          Clopenthixole

\-          Levopromazine

\-          Thioridazine

\-          Droperidole

Conventional antipsychotics – (classical neuroleptics)

-        Flupenthixol

\-          Zuclopenthixole

   Depot antipsychotics: (Fluphenazine deconate-Modecate)

\
\-          Amisulpiride

\-          Clozapine

\-          Olanzapine

\-          Quetiapine

\-          Risperidone

\-          Sertindole

\-          Sulpiride

Atypical antipsychotics – (new neuroleptics);

\-          Old age of  onset

\-          Female

\-          Married

\-          No family history

\-          Good premorbid personality

\-          High IQ

\-          Precipitants

\-          Positive symptoms

\-          Treatment compliance

\-          Good support

\-          Acute onset

\-          Presence of mood component

    Good prognosis

\-          Young age of onset

\-          Male

\-          Unmarried

\-          Family history

\-          Personality problems

\-          Low IQ

\-          No obvious precipitants

\-          Negative symptoms

\-          Poor treatment compliance

\-          Low support

\-          Insidious onset

\-          No mood component

POOR PROGNOSIS

\

PSYCHOTIC DISORDER

S chizophreniform disorder

S hared pychotic disorder (Folie a deux)

S chizoaffective disorder

B rief psychotic disorder

D elusional psychotic disorder

\
**S3BD**

OTHER PSYCHOTIC DISORDER

-          Schizophrenic symptoms for a few months **(less than 6 months)**

\-          Associated with good premorbid functioning

\-          Most resume normal lives

\-          The same treatments recommended for schizophrenia may also be utilized here

Schizophreniform Disorder

-          Delusion from one person manifest in another person

\-          The most common relationships are among parents and children, spouses and siblings

\- - Separation from the dominant person and immersion into normal social interaction

   Shared psychotic disorder (Folie à Deux)

-          Symptoms of schizophrenia and a mood disorder

\-          Both disorders are independent of one another

\-          Such persons do not tend to get better on their own

\-          Long-term outcome of patients is not good as that for patients with a mood disorder, yet not as grave as that for patients with schizophrenia.

Schizoaffective disorder

-          Characterized by eccentric behavior and by deviations of thinking and affectivity, which are similar to that occurring in schizophrenia, but without psychotic features and expressed symptoms of schizophrenia of any type.

\-          May affect a less severe form of schizophrenia

Schizotypal disorder

\-          Rare disorder, occurring in perhaps less than 1 or 2 per 1000 deliveries

\-          It is more common in primiparous than in multiparous women

\-          Many of these patients never experience another psychotic illness unless they again become pregnant

\-          Symptoms generally appear abruptly within about 3 days to several weeks after delivery

\-          Hospitalization is generally indicated

Postpartum psychosis (puerperal psychosis)