Schizophrenia

Origin of schizophrenia - dates back to the Ebers Papyrus of 1550BC from Egypt. Descriptions of episodes of madness involving hearing voices, seeing visions and erratic and unruly behaviour start to appear in the literature from the 17th century.

Emil Kraepelin(late 1850s) - identified manic depression and dementia praecox, later termed schizophrenia, as distinct forms of psychosis.

Eugen Bleuler - defined schizophrenia as a group of diseases rather than just one disorder. He defined the main symptoms of the disease as the four A's: associations, affect, ambivalence, and autism. Bleuler explained the four A's in his book Dementia Praecox or the Group of Schizophrenias.

Criteria for schizophrenia - At least 2 or more of the following, with at least one being #1,2 or 3.

psychosis - when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions).

  1. Delusions - fixed beliefs that are not amenable to change in light of conflicting evidence. Often considered bizarre if they are clearly implausible and not understand to same-culture peers and do not derive from ordinary life experiences.

  2. Hallucinations - perceptive like experiences that occur without an external stimulus. Vivid and clear with the full impact of normal perceptions. May occur in any sensory modality, but auditory are the most common.

  3. Disorganized thinking(speech)- person may switch from subject to subject, may answer in completely unrelated terms, and may be incomprehensible.

  4. Grossly disorganized or abnormal motor behavior - silliness, unpredictable behavior, or catatonic.

  5. Negative symptoms - usually diminished emotional expression (flat affect) and

    1. abolition- decrease in purposeful self-initiated activities
    2. alogia- diminished speech output
    3. anhedonia-decreased ability to enjoy positive stimuli
    4. associalito- lack of interest in social interactions

Positive symptoms - hallucinations (sensations that aren't real), delusions (beliefs that can't be real), and repetitive movements that are hard to control

Schizophreniform disorder - a psychotic disorder that affects how you act, think, relate to others, express emotions and perceive reality. Unlike schizophrenia, it lasts one to six months instead of the rest of your life.

Schizoaffective disorder- a condition where symptoms of both psychotic and mood disorders are present together during one episode (or within a two week period of each other).

Delusional disorder - a type of mental health condition in which a person can't tell what's real from what's imagined. There are many types, including persecutory, jealous and grandiose types. It's treatable with psychotherapy and medication.

Brief psychotic disorder - the presence of one or more psychotic symptoms with a sudden onset and full remission within one month.

Shared psychotic disorder - a rare disorder characterized by sharing a delusion among two or more people in a close relationship. The inducer (primary) who has a psychotic disorder with delusions influences another nonpsychotic individual or more (induced, secondary) based on a delusional belief.

Catatonia - a disorder that disrupts a person's awareness of the world around them. People with this condition sometimes react very little or not at all to their surroundings, or might behave in ways that are unusual, unexpected or unsafe to themselves or others

Attenuated Psychosis Syndrome - individual has symptoms but is relatively intact with reality; experiences symptoms but is aware that there are unusual experiences are not typical for a healthy person. Designed to target those who will benefit from early diagnosis and treatment (early intervention).

Tardive Dyskinesia - a condition where your face, body or both make sudden, irregular movements which you cannot control. It can develop as a side effect of medication, most commonly antipsychotic drugs.

Causes of schizophrenia:

  • genetic - tends to run in families, but no single gene is thought to be responsible.
  • organic - It includes many different clinical conditions that may cause schizophrenia-like psychosis such as drug intoxication, temporal lobe epilepsy, traumatic brain injury, cerebrovascular disease, storage disorders, mitochondrial disorders, leukodystrophies

High comorbidity rate with suicide: 30% of schizophrenics who commit suicede will do so within sic months of initial diagnosis

Dopamine hypothesis- hyperactivity of dopamine D2 receptor neurotransmission in subcortical and limbic brain regions contributes to positive symptoms of schizophrenia

Treatment of schizophrenia:

  • First generation antipsychotics - Thorazine and Haldol
  • Second generation antipsychotics (developed later) - Clozaril, Risperfal, Zypreca, Geodon, Abilify
  • Therapy - Individual and family, day treatment

Affect - the immediate expression of emotion, and can be used to objectively assess a patient's mood.

Prevelance rate in the US is approximately .3-.7% of the population with childhood onset even more rare.

The essential features of schizophrenia are the same in childhood, but it is more difficult to make the diagnosis.

In children, delusions and hallucinations may be less elaborate than in adults, and visual hallucinations are more common and should be distinguished from fantasy play. Disorganized speech occurs in many disorders with childhood onset.