Transcript Schizophrenia

Schizophrenia Overview
Schizophrenia is the most
severe and debilitating mental
illness in psychiatry and is a
brain disorder
History
Bleuiler
1) Autism
2) Ambivalence
3) Affect
4) Association
Diagnosis of Schizophrenia
A. Characteristic symptoms
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized or catatonic behavior
-Negative symptoms
B. Social/occupational dysfunction
C. Overall duration > 6 months
D. Exclude mood disorders, drugs, pervasive
developmental disorders
Positive Symptoms
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Additions to normal function
Delusions
Hallucinations
Distorted language/communication
Disorganised speech / behaviour
Catatonic behaviour
Agitation
Negative Symptoms
Losses of normal function
-Affective flattening
-Alogia
-Avolition
-Anhedonia
-Attentional impairment
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Blunted affect, emotional withdrawal, poor rapport,
passivity, apathetic, social withdrawal
Cognitive Symptoms
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Thought disorder
Odd use of language
incoherence, loose associations, neologisms
Impaired attention / cognition
reduced verbal fluency
learning/memory
executive functions
Subtypes of schizophrenia
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Paranoid
Disorganized
Catatonic
Undifferentiated
Residual
Childhood onset schizophrenia
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Onset before 12 years
Increased developmental abnormalities
Lower IQ
1 in 10000
Increased heritability
Decreased gray matter
Epidemiology
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1% prevalence worldwide
Most begin in late adolescence to 20’s
M=F
Females age of onset is generally later
– better outcome
Downward drift social-economically
Die younger – 10% suicide
Etiology of schizophrenia
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Genetic
Structural brain changes
Functional brain changes
Dopamine hypothesis
Risk Factors
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Genetic
Canabis
Infection & Birth Season
prognosis
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Age of onset
Function level before onset
IQ
Drug response
Family support
sex
Structural changes in brain
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Larger ventricles
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Subgroup: inverse correlation between
ventricle size and response to drugs
Structural changes in brain
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Increased loss of gray matter in
adolescence
Dopamine hypothesis
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Amphetamine (very high doses)  paranoia,
delusions, auditory hallucination
Amphetamines worsen schizophrenia
symptoms
Effects blocked by dopamine antagonist
chlorpromazine (Thorazine)
Typical antipsychotics block D2 receptors and
alleviate positive symptoms.
A 20th-century artist, Louis Wain, who was fascinated by cats,
painted these pictures over a period of time in which he developed
schizophrenia. The pictures mark progressive stages in the illness
and exemplify what it does to the victim's perception.
Treatment of Schizophrenia
Medications for schizophrenia
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Conventional antipsychotics
- Haldol, Thorazine, Mellaril, etc.
Second generation antipsychotics
-Risperidone, Zyprexa, Seroquel,
Geodon, Abilify, Clozaril
Medications are better for positive symptoms
than negative symptoms
First generation antipsychotic
side-effects
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Extrapyramidal side-effects – Parkinson
symptoms, dystonia, restlessness
Sedation
Weight gain
Dry mouth, constipation
Cardiac toxicity
Postural hypotension
Second generation antipsychotic
side-effects
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Weight gain
Increase blood sugar – diabetes
Increased lipids
Sedation
Non-pharmacologic treatments
for schizophrenia
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Psychotherapy – supportive
Social skills training
Family Therapy – expressed emotion
Psychosocial rehabilitation
Future Directions in the
Treatment of Schizophrenia
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More optimistic view of outcome
Much stronger focus on early intervention and
prevention e.g. early psychosis clinics and prodromal
studies
Increased understanding of neurobiological basis
beyond dopamine hypothesis with non-dopamine
treatments
Renewed emphasis on rehabilitation, supported
employment etc.