Transcript BS 4
BS 11 Schizophrenia And Other psychotic disorders Schizophrenia Basically means that the person has lost touch with reality in some way, shape or form. It is a chronic > 6 months, debilitating mental disorder Peak age of onset 15 – 25 yrs for men, 25 – 35 yrs in women Equally in men & women, in all cultures & ethnic groups Has intact memory, and is oriented to person, place & time Symptoms 1. Positve sym: are additional to expected behavior – includes hallucinations, delusions, agitation & talkativeness respond well with traditional antipsychotic agents Negative sym: are missing from expected behavior – lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming & poor speech content respond well with Atypical antipsychotics Course It has 3 phases 1. Prodromal: symptoms occuring prior to 1st psychotic episode – avoidance of social activities, physical complaints, new interest in religion, the occult / philosophy 2. Psychotic: pt loses touch with reality – disorders of perception, thought content, thought processes & form of thought 3. Residual: (period between psychotic episodes) – back to reality, but social withdrawal & peculiar thinking Perception Illusion Misperception of real stimuli Mistaking a shadow for someone. hallucination False sensory perception Hearing voices Thought content Delusion False belief Feeling of being followed by FBI Thought processes Impaired abstraction Lack of object relationship Says eating Inventing words Medocrat Neologism Form of thought Loose association Shift of ideas from one topic to another Health to basket ball Tangentiality Getting farther away from one point From his health to brothers health Prognosis Usually repeated psychotic episodes – chronic downhill course over years – stabilizes in midlife Suicidal tendency common – 50% attempt - 10% succeed Prognosis is better if pt is older, married, has social relationship, female with positive symptoms Etiology Not known 1. Genetic factors – general population ………….. – 1% having 1 schizophrenic parent / sibling – 12% Having 2 schizophrenic parent …… - 40% Having monozygotic schizophrenic twin – 50% 2. Other factors: Season of birth: cold season – Jan April - probable viral infections to mothers during 2nd trimester Neural pathology 1. Anatomy abnormalities in frontal lobe functions reduced glucose meta as seen in PET Lateral & 3rd Vent enlargement / abnormal cerebral symmetry / changes in density of brain Neurotransmitters & other abnormalitis: Excessive dopaminergic activities – excessive no of dopamine receptors, excessive concentration of dopamine – amphetamine & cocaine cause psychotic symps – elevated levels of homovanillic acid (HVA) – a metabolite of dopamine in pts serum Serotonin hyperactivity Eye movement: poor smooth visual pursuit – in schizophrenic pts and in their relatives As per Diagnostic & Statistical Manual of Mental disorders IV Edn (DSM-IV) – 5 types 1.Disorganized Poor grooming, inappropriate emotional response, disinhibition – onset before 25 yrs of age 2.Catatonic Stupor / agitation / lack of coherant speech, bizarre posturing (waxy Flexibility) 3.Paranoid Delusions of persecution – older age of onset 4.Undifferentiated Characteristics of more than one type 5.Residual One previous episode & subsequent residual symptoms with no psychotic symptoms Differential diagnosis Medical illnesses Medications Psychiatric illnesses Treatment antipsychotic medication, Cognitive-Behavioural Therapy Family and Group Therapy Psychodynamic therapies Typical Antipsychotics Atypical Antipsychotics Chlorpromazine (Largactil) Droperidol (Droleptan, Thalamonal) Flupenthixol (Depixol, Fluanxol) Fluphenazine (Modecate, Moditen, Motipress, Motival) Haloperidol (Haldol, Serenace) Thioridazine (Melleril) Trifluoperazine (Stelazine, Parstelin) Zuclopenthixol (Clopixol) Clozapine (Clozaril) Olanzapine Risperidone Other psychotic disorders Brief psychotic disorder Schizophreniform disorder Schizoactive disorder Shared delusional disorder Disorder Characteristics prognosis Schizophrenia Psychotic & residual symptoms lasting for > 6 months Lifelong, social & occupational impairment Brief psychotic disorder Psychotic symptoms lasting for > 1 day, but < 1 month – often precipitating social factors 50% - 80% recover completely Schizophrenifom Psychotic & residual disorder symptoms lasting 1 – 6 months Schizoaffective disorder Symptoms of mood disorder + psychotic symptom 33% recover completely Lifelong social & occupationa l impairment Delusional disorder fixed, persistant, nonbizare delusional system – paranoid in persecutory / romantic in erotomanic type 50% recover completely Shared delusional disorder Delusion in a close relative shared by this person 10 – 40% recover completely