Psychoses/ Schizophrenia

By: Dr Urmila M. Aswar

Psychoses- Severe psychiatric illness with serious

distortion of thought, behaviour, capacity to recognize

reality and perception.

Schizophrenia- Schizophrenia is a particular type of psychosis

that is, a mental disorder caused by some inherent dysfunction of

the brain.

2

Fig. 1 Schizophrenia

Prevalence

Schizophrenia occurs with regular frequencynearly everywhere in the world in 1 % of thepopulation and begins mainly in young age (mostlyaround 16 to 25 years).

Schizophrenia leads to A group of characteristic positive and negative symptoms

Deterioration in social, occupational, or interpersonalrelationships

Continuous signs of the disturbance for at least 6 months

The Primary symptom of schizophrenia :

Mania –Hyperactivity, uncontrollable thought and speech,

may be associated with violent behaviour

Depression – Sadness, guilt, physical and mental slowing,

self destructive ideation.

Bipolar - (manic-depressive)

Unipolar- (mania or depression)

4Fig. 2 symptom

Positive Symptoms

Hallucinations

Delusions

Disorganized thought

Perception disturbances

Inappropriate emotions

Negative Symptoms

Blunted emotions

Anhedonia

Lack of feeling

Cognition

New Learning

Memory

Mood Symptoms

Loss of motivation

Social withdrawal

Insight

Demoralization

Suicide

5

POSITIVE SYMPTOMS: Hallucinations

Hallucinations are things a person sees, hears,

smells, or feels that no one else can see, hear,

smell, or feel.

"Voices" are the most common type of hallucination in

schizophrenia. The voices may talk to the person about

his or her behavior, order the person to do things, or

warn the person of danger. Sometimes the voices talk to

each other.

Other types of hallucinations include seeing people or

objects that are not there, smelling odors that no one

else detects, and feeling things like invisible fingers

touching their bodies when no one is near.

POSITIVE SYMPTOMS : Delusions Delusions are false beliefs. The person believes delusions even

after other people prove that the beliefs are not true or logical.People with schizophrenia can have delusions that seem bizarre,such as believing that neighbors can control their behavior withmagnetic waves.

They may also believe that people on television are directingspecial messages to them.

Sometimes they believe they are someone else, such as a famoushistorical figure.

They may have paranoid delusions and believe that others aretrying to harm them, such as by cheating, harassing, poisoning,spying on, or plotting against them or the people they care about.These beliefs are called "delusions of persecution."

Negative symptoms

Negative symptoms are associated with

disruptions to normal emotions and behaviors.

These symptoms include the following:

"Flat affect" (a person's face does not move or he

or she talks in a dull or monotonous voice)

Lack of pleasure in everyday life-Anhedonia

Lack of ability to begin and sustain planned

activities

Speaking little, even when forced to interact.

Movement disorders

Movement disorders may appear as

agitated body movements. A person with a

movement disorder may repeat certain

motions over and over. In the other

extreme, a person may become catatonic.

Cognitive symptoms

Like negative symptoms, cognitive symptoms may be

difficult to recognize as part of the disorder. They are

detected when other tests are performed.

The ability to understand information and use it to make

decisions.

Trouble in paying attention

Problems with "working memory" (the ability to use

information immediately after learning it).

Cognitive symptoms often make it hard to lead a normal

life and earn a living.

They can cause great emotional distress.

11

12

Carlsson and Lindqvist (1963)

Repeated administration of stimulants likeamphetamines and cocaine, which enhancecentral dopaminergic neurotransmission, cancause a psychosis that resembles the positivesymptoms of schizophrenia.

Stress, a major predisposing factor inschizophrenia.

13

This disorder is far more complex than

originally supposed, but it involves a

combination of genetics and

abnormalities in amine

neurotransmitter function (especially

that of dopamine)

Main categories are:

A) Typical antipsychotics

Phenothiazines (chlorpromazine, fluphenazine,

thioridazine)

Thioxanthenes (flupenthixol, clopenthixol)

Butyrophenones (haloperidol, droperidol)

B) Atypical antipsychotics (e.g. clozapine, risperidone,

sulpiride, olanzapine)15

The difference between ‘typical’ and ‘atypical’

antipsychotic is based on the

Incidence of extrapyramidal side-effects (less in

‘atypical’ group)

Efficacy in treatment-resistant group of patients

Efficacy against negative symptoms.

16