schizophrenia

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all about schizophrenia

Text of schizophrenia

  • original term-dementia praecox-early age, chronic deteriorating course. coined the term schizophrenia (split mind) affective blunting, loosening of associations, autism (withdrawal) and ambivalence (coexisting conflicting ideas) - 4 As- earned acceptance in USA first rank symptom
  • Psychotic mental disorder of unknown etiology characterized by disturbances in: (e.g. distortion of reality, delusions and hallucinations) (e.g. ambivalence, inappropriate affect) (e.g. Apathetic withdrawal, bizarre activity)
  • Age-related demographics According to DSM5, the onset of schizophrenia usually occurs between the late teens and the mid 30s Sex-related demographics The prevalence of schizophrenia is about the same in men & women The onset is later in women than un men The clinical course is less severe in women than in men Race-related demographics No racial differences in the prevalence of schizophrenia have been positively identified
  • Dopaminergic system hypothesis Increased Ventricular size Glutaminergic dysfunction Decreased brain volume in medial temporal areas Serotonin abnormalities Changes in the hippocampus Overactivation of immune system Alteration in brain structure & function Metabolic disturbance (Insulin resistance)
  • DSM (Diagnostic & Statistical Manual) of Mental Disorders Published by APA ( American Psychiatry Association) DSM I 1952 DSM II 1968 DSM III 1980 DSM IV 1994 Classified Schizophrenia to 5 Subtypes DSM V 2013 Proposed the deletion of subtypes ICD ( International Classification of diseases) Published by WHO ICD 10 Classified Schizophrenia to 7 Subtypes
  • i Paranoid Vii Simple Schizophrenia ii Catatonic Vi PostSchizophrenic iii Disorganized V Residual IV Undifferentiated
  • A-preoccupation with 1 or more delusions or frequently auditory hallucinations B-Non of the following is prominent: -Disorganized speech -Disorganized or catatonic behavior - Flat affect -At least 2 of the following: i-Motoric immobility evidenced by catalepsy or stupor ii-excessive motor activity (purposeless& without stimulus) iii-Echolalia iv-Excessive negatism A- All of the following are prominent : - Disorganized speech -Disorganized behavior - Flat affect B- the criteria are not met for catatonic type
  • - Psychotic symptoms are present but criteria for paranoid, catat onic or disorganized have not been met - - Depressive episodes arising in the aftermath of schizophrenic illness where some low-level symptoms may still be present -The general criteria for schizophrenia have been met at sometime in the past but are not met in the present time - Insidious & progressive development of negative symptoms with no history of psychotic episodes
  • Family history of Schizophrenia Any potential cause of fetal hypoxic brain damage History of brain complications Advanced age of mother during pregnancy Birth during winter months !! Substance abuse Single marital status Low socioeconomic class Urban environment Environmental stress
  • Hallucination Delusions Illusions Disorganized speech Behavioral disturbances Absence of normal cognition Allogia Avolition Anhedonia Social isolation Impaired - attention - Working memory - Executive functions Seems cheerful or sad without obvious reasons
  • Gradual development of symptoms Precedes 1st psychotic episode Includes: - Isolation -Deterioration of hygiene - loss of interest in work Out of reality Hallucination Delusion Ambivalence Autism Disturbed sleep &appetite Impaired self care skills Flat affect Disconnected thoughts Aggression Occurs between episodes of psychosis Includes: - Anxiety - Avolition - poor insight - social withdrawal - lack of motivation - impaired judgment
  • Diagnostic criteria of schizophrenia DSM-IV ICD-10
  • DSM-IV Diagnostic Criteria A. Characteristic symptoms. At least 2 of the following; each for 1- month period a. Delusions b. Hallucinations c. Disorganized speech d. Grossly disorganized or catatonic behavior e. Negative symptoms, i.e. avolition, flattening of affect, alogia (poverty of speech) B. Social/occupational dysfunction C. Continuous signs of the disturbance persists for at least six months D. Schizoaffective and mood disorder exclusion E. Substance/medical condition exclusion F. Relationship to pervasive developmental disorder : the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month
  • ICD-10 Diagnostic Criteria At least one of the symptoms : OR At least one of the symptoms : a. Thought echo, insertion, or withdrawal and thought broadcasting b. Delusions of control, influence, or passivity; delusional perception c. Hallucinatory voices-running commentary or other < part of body d. Persistent delusions of other kinds a. Persistent hallucinations in any modality occurring everyday for weeks or months b. Breaks or interpolation in the train of thought > incoherence or irrelevant speech, or neologism c. Catatonic behavior, such as excitement, posturing, or waxy flexibility, negativism, mutism, st upor d. Negative symptoms: apathy, paucity of speech, blunting of emotional response
  • Persistent dysfunction lasting longer than 6 months 2 or more symptoms for at least 1 month ( at least 1 of i, ii or iii) i- Hallucination ii- Delusions iii- Disorganized speech iv- Grossly disorganized or catatonic behavior v- Negative symptoms Significantly impaired functioning ( work, self care , interpersonal )
  • Differential Diagnosis Alcohol-related psychosis Bipolar affective disorder Brief psychotic disorder Cocaine-related psychiatric disorders Delusional disorder Depression Mental disorders secondary to general medical conditions Schizoaffective disorder Schizophreniform disorder
  • 25% Complete recovery 35% Much improved 15% Improved but require extensive therapy 10% Hospitalized (unimproved ) 15% Dead ( mostly Suicide )
  • 1. Alleviation of target symptoms 2. Avoidance of side effects 3. Importance of Psychosocial functioning and proactively 4. Compliance with the prescribed regimen 5. Involvement of the patient in the treatment plan 6. Not to be hospitalized
  • 1. Mental status examination 2. Physical & neurological examination 3. Complete family & social history (take in consideration family history of response to drugs) 4. Psychiatric diagnostic interview 5. Laboratory work up ( CBC, electrolytes, hepatic & renal functions, ECG, FBG, lipid profile, thyroid functions and urine drug screening )
  • Typical APs. Atypical APs. first generation Second generation
  • Typical APs. Atypical APs. traditional, conventional, first generation antipsychotics, classical neuroleptics, major tranquilizers Second generation Low potency Chlorobromazine: Neurazine Thioridazine: Mellcril Medium potency Molindone: Thiothixene: Navane Pimozide: Orape forte Moban High potency Trifluperazine: Stellazine Haloperidol: Haldol Fluphenazine: Modecate Zuclopenthixol: Clopexol Aripiprazole: Apilify Clozapine: leponex Olanzapine: Zyprexa Quetiapine: Seroquil Resperidone: Resperidal Sulpiride: Dogmatil Ziprasidone: Zeldox
  • Typical APs. Atypical APs. first generation Second generation : - DA receptor blocker -Have activity on histamine, muscarinic & -receptors ( not responsible for the therapeutic activity ) -DA antagonist and 5-HT2A receptor blocker EXCEPT Aripiprazole Partial DA & 5-HT1Aagonist 5-HT2A- antagonist - Have activity on histamine, muscarinic & -receptors ( not responsible for the therapeutic activity )
  • Typical APs. Atypical APs. first generation Second generation : - DA receptor blocker -Have activity on histamine, muscarinic & -receptors ( not responsible for the therapeutic activity ) -DA antagonist and 5-HT2A receptor blocker EXCEPT Aripiprazole Partial DA & 5-HT1Aagonist 5-HT2A- antagonist - Have activity on histamine, muscarinic & -receptors ( not responsible for the therapeutic activity )
  • Typical APs. Atypical APs. first generation Second generation Sed. EPS A.Ch O.HoTN CPZ +++ ++ ++ +++ Thioridazine +++ + +++ +++ Molindone ++ ++ + + Sed. EPS A.Ch O.HoTN Wt.G clozapine +++ 0 +++ +++ +++ Resperidone + + 0 + ++ Olanzapine ++ + ++ + +++ Quetiapine ++ + 0 ++ ++ Thiothixene + +++ + ++ Trifluper