Schizophrenia

1. Schizophrenia Tutorial (6/7/06) O.Arikawe

2. Definition: Splitting of psychic functions . Incidence : Low incidence but relatively high prevalence Annual incidence using current diagnostic criteria is 0.17 and 0.54 per 1000 population

3. Types Acute and chronic The difference between the two is based on the characteristic features and the progression of the illness. Some recover from the acute illness but once the the chronic syndrome is established very few recover completely

4. Features of acute syndrome Thoughts disorder : a) disorders of stream of thought • pressure of thought • poverty of thought • thought blocking • thought withdrawal

5. b) disorders of the form of thought • Loosening of association • Knights move or talking past the point • Word salad or verbigeration • Using ordinary words in unusual ways (paraphrases or metonyms) • Coining new words (neologisms)

6. Abnormalities of mood : • Blunting of affect – sustained emotional indifference or dimunition of emotional response. • Incongruity of affect – expressed mood is not in keeping with the situation or patient’s feelings • Anxiety,depression,irritability or euphoria.

7. Hallucinations : • Auditory hallucinations – voices given commands, hearing own thoughts spoken out loud as they think them or immediately afterwards , voices discussing them in the third person or voices commenting on their actions. • Visual hallucinations • Tactile ,olfactory,gustatory,and somatic halluciantions

8. Delusions : false unshakable beliefs • Persecutory delusion • Delusion of reference – objects,events or people unconnected with the patient have a personal significance for him. • Delusion of control – actions ,impulses or thoughts are controlled by an outside agency. • Delusion about the possession of thought : Thought insertion Thought broadcast Thought withdrawal

9. Other features : • Lack of insight (most frequent symptoms) • Generalized deficits in cognitive functions including learning, memory,perception,and motor skills.

10. Features of chronic syndrome • Characterized by thought disorders and negative symptoms – • Underactivity • Lack of drive • Social withdrawal • Emotional apathy

11. Diagnosis Schneider’s first rank symptoms Hallucinations : • 3rd person hallucination • Somatic hallucination • Hallucination in form of commentary Thought disorder: • Thought withdrawal or insertion • Hearing thoughts spoken aloud • Thought broadcast Delusion: • Delusional perception • Delusions of control

12. Subtypes of schizophrenia • Hebephrenic - appear silly and childish in their behaviour • Catatonic - characterized by motor symptoms and by changes in activity varying between excitement and stupor. • Simple – characterized by insidious development of odd behaviour,social withdrawal,and declining performance at work. • Paranoid - features dominated by paranoid delusions

13. Treatment Drug - typical and atypical antipsychotics • Typical – haloperidol, chlorpromazine,fluphenazine,thioridazine • Atypical – olanzepine,clozapine,risperidone These produces fewer extrapyramidal movements disorder. • Antidepresants and mood stabilizers are useful in schizo-affective disorder.

14. Electroconvulsive therapy – indicated in catatonic stupor and severe depressive symptoms accompanying schizophrenia • Psychotherapy Dynamic Group Family • Social skills training and illness self management • Cognitive behavioural therapy

15. Prognosis • Overall poor but good outcome if • sudden onset, • short episode, • no previous history, • paranoid type illness, • older age of onset • married, • good social relationships, • good previous personality, • good compliance

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