SCHIZOPHRENIA

Definition

- A chronic psychiatric disorder that shows marked disturbance in thought,

   mood & behavior that leads to impairment of function and deterioration of

   personality.

- The disturbance lasts for at least 6 months including at least one month of

   active phase symptoms that is 2 or more of the following (delusions,hallucinations disorganized speech & negative symptoms). 

Epidemiology

-Equal prevalence in booth men and women.

-Peak age 15- 25 years for males & 25-33 years for females.

Etiology

• BIOLOGICAL FACTORS

1- Genetic factors :

- Higher incidence in children with biological parents with schizophrenia.

- Abnormalities in chromosomes 5111 118119 and X chromosome.

2- Anatomical changes :

Abnormal function of the limbic system I frontal cortex & basal ganglia.

3- Neurotransmitters :

- Excessive dopaminergic activities.

- Other neurotransmitte·rs as serotonin I norepinephrin and GABA.

• PSYCHOSOCIAL FACTORS

1. Role of family : abnormal relations between family.
2. Learning theories: thinking by imitating parents in certain problems.
3. Social theories: immigration & urbanization.

 Diagnosis and clinical picture

' .Symptoms of schizophrenia divided into :

Positive symptoms                              Negative symptoms

'

- Delusions                                                 - Flat affect

- Hallucinations                                        - Social withdrawal

- Disorganized behavior                           - Avoliation

- Respond to typical antipsychotics.        - Respond to atypical antipsychotics

Patient may present with one or more of following features:

1. Hearing voices, giving a running commetary on the patients behaviour or discussing the patient among themselves. OR
2. persistent dellusion that are completely impossible like superman       powers or political identity. OR
3. Dellusion of being controlled or influenced by some forces. they believe that peoples are planning to harm them. OR
4. Thought echo, thought insertion, thought withdrawal, and thought broadcasting.OR
5. Irrelevant speech which is not understandable. OR
6. Social withdrawal, poor speech and inappropriate emotional response. these symptoms should be present for a period of one month or more.

Types of schizophrenia

1- Disorganized schizophrenia : -·

• All symptoms of schizophrenia are present.

• Bizarre delusions.

• Gross disorganization of speech and behavior.

• Marked social and occupational withdrawal.

2- Paranoid schizophrenia

• One or more delusions.

• No gross organization of speech and behavior.

• Mild social and occupational deterioration.

3- Catatonic schizophrenia:

• Catatonic features dominate the clinical picture e.g. waxy flexibility.

• Other symptoms of schizophrenia are present.

• Profound social and occupational deterioration.

4- Undifferentiated schizophrenia :

• Intermittent form between paranoid and disorganized types.

• Delusions are less than seen in the paranoid type & disorganization is less

  than seen is disorganized type.

• Social dysfunction and occupational deterioration are intermittent

  between paranoid and disorganized types.

5- Residual schizophrenia:

- Absence of prominent delusions & hallucinations.

- Usually the result of partial improvement on treatment.

6- Schizoaffective disorder:

- Prominent mood disorder in the form of depression or elation.

  in the presence of schizophrenic symptoms.

- It is of two types : - Depressive type -Bipolar type.

7- Simple schizophrenia:

  • No positive symptoms.

• Gradual social withdrawal and social deterioration.

• Early onset and slowly progressive course.

Course and prognosis

•  Chronic course with remissions and exacerbations.
•   High level of residual symptoms is a predisposing factor for the next
•    exacerbation.
•  The introduction of atypical antipsychotics changed dramatically the
•    prognosis of schizophrenia.
•  30% of patients are able to lead a normal life.
•  30% of patients continue to experience moderate symptom~ with variable
• degrees of social adaptation.
•  40% of patients are significantly impaired.

 Treatment

1- Hospitalization :

• For observation and to ensure safety of the patient and his relatives.

• To ensure compliance to treatment.

2-Pharmacotherapy:

• Typical antipsychotics :

   For positive symptoms.

-  high side effects.

- e.g.chlorpromazine

• Atypical antipsychotics

- For positive and negative symptoms ·

- In resistant cases.

- Less side effects.

e.g. Clozapine & Respiredone

3- Psychotherapy :

all modules of psychotherapy , e.g. behavioral , supportive & group therapy.

4- Electro-convulsive-therapy (ECT) i

indicated in :

-Inadequate response to pharmacotherapy.

- Acute cases.

- Prominent delusions and hallucinations.

-Mood symptoms.

-Suicidal patients.

-Catatonic patients.