SCHIZOPHRENIAS BY DR NDUKUBA

HISTORICAL B/GROUND UNITORY PSYCHOSIS by Griesinger to which Morel objected and maintained that the serious mental illnesses can be separated and classified Morel >> Demence precoce as starting in adolescence and leading first to withdrawal>odd mannerism>>self-neglect >>>intellectual deterioration. Khalbaum (1863) described features of catatonia Hercker (1871) desribed hebephrenia Emil kreapelin( ) studied the course of the illness and disagreed with unitary psychosis. He suggested in (1893)division into dementia praecox and manic-depressive psychosis with D Praecox subsuming the hebephrenia and the catatonia as well as the paranoid type. He also differentiated DP from Paraphrenia by its starting much earlier. Eugen Bleuler, concerning himself more with the mechanism of symptom formation proposed the term Schizophrenia to denote a “splitting” of the psychic functions which he thought was the central feature.

Four A’s Disturbances of association(loosening of association) Changes in emotional reactivity( flattening of affect) Withdrawal from reality into the internal world of fantasy(Autism) Fluctuation between two opposing ideas(ambivalence)

Schneider’s first rank symptoms Hearing thoughts spoken aloud Third person auditory hallucination Hallucination in the form of commentary Somatic hallucination Thought withdrawal or insertion Thought broadcasting Delusional perception Feelings or actions experienced as made or influenced by external agents.

ICD 10 criteria Minimum of 1 very clear (or 2 if less clear) of a-d symptoms or at least 2 from e-h clearly present for most of the time during 1 month or more. A. thought echo, insertion, withdrawal, or broadcasting. B. delusion of control, influence or passivity clearly referred to body or limb movements or specific thoughts, actions or sensation; delusional perception. C. hallucinatory voices giving a running commentary on the patients behaviour or discussing the patient among themselves or other types of hallucinatory voices coming from some part of the body. D. persistent delusion of other kinds that are culturally inappropriate and completely impossible.

ICD 10 criteria E. persistent hallucination in any modality, when accompanied either by fleeting or half formed delusions without clear affective content, or by persistent overvalued ideas, or when occurring every day for weeks or months on end F. breaks or interpolations in the train of thought resulting in incohernce or irrelevant speech, or neologisms G. catatonic behaviour such as excitement, posturing, or waxy flexibility, negativity, mutism and stupor H. negative symptoms such as marked apathy, paucity of speech, and blunting or incongruity of affect usually resulting in lowered social functioning. i. a significant and consistent change in the overall quality of some personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude and social withdrawal.

Subtypes Paranoid schizophrenia- persecutory delusions and often by persecutory auditory hallucination. Thought disorder and affective, catatonic and negative symptoms are not prominent. Later onset and better prognosis Hebephrenic(disorganized): thought disorder and affective symptoms are prominent. Delusions are fleeting and mannerisms are common, negative symptoms occur early Catatonic: marked motor symptoms Simple: insidious dev of odd behaviour, social withdrawal and decline in work. Delusion and hallucination not prominent Undifferentiated: Residual:

Aetiology Genetic – family, twin, adoption studies. Approximate lifetime risk of developing schiz in relatives of proband: Parents 4.4% All siblings 8.5% Siblings (one parent schiz) 13.8% Children 12.3% Children (both parents)36.6% Half sibling 3.2% Nephew and nieces 2.2%

Aetiology Environmental Obstetric complications Maternal influenza Winter birth Social and psychosocial factors: low social class, migration, social isolation, life events,

Factors predicting the outcome Good prognosispoor prognosis Sudden onsetinsidious Short episodelong episode No previous hx previous hx Prominent affective sxnegative sx Paranoid typehebephrenia Femalemale Older age at onsetyounger age Married single/separated/wid Good ps adjustment poor ps adjustment Good premorbid personabnormal PM personality Good social relationshipsocial isolation Absent Neuroimaging findingsenlarged lateral ventricles

Treatment Biopsychosocial treatment Antipsychotics ECT(catatonic subtype and in resistant schiz) Psychosocial: family therapy, CBT, cognitive remediation, social skill training, supported employment etc.