Schizophrenia2 symptomatology Prof.Dr Elham Aljammas 13l11l2013

Features of Schizophrenia Positive symptoms Delusions Hallucinations Cognitive deficits Attention Memory Verbal fluency Executive function (eg, abstraction) Functional Impairments Work/school Interpersonal relationships Self-care Negative symptoms Anhedonia Affective flattening Avolition Social withdrawal Alogia Mood symptoms Depression/Anxiety Aggression/Hostility Suicidality Disorganization Speech Behavior

Behaviour : Behaviour : ِ Acute stage: Varied : (mute,withdrawn,entirely wrapped up in their abnormal experience,Violent.Bizzare) ِ Acute stage: Varied : (mute,withdrawn,entirely wrapped up in their abnormal experience,Violent.Bizzare) some adopt strange posture (catatonia)or (catatonic excitement) Seem to respond to their Hall.i.e looking around. Neglecting their personal hygiene

Affect: Affect: Highly aroused Highly aroused Bewildered mused Bewildered mused Incongruent affect Incongruent affect Flattening or blunting of affect Flattening or blunting of affect

Speech: Speech: Seem to echo their thought pattern,i.e difficult to be understood. Knight's move thinking Neologisms Neologisms Clang association Clang association Word salad Word salad

Thought: Thought: Delusions-Persecutory hearing), Delusion of reference Delusion of reference Primary delusion Delusion of perception Primary delusion Delusion of perception Thoughts-thought broadcasting Thoughts-thought broadcasting Thought insertion Thought withdrawal Thought echo Passivity feeling – somatic,action,mood. Passivity feeling – somatic,action,mood. Hallucinations:in all sensory modalities. Hallucinations:in all sensory modalities. Most common auditory hall. (several voices) Most common auditory hall. (several voices) Visual,less common& suggest organic cause Insight: Insight: Frequently sch. Patient do not agree that they are unwell Frequently sch. Patient do not agree that they are unwell

Chronic schizophrenia:(negative symptoms,type 11) Chronic schizophrenia:(negative symptoms,type 11) Is chronic relapsing illness with episode of acute disturbance Is chronic relapsing illness with episode of acute disturbance Apathy or loss of volition Apathy or loss of volition Flattening of affect Flattening of affect Poverty of speech Poverty of speech Poor prognosis Poor prognosis Increased vent. Brain ratio. Increased vent. Brain ratio. Soft neurological signs,& cognitive impairment(disorientation) Soft neurological signs,& cognitive impairment(disorientation)

Subtypes of schizophrenia: Subtypes of schizophrenia: 1. Paranoid 1. Paranoid 2.Disorganized 2.Disorganized 3. catatonic 3. catatonic 4.Simple 4.Simple

paranoid: paranoid: commonest,delusion or hallucinations commonest,delusion or hallucinations No major disturbances of speech or of behaviour No major disturbances of speech or of behaviour Disorganized: Disorganized: Disorganized speech & behaviour Disorganized speech & behaviour Inappropriate affect is common Inappropriate affect is common

Catatonic: Catatonic: Disturbances of motor activities(stupor,waxy flexibility,period of immobility may alternate with extreme overactivity,echolalia,echopraxia,&negativism) Disturbances of motor activities(stupor,waxy flexibility,period of immobility may alternate with extreme overactivity,echolalia,echopraxia,&negativism)

Simple: Simple: Keep a distance from social relationship,few interest & pleasure in life,emotionally cold & flat. Keep a distance from social relationship,few interest & pleasure in life,emotionally cold & flat.

Aetiology of schizophrenia: Aetiology of schizophrenia: 1.abnormality of dopamine metabolisim 1.abnormality of dopamine metabolisim 2.environmental theories 2.environmental theories 3.genetic 3.genetic 4.social theory 4.social theory

Abnormality of dopamine turnover Abnormality of dopamine turnover increase level of D.A.,increased DA receptors. increase level of D.A.,increased DA receptors. Environmental theory Environmental theory Season of birth ( early months of the year ) influenza virus Season of birth ( early months of the year ) influenza virus Birth trauma Birth trauma

Genetics Genetics 60% of schizophrenic have no family historyof the illness 60% of schizophrenic have no family historyof the illness if one parent hase schiz. There is15%chance of their children to develop the illness,46%if both. if one parent hase schiz. There is15%chance of their children to develop the illness,46%if both. Fertility of sch.is low. Fertility of sch.is low. Adoption studies higher than control Adoption studies higher than control

Social theory Social theory Family(skew,schism) Family(skew,schism) Social class-lower social classes. Social class-lower social classes.

Epidemiology mean age is 25 years Epidemiology mean age is 25 years Incidence 15-20per per year Incidence 15-20per per year Prevalence % Prevalence %