1. C/F prodrome social contact, drive Acute phase Chronic phase

2. acute phase  appearance and behavior withdrawal,perplexity,violance,  posturing  Affect  suspiciosness,bewilderment,  incongruent  Speech  ununderstandable,irrelivant,incoherent

3. Acute phase  Thought  Form, lack of association  knight moves  neologisms  derailment  content, delusions primary secondary

4. Acute phase  Perception  auditory hallucination,commentory,3 rd  thought echo  Self experience  Thought interference  Broadcasting  Withdrwal  Insertion  Passivity, made action, impulse, feeling, somatic sensation

5. Chronic phase  Mainly negative symptoms  Lack of volition  Poverty of affect  Poverty of speech  Ventricular enlargement  Poor response to narcoleptics  Poor prognosis

6. Epidemiology  25-40  men=women  1%

7. Diagnosis  Schnieder`s first rank  ICD 1O DSM IV Subtypes  paranoid  disorgenized  catatonic

8. DDx  Depression  Mania  Delusional disorder  Drugs  Medical conditions

9. Prognosis  20% recover  35% relapsing no symptoms between  20% relapsing symptoms between  20% down since start  10% suicide

10. Factors of prognosis  Onset  Event  Family history  Premorbid personality  Affective symptoms  EE  IQ  Ventricle size  Positive or negative  culture

11. Etiology  genetic factors 60 % no family history one parent two parents mono twines di twins

12. Etiology  environmental factors Season of birth, Influenza, Birth trauma Biological dopamine hypothesis brain changes

13. Etiology  social factors shizophrenic mother schism skew double bind social class

14. Management  Admission  Violent patient  Drugs

15. Phenothiazines  Aliphatic chlorpromazine ( largactile)  Piperdines thioridazine ( melleril)  Piprazines trifluorperazine(stelazine) , fluphenazine  N/B fluphenazine decanoate (modecate)  Actions  Antidopaminergic anticholenergic antiserotoninergic, antiadrenergic

16. Management SE  early hrs  intermediate days  late months Butyrophenones, haloparidol Atypicals resperdone clozapine, olanzapines ECT

17. Management of chronic phase  Relapse prevention, atypicals  Rehabilitation  Services

18. Relapse prevention  Drugs  EE  Events  Social asylum vs. community