1. Schizophrenia and other psychotic disorders Symptoms, models, course, epidemiology Lucie Bankovská Motlová

2. Psychotic Disorder –Psychotic: loss of contact with reality, inability to distinguish reality from fantasy, impaired reality testing, with the creation of a new reality –Characteristics: »disorganized and delusional thinking »disturbed perceptions »inappropriate emotions and actions

3. schizoaffective disorder schizophrenia brief psychotic disorder schizophreniform disorder substance-induced psychotic disorder PSYCHOSES

4. Psychotic Disorders: Classification Diagnostic and Statistical Manual of Mental Disorders DSM-IV Schizophrenia Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder Psychotic disorder due to a general medical condition Substance-induced psychotic disorder International Classification of Diseases and Related Health Problems ICD-10 Schizophrenia Schizotypal disorder Persistent delusional disorders Acute and transient psychotic disorders Induced delusional disorder Schizoaffective disorders

5. Schizophrenia

6. John Nash

7. Symptoms Positive Negative Cognitive

8. Positive Symptoms Symptom Hallucinations Disorganized Speech Bizarre/catatonic behavior Delusions Function Distorted Perception Thought/Language Behavioral monitoring Inferential thinking Auditory, Visual, Tactile,Olfactory Persecutory, Paranoid, Grandiose, Religious, Jealous, Somatic

9. April 1991 Bryan Charnley 1949-1991 Stefan M., Travis M. and Murray R., An Atlas of Schizophrenia, 2002

10. May 1991 Stefan M., Travis M. and Murray R., An Atlas of Schizophrenia, 2002

11. June 1991 Stefan M., Travis M. and Murray R., An Atlas of Schizophrenia, 2002

12. DOPAMIN

13. Endogenous dopaminergic sensitization: PET Amphetamines intake = ↑↑↑ endogenous dopamin in schizophrenia patients in the acute phase, in comparison with healthy persons Relapse of schizophrenia = recurrence of hyperdopaminergic state in subcortical structures IMPLICATIONS FOR TREATMENT Chronic blockade of D2 receptors: blocking of sensitization processes Laurelle 1999 Neurochemical sensitization in mesolimbic dopaminergic system (studies in schizophrenia)

14. Negative Symptoms Symptom Alogia Affective blunting Avolition Anhedonia Function Diminished Fluency of speech/thought Emotional expression Volition and drive Hedonic capacity Impair ability to function in daily life Holding a job Attending school Forming friendships Having intimate family relationships

15. Cognitive Symptoms Symptom forgetfullness distractibility reasoning/problem solving Function Diminished working memory Attention span "set-shifting", i.e. the ability to display flexibility in the face of changing schedules of reinforcement Learning difficulties Inability to read Problems with planning

16. Historical Concepts Emil Kraepelin Eugen Bleuler Kurt Schneider Video: 1942

17. Emil Kraepelin (1856-1926) Dementia Praecox “Dementia praecox consists of a series of states, the common characteristic of which is a peculiar destruction of internal connections of the psychic personality....the majority of the clinical pictures are the expression of a single morbid process, though outwardly they often diverge very far from one another.”

18. Eugen Bleuler (1857-1939): Group of Schizophrenias “Of the thousands of associative threads that guide our thinking, this disease seems to interrupt, quite haphazardly, sometimes single threads, sometimes a whole group, and sometimes whole segments of them.”

19. Bleuler’s Fundamental Symptoms: 4 „A“ Associations Affective Blunting Autism Ambivalence

20. Kurt Schneider (1887-1967) First-Rank Symptoms

21. First-Rank Symptoms of Kurt Schneider Audible thoughts Voices arguing or discussing Voices commenting on patient´s actions Somatic passivity Thought withdrawal Thought broadcasting Made feelings Made impulses or drives Made volitional acts Delusional perception

22. Syndromes, models, classification systems John Hughlins Jackson Timothy Crow ICD -10, DSM IV

23. John Hughlins Jackson (1835-1911) Positive and negative symptoms Positive Delusions, hallucinations Pathological disinhibition of cortical functions Absent in normal „psyche“ Negative Flat affect, apathy, lack of motivation Generalized loss of functions Normal „psyche“ lost them

24. Timothy Crow Schizophrenia type I and II I Positive symptoms Normal size of brain ventricules Better prognosis Better treatment response II Negative symptoms Brain ventricules enlargement Worse prognosis Worse treatment response

25. Classification ICD-10 Europe; DSM-IV-USA General criteria 1st rank symptoms according to Schneider Long-term course types Clinical subtypes

26. Traditional clinical Subtypes Paranoid Disorganized (Hebephrenic) Catatonic Simplex Undifferentiated Residual Out of the Shadow

27. What symptoms of schizophrenia have you identified?

28. Course and prognosis of schizophrenia

31. Long-term course: Attack, Relapse, Remission 203040506070 roky M E D I K A C E

32. The natural history of schizophrenia: a 5-year follow-up.

33. Early Warning Signs Early Warning Signs

34. Early Warning Symptoms of Relapse Patient 1.Troubles with sleep. 2.Decreased appetite. 3.Difficulty concentrating on reading or watching television. 4.Fear, anxiety or annoying feelings from other people. 5.Restlessness, irritability or quick temperedness. 6.Feeling that something unusual and incomprehensible is about to happen around me. 7.Loss of energy or interests. 8.Decreased capacity to cope with everyday problems. 9.Experience of hearing people's voices speaking when nobody seems to be around. 10.Have you noticed any of your individual warning signs since last evaluation? Family member 1. Troubles with sleep. 2. Marked behavioral changes. 3. Social withdrawal. 4. Decline in daily activities. 5. Decline in personal hygiene. 6. Loss of initiative, motivation. 7. Preoccupation with peculiar ideas and thoughts. 8. Marked poverty of speech or content of speech. 9. Irritability, quick temperedness or aggression. 10. Have you noticed any of warning signs individual for your relative since last evaluation?

35. 10 20 30 40 50 60 70 (%) 1 year2 years5 years15 years 80 30-50%40-60%80% (Shepherd et al, 1989, Hogarty et al 1993, Möller et al., 1995, Wieden a Olfson 1995, Mason et al, WHO studie, 1996, Doering et al.,1998, Wiersma et al. 1998, Robinson et al. 1999, Ohmori et al. 1999, Rabinowitz et al. 2001, Gaebel 2002, Schooler et al., 2003) Relapse rates

36. Epidemiology

37. Onset and Prevalence of Schizophrenia worldwide About 0.2% to 1.5% (or about 1% population) Often develops in early adulthood Can emerge at any time Schizophrenia Is Generally Chronic Most suffer with moderate-to-severe lifetime impairment Life expectancy is less than average Schizophrenia Affects Males and Females About Equally Females tend to have a better long-term prognosis Onset differs between males and females Schizophrenia has a Strong Genetic Component