1. BS 11 Schizophrenia And Other psychotic disorders Schizophrenia And Other psychotic disorders

2. Schizophrenia  Basically means that the person has lost touch with reality in some way, shape or form.  It is a chronic > 6 months, debilitating mental disorder  Peak age of onset 15 – 25 yrs for men, 25 – 35 yrs in women  Equally in men & women, in all cultures & ethnic groups  Has intact memory, and is oriented to person, place & time  Basically means that the person has lost touch with reality in some way, shape or form.  It is a chronic > 6 months, debilitating mental disorder  Peak age of onset 15 – 25 yrs for men, 25 – 35 yrs in women  Equally in men & women, in all cultures & ethnic groups  Has intact memory, and is oriented to person, place & time

3. Symptoms  1. Positve sym: are additional to expected behavior – includes hallucinations, delusions, agitation & talkativeness respond well with traditional antipsychotic agents  Negative sym: are missing from expected behavior – lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming & poor speech content respond well with Atypical antipsychotics  1. Positve sym: are additional to expected behavior – includes hallucinations, delusions, agitation & talkativeness respond well with traditional antipsychotic agents  Negative sym: are missing from expected behavior – lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming & poor speech content respond well with Atypical antipsychotics

4.  Course  It has 3 phases 1. Prodromal: symptoms occuring prior to 1 st psychotic episode – avoidance of social activities, physical complaints, new interest in religion, the occult / philosophy 2. Psychotic: pt loses touch with reality – disorders of perception, thought content, thought processes & form of thought 3. Residual: (period between psychotic episodes) – back to reality, but social withdrawal & peculiar thinking  Course  It has 3 phases 1. Prodromal: symptoms occuring prior to 1 st psychotic episode – avoidance of social activities, physical complaints, new interest in religion, the occult / philosophy 2. Psychotic: pt loses touch with reality – disorders of perception, thought content, thought processes & form of thought 3. Residual: (period between psychotic episodes) – back to reality, but social withdrawal & peculiar thinking

5. PerceptionIllusion hallucination Misperception of real stimuli False sensory perception Mistaking a shadow for someone. Hearing voices Thought contentDelusionFalse beliefFeeling of being followed by FBI Thought processes Impaired abstraction Neologism Lack of object relationship Inventing words Says eating Medocrat

6.   Form of thoughtLoose association Tangentiality Shift of ideas from one topic to another Getting farther away from one point Health to basket ball From his health to brothers health

7. Prognosis  Usually repeated psychotic episodes – chronic downhill course over years – stabilizes in midlife  Suicidal tendency common – 50% attempt - 10% succeed  Prognosis is better if pt is older, married, has social relationship, female with positive symptoms  Usually repeated psychotic episodes – chronic downhill course over years – stabilizes in midlife  Suicidal tendency common – 50% attempt - 10% succeed  Prognosis is better if pt is older, married, has social relationship, female with positive symptoms

8. Etiology  Not known  1. Genetic factors –  2. Other factors: Season of birth: cold season – Jan - April - probable viral infections to mothers during 2 nd trimester  Not known  1. Genetic factors –  2. Other factors: Season of birth: cold season – Jan - April - probable viral infections to mothers during 2 nd trimester general population ………….. – 1% having 1 schizophrenic parent / sibling – 12% Having 2 schizophrenic parent …… - 40% Having monozygotic schizophrenic twin – 50%

9. Neural pathology  1. Anatomy  abnormalities in frontal lobe functions - reduced glucose meta as seen in PET  Lateral & 3 rd Vent enlargement / abnormal cerebral symmetry / changes in density of brain  1. Anatomy  abnormalities in frontal lobe functions - reduced glucose meta as seen in PET  Lateral & 3 rd Vent enlargement / abnormal cerebral symmetry / changes in density of brain

10.  Neurotransmitters & other abnormalitis:  Excessive dopaminergic activities – excessive no of dopamine receptors, excessive concentration of dopamine – amphetamine & cocaine cause psychotic symps – elevated levels of homovanillic acid (HVA) – a metabolite of dopamine in pts serum  Serotonin hyperactivity  Eye movement: poor smooth visual pursuit – in schizophrenic pts and in their relatives  Neurotransmitters & other abnormalitis:  Excessive dopaminergic activities – excessive no of dopamine receptors, excessive concentration of dopamine – amphetamine & cocaine cause psychotic symps – elevated levels of homovanillic acid (HVA) – a metabolite of dopamine in pts serum  Serotonin hyperactivity  Eye movement: poor smooth visual pursuit – in schizophrenic pts and in their relatives

11. As per Diagnostic & Statistical Manual of Mental disorders IV Edn (DSM-IV) – 5 types 1.DisorganizedPoor grooming, inappropriate emotional response, disinhibition – onset before 25 yrs of age 2.CatatonicStupor / agitation / lack of coherant speech, bizarre posturing (waxy Flexibility) 3.ParanoidDelusions of persecution – older age of onset

12. 4.UndifferentiatedCharacteristics of more than one type 5.ResidualOne previous episode & subsequent residual symptoms with no psychotic symptoms

13. Differential diagnosis  Medical illnesses  Medications  Psychiatric illnesses  Medical illnesses  Medications  Psychiatric illnesses

14. Treatment  antipsychotic medication, antipsychotic medication  Cognitive-Behavioural Therapy Cognitive-Behavioural Therapy  Family and Group Therapy FamilyGroupTherapy  Psychodynamic therapies Psychodynamic therapies  antipsychotic medication, antipsychotic medication  Cognitive-Behavioural Therapy Cognitive-Behavioural Therapy  Family and Group Therapy FamilyGroupTherapy  Psychodynamic therapies Psychodynamic therapies

15. Typical AntipsychoticsAtypical Antipsychotics ChlorpromazineChlorpromazine (Largactil) DroperidolDroperidol (Droleptan, Thalamonal) FlupenthixolFlupenthixol (Depixol, Fluanxol) FluphenazineFluphenazine (Modecate, Moditen, Motipress, Motival) HaloperidolHaloperidol (Haldol, Serenace) ThioridazineThioridazine (Melleril) TrifluoperazineTrifluoperazine (Stelazine, Parstelin) ZuclopenthixolZuclopenthixol (Clopixol) ClozapineClozapine (Clozaril) Olanzapine Risperidone

16. Other psychotic disorders  Brief psychotic disorder  Schizophreniform disorder  Schizoactive disorder  Shared delusional disorder  Brief psychotic disorder  Schizophreniform disorder  Schizoactive disorder  Shared delusional disorder

17. DisorderCharacteristicsprognosis SchizophreniaPsychotic & residual symptoms lasting for > 6 months Lifelong, social & occupational impairment Brief psychotic disorder Psychotic symptoms lasting for > 1 day, but < 1 month – often precipitating social factors 50% - 80% recover completely

18. Schizophrenifom disorder Schizoaffective disorder Psychotic & residual symptoms lasting 1 – 6 months Symptoms of mood disorder + psychotic symptom 33% recover completely Lifelong social & occupationa l impairment

19. Delusional disorder fixed, persistant, nonbizare delusional system – paranoid in persecutory / romantic in erotomanic type 50% recover completely Shared delusional disorder Delusion in a close relative shared by this person 10 – 40% recover completely