Schizophrenia Overview

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Schizophrenia Overview
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Schizophrenia is the most severe and debilitating
mental illness in psychiatry and is a brain
disorder
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History

• Bleuiler
• Autism
• Ambivalence
• Affect
• Association
  

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Diagnosis of Schizophrenia

• A. Characteristic symptoms
• -Delusions
• -Hallucinations
• -Disorganized speech
• -Grossly disorganized or catatonic
  behavior
• -Negative symptoms
• B. Social/occupational dysfunction
• C. Overall duration gt 6 months
• D. Exclude mood disorders, drugs, pervasive
  developmental disorders

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Positive Symptoms

• Additions to normal function
• Delusions
• Hallucinations
• Distorted language/communication
• Disorganised speech / behaviour
• Catatonic behaviour
• Agitation

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Negative Symptoms

• Losses of normal function
• -Affective flattening
• -Alogia
• -Avolition
• -Anhedonia
• -Attentional impairment
• Blunted affect, emotional withdrawal, poor
  rapport, passivity, apathetic, social withdrawal

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Cognitive Symptoms

• Thought disorder
• Odd use of language
• incoherence, loose associations, neologisms
• Impaired attention / cognition
• reduced verbal fluency
• learning/memory
• executive functions

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Subtypes of schizophrenia

• Paranoid
• Disorganized
• Catatonic
• Undifferentiated
• Residual

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Childhood onset schizophrenia

• Onset before 12 years
• Increased developmental abnormalities
• Lower IQ
• 1 in 10000
• Increased heritability
• Decreased gray matter

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Epidemiology

• 1 prevalence worldwide
• Most begin in late adolescence to 20s
• MF
• Females age of onset is generally later better
  outcome
• Downward drift social-economically
• Die younger 10 suicide

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Etiology of schizophrenia

• Genetic
• Structural brain changes
• Functional brain changes
• Dopamine hypothesis

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Risk Factors

• Genetic
• Canabis
• Infection Birth Season

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prognosis

• Age of onset
• Function level before onset
• IQ
• Drug response
• Family support
• sex

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Structural changes in brain

• Larger ventricles
• Subgroup inverse correlation between ventricle
  size and response to drugs

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Structural changes in brain

• Increased loss of gray matter in adolescence

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Dopamine hypothesis

• Amphetamine (very high doses) ? paranoia,
  delusions, auditory hallucination
• Amphetamines worsen schizophrenia symptoms
• Effects blocked by dopamine antagonist
  chlorpromazine (Thorazine)
• Typical antipsychotics block D2 receptors and
  alleviate positive symptoms.

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A 20th-century artist, Louis Wain, who was
fascinated by cats, painted these pictures over a
period of time in which he developed
schizophrenia. The pictures mark progressive
stages in the illness and exemplify what it does
to the victim's perception.
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Treatment of Schizophrenia
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Medications for schizophrenia

• Conventional antipsychotics
• - Haldol, Thorazine, Mellaril, etc.
• Second generation antipsychotics
• -Risperidone, Zyprexa, Seroquel,
  Geodon, Abilify, Clozaril
• Medications are better for positive symptoms than
  negative symptoms

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First generation antipsychotic side-effects

• Extrapyramidal side-effects Parkinson symptoms,
  dystonia, restlessness
• Sedation
• Weight gain
• Dry mouth, constipation
• Cardiac toxicity
• Postural hypotension

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Second generation antipsychotic side-effects

• Weight gain
• Increase blood sugar diabetes
• Increased lipids
• Sedation

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Non-pharmacologic treatments for schizophrenia

• Psychotherapy supportive
• Social skills training
• Family Therapy expressed emotion
• Psychosocial rehabilitation

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Future Directions in the Treatment of
Schizophrenia

• More optimistic view of outcome
• Much stronger focus on early intervention and
  prevention e.g. early psychosis clinics and
  prodromal studies
• Increased understanding of neurobiological basis
  beyond dopamine hypothesis with non-dopamine
  treatments
• Renewed emphasis on rehabilitation, supported
  employment etc.

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