schizophrenian.ppt

8/14/2019 Schizophrenian.ppt

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Schizophrenia

Cancer of Psychiatry


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Introduction

Schizophrenia- is a Greek word

~ schizein-"to split

~phren-"mind

~ is a psychiatric diagnosis

~ disorder is thought to mainly affect cognition

~characterized by abnormalities in the perception or expression ofreality.

~also can have additional (comorbid) conditions, including majordepression and anxiety disorders, lifetime occurrence of subs abuseis 40%

~~ It most commonly manifests as auditory hallucinations, paranoid or

bizarre delusions, or disorganized speech and thinking withsignificant social or occupational dysfunction

~these symptoms occur in clear consciousness


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Epidemiology

Schizophrenia is the fourth leading causeof diasbility inthe world

Males = females

typical earlier in menpeaking at age 2028 years , 26

32 years for females Onset in childhood,middle- or old age is rare

Lifetime prevelence of schizophreniathe proportion ofindividuals expected to experience the disease at anytime in their livesis commonly given at 1% (0.5%-

1.5%) which is 10 to 12 years less than those without thedz, due to increased physical health problems and ahigher suicide rate

2002~lifetime prevalence of 0.55%.


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Course: Onset- may be abrupt or

insidious, but usually gradual prepsychotic phaseof

increasing negative symptoms(e.g., social withdrawal,deterioration in hygiene andgrooming, unusual behavior,

outbursts of anger, and loss ofinterest in school or work).

these symptoms topredominate in men

symptoms are less responsiveto antipsychotic meds.

A few months or years later, apsychotic phasedevelops(with delusions, hallucinations,or grossly bizarre/disorganizedspeech and behavior)-positive

symptoms these symptoms tend to

predominate in women.

These symptoms respond theantipsychotic meds

This psychotic phase must lastfor at least one month (or lessif successfully treated).


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If onset of Schizophrenia later in their 20'sor 30'soften femaleless evidence of

structural brain abnormalities or cognitiveimpairmentbetter outcome.

Disease can persists (continuously orepisodically) for a life-time.

Some pts can have a relatively stablecourse, while some show a progressiveworsening associated with severe

disability. Complete remission -return to full

premorbid functioning, is uncommon.


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Positive and negative symptoms

Positive symptomsinclude delusions, auditoryhallucinations, and thought disorder, and are typicallyregarded as manifestations of psychosis.

Negative symptomsare so-named because they areconsidered to be the loss or absence of normal traits or

abilities, and include features such as flat or bluntedaffectand emotion, poverty of speech(alogia), inabilityto experience pleasure (anhedonia), and lack ofmotivation (avolition). Despite the appearance of bluntedaffect, recent studies indicate that there is often a normal

or even heightened level of emotionality inschizophrenia, especially in response to stressful ornegative events.
http://en.wikipedia.org/wiki/Hallucinationhttp://en.wikipedia.org/wiki/Hallucinationhttp://en.wikipedia.org/wiki/Thought_disorderhttp://en.wikipedia.org/wiki/Psychosishttp://en.wikipedia.org/wiki/Blunted_affecthttp://en.wikipedia.org/wiki/Blunted_affecthttp://en.wikipedia.org/wiki/Speech_communicationhttp://en.wikipedia.org/wiki/Alogiahttp://en.wikipedia.org/wiki/Anhedoniahttp://en.wikipedia.org/wiki/Avolitionhttp://en.wikipedia.org/wiki/Avolitionhttp://en.wikipedia.org/wiki/Anhedoniahttp://en.wikipedia.org/wiki/Alogiahttp://en.wikipedia.org/wiki/Speech_communicationhttp://en.wikipedia.org/wiki/Blunted_affecthttp://en.wikipedia.org/wiki/Blunted_affecthttp://en.wikipedia.org/wiki/Psychosishttp://en.wikipedia.org/wiki/Thought_disorderhttp://en.wikipedia.org/wiki/Hallucinationhttp://en.wikipedia.org/wiki/Hallucination


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Problems encountered!

Prepsychotic (Prodromal) OrPostpsychotic (Residual) Phase

Social and/or OccupationalImpairment

Apathy

Lack of Physical Exercise

Poor Sexual Interest or Ability Increased Smoking

Sad or DepressedMood

Poor Concentration or Attention

Poor Memory

Impaired Executive Functioning

(planning, problem-solving) Lack of Insight

Solitary Lifestyle

Indifference To Others

Lack of Self-Confidence

Shyness

Psychotic (Active) Phase

Social and/or Occupational Impairment

Delusions or Hallucination

Disorganized or Bizarre Behaviour

Apathy

Impaired Communication With Words

Impaired Communication WithEmotions

Lack of Physical Exercise

Poor Sexual Interest or Ability

Distrust or Suspiciousness

Increased Smoking

Sador Depressed Mood

Poor Concentration or Attention Generalized Worry

Poor Memory
http://www.mentalhealth.com/mag1/scz/sb-prod.htmlhttp://www.mentalhealth.com/icd/p22-ps01.htmlhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11217534&dopt=Abstracthttp://www.mentalhealth.com/dis1/p21-ps01.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10098919&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11458306&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17185240&query_hl=2&itool=pubmed_docsumhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10739413http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10739413http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10739413http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17185240&query_hl=2&itool=pubmed_docsumhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17185240&query_hl=2&itool=pubmed_docsumhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11458306&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10098919&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10098919&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/7663824?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.mentalhealth.com/dis1/p21-ps01.htmlhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11217534&dopt=Abstracthttp://www.mentalhealth.com/icd/p22-ps01.htmlhttp://www.mentalhealth.com/mag1/scz/sb-prod.html


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Problems When severe!

Prepsychotic orPostpsychotic PhaseWhen Severe Distrust orSuspiciousness Mistrustof Friends Difficulty

Handling Conflict PoorMoney Management Riskof Harming Self ImpairedCommunication WithWords Impaired

Communication WithEmotions Poor Groomingand Hygiene Need forInstitutional Care

Psychotic Phase WhenSevere Poor MoneyManagement PhysicalViolenceObsessiveThinking or Compulsive

Rituals Risk of HarmingSelf Poor Grooming andHygiene Need forInstitutional Care
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12042226&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12042226&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12042226&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12042226&dopt=Abstract


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Comorbidity

Alcoholism and drug abuse worsen the

course

Are aften associated with it

80% to 90% patients with Schizophrenia

are regular cigarette smokers.

Anxiety and phobias increased risk of Obsessive-Compulsive

Disorder and Panic Disorder.


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Subtypes of Schizophrenia

The DSM-IV-TR contains five sub-classifications of

schizophrenia.

Paranoid schizophrenia- These persons arevery suspiciousof others and often have grandschemes of persecution at the root of theirbehavior. Halluciations, and more frequently

delusions, are a prominentand common part ofthe illness.

Disorganized schizophrenia- Person isverbally incoherentand may have moods andemotions that are not appropriate to the

situation. Hallucinations are notusually present. Catatonic schizophrenia- In this case, the

person is extremely withdrawn, negative andisolated,and has marked psychomotor

disturbances.


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Residual schizophrenia- In this case theperson is not currentlysuffering from

delusions, hallucinations, or disorganizedspeech and behavior, but lacks motivationand interest in day-to-day living.

Undifferentiated Schizophrenia -

Conditions meeting the general diagnosticcriteriafor schizophrenia butnotconforming to any of the above subtypes,or exhibiting the features of more than oneof them without a clear predominance of aparticular set of diagnostic characteristics.


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The ICD-10defines two additionalsubtypes.

Post-schizophrenic depression: Adepressive episode arising in theaftermath of a schizophrenicillness where

some low-level schizophrenic symptomsmay still be present.

Simple schizophrenia: Insidious andprogressive development of prominentnegative symptomswith no history ofpsychotic episodes.
http://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/ICD


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Causes

but no single organic cause has beenfound

a PET study suggests that the less the

frontal lobes are activated during aworking memory task, the greater theincrease in abnormal dopamine activity inthe mesolimbic pathway of the brainrelates to the neurocognitive deficits inschizophrenia.


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Genetic- Familial pattern - first-degree biologicalrelativesare at risk about 10 times greater than that of

the general population. Rates are also increased in monozygotic twins than indizygotic twins.

Prenatal

Social

Drugs-A 2007 meta-analysisestimated that cannabisuse is statistically associatedwith a dose-dependentincrease in risk of development of psychotic disorders,including schizophrenia

There is some support for the theory that they use drugs

to cope with unpleasant states such as depression,anxiety, boredom and loneliness.[61]

Psychological

Neural
http://en.wikipedia.org/wiki/Meta-analysishttp://en.wikipedia.org/wiki/Association_(statistics)http://en.wikipedia.org/wiki/Dose-response_relationshiphttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Dose-response_relationshiphttp://en.wikipedia.org/wiki/Dose-response_relationshiphttp://en.wikipedia.org/wiki/Dose-response_relationshiphttp://en.wikipedia.org/wiki/Association_(statistics)http://en.wikipedia.org/wiki/Meta-analysishttp://en.wikipedia.org/wiki/Meta-analysishttp://en.wikipedia.org/wiki/Meta-analysis


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Diagnosis

No laboratory test for schizophreniacurrently exists

is based on the self-reported experiences

of the person, and abnormalities inbehavior reported by family members,friends or co-workers, followed by aclinical assessment by a psychiatrist,

social worker. Psychiatric assessment includes a

psychiatric history and some form of

mental status examination.


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According to the revised fourth edition of theDiagnostic and Statistical Manual of MentalDisorders (DSM-IV-TR), to be diagnosed withschizophrenia, three diagnostic criteria must bemet.

1. Characteristic symptoms: Two or moreof thefollowing.

Delusions Hallucinations

Disorganized speech,

Grossly disorganized behavior (e.g. dressinginappropriately, crying frequently) or catatonicbehavior

Negative symptomsaffective flattening (lack ordecline in emotional response), alogia(lack ordecline in speech), or lack or decline in motivation


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2. Social/occupational dysfunction: For a significantportion of the time since the onset of the disturbance,one or more major areas of functioningsuch as work,

interpersonal relations, or self-care, are markedlybelow the level achieved prior to the onset.

3. Duration: Continuous signs of the disturbancepersist for at least six months. This six-month periodmust include at least one month of symptoms (or less,

if symptoms remitted with treatment).

Schizophrenia cannot be diagnosed if symptoms ofmood disorderor pervasive developmental disorder

are present, or the symptoms are the direct result of ageneral medical condition or a substance, such asabuse of a drug or medication
http://en.wikipedia.org/wiki/Mood_disorderhttp://en.wikipedia.org/wiki/Pervasive_developmental_disorderhttp://en.wikipedia.org/wiki/Pervasive_developmental_disorderhttp://en.wikipedia.org/wiki/Mood_disorder


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However, individuals with Schizophrenia oftenhave a number of (non-diagnostic)

neurological abnormalities. They haveenlargement of the lateral ventricles, decreasedbrain tissue, decreased volume of the temporallobe and thalamus, decreased blood flow and

metabolic functioning of the frontal lobes. Theyalso have a number of cognitive deficitsonpsychological testing (e.g., poor attention, poormemory, difficulty in changing response set,impairment in sensory gating, abnormal smoothpursuit and saccadic eye movements, slowedreaction time


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Treatment

The effectiveness of treatment is often assessed using standardizedmethods, one of the most common being the Positive and NegativeSyndrome Scale (PANSS).

It should be noted that management of symptoms and improving function isthought to be more achievable than a cure

mainstay of treatment is antipsychotic medication

two classes of antipsychotics are generally thought equally effectivefor thetreatment of the positive symptoms.

Some researchers have suggested that the atypicals offer additional benefitfor the negative symptoms and cognitive deficits associated withschizophrenia

this type of drug primarily works by suppressing dopamine activityreducingpositive symptoms of psychosis. Also shorten the duration of phycosis and

prevents recurrences. Risperidone is a common atypical antipsychotic medication.

Although expensive, the newer atypical antipsychotic drugs are usuallypreferred for initial treatmentover the older typical antipsychotic, althoughthey are more likely to induce weight gain and obesity-related diseases


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atypical antipsychotics have fewer extrapyramidal side

effectsthan typical antipsychotics treatment-resistant schizophreniais a term used for the

failure of symptoms to respond satisfactorily to at leasttwo different antipsychotics.

Treat with clozapine (SE- agranulocytosis and

myocarditis). If compliance becomes a problem depot preparations of

antipsychotics may be given every two weeks to achievecontrol.

Psychotherapy vocationaland social rehabilitation are

also important. In more serious caseswhere there is riskto self and othersinvoluntary hospitalization may benecessary

Cognitive behavioral therapy-improves self esteem

Family therapy or education


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Outcome

Best when early and persistent treatmentwith antipsychotic medication aregiven soon after the onset of Schizophrenia.

Other factorsthat are associated with a better prognosis include goodpremorbid adjustment, acute onset, later age at onset, good insight, beingfemale, precipitating events, associated mood disturbance, brief duration ofpsychotic symptoms, good interepisode functioning, minimal residualsymptoms, absence of structural brain abnormalities, normal neurological

functioning, a family history of Mood Disorder, and no family history ofSchizophrenia

After each psychotic relapse there is increased intellectual impairment

Unfortunately, even on antipsychotic medication, most individuals withSchizophrenia can't return to gainful employment due to the intellectualimpairmentscaused by this illness (e.g., poor concentration, poor memory,impaired problem-solving, inability to "multi-task", and apathy).

Life-long treatmentwith antipsychotic medication is essentialfor recoveryfrom Schizophrenia. Individuals also require long-term emotional andfinancial supportfrom their families

schizophrenian.ppt

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