The document provides an overview of schizophrenia including its introduction, history, epidemiology, clinical picture including positive and negative symptoms, aetiology including genetic and biochemical factors, and interactive models. It covers the key aspects and evolution of understanding schizophrenia.
The document provides an overview of schizophrenia including its introduction, history, epidemiology, clinical picture including positive and negative symptoms, aetiology including genetic and biochemical factors, and interactive models. It covers the key aspects and evolution of understanding schizophrenia.
The document provides an overview of schizophrenia including its introduction, history, epidemiology, clinical picture including positive and negative symptoms, aetiology including genetic and biochemical factors, and interactive models. It covers the key aspects and evolution of understanding schizophrenia.
The document provides an overview of schizophrenia including its introduction, history, epidemiology, clinical picture including positive and negative symptoms, aetiology including genetic and biochemical factors, and interactive models. It covers the key aspects and evolution of understanding schizophrenia.
• Schizophrenia derived from the Greek word schizo = “to split or
crack,” phren = “mind”
• It is one of the most complex, chronic, and challenging of psychiatric disorder,
that affects how a person thinks feels and behave.
• It represents a heterogenous syndrome of disorganized thoughts, delusion,
hallucinations, and impaired psychosocial functioning. SCHIZOPHRENIA BRAIN NORMAL BRAIN 02 HISTORY HISTORY OF SCHIZOPHRENIA In 1810 Haslam described the case of a patient who appears to have suffered from a variety of symptoms—including delusions.
Morel thought the boy’s intellectual, moral, and physical
functions had deteriorated as a result of brain degeneration of John Haslam (1764-1844) hereditary origin.
Benedict Morel Benedict Morel used the term démence précoce (mental (1809-1873) deterioration at an early age) to describe the condition and to distinguish it from the dementing disorders associated with old age. HISTORY OF SCHIZOPHRENIA Kraepelin, described the patient with dementia praecox as someone who “becomes suspicious of those around him, sees poison in his food, is pursued by the police, feels his body is being influenced, or thinks that he is going to be shot or that the neighbors are jeering at Emil Kraepelin him” (1856-1926)
Eugene Bleuler believed the condition was characterized primarily
by disorganization of thought processes, a lack of coherence between thought and emotion, and an inward orientation away (split off) from Eugene Bleuler reality. (1809-1873) 03 EPIDEMIOLOGY EPIDEMIOLOGY
The risk of developing schizophrenia over
the course of one’s lifetime is a little under 1 percent—actually around 0.7 percent (Saha et al., 2005).
Most cases of schizophrenia begin in late In men, peak of new cases is between ages adolescence and early adulthood, with 18 to 20 and 24. Whereas, in women it peaks 30 years of age being the peak time for the during the same age period, but the peak onset of the illness (Tandon et al., 2009). is less marked than it is for men. 04 CLINICAL PICTURE OF SCHIZOPHRENIA POSITIVE SYMPTOMS OF SCHIZOPHRENIA 1. Hallucinations: Hallucinations involve perceiving sensory experiences that are not based on external stimuli. The word comes from the Latin verb hallucinere or allucinere, meaning to “wander in mind” or “idle talk.
TYPES OF HALLUCINATION
(a). Auditory Hallucinations: sounds or voices
(b). Visual Hallucinations: seeing images, objects, or people
(c). Tactile Hallucinations: sensations of touch or movement on the skin
(d). Gustatory Hallucinations: perceiving tastes or flavors
(e). Olfactory Hallucinations: perceiving smells or odors
POSITIVE SYMPTOMS OF SCHIZOPHRENIA 2. Delusions: Delusions are fixed false beliefs that are not based on reality and are resistant to rational argument or evidence to the contrary. The word delusion comes from the Latin verb ludere, which means “to play
TYPES OF DELUSIONS (a). Persecutory Delusions:targeted, harassed, threatened, or harmed by others.
(b). Grandiose Delusions: exaggerated beliefs about one's own importance, abilities, identity, or relationships. (c). Referential Delusions: beliefs that unrelated events, objects, or actions have personal significance or meaning. (d). Erotomanic Delusions: beliefs that another person, usually of higher status or celebrity, is in love with the individual. (e). Somatic Delusions: beliefs about bodily functions, sensations, or appearance that are not grounded in reality. COGNITIVE SYMPTOMS Disorganised Thinking: Disorganised thinking, also known as formal thought disorder, refers to disturbances in the thought process that result in incoherent or illogical speech or behaviour.
This may manifest as:
(a). Loosening of associations, also referred to as cognitive slippage:
rapidly shifting from one topic to another without a logical connection
(b). Tangentiality: providing responses that are irrelevant to the
question,
(c). Thought blocking: sudden interruption of thought process
(d). Overinclusiveness: in their thinking: categorising unrelated items
together. PSYCHOMOTOR ABNORMALITIES Grossly Disorganized or Abnormal Motor Behavior: This type of behavior can manifest in various ways, from childlike "silliness" to unpredictable agitation. It can significantly impair goal-directed activities, causing difficulties in performing daily living tasks.
Catatonic Behaviour: This involves a marked decrease in reactivity to the
environment, including resistance to instructions (negativism), maintaining rigid or bizarre postures, and a complete lack of verbal and motor responses (mutism and stupor).
It can also include purposeless excessive motor activity (catatonic excitement), repeated stereotyped movements, staring, grimacing, and echoing speech. NEGATIVE SYMPTOMS Negative symptoms of schizophrenia are associated with an inability or decreased ability to initiate actions or speech, express emotions, or feel pleasure (Barch, 2013). Such symptoms include:
(a). Affective Flattening: also known as blunted affect or flat affect, refers to a reduction or absence of emotional expression. (b). Social Withdrawal: a tendency to avoid or minimize social interactions and interpersonal relationships.
(c). Avolition: also known as apathy or lack of motivation, refers to a
diminished ability to initiate and sustain goal-directed activities.
(d). Anhedonia: refers to the inability to experience pleasure or derive enjoyment
from activities that are typically rewarding.
(e). Alogia: Alogia, or poverty of speech, refers to a reduction in the amount or
quality of speech output. 05 AETIOLOGY OF SCHIZOPHRENIA GENETIC FACTOR 1. Genetic Contribution and Heritability: Schizophrenia has a significant genetic component. The risk of developing schizophrenia correlates with genetic relatedness, being highest among monozygotic twins.
2. Adoption Studies and Genetic Vulnerability: the biological
relatives of adopted-away individuals who develop the disorder, compared to their adoptive, non-biological relatives.
3. Paternal Age and Schizophrenia Risk: with individuals born to
fathers older than 60 years showing increased vulnerability. This may be due to greater epigenetic damage in the sperm of older men. Interactive Variables and the onset of Clinical Psychosis This model shows how psychological and social factors may interact with genetic vulnerability to result in psychosis BIOCHEMICAL FACTORS
Schizophrenia is may cause both GABAergic schizophrenia could be linked to excessive positive and neurons in the due to selective dopaminergic negative hippocampus may degeneration in the activity symptoms of lead to increased norepinephrine schizophrenia. dopaminergic reward system. activity. A B C D STRESS AS A EARLY LIFE BRAIN CHANGES PSYCHOLOGICAL STRESSORS TRIGGER STRESS
Stressful life events, Prenatal stress or Chronic stress can alter Social isolation, like loss, childhood trauma brain structure and discrimination, and unemployment, or can increase the risk function, affecting family conflict, lack of relocation, can trigger of schizophrenia neurotransmitter support systems, the onset or worsening systems stigma, of schizophrenia symptoms. A DIATHESIS-STRESS MODEL OF SCHIZOPHRENIA A B C D PARANOID DISORGANISED CATATONIC UNDIFFERENTIATED TYPE TYPE TYPE TYPE
Delusions and Severe Extreme disturbances Diagnosis when
auditory disorganization in in motor behaviour, symptoms meet hallucinations of speech and including stupor or schizophrenia persecution or behaviour, typically excessive activity and criteria but do not fit grandeur appearing before 25 echolalia, and a specific subtype echopraxia 06 OTHER SCHIZOPHRENIA SPECTRUM DISORDER DELUSIONAL DISORDER 1. Normal Behaviour Outside Delusions: Patients with delusional disorder hold persistent, false beliefs but generally behave normally, without the disorganization and performance deficiencies seen in schizophrenia.
2. Distinct Lack of Broader Psychotic Symptoms: Unlike other psychotic
disorders, delusional disorder is marked by the absence of significant disturbances in thoughts or perceptions, apart from occasional hallucinations related to the delusion.
3. Low Diagnosis Rate and Limited Self-Recognition: The prevalence of
delusional disorder is low (0.03–0.18 percent), partly because individuals often do not recognize they have a problem and do not seek help. Common themes involved in delusional disorders:
Erotomania—the belief that someone is in love with the individual; this
delusion typically has a romantic rather than sexual focus.
Grandiosity—the conviction that one has great, unrecognised talent,
special abilities, or a relationship with an important person or deity
Jealousy—the conviction that one’s spouse or partner is being
unfaithful.
Persecution—the belief that one is being conspired or plotted against.
Somatic complaints—convictions of having body odour, being
malformed, or being infested by insects or parasites.
Folie à deux: Delusion or mental illness shared by two people in close
association. SCHIZOAFFECTIVE DISORDER 1.Combination of Schizophrenia and Mood Disorder Symptoms: Schizoaffective disorder involves psychotic symptoms meeting schizophrenia criteria alongside major depressive or manic episodes, with the mood symptoms present for the majority of the illness duration.
2. Distinctive Diagnostic Criteria: According to DSM-5, psychotic symptoms
must persist for at least two weeks after the mood episode subsides, distinguishing schizoaffective disorder from mood disorders with psychotic features.
3. Diagnostic Challenges and Future Uncertainty: Due to the overlap with
mood disorders and the presence of psychotic symptoms during mood episodes, diagnosing schizoaffective disorder is challenging, and its validity as a distinct category is debated in the DSM-5. 07 CONTEMPORARY TRENDS AND FUTURE DIRECTIONS 1. Shift Towards the Recovery Model: Exemplified by Dr. Elyn Saks' success story. By highlighting the significance of medication, therapy, and personal resilience, this model shifts the focus from symptom elimination to functional recovery and achieving one's potential, even in the presence of ongoing symptoms.
2. Focus on Early Identification and Intervention: Another
significant trend involves early identification and intervention for individuals at high risk of developing schizophrenia, particularly targeting adolescents and young adults. THANK YOU ANY QUESTIONS?
