SchizophreniaSchizophrenia

Department of PsychiatryDepartment of Psychiatry

11stst Faculty of Medicine Faculty of Medicine

Charles University, PragueCharles University, Prague

Head: Prof. MUDr. Jiří Raboch, DrSc.Head: Prof. MUDr. Jiří Raboch, DrSc.

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DefinitionDefinition The schizophrenic disorders are characterized in The schizophrenic disorders are characterized in

general by fundamental and characteristic general by fundamental and characteristic distortions of distortions of thinking and perception, and affectsthinking and perception, and affects that are that are inappropriate or blunted. Clear consciousness and inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained although intellectual capacity are usually maintained although certain cognitive deficits may evolve in the course of certain cognitive deficits may evolve in the course of time. time.

The most important psychopathological phenomena The most important psychopathological phenomena includeinclude• thought echothought echo• thought insertion or withdrawalthought insertion or withdrawal• thought broadcastingthought broadcasting• delusional perception and delusions of controldelusional perception and delusions of control• influence or passivityinfluence or passivity• hallucinatory voices commenting or discussing the patient in hallucinatory voices commenting or discussing the patient in

the third personthe third person• thought disorders and negative symptoms.thought disorders and negative symptoms. Brought to you by

SchizophreniaSchizophrenia Schizophrenia occurs with regular frequency Schizophrenia occurs with regular frequency

nearly everywhere in the world in 1 % of nearly everywhere in the world in 1 % of population and begins mainly in young age population and begins mainly in young age (mostly around 16 to 25 years).(mostly around 16 to 25 years).

Schizophrenia is defined by Schizophrenia is defined by • a group of characteristic positive and negative a group of characteristic positive and negative

symptomssymptoms• deterioration in social, occupational, or interpersonal deterioration in social, occupational, or interpersonal

relationshipsrelationships• continuous signs of the disturbance for at least 6 continuous signs of the disturbance for at least 6

monthsmonths

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HistoryHistory Emil KraepelinEmil Kraepelin: This illness develops relatively early in : This illness develops relatively early in

life, and its course is likely deteriorating and chronic; life, and its course is likely deteriorating and chronic; deterioration reminded dementia deterioration reminded dementia („Dementia („Dementia praecox“praecox“), but was not followed by any organic changes ), but was not followed by any organic changes of the brain, detectable at that time.of the brain, detectable at that time.

Eugen BleulerEugen Bleuler: He renamed Kraepelin’s dementia : He renamed Kraepelin’s dementia praecox as praecox as schizophreniaschizophrenia (1911); he recognized the (1911); he recognized the cognitive impairment in this illness, which he named as cognitive impairment in this illness, which he named as a „splittinga „splitting““ of mind. of mind.

Kurt SchneiderKurt Schneider: He emphasized the role of psychotic : He emphasized the role of psychotic symptoms, as hallucinations, delusions and gave them symptoms, as hallucinations, delusions and gave them the privilege of the privilege of „the first rank symptoms”„the first rank symptoms” even in the even in the concept of the diagnosis of schizophrenia. concept of the diagnosis of schizophrenia.

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4 A (Bleuler)4 A (Bleuler) Bleuler maintained, that for the diagnosis of Bleuler maintained, that for the diagnosis of

schizophrenia are most important the following four schizophrenia are most important the following four fundamental symptoms:fundamental symptoms:

• affective bluntingaffective blunting• disturbance of associationdisturbance of association (fragmented thinking) (fragmented thinking)• autismautism• ambivalenceambivalence (fragmented emotional response) (fragmented emotional response)

These groups of symptoms, are called „four A’ s” and These groups of symptoms, are called „four A’ s” and Bleuler thought, that they are „primary” for this Bleuler thought, that they are „primary” for this diagnosis.diagnosis.

The other known symptoms, hallucinations, delusions, The other known symptoms, hallucinations, delusions, which are appearing in schizophrenia very often also, which are appearing in schizophrenia very often also, he used to call as a “secondary symptoms”, because he used to call as a “secondary symptoms”, because they could be seen in any other psychotic disease, they could be seen in any other psychotic disease, which are caused by quite different factors — from which are caused by quite different factors — from intoxication to infection or other disease entities.intoxication to infection or other disease entities.

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Course of IllnessCourse of Illness

Course of schizophrenia:Course of schizophrenia:• continuous without temporary improvementcontinuous without temporary improvement• episodic with progressive or stable deficitepisodic with progressive or stable deficit• episodic with complete or incomplete episodic with complete or incomplete

remission remission

Typical stages of schizophrenia:Typical stages of schizophrenia:• prodromal phaseprodromal phase• active phaseactive phase• residual phaseresidual phase

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Clinical PictureClinical Picture Diagnostic manuals: Diagnostic manuals:

• lCD-10lCD-10 („International Classification of Disease“, WHO) („International Classification of Disease“, WHO)• DSM-IVDSM-IV („Diagnostic and Statistical Manual“, APA) („Diagnostic and Statistical Manual“, APA)

Clinical picture of schizophrenia is according to lCD-10, Clinical picture of schizophrenia is according to lCD-10, defined from the point of view of the presence and defined from the point of view of the presence and expression of primary and/or secondary symptoms (at expression of primary and/or secondary symptoms (at present covered by the terms negative and positive present covered by the terms negative and positive symptoms)symptoms)::• tthe he negative symptomsnegative symptoms are represented by cognitive disorders, are represented by cognitive disorders,

having its origin probably in the disorders of associations of having its origin probably in the disorders of associations of thoughts, combined with emotional blunting and small or thoughts, combined with emotional blunting and small or missing production of hallucinations and delusionsmissing production of hallucinations and delusions

• tthe he positive positive symptomsymptom are characterized by the presence of are characterized by the presence of hallucinations and delusionshallucinations and delusions

• tthe division is not quite strict and lesser or greater mixture of he division is not quite strict and lesser or greater mixture of symptoms from these two groups are possiblesymptoms from these two groups are possible

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Positive and Negative SymptomsPositive and Negative Symptoms

NegativeNegative PositivePositive

AlogiaAlogia HallucinationsHallucinations

Affective flatteningAffective flattening DelusionsDelusions

Avolition-apathyAvolition-apathy Bizarre behaviourBizarre behaviour

Anhedonia-asocialityAnhedonia-asociality Positive formal thought Positive formal thought disorderdisorder

Attentional impairmentAttentional impairment

Andreasen N.C., Roy M.-A., Flaum M.: Positive and negative symptoms. In: Schizophrenia, Hirsch S.R. and Weinberger D.R., eds., Blackwell Science, pp. 28-45, 1995

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The Criteria of DiagnosisThe Criteria of DiagnosisFor the For the diagnosis of schizophreniadiagnosis of schizophrenia is necessary is necessary presence of one very clear symptom presence of one very clear symptom - - from point a) to d)from point a) to d) or the presence of the symptoms from at least two groups or the presence of the symptoms from at least two groups - - from from

point e) to h)point e) to h)for one month or more:for one month or more:

a)a) the hearing of own thoughts, the feelings of thought withdrawal, the hearing of own thoughts, the feelings of thought withdrawal, thought insertion, or thought broadcastingthought insertion, or thought broadcasting

b)b) the delusions of control, outside manipulation and influence, or the the delusions of control, outside manipulation and influence, or the feelings of passivity, which are connected with the movements of feelings of passivity, which are connected with the movements of the body or extremities, specific thoughts, acting or feelings, the body or extremities, specific thoughts, acting or feelings, delusional perceptiondelusional perception

c)c) hallucinated voices, which are commenting permanently the hallucinated voices, which are commenting permanently the behavior of the patient or they talk about him between behavior of the patient or they talk about him between themselves, or the other types of hallucinatory voices, coming themselves, or the other types of hallucinatory voices, coming from different parts of bodyfrom different parts of body

d)d) permanent delusions of different kind, which are inappropriate and permanent delusions of different kind, which are inappropriate and unacceptable in given cultureunacceptable in given culture

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The Criteria of DiagnosisThe Criteria of Diagnosise)e) the lasting hallucination of every formthe lasting hallucination of every formf)f) blocks or intrusion of thoughts into the flow of thinking and blocks or intrusion of thoughts into the flow of thinking and

resulting incoherence and irrelevance of speach, or neologismsresulting incoherence and irrelevance of speach, or neologismsg)g) catatonic behaviorcatatonic behaviorh)h) „„the negative symptoms”, for instance the expressed apathy, the negative symptoms”, for instance the expressed apathy,

poor speech, blunting and inappropriatness of emotional reactionspoor speech, blunting and inappropriatness of emotional reactionsi)i) expressed and conspicuous qualitative changes in patient’s expressed and conspicuous qualitative changes in patient’s

behavior, the loss of interests, hobbies, aimlesness, inactivity, the behavior, the loss of interests, hobbies, aimlesness, inactivity, the loss of relations to others and social withdrawalloss of relations to others and social withdrawal

Diagnosis of Diagnosis of acute schizophorm disorderacute schizophorm disorder (F23.2) – if the (F23.2) – if the conditions for diagnosis of schizophrenia are fulfilled, but lasting conditions for diagnosis of schizophrenia are fulfilled, but lasting less than one monthless than one month

Diagnosis of Diagnosis of schizoaffective disorderschizoaffective disorder (F25) - if the schizophrenic (F25) - if the schizophrenic and affective symptoms are developing together at the same timeand affective symptoms are developing together at the same time

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F20-F29 F20-F29 Schizophrenia, Schizotypal Schizophrenia, Schizotypal and Delusional Disorders and Delusional Disorders

F20 F20 SchizophreniaSchizophrenia F20.0 F20.0 Paranoid schizophrenia Paranoid schizophrenia F20.1 Hebephrenic schizophrenia F20.1 Hebephrenic schizophrenia F20.2 Catatonic schizophrenia F20.2 Catatonic schizophrenia F20.3 Undifferentiated schizophrenia F20.3 Undifferentiated schizophrenia F20.4 Post-schizophrenic depression F20.4 Post-schizophrenic depression F20.5 Residual schizophrenia F20.5 Residual schizophrenia F20.6 Simple schizophrenia F20.6 Simple schizophrenia F20.8 Other schizophrenia F20.8 Other schizophrenia F20.9 Schizophrenia, unspecified F20.9 Schizophrenia, unspecified Brought to you by

F20-F29 F20-F29 Schizophrenia, Schizotypal Schizophrenia, Schizotypal and Delusional Disordersand Delusional Disorders

F21 F21 Schizotypal disorderSchizotypal disorder F22 F22 Persistent delusional disordersPersistent delusional disorders F22.0 F22.0 Delusional disorder Delusional disorder F22.8 F22.8 Other persistent delusional disorders Other persistent delusional disorders F22.9 F22.9 Persistent delusional disorder, unspecified Persistent delusional disorder, unspecified F23 F23 Acute and transient psychotic disordersAcute and transient psychotic disorders F23.1 F23.1 Acute polymorphic psychotic disorder with Acute polymorphic psychotic disorder with

symptoms of schizophrenia symptoms of schizophrenia F23.2 F23.2 Acute schizophrenia-like psychotic disorder Acute schizophrenia-like psychotic disorder F23.3 F23.3 Other acute predominantly delusional psychotic Other acute predominantly delusional psychotic

disorders disorders F23.8 F23.8 Other acute and transient psychotic disorders Other acute and transient psychotic disorders F23.9 F23.9 Acute and transient psychotic disorder, unspecified Acute and transient psychotic disorder, unspecified

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F20-F29 F20-F29 Schizophrenia, Schizotypal Schizophrenia, Schizotypal and Delusional Disordersand Delusional Disorders

F24 F24 Induced delusional disorderInduced delusional disorder F25 F25 Schizoaffective disordersSchizoaffective disorders F25.0 F25.0 Schizoaffective disorder, manic type Schizoaffective disorder, manic type F25.1 F25.1 Schizoaffective disorder, depressive type Schizoaffective disorder, depressive type F25.2 F25.2 Schizoaffective disorder, mixed type Schizoaffective disorder, mixed type F25.8 F25.8 Other schizoaffective disorders Other schizoaffective disorders F25.9 F25.9 Schizoaffective disorder, unspecified Schizoaffective disorder, unspecified F28 F28 Other nonorganic psychotic disorders Other nonorganic psychotic disorders F29 F29 Unspecified nonorganic psychosisUnspecified nonorganic psychosis

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F20.0 Paranoid Schizophrenia F20.0 Paranoid Schizophrenia Paranoid schizophreniaParanoid schizophrenia is characterized mainly is characterized mainly

by delusions of persecution, feelings of passive by delusions of persecution, feelings of passive or active control, feelings of intrusion, and or active control, feelings of intrusion, and often by megalomanic tendencies also. The often by megalomanic tendencies also. The delusions are not usually systemized too much, delusions are not usually systemized too much, without tight logical connections and are often without tight logical connections and are often combined with hallucinations of different combined with hallucinations of different senses, mostly with hearing voices. senses, mostly with hearing voices.

Disturbances of affect, volition and speech, and Disturbances of affect, volition and speech, and catatonic symptoms, are either absent or catatonic symptoms, are either absent or relatively inconspicuous. relatively inconspicuous.

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F20.1 Hebephrenic SchizophreniaF20.1 Hebephrenic Schizophrenia Hebephrenic schizophreniaHebephrenic schizophrenia is characterized by disorganized is characterized by disorganized

thinking with blunted and inappropriate emotions. It begins thinking with blunted and inappropriate emotions. It begins mostly in adolescent age, the behavior is often bizarre. mostly in adolescent age, the behavior is often bizarre. There could appear mannerisms, grimacing, inappropriate There could appear mannerisms, grimacing, inappropriate laugh and joking, pseudophilosophical brooding and sudden laugh and joking, pseudophilosophical brooding and sudden impulsive reactions without external stimulation. There is a impulsive reactions without external stimulation. There is a tendency to social isolation.tendency to social isolation.

Usually the prognosis is poor because of the rapid Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening development of "negative" symptoms, particularly flattening of affect and loss of volition. Hebephrenia should normally be of affect and loss of volition. Hebephrenia should normally be diagnosed only in adolescents or young adultsdiagnosed only in adolescents or young adults..

Denoted also as Denoted also as disorganized schizophreniadisorganized schizophrenia

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F20.2 Catatonic SchizophreniaF20.2 Catatonic Schizophrenia Catatonic schizophreniaCatatonic schizophrenia is characterized mainly is characterized mainly

by motoric activity, which might be strongly by motoric activity, which might be strongly increased (hypekinesis) or decreased (stupor), increased (hypekinesis) or decreased (stupor), or automatic obedience and negativism. or automatic obedience and negativism.

We recognize two forms:We recognize two forms:• productive formproductive form — which shows catatonic — which shows catatonic

excitement, extreme and often aggressive activity. excitement, extreme and often aggressive activity. TreatmentTreatment by neuroleptics or by electroconvulsive by neuroleptics or by electroconvulsive therapy.therapy.

• stuporose formstuporose form — characterized by general inhibition — characterized by general inhibition of patient’s behavior or at least by retardation and of patient’s behavior or at least by retardation and slowness, followed often by mutism, negativism, slowness, followed often by mutism, negativism, fexibilitas cerea or by stupor. The consciousness is fexibilitas cerea or by stupor. The consciousness is not absent. not absent. Brought to you by

F20.3 Undifferentiated F20.3 Undifferentiated SchizophreniaSchizophrenia

Psychotic conditions meeting the general Psychotic conditions meeting the general diagnostic criteria for schizophrenia but diagnostic criteria for schizophrenia but not conforming to any of the subtypes in not conforming to any of the subtypes in F20.0-F20.2, or exhibiting the features of F20.0-F20.2, or exhibiting the features of more than one of them without a clear more than one of them without a clear predominance of a particular set of predominance of a particular set of diagnostic characteristics.diagnostic characteristics.

This subgroup represents also the former This subgroup represents also the former diagnosis of diagnosis of atypical schizophreniaatypical schizophrenia..

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F20.4 Postschizophrenic F20.4 Postschizophrenic DepressionDepression

A depressive episode, which may be A depressive episode, which may be prolonged, arising in the aftermath of a prolonged, arising in the aftermath of a schizophrenic illness. Some schizophrenic schizophrenic illness. Some schizophrenic symptoms, either symptoms, either „„positivepositive““ or or „„negativenegative““, , must still be present but they no longer must still be present but they no longer dominate the clinical picture. dominate the clinical picture.

These depressive states are associated These depressive states are associated with an increased risk of suicide. with an increased risk of suicide.

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F20.5 Residual SchizophreniaF20.5 Residual Schizophrenia AA chronic stage in the development of chronic stage in the development of

schizophrenia with clear succession from schizophrenia with clear succession from the initial stage with one or more episodes the initial stage with one or more episodes characterized by general criteria of characterized by general criteria of schizophrenia to the late stage with long-schizophrenia to the late stage with long-lasting negative symptoms and lasting negative symptoms and deterioration (not necessarily irreversible).deterioration (not necessarily irreversible).

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F20.6 Simple SchizophreniaF20.6 Simple Schizophrenia

Simple schizophrenia is characterized by Simple schizophrenia is characterized by early and slowly developing initial stage early and slowly developing initial stage with growing social isolation, withdrawal, with growing social isolation, withdrawal, small activity, passivity, avolition and small activity, passivity, avolition and dependence on the others.dependence on the others.

The patients are indifferent, without any The patients are indifferent, without any initiative and volition. There is not initiative and volition. There is not expressed the presence of hallucinations expressed the presence of hallucinations and delusions.and delusions.

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F21 F21 Schizotypal disorderSchizotypal disorder According to lCD-10 this disorder is According to lCD-10 this disorder is

characterized by eccentric behavior and characterized by eccentric behavior and by deviations of thinking and affectivity, by deviations of thinking and affectivity, which are similar to that occurring in which are similar to that occurring in schizophrenia, but without psychotic schizophrenia, but without psychotic features and expressed symptoms of features and expressed symptoms of schizophrenia of any type.schizophrenia of any type.

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F22 Persistent Delusional F22 Persistent Delusional DisordersDisorders

Includes a variety of disorders in which Includes a variety of disorders in which long-standing delusions constitute the long-standing delusions constitute the only, or the most conspicuous, clinical only, or the most conspicuous, clinical characteristic and which cannot be characteristic and which cannot be classified as organic, schizophrenic or classified as organic, schizophrenic or affective. affective.

Their origin is probably heterogeneous, Their origin is probably heterogeneous, but it seems, that there is some relation to but it seems, that there is some relation to schizophrenia.schizophrenia.

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F22.0 F22.0 Delusional DisorderDelusional Disorder A disorder characterized by the A disorder characterized by the

development of one delusion or of the development of one delusion or of the group of similar related delusions, which group of similar related delusions, which are persisting unusually long, very often are persisting unusually long, very often for the whole life. for the whole life.

Other psychopathological symptoms — Other psychopathological symptoms — hallucinations, intrusion of thoughts etc. hallucinations, intrusion of thoughts etc. are not present and are excluding this are not present and are excluding this diagnosis. diagnosis.

It begins usually in the middle age.It begins usually in the middle age.

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F23 F23 Acute and Transient Acute and Transient Psychotic DisordersPsychotic Disorders

The criteria should be the following features:The criteria should be the following features:• acute beginning (to two weeks)acute beginning (to two weeks)• presence of typical symptoms (quickly changing presence of typical symptoms (quickly changing

“polymorphic symptoms”)“polymorphic symptoms”)• presence of typical schizophrenic symptoms.presence of typical schizophrenic symptoms.

Complete recovery usually occurs within a few Complete recovery usually occurs within a few months, often within a few weeks or even days.months, often within a few weeks or even days.

The disorder may or may not be associated with The disorder may or may not be associated with acute stress, defined as usually stressful events acute stress, defined as usually stressful events preceding the onset by one to two weeks. preceding the onset by one to two weeks.

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F24 Induced Delusional Disorder F24 Induced Delusional Disorder A delusional disorder shared by two or more people A delusional disorder shared by two or more people

with close emotional links. Only one of the people with close emotional links. Only one of the people suffers from a genuine psychotic disorder; the suffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usually delusions are induced in the other(s) and usually disappear when the people are separated.disappear when the people are separated.

The psychotic disorder of the dominant member of The psychotic disorder of the dominant member of this dyad is mainly, but not necessarily, of this dyad is mainly, but not necessarily, of schizophrenic type. The original delusions of schizophrenic type. The original delusions of dominant member and his partner are usually dominant member and his partner are usually chronic, either persecutory or megalomanic.chronic, either persecutory or megalomanic.

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F25 Schizoaffective Disorders F25 Schizoaffective Disorders Episodic disorders in which both affective and Episodic disorders in which both affective and

schizophrenic symptoms are prominent schizophrenic symptoms are prominent ((during the during the same episode of the illness or at least during few dayssame episode of the illness or at least during few days)) but which do not justify a diagnosis of either but which do not justify a diagnosis of either schizophrenia or depressive or manic episodes. schizophrenia or depressive or manic episodes.

Patients suffering from periodic schizoaffective Patients suffering from periodic schizoaffective disorders, especially with manic symptoms, have disorders, especially with manic symptoms, have usually good prognosis with full remissions without any usually good prognosis with full remissions without any remaining defects.remaining defects.

They are divided in different subgroups:They are divided in different subgroups:• F25.0 Schizoaffective disorder, manic type F25.0 Schizoaffective disorder, manic type • F25.1 Schizoaffective disorder, depressive type F25.1 Schizoaffective disorder, depressive type • F25.2 Schizoaffective disorder, mixed type F25.2 Schizoaffective disorder, mixed type • F25.8 Other schizoaffective disorders F25.8 Other schizoaffective disorders • F25.9 Schizoaffective disorder, unspecifiedF25.9 Schizoaffective disorder, unspecified

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Genetics of SchizophreniaGenetics of Schizophrenia

Many psychiatric disorders are Many psychiatric disorders are multifactorial (caused by the interaction of multifactorial (caused by the interaction of external and genetic factors) and from the external and genetic factors) and from the genetic point of view very often genetic point of view very often polygenically determined.polygenically determined.

Relative risk for schizophrenia is around:Relative risk for schizophrenia is around:• 1% for normal population1% for normal population• 5.6% for parents5.6% for parents• 10.1% for siblings10.1% for siblings• 12.8% for children12.8% for children

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Etiology of SchizophreniaEtiology of Schizophrenia The etiology and pathogenesis of The etiology and pathogenesis of

schizophrenia is not knownschizophrenia is not known

It is accepted, that schizophrenia is „the It is accepted, that schizophrenia is „the group of schizophrenias“ which origin is group of schizophrenias“ which origin is multifactorial:multifactorial:• internal factors – genetic, inborn, biochemicalinternal factors – genetic, inborn, biochemical• external factors – trauma, infection of CNS, external factors – trauma, infection of CNS,

stressstress

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Etiology of Schizophrenia - Etiology of Schizophrenia - Dopamine HypothesisDopamine Hypothesis

The most influential and plausible are the hypotheses, based on the The most influential and plausible are the hypotheses, based on the supposed disorder of neurotransmission in the brain, derived mainly fromsupposed disorder of neurotransmission in the brain, derived mainly from1.1. the effects of antipsychotic drugs that have in common the ability to inhibit the effects of antipsychotic drugs that have in common the ability to inhibit

the dopaminergic system by blocking action of dopamine in the brainthe dopaminergic system by blocking action of dopamine in the brain2.2. dopamine-releasing drugs (amphetamine, mescaline, diethyl amide of dopamine-releasing drugs (amphetamine, mescaline, diethyl amide of

lysergic acid - LSD) that can induce state closely resembling paranoid lysergic acid - LSD) that can induce state closely resembling paranoid schizophreniaschizophrenia

Classical dopamine hypothesis of schizophreniaClassical dopamine hypothesis of schizophrenia: Psychotic symptoms are : Psychotic symptoms are related to dopaminergic hyperactivity in the brain. Hyperactivity of related to dopaminergic hyperactivity in the brain. Hyperactivity of dopaminergic systems during schizophrenia is result of increased dopaminergic systems during schizophrenia is result of increased sensitivity and density of dopamine D2 receptors in the different parts of sensitivity and density of dopamine D2 receptors in the different parts of the brain.the brain.

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Etiology of Schizophrenia - Etiology of Schizophrenia - Contemporary ModelsContemporary Models

Dopamine hypothesis revisitedDopamine hypothesis revisited: various : various neurotransmitter systems probably takes place in the neurotransmitter systems probably takes place in the etiology of schizophrenia (norepinephric, serotonergic, etiology of schizophrenia (norepinephric, serotonergic, glutamatergic, some peptidergic systems); based on glutamatergic, some peptidergic systems); based on effects of atypical antipsychotics especially.effects of atypical antipsychotics especially.

Contemporary models of schizophreniaContemporary models of schizophrenia conceptualize conceptualize it as a neurocognitive disorder, with the various signs it as a neurocognitive disorder, with the various signs and symptoms reflecting the downstream effects of a and symptoms reflecting the downstream effects of a more fundamental cognitive deficit:more fundamental cognitive deficit:• the symptoms of schizophrenia arise from “cognitive the symptoms of schizophrenia arise from “cognitive

dysmetria” (Nancy C. Andreasen)dysmetria” (Nancy C. Andreasen)• concept of schizophrenia as a neurodevelopmental disorder concept of schizophrenia as a neurodevelopmental disorder

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Etiology of Schizophrenia - Etiology of Schizophrenia - Neurodevelopmental ModelNeurodevelopmental Model

Neurodevelopmental modelNeurodevelopmental model supposes in supposes in schizophrenia the presence of “silent lesion” in schizophrenia the presence of “silent lesion” in the brain, mostly in the parts, important for the the brain, mostly in the parts, important for the development of integration (frontal, parietal and development of integration (frontal, parietal and temporal), which is caused by different factors temporal), which is caused by different factors (genetic, inborn, infection, trauma...) during very (genetic, inborn, infection, trauma...) during very early development of the brain in prenatal or early early development of the brain in prenatal or early postnatal period of life. postnatal period of life.

It does not interfere too much with the basic brain It does not interfere too much with the basic brain functioning in early years, but expresses itself in functioning in early years, but expresses itself in the time, when the subject is stressed by the time, when the subject is stressed by demands of growing needs for integration, during demands of growing needs for integration, during formative years in adolescence and young formative years in adolescence and young adulthood.adulthood. Brought to you by

Treatment of SchizophreniaTreatment of Schizophrenia The acute psychotic schizophrenic patients will The acute psychotic schizophrenic patients will

respond usually to antipsychotic medication.respond usually to antipsychotic medication. According to current consensus we use in the first According to current consensus we use in the first

line therapy the newer atypical antipsychotics, line therapy the newer atypical antipsychotics, because their use is not complicated by appearance because their use is not complicated by appearance of extrapyramidal side-effects, or these are much of extrapyramidal side-effects, or these are much lower than with classical antipsychotics.lower than with classical antipsychotics.

conventional antipsychotics(classical neuroleptics)

chlorpromazine, chlorprotixene, clopenthixole, levopromazine, periciazine, thioridazine

droperidole, flupentixol, fluphenazine, fluspirilene, haloperidol, melperone, oxyprothepine, penfluridol, perphenazine, pimozide, prochlorperazine, trifluoperazine

atypical antipsychotics

amisulpiride, clozapine, olanzapine, quetiapine, risperidone, sertindole, sulpiride

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