Schizophrenia Overview

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

History

Bleuiler 1) Autism 2) Ambivalence3) Affect4) Association

Diagnosis of Schizophrenia

A. Characteristic symptoms -Delusions -Hallucinations -Disorganized speech -Grossly disorganized or catatonic behavior -Negative symptoms

B. Social/occupational dysfunction C. Overall duration > 6 months D. Exclude mood disorders, drugs,

pervasive developmental disorders

Positive Symptoms

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

Negative Symptoms

Losses of normal function -Affective flattening -Alogia -Avolition -Anhedonia -Attentional impairment

Blunted affect, emotional withdrawal, poor rapport, passivity, apathetic, social withdrawal

Cognitive Symptoms

Thought disorder Odd use of language

incoherence, loose associations, neologisms

Impaired attention / cognitionreduced verbal fluencylearning/memoryexecutive functions

Subtypes of schizophrenia

Paranoid Disorganized Catatonic Undifferentiated Residual

Childhood onset schizophrenia

Onset before 12 years Increased developmental

abnormalities Lower IQ 1 in 10000 Increased heritability Decreased gray matter

Epidemiology

1% prevalence worldwide Most begin in late adolescence to

20’s M=F Females age of onset is generally

later – better outcome Downward drift social-economically Die younger – 10% suicide

Etiology of schizophrenia

Genetic Structural brain changes Functional brain changes Dopamine hypothesis

Risk Factors

Genetic Canabis Infection & Birth Season

prognosis

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

Structural changes in brain

Larger ventricles Subgroup: inverse correlation

between ventricle size and response to drugs

Structural changes in brain

Increased loss of gray matter in adolescence

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.

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.

Treatment of Schizophrenia

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

First generation antipsychotic

side-effects

Extrapyramidal side-effects – Parkinson symptoms, dystonia, restlessness

Sedation Weight gain Dry mouth, constipation Cardiac toxicity Postural hypotension

Second generation antipsychotic side-effects

Weight gain Increase blood sugar – diabetes Increased lipids Sedation

Non-pharmacologic treatments for schizophrenia

Psychotherapy – supportive Social skills training Family Therapy – expressed

emotion Psychosocial rehabilitation

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.