Schizophrenia

  • Split mind
    • not split personality
  • Splitting of normal links between
    • perception
    • mood
    • thinking
    • behaviour
    • contact with reality
  • One of the most severe & debilitating form of mental disorder
  • Various presentations
  • Relapsing in nature
  • Subtypes of schizophrenia
    • Hebephrenic
      • childish, silly behaviour
      • mood is inappropriate
        • giggling
        • shallowness
      • thoughts disorganised
    • Catatonic
      • psychomotor disturbance
        • stupor to outburst of activity
      • wavy flexibility
    • Paranoid
      • complex delusions & hallucinations
    • Simple
      • -ve symptoms predominates
  • According to DSM-IV-TR, diagnostic when:
    • a disturbance lasts for at least 6 months
    • include at least a month of active phase symptoms
      • 2 of the following
        • delusions
        • hallucinations
        • disorganised speech
        • grossly disorganised/catatonic behaviour
        • -ve symptoms
          • affective flattening
          • alogia
          • avolition
        • Social & occupational dysfunction
  • Main symptoms (4 As)
    • loosing of associations
      • shifts in topic
      • no logical connection between one topic & the next
    • autism
    • changes in affect
    • ambivalence
  • Clinical features (The acute syndrome)
    • Normal appearance & behaviour
      • preoccupied with health, appearance, religion, own thoughts
      • social withdrawn/restless/immobile
      • smile/laugh without reason
    • Speech
      • lack of connection btwn ideas
      • loosening of association
      • illogical thinking
      • neologisms
        • new words
      • pressure of speech
        • associated with flight of ideas
    • Thought disorder
      • flight of ideas
      • poverty of thought
        • thought block
        • though insertion/withdrawal
      • delusions
        • fixed false belief
      • concrete thinking
        • lack abstract thinking
    • Perceptual disturbances
      • hallucinations
        • no stimulus
        • auditory,visual,tactile,somatic,olfactory,gustatory
      • illusions
        • misinterpretation
    • Orientation
      • normal
    • Attention
      • impaired
    • Memory
      • impaired
    • Insight
      • impaired
  • Epidemiology
    • Onset
      • Males (earlier, 15-25 yo)
      • Females (later, 25-35 yo)
    • Outcome
      • better for women
      • men: –ve symptoms
  • Frequency of symptom of acute schizophrenia
    • Most frequent: flatness of affect
    • Least frequent: lack of insight
  • Frequency of symptom of chronic schizophrenia
    • Most frequent: hallucinations
    • Least frequent: underactivity
  • Mode of inheritance
    • does not follow mendelian pattern
      • no single gene has been identified
      • cumulative effect of several genes
        • expressed when threshold of susceptibility is exceeded
  • Neurological dysfunction
    • Birth complications
      • low birth weight
      • obstetric complications
      • perinatal injuries
    • hypofrontality
      • reduction of blood flow in frontal & prefrontal cortex
  • Biochemical abnormalities
    • Dopamine overactivity in mesolimbic pathways
      • D2, D4
      • Drugs that reduce dopamine tend to reduce +ve symptoms
      • Amphetamines
        • increase level of dopamine
        • increase psychotic symptoms
      • Serotonin regulates dopamine release
  • Other causes of schizophrenia
    • personality
      • socially withdrawn
    • Migration
    • Social isolation
    • Family
      • double bind
        • parent gives child simultaneous messages more than 1 level but contradict each other
      • deviant role relationships
        • mother dominates
  • Management
    • exclude other medical conditions that may present with psychosis
      • temporal lobe epilepsy
      • trauma
      • stroke
      • hypothyroidism
    • Pharmacotherapy
      • antipsychotics
    • Other therapy
      • behaviour therapy
      • occupational therapy
    • Counseling
  • Good prognostic factors
    • sudden onset
    • short episode
    • no part history of psychiatric disoder
    • prominent affective syndrome
    • paranoid type
    • older age of onset
    • married
    • good previous personality
    • good work record
    • good social relationships
    • good compliance*

Depression

  • Diagnostic criteria (DSM-IV-TR) for major depression
    • severe depression
      • single episode/recurrent
    • depression & loss of pleasure
      • at least 2 weeks
  • Symptoms
    • depressed mood nearly everyday
    • marked diminished interest/pleasure
    • significant change in appetite/weight
    • insomnia/hypersomnia
    • psychomotor retardation
    • agitation
    • lack of energy*
      • tires easily
    • inappropriate guilt
    • feeling useless
    • decreased ability to think/concentrate/make decisions
    • recurrent thoughts of death
  • May coexist with other disorders
    • Psychiatric disorder
      • schizophrenia
    • Physical illness
      • hypothyroidism
      • stroke
    • Psychotic symptoms
      • delusions
      • hallucinations
  • Aetiology
    • genetics
    • < /ul>

    • Biochemical hypotheses
      • Abnormality in the monoamine neurotransmitter system
        • serotonin
        • noradrenaline
        • dopamine
          • low
    • Neuroimaging
      • decrease in caudate size
    • Beck’s triad
      • Negative view on
        • self
        • future
        • environment
      • image
    • Organic causes
      • endocrine
        • hypo/hyperthyroid
        • drugs (steroids)
    • Treatment
      • antidepressants
      • electro-convulsive therapy
      • psychotherapy
      • cognitive behaviour therapy

    Mania

    • Diagnostic criteria (DSM-IV-TR)
      • mood
        • elevated, expansive or irritable lasting for at least 1 week
      • 3 or more symptoms
        • inflated self esteem/grandiosity
        • decreased need for sleep
        • more talkative than usual
        • flights of ideas
        • racing thoughts
        • distractibility
        • increased in goal directed activity
    • May be intermingled with transient depression
    • Other features
      • insomnia
      • good appetite
      • loss of weight
        • due to overactivity
      • marked impairment in social & occupational activities
      • brightly coloured clothes
      • untidy
      • hallucinations
    • Aetiology
      • genetic
      • noradrenaline excess
      • imbalance in dopamine (GABA system)
      • Psychosocial
        • not significant
    • Treatment
      • Antipsychotics
      • Mood stabilizers
      • ECT
      • Education – to the family
    • Course & prognosis
      • Usually recur
      • Untreated episodes
        • last 3-6 months
      • most will develop depression
        • Bipolar disorder
      • mostly partial recovery
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Terri is obsessed with making medical school as painless as possible. She studies and compiles medical school notes in a concise, easy-to-understand format. She also enjoys reading contributions by others. She is an investor in sustainability projects. Her ideal weekend is wine tasting and experimenting on bread-making. She has yet to master the art of Sourdough baking.

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