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- social withdrawn/restless/immobile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
- 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
- Organic causes
- endocrine
- hypo/hyperthyroid
- drugs (steroids)
- Treatment
- antidepressants
- electro-convulsive therapy
- psychotherapy
- cognitive behaviour therapy
- 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
Mania
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