• Schizophrenia

    by  • 03/12/2013 • Psychiatry

    Definition:disintegration of thought processes and of emotional responsiveness

    Classification / type of disease:

    Schizophrenia can be subtyped depending on predominant symptoms =

    • Paranoid, disorganized, catatonic,

    Epidemiology:  

    • Typically occurs in young adulthood
    • Global lifetime prevalence of about 0.3–0.7%.

    Presenting symptoms / signs:  

    • Auditory hallucinations
    • Paranoia = a thought process influenced by anxiety or fear – to the point of irrationality or delusion. Ie. People are talking about me, people are comin to get me.
    • Bizarre delusions ( a fixed belief that is false) – often persecutory
    • Disorganized speech and thinking
    • Significant social or occupational dysfunction
    • Loss of train of though
    • Incoherent words = “word salad”
    • Social withdrawal
    • Abnormally poor dress sense, hygiene, judgement
    • Poor social cognition = struggle in encoding, storage, retrieval, and processing, in the brain, of information relating to other people
    • In rare cases = catatonia (no, or excessive motor activity)

    Symptoms are often described as positive (those which are not seen in normal health – psychosis) and negative symptoms (those which are normally present – anhedonia [not enjoying the things that you would normally enjoy] )…

    Diagnostic investigations: diagnosed based on criteria in either the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders, version DSM-IV-TR, or the World Health Organization‘s International Statistical Classification of Diseases and Related Health Problems, the ICD-10.

    • ICD-10 most often used in Europe
    • DSM-4 most often used in US

    The following criteria must be met to diagnose =

    Two or more of the following, each present for much of the time during a one-month period (or less, if symptoms remitted with treatment).

      • Delusions
      • Hallucinations
      • Disorganized speech, which is a manifestation of formal thought disorder
      • Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior
      • Negative symptoms: Blunted affect (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation)
    • Social or occupational dysfunction
    • Significant duration: Continuous signs of the disturbance persist for at least six months

     

    Aetiology:

    • Genetics
    • Environment
    • Neurobiology
    • Psychological and social processes
    • Recreational or prescription drugs may precipitate disease
    • Drug abuse (cocaine, cannabis, amphetamines)
    • Prenatal – hypoxia, stress, malnutrition, infection.

    Pathophysiology:A number of attempts have been made to explain the link between altered brain function and schizophrenia.One of the most common is the dopamine hypothesis, which attributes psychosis to the mind’s faulty interpretation of the misfiring of dopaminergic neurons.

    Transmission:

    • Treatment / management: antipsychotic medications (based on benefit and s/s’s) = risperidone, quetiapine, clozapine
    • Psychotherapy = vocational and social rehabilitation, family therapy, CBT
    • Hospitalization if neccessary

    Prognosis:

    • More likely to have additional health issues – depression, anxiety, substance misuse, suicide
    • Life expectancy is 12-15 shorter than others due to comorbid complications and increased suicide risk.  
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