Understanding Schizophrenia: Symptoms, Diagnosis, Treatment

1. Schizophrenia and other Psychotic Disorders

2. Schizophrenia is Heterogeneous... • A syndrome defined by a constellation of clinical symptoms • With multiple causes, that are similarly expressed

3. Schizophrenia: Epidemiology • One in every 100 people develops schizophrenia • Equal prevalence in men and women • Adolescence and early adulthood

4. Schizophrenia : Etiology • Genetic vulnerability • Environmental stress • … imbalance in brain neurotransmitters including dopamine level in the form of increase in dopaminergic activity in certain areas of brain • Abnormal finding in MRI and fMRI

6. Diagnosis of schizophrenia

7. A. Two (or more) of the following, each present for a significant portion of time during a 1 -month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition). B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

8. C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

9. Positive Symptoms: Hallucinations Auditory Hallucinations • involve voices or sounds • single or multiple • familiar or unfamiliar • may make insulting remarks or be pleasant • may comment on behavior • may command person to perform acts

10. Positive Symptoms: Delusions Delusions • fixed false beliefs • examples: • persecutory delusions • delusions of reference • grandiose • Religious • somatic

11. Negative Symptoms Negative symptoms include: • decreased expression of feelings • diminished emotional range • poverty of speech • decreased interests • diminished sense of purpose • diminished social drive

15. Course • varies from recovery to severe disability • in treatment settings commonly see more severe, chronic course

16. Near Complete recovery (20-30%) • almost complete remission of symptoms, but with periodic exacerbations of illness symptoms(20-30%) • Chronic symptoms, serious impact in function(40-60%)

17. Factors affecting prognosis: • age of onset • sex • premorbid function • abrupt versus insidious onset • family history of mood disorder • precipitating events • duration of untreated illness • substance abuse

18. Treatment of schizophrenia • Drug therapy • Family consultation • Antipsychotic drugs (traditional or atypical antipsychotics)

19. Natural History Of Schizophrenia Stages Of Illness Premorbid Prodromal Onset/Deterioration Residual/Stable Healthy   WorseningSeverity OfSigns AndSymptoms Gestation/Birth 10 20 30 40 50 Years

20. Psychotic disorder NOS :Brief psychotic disorder • Hallucinations, delusions or disorganized speech • Duration: at least one day and less than one month • with stressor, without marked stressor or post partum

21. Schizophreniform disorder • Similar to schizophrenia except in duration. • More than 1 month and less than 6 months • Prevalence :less than half as common as schizophrenia

22. Schizoaffective disorder • Symptoms of schizophrenia in combination with symptoms of mood disorders • During the same period of illness , there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms • Life time prevalence: 0.5-0.8% • More in women

23. Treatment and prognosis • Depressed type : same as schizophrenia • Bipolar type : same treatment as bipolar disorder but with worst prognosis

24. Delusional disorder • Rarer compared to schizophrenia • Mean age of onset:40 years • More frequent in men • More dangerous in men • Chronic fluctuating course • Same treatment as schizophrenia

25. Diagnosis and subtypes • Presence of one prominent delusion (other delusions are related to it) for at least one month • Absence of remarkable impairment in other aspects of patients life except what is related to delusion • Subtype: persecutory, grandiose, jealous(infidelity), erotomanic, somatic, mixed