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Schizophrenia Overview

Schizophrenia Overview. Schizophrenia is the most severe and debilitating mental illness in psychiatry and is a brain disorder. History. Bleuiler Autism Ambivalence Affect Association. Diagnosis of Schizophrenia. A. Characteristic symptoms -Delusions -Hallucinations

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Schizophrenia Overview

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  1. Schizophrenia Overview

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

  3. History Bleuiler • Autism • Ambivalence • Affect • Association

  4. 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

  5. Positive Symptoms • Additions to normal function • Delusions • Hallucinations • Distorted language/communication • Disorganised speech / behaviour • Catatonic behaviour • Agitation

  6. Negative Symptoms • Losses of normal function -Affective flattening -Alogia -Avolition -Anhedonia -Attentional impairment Blunted affect, emotional withdrawal, poor rapport, passivity, apathetic, social withdrawal

  7. Cognitive Symptoms • Thought disorder • Odd use of language incoherence, loose associations, neologisms • Impaired attention / cognition reduced verbal fluency learning/memory executive functions

  8. Subtypes of schizophrenia • Paranoid • Disorganized • Catatonic • Undifferentiated • Residual

  9. Childhood onset schizophrenia • Onset before 12 years • Increased developmental abnormalities • Lower IQ • 1 in 10000 • Increased heritability • Decreased gray matter

  10. 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

  11. Etiology of schizophrenia • Genetic • Structural brain changes • Functional brain changes • Dopamine hypothesis

  12. Risk Factors • Genetic • Canabis • Infection & Birth Season

  13. prognosis • Age of onset • Function level before onset • IQ • Drug response • Family support • sex

  14. Structural changes in brain • Larger ventricles • Subgroup: inverse correlation between ventricle size and response to drugs

  15. Structural changes in brain • Increased loss of gray matter in adolescence

  16. 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.

  17. 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.

  18. Treatment of Schizophrenia

  19. 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

  20. First generation antipsychotic side-effects • Extrapyramidal side-effects – Parkinson symptoms, dystonia, restlessness • Sedation • Weight gain • Dry mouth, constipation • Cardiac toxicity • Postural hypotension

  21. Second generation antipsychotic side-effects • Weight gain • Increase blood sugar – diabetes • Increased lipids • Sedation

  22. Non-pharmacologic treatments for schizophrenia • Psychotherapy – supportive • Social skills training • Family Therapy – expressed emotion • Psychosocial rehabilitation

  23. 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.

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