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Definition etymology of the term from the Greek roots skhizein ("to split") and phrn, phren- ("mind")

) It is a term which implies splitting or breaking up of the mind or personality or more specially the EGO. The person regresses to earlier level of development where the ego wasnt form or just about to form. According to ICD-10: Schizophrenia disorders are characterized in general by fundamental & characteristic distortion of thinking, perception & inappropriate or blunted affect. Delusions are bizarre in nature. Hallucination especially auditory are the commonest. Thinking is vague & speech sometimes incomprehensiveble. Mood is characteristically shallow & incongruous, ambivalence, negativism, stupor or catatonia may be present. The onset may be acute or insidious with a seriously disturbed behavior. The schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained although certain cognitive deficits may evolve in the course of time. Course of schizophrenia: continuous without temporary improvement episodic with progressive or stable deficit episodic with complete or incomplete remission Recurrent acute exacerbations of psychosis Increase in residual dysfunction and deterioration with each relapse

Typical stages of schizophrenia: 1. Acute phase Positive symptoms and negative symptoms Delusion (Grandeur, Persecution)

Hallucination (Auditory 70%, Visual 25%, Tactile 5%) Disorganized Symptoms (Catatonia, Waxy Flexibility, Inappropriate Affect) Negative Symptoms (4As)

2. Maintenance phase Acute symptoms are less severe

3. Stabilization phase Epidemeology The exact incidence & prevalence is unknown. It is believed that: Incidence- 10-20 per lac per year Prevalence- 1% Age of onset- adolescence or early adulthood Sex ratio- equal in male & females Others- increased in winter births, low births & low SES Remission of symptoms

History Emil Kraepelin: This illness develops relatively early in life, and its course is likely deteriorating and chronic; deterioration reminded dementia (Dementia praecox), but was not followed by any organic changes of the brain, detectable at that time. Categorization and Early onset. Demetia Loss of Mind Praecox Early, Premature Eugen Bleuler: He renamed Kraepelins dementia praecox as schizophrenia (1911); he recognized the cognitive impairment in this illness, which he named as a splitting of mind.

Bleuler maintained, that for the diagnosis of schizophrenia are most important the following four fundamental symptoms: affective blunting disturbance of association (fragmented thinking) autism ambivalence (fragmented emotional response) These groups of symptoms, are called four A s and Bleuler thought, that they are primary for this diagnosis. Kurt Schneider: He emphasized the role of psychotic symptoms, as hallucinations, delusions and gave them the privilege of the first rank symptoms even in the concept of the diagnosis of schizophrenia. A- Hallucinations1. audible thoughts 2.voices heard arguing 3. voices commenting on ones action B- Thought Alienation Phenomena 4. thought withdrawal 5. thought insertion 6. thought broadcasting C- Passivity Phenomena 7. made feeling or affect 8. made impulses 9. made acts 10. somatic passivity D- Delusional Perception Etiology

Neurobiochemical Dopamine hypothesis Serotonin Glutamate

Neuroanatomical Structural cerebral abnormalities

Genetic Several genes on different chromosomes interact with environment

Non - genetic risk factors Complications of pregnancy and birth Stress

A single gene has not been identified. Research is focused on chromosomes 6, 13, 18 & 22. The risk of developing the disorder is as follows: One parent 12-15%+ Both parents 40%+ Identical twins 50%+

Viral etiologies:- Post-viral encephalitis conditions resembling schizophrenia have been reported eg with influenza, epstein-barr virus etc. Viral infection during prenatal period. Rate higher in those born in late winter coinciding with seasonal pattern of viruses.

Psychological factors:# Psychoanalytic theory- Freud postulated ego defect in schizophrenic pts. -Ego disintegration represents a return to the time when the ego was not yet or had not begun to be established. (Fixation at oral phase of development)

A/c to Harry Stake sullivan- Schizophrenia is a disturbance in interpersonal relatedness. It is a adaptive method to avoid panic, terror & disintegration of the sense of self. A/c to Ericson- Schizophrenia develops when there is fixation at the stage Trust vs mistrust. Learning theories:- A/c to this, children who later have schizophrenia learn irrational reactions & ways of thinking by imitating parents who have their own significant emotional problems. The poor IPR of persons with schizophrenia develop because of poor models for learning during childhood. Family theory: Double bind theory Marital schism & shew Psedomutual & Psedohostile families Expressed Emotion

Social theories: # Low SES # Social isolation # Social drift hypothesis

Premorbid personality: # it is suspicious, introverted, withdrawn & ecentric.

. Signs and Symptoms Diagnostic manuals: lCD-10 (International Classification of Disease, WHO) DSM-IV (Diagnostic and Statistical Manual, APA)

Clinical picture of schizophrenia is according to lCD-10, defined from the point of view of the presence and expression of primary and/or secondary symptoms (at present covered by the terms negative and positive symptoms): the negative symptoms are represented by cognitive disorders, having its origin probably in the disorders of associations of thoughts, combined with emotional blunting and small or missing production of hallucinations and delusions the positive symptom are characterized by the presence of hallucinations and delusions the division is not quite strict and lesser or greater mixture of symptoms from these two groups are possible

Negative Alogia Affective flattening Avolition-apathy Anhedoniaasociality

Positive Hallucinations Delusions Bizarre behaviour Positive formal thought disorder

Attentional impairment

Potential Early Symptoms: Pre-psychotic Withdrawn from others Depressed Anxious Phobias Obsessions and compulsions Difficulty concentrating Preoccupation with religion Preoccupation with self Positive symptoms An exaggeration of distortion of normal function Bizarre behavior Cognitive symptoms Inattention, easily distracted Impaired memory Poor problem-solving skills Poor decision-making skills

Illogical thinking Impaired judgment

Thinking Delusions: false, fixed beliefs that cannot be corrected by reasoning Ideas of reference Persecution Grandiosity Somatic sensations Jealousy Control Thought broadcasting Thought insertion Thought withdrawal Delusion of being controlled

Concrete thinking

Mood symptoms Dysphoria Suicidal ideation Hopelessness

Speech Associative looseness Neologisms Echolalia Clang association

Word salad

Perception Hallucinations: sensory perceptions for which no external stimulus exists Auditory Visual Olfactory Tactile Personal boundary difficulties

Behavior Hallucinations: sensory perceptions for which no external stimulus exists Auditory Visual Olfactory Tactile Personal boundary difficulties

Negative symptoms Affect Apathy Emotional blunting Emotional shallowness

Anergia

Anhedonia Avolition (Motor)

Increased or decreased psychomotor activity Mannerisms Stereotypes Decreased self care

Poverty of content of speech Thought blocking

Dimensions Altered in Individuals with Schizophrenia Ability to work Interpersonal relationships Self-care abilities Social functioning Quality of life

Diagnostic Criteria A. Characteristic symptoms-two or more of the following, each present for significant portion of time during a month period (or less if successfully treated): Delusions Hallucination Disorganized speech (e.g. frequent derailment or incoherence) Grossly disorganized or catatonic behavior Negative symptoms. B Social/occupational dysfunction -major areas of functioning such as work, interpersonal relations or self care are markedly below the level achieved prior to the onset.

C Duration -continuous signs of disturbance persist for at least 6 months. This period must include at least 1 month of symptoms. D Schizoaffective & Mood disorder exclusion These have been ruled out because either No major depressive, manic or mixed episodes have occurred concurrently with the active phase symptoms. If mood disorder have occurred during active phase symptoms their total duration has been brief reactive to the duration of the active & the residual periods. E Substance/general medical conditions exclusion. Types Subtypes Paranoid Catatonic Disorganized Undifferentiated Residual