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SCHIZOPHRENIA

SCHIZOPHRENIA. History. Emil Kraeplin - dementia precox Eugen Bleuler - schizophrenia 4A’s : associational disturbances affective disturbances ambivalence autism - Secondary Symptoms: hallucinations & delusions. Other Theorists:

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SCHIZOPHRENIA

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  1. SCHIZOPHRENIA

  2. History • Emil Kraeplin - dementia precox • Eugen Bleuler - schizophrenia • 4A’s : associational disturbances affective disturbances ambivalence autism - Secondary Symptoms: hallucinations & delusions

  3. Other Theorists: • Adolf Meyer - founder of psychobiology; schizophrenic reaction • Harry Stack Sullivan - founder of interpersonal psychoanalytic school; social isolation • Gabriel Langfeldt - 2 groups: with true schizophrenia & schizophreniform psychosis • Kurt Schneider - first rank symptoms

  4. Epidemiology • Lifetime prevalence (US) = 0.6 - 1.9% • Annual incidence of 0.5 - 5.0 per 10,000 • Age & Sex: M=F • M: early onset (15-25 yrs), > (-) sxs • F: peak onset=25-35 yrs, better outcome • 90% of cases - between 15-55 years old • Onset before 10yrs & after 50 yrs=rare

  5. Medical Illness • Have higher mortality rate from accidents and natural causes • 80% - have significant concurrent medical illness

  6. 3. Suicide - 50% attempt suicide 50% attempt suicide 10-15% die by suicide M=F, likelihood to commit suicide Major risk factors: (+) depressive sxs, young age, high levels of premorbid functioning

  7. 4. Associated Substance Use & Abuse cigarette smoking substance abuse 5. Cultural and Socioeconomic Consideration a. Downward Drift Hypothesis b. Social Causation Hypothesis

  8. Etiology • Stress-Diathesis Model • Biological Factors - limbic system, basal ganglia, frontal cortex • Dopamine Hypothesis - too much dopaminergic activity • Other Neurotransmitters • 5HT • NE • Amino Acids

  9. Neuropathology • Limbic system • Basal ganglia • Brain Imaging - CT scan, MRI • EEG

  10. 3. Genetics 4. Psychosocial Factors a. Psychoanalytic theories b. Psychodynamic theories c. Expressed emotions (EE) 5. Social Theories

  11. Diagnosis • DSM IV SUBTYPES • Paranoid type • Disorganized/Hebephrenic type • Catatonic type • Undifferentiated type • Residual type • Type I : (+) symptoms, N brain structures on CT scan, good response to tx Type II: (-) symptoms, structural brain abN, poor response to tx

  12. Clinical Features • History is important • Symptoms change with time • Premorbid sxs : schizoid or schizotypal personalities • Consider px’s educational level, intellectual ability and cultural background

  13. Mental Status Examination • General Description : broad • Mood, Feelings, Affect : secondary depression or post-psychotic depression; flat or blunted affect • Perceptual disturbances : hallucinations, illusions

  14. 4. Thought : content - delusions form of thought thought process 5. Impulsiveness, suicide, homicide 6. Sensorium & Cognition : intact 7. Judgment & Insight ; poor 8. Reliability : poor

  15. Differential Diagnosis • Secondary & Substance-Induced Pscyhotic Do • Malingering & Factitious DO • Other Psychotic Dos • Mood DO • Personality DO

  16. Course and Prognosis • Course : retrospective recognition of symptoms • Each relapseof psychosis is followed by a further deterioration in the px’s baseline functioning • Exacerbations and remissions • (+) symptoms tend to become less severe with time, (-) symptoms may increase in severity

  17. Prognosis : • Study : 10-20% good outcome >50% poor outcome • Literature - range of recovery rate= 10-60% 20-30% lead normal lives 20-30% moderate sxs 40-60% significantly impaired

  18. Treatment • CONSIDERATIONS • Unique individual, familial, social, psychological profile • Environmental and psychological factors • Complex disorder

  19. Hospitalizations • Indications: diagnostic purposes stabilization on medications patient safety grossly disorganized or inappropriate behavior

  20. Somatic Treatment • Antipsychotic/Neuroleptics • Dopamine-Receptor antagonist • Remoxipride • Risperidone • Clozapine

  21. Therapeutic Principles • Define target symptoms to be treated • AP that worked in the past should be used for the patient again • Minimum length of an AP trial = 4-6 wks • Use of monopharmacology • Maintain on lowest possible effective dosage

  22. 2. Psychosocial Treatment • Behavior therapy • Family-oriented therapy • Group therapy • Individual psychotherapy

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