Schizophrenia

SCHIZOPHRENIASCHIZOPHRENIA

HISTORY OF HISTORY OF SCHIZOPHRENIASCHIZOPHRENIA

The word "schizophrenia" is less than The word "schizophrenia" is less than 100 years old. However the disease 100 years old. However the disease was first identified as a discrete was first identified as a discrete mental illness by Dr. mental illness by Dr. Emile Emile KraepelinKraepelin in the 1887 and the illness itself is in the 1887 and the illness itself is generally believed to have generally believed to have accompanied mankind through its accompanied mankind through its history. history.


Written documents that identify Written documents that identify Schizophrenia can be traced to the old Schizophrenia can be traced to the old Pharaonic Egypt, as far back as the second Pharaonic Egypt, as far back as the second millennium before Christ. Depression, millennium before Christ. Depression, dementia, as well as thought disturbances dementia, as well as thought disturbances that are typical in schizophrenia are that are typical in schizophrenia are described in detail in the Book of Hearts. described in detail in the Book of Hearts. The Heart and the mind seem to have been The Heart and the mind seem to have been synonymous in ancient Egypt. The physical synonymous in ancient Egypt. The physical illnesses were regarded as symptoms of illnesses were regarded as symptoms of the heart and the uterus and originating the heart and the uterus and originating from the blood vessels or from purulence, from the blood vessels or from purulence, fecal matter, a poison or demons. fecal matter, a poison or demons.


At one point, all people who were considered At one point, all people who were considered "abnormal," whether due to mental illness, "abnormal," whether due to mental illness, mental retardation, or physical deformities, mental retardation, or physical deformities, were largely treated the same. Early were largely treated the same. Early theories supposed that mental disorders theories supposed that mental disorders were caused by evil possession of the body, were caused by evil possession of the body, and the appropriate treatment was then and the appropriate treatment was then exorcising these demons, through various exorcising these demons, through various means, ranging from innocuous treatments, means, ranging from innocuous treatments, such as exposing the patient to certain such as exposing the patient to certain types of music, to dangerous and sometimes types of music, to dangerous and sometimes deadly means, such as releasing the evil deadly means, such as releasing the evil spirits by drilling holes in the patient's skull. spirits by drilling holes in the patient's skull.


One of the first to classify the mental One of the first to classify the mental disorders into different categories disorders into different categories was the German physician, was the German physician, Emile Emile KraepelinKraepelin. Dr. Kraepelin used the . Dr. Kraepelin used the term "dementia praecox" for term "dementia praecox" for individuals who had symptoms that individuals who had symptoms that we now associate with schizophrenia. we now associate with schizophrenia.


The Swiss psychiatrist, Eugen Bleuler, The Swiss psychiatrist, Eugen Bleuler, coined the term, "schizophrenia" in 1911. coined the term, "schizophrenia" in 1911. He was also the first to describe the He was also the first to describe the symptoms as "positive" or "negative." symptoms as "positive" or "negative." Bleuler changed the name to schizophrenia Bleuler changed the name to schizophrenia as it was obvious that Krapelin's name was as it was obvious that Krapelin's name was misleading as the illness was not a misleading as the illness was not a dementia (it did not always lead to mental dementia (it did not always lead to mental deterioration) and could sometimes occur deterioration) and could sometimes occur late as well as early in life. late as well as early in life.

HISTORY OF HISTORY OF SCHZOPHRENIASCHZOPHRENIA

The word "schizophrenia" comes The word "schizophrenia" comes from the Greek roots schizo (split) from the Greek roots schizo (split) and phrene (mind) to describe the and phrene (mind) to describe the fragmented thinking of people with fragmented thinking of people with the disorder. His term was not meant the disorder. His term was not meant to convey the idea of split or multiple to convey the idea of split or multiple personality. personality.


Henri laborit used chlorpromazine as Henri laborit used chlorpromazine as anesthetic in his surgical cases.anesthetic in his surgical cases.

Laborit goaded his brother-in-law, Laborit goaded his brother-in-law, Pierre Deniker, a psychiatrist who Pierre Deniker, a psychiatrist who used it in his patients.used it in his patients.

Chlorpromazine was the first Chlorpromazine was the first antipsychotic approved by the antipsychotic approved by the USFDA in 1954 for mental illness USFDA in 1954 for mental illness

FACTS ABOUT FACTS ABOUT SCHIZOPHRENIASCHIZOPHRENIA

About 150 of every 100,000 About 150 of every 100,000 persons will develop persons will develop schizophrenia. schizophrenia.

Schizophrenia affects men and Schizophrenia affects men and women equally women equally

About 1% of the population About 1% of the population suffers from schizophrenia. suffers from schizophrenia.

About 75% of patients developed About 75% of patients developed schizophrenia between the ages schizophrenia between the ages of 15-25. of 15-25.

SYMPTOMSSYMPTOMS

Changes in work performance Changes in work performance Disordered thinking Disordered thinking Talking in nonsense Talking in nonsense Hallucinations and delusions Hallucinations and delusions Unusual perceptions Unusual perceptions Changes in social relationships Changes in social relationships

PSYCHOSOCIAL FACTORSPSYCHOSOCIAL FACTORS Life/Health Changes:Life/Health Changes: Environmental effects, such as viral Environmental effects, such as viral

infections that changed the body’s chemistry or a highly stressful infections that changed the body’s chemistry or a highly stressful situation, may trigger susceptibility to the illness. situation, may trigger susceptibility to the illness.

Family History:Family History: There is an 8-18% chance of children, with one There is an 8-18% chance of children, with one parent who is schizophrenic, to develop the illness. In children parent who is schizophrenic, to develop the illness. In children with two parents who are schizophrenic, there is a 15-50% risk. with two parents who are schizophrenic, there is a 15-50% risk.

Genetics: Genetics: Genetic combinations could result in a person not Genetic combinations could result in a person not having certain enzymes or fully developed nerves; both of which having certain enzymes or fully developed nerves; both of which could lead to the illness. could lead to the illness.

Developmental Problems:Developmental Problems: In some schizophrenic patients, the In some schizophrenic patients, the prefrontal cortex in the brain may have developed abnormally, prefrontal cortex in the brain may have developed abnormally, thus leading to the disturbances in thought patterns. thus leading to the disturbances in thought patterns.

Illness:Illness: Autoimmune illness and viral infections may combine with Autoimmune illness and viral infections may combine with genetics to cause schizophrenia. genetics to cause schizophrenia.

Medication:Medication: Use of medication may interfere with the brain’s Use of medication may interfere with the brain’s production of dopamine. Schizophrenia sufferers may be extra production of dopamine. Schizophrenia sufferers may be extra sensitive to dopamine, or may produce too much of it. sensitive to dopamine, or may produce too much of it.

Coronal MR scans from a normal comparison subject (left), and chronic schizophrenic (right). Note increase in CSF in right amygdala-hippocampal complex. (image courtesy of Harvard University Schizophrenia Project

Variability maps are similar in both groups with highest variability in the posterior horns (NC = normal controls, SZ = schizophrenic patients). Increases in LH ventricle length and volume were determined. The color bar encodes the root mean square magnitude of variability in millimeters

Displacement maps show the magnitude of displacement (mm) between schizophrenic patients and normal controls as represented by the color bar for the lateral ventricles and corpus callosum. A significant vertical displacement of the lateral ventricles in schizophrenic patients reflects a bilateral increase in ventricular volume, and corresponds to the displacement of the corpus callosum

Mapping Brain Tissue Loss in Adolescents with Schizophrenia. This map reveals the 3-dimensional profile of gray matter loss in the brains of teenagers with early-onset schizophrenia, with a region of greatest loss in the temporal and frontal brain regions that control memory, hearing, motor functions, and attention. Using novel image analysis algorithms, dramatic reductions in the profiles of gray matter were detected, based on a database of 96 images from schizophrenic patients scanned repeatedly with MRI. The parallel extraction of anatomical models from all patients in the image database required 60 CPU hours, when running in parallel on an SGI RealityMonster with 32 internal CPUs. [Image by Paul Thompson, Christine Vidal, Judy Rapoport, and Arthur Toga].

Value of Early Diagnosis Value of Early Diagnosis and Treatment in and Treatment in

SchizophreniaSchizophrenia Patients with long DUP (delayed untreated psychosis) had a Patients with long DUP (delayed untreated psychosis) had a

worse outcome regarding the severity level of positive worse outcome regarding the severity level of positive symptoms, of general symptoms and social disability symptoms, of general symptoms and social disability

Longer DUP results partly from a pattern of symptoms and Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and social functioning which reduces concern by the sufferer and relevant others. DUP's relationship to outcome is strongest in relevant others. DUP's relationship to outcome is strongest in the initial months of psychosis. This has implications for the initial months of psychosis. This has implications for targeting early intervention.targeting early intervention.

Earlier diagnosis of schizophrenia improves results of Earlier diagnosis of schizophrenia improves results of treatmenttreatment

The DUP prior to first psychiatric admission adversely affects The DUP prior to first psychiatric admission adversely affects the long-term outcome in schizophrenia. The findings the long-term outcome in schizophrenia. The findings underline the importance of establishing health service underline the importance of establishing health service programs for early detection and treatment of schizophrenic programs for early detection and treatment of schizophrenic patients with the aim to shorten the DUP and to consequently patients with the aim to shorten the DUP and to consequently improve the course and outcome of schizophrenic patients.improve the course and outcome of schizophrenic patients.

SYMPTOMS OF SYMPTOMS OF SCHIZOPHRENIASCHIZOPHRENIA

HALLUCINATIONSHALLUCINATIONS BIZARRE DELUSIONSBIZARRE DELUSIONS DISORGANIZED SPEECHDISORGANIZED SPEECH GROSSLY DISORGANIZED BEHAVIOR GROSSLY DISORGANIZED BEHAVIOR

OR CATATONIC BEHAVIOROR CATATONIC BEHAVIOR NEGATIVE SYMPTOMSNEGATIVE SYMPTOMS

TYPES OF SCHIZOPHRENIATYPES OF SCHIZOPHRENIA Paranoid schizophreniaParanoid schizophrenia a person feels extremely a person feels extremely

suspicious, persecuted, grandiose, or experiences suspicious, persecuted, grandiose, or experiences a combination of these emotions. a combination of these emotions.

Disorganized schizophreniaDisorganized schizophrenia a person is often a person is often incoherent but may not have delusions. incoherent but may not have delusions.

Catatonic schizophreniaCatatonic schizophrenia a person is withdrawn, a person is withdrawn, mute, negative and often assumes very unusual mute, negative and often assumes very unusual postures. postures.

Residual schizophreniaResidual schizophrenia a person is no longer a person is no longer delusion or hallucinating, but has no motivation delusion or hallucinating, but has no motivation or interest in life. These symptoms can be most or interest in life. These symptoms can be most devastating. devastating.

POSITIVE vs NEGATIVE SYMPTOMSPOSITIVE vs NEGATIVE SYMPTOMS

POSITIVEPOSITIVE– HallucinationsHallucinations– DelusionsDelusions– Disorganized Disorganized

thinkingthinking– agitationagitation

NEGATIVE NEGATIVE SYMPTOMSSYMPTOMS– LACK OF DRIVELACK OF DRIVE– SOCIAL SOCIAL

WITHDRAWALWITHDRAWAL– APATHYAPATHY– EMOTIONAL EMOTIONAL

UNRESPONSIVENESUNRESPONSIVENESSS

DISORGANIZED TYPE OF SCHIZOPHRENIA

CATATONIC SCHIZOPHRENIA

Schizophrenia

Health & Medicine

Transcript of Schizophrenia