Schizophrenia

schizophrenia
First affiliated hospital

Wenzhou medical university
department of psychiatry
Guo hanfeng
Eugen Bleuler
 Bleuler a Swiss
psychiatrist
 coining the term "
schizophrenia."
schizophrenia
 The word schizophrenia"splitting of the mind" and
comes from the Greek roots
 schizein " split"
 phren "mind"
 was coined byEugen Bleuler in 1908 and was inte
nded to describe the separation of function
schizophrenia
 between personality, thinking, memory, perception
.
 Bleuler described the main symptoms as 4 A's: flat
tened
 Affect,
 Autism,
 Association disorder.
 Ambivalence.
schizophrenia
 delusions and hullucinations that comes on i
n early adult life.(14year--24year)
 Chronic,relapsing course.
 Sufferers usually have episodes,
 often with more persistent social impairment
.
top five most expensive disorders in all of
medicine.
epidemiology
 Epidemiology  Characteristics
 Incidence(rate of new)  0.02% per year
 Prevalence  1 in 200 people
 Global rates  In some subgroups higher
 Social class rate e.g. black caribbeans
 Sex
 Peak age at onset
 18-25 year in man,
 20-28year in women
 Family history  1/3
symptoms
 Positive symptoms
 Hallucinations.
 seeing, hearing, tasting, smelling, or feeling

something that doesn't really exist.
 Auditory hallucinations are false senses of
sound such as hearing voices that go unheard
by others.
Positive symptoms
 Delusions.
fixed, false belief.

It can be bizarre (such as invisible aliens have entered the
room through an electric socket)
or nonbizarre (such as unwarranted jealousy or the
paranoid belief in being persecuted or watched).
 Schizophrenic formal thought disorder
Schizophrenic formal thought disorder
 The person speech lose the usual logical

flow between one idea and the next.
 Segments of speech become partly
disjointed from each other.
symptoms
 Negative symptoms
 Poor self-care
 Little spontaneous speech
 Blunted affect (mood)
 Loss of normal willpower

Negative symptoms
 They commonly include flat or blunted affect
and emotion,
 poverty of speech (alogia),
 inability to experience pleasure (anhedonia),
 lack of desire to form relationships (
asociality),
 and lack of motivation (avolition).
negative symptoms contribute
 poor quality of life,
 functional disability,
 burden on others than do positive symptoms.
 a history of poor adjustment
 response to medication is often limited.
Schneider's first-rank symptoms.
 The psychiatrist Kurt Schneider (1887–
1967) listed the forms of psychotic
symptoms that he thought distinguished
schizophrenia from other psychotic
disorders.
First-rank symptoms in
schizophrenia
 1.Auditory hallucinations
 Hearing voices conversing with one another.
 Voices heard commenting on one's actions
(hallucination of running commentary).
 Thought echo (a form of auditory hallucination
in which the patient hears his/her thoughts
spoken aloud).
schizophrenia
 2.Passivity experiences
 inwhich the individual has the experience of the
mind or body being under the influence or
control of some kind of external force or
agency; delusions of control or of being
controlled)
schizophrenia
 Thought withdrawal (the delusional belief that
thoughts have been 'taken out' of the patient's
mind)
 Thought insertion (thoughts are ascribed to other
people who are intruding into the patient's mind)
 Thought broadcasting (also called thought
diffusion)
 Delusional perception (linking a normal sensory
perception to a bizarre conclusion, e.g. seeing an
aeroplane means the patient is the president)
Schneider ： first rank symptoms
1.Thought hearing
2. Third-person hallucinations
3. Hallucinations in the form of a commentary
4. Thought withdrawal or insertion
5. Thought broadcasting /diffusion
6. Forced feeling
7. Forced impulsive
8. Forced behavior
9. Somatic passivity experience
10. Delusional perception
22
Appearance and behaviour
 Restless and agitated
 Doing unusual things
 Mannerisms
 Stereotypies
 Catatonic signs
 Abnormal movement
 Negative symptoms : poor personal hygiene and self-care,
dishevelled or unwashed.
Speech
 Loosening of associations knight’s move
thinking.schizophrenic formal thought disorder. 思
维松弛，思维破裂。
 Concrete thinking 象征性思维。 Impair of the
ability to think in abstract way.
dove-----peace %-------divorce
Mood
 Blunted affect :lost its usual
variability,unresponsive,unchanging
expression.
 Incongruous affect:giggle or smile secretively
that is inappropriate .only in schzophrenia.
情感不协调
Thought
 Ideas of reference or delusions.
 persecutory
grandiose , religious or hypochondriacal.

Primary, they arise out of the blue ,often
suddenly
extremely bizarre .
secondary as an attempt to explain pre-existing
hallucinations.
Aboormal experiences
 Hallucinations auditory visual olfactory
tactile
 Do you even to hear things when no-one is
around.
 Are they voices ?
 Do you hear them with your ears? or is in

your mind?where does the voice come from.
 How many voice are there? do they say
pleasant or unpleasant thing? how loud are
they? How ofen do they happen?
 Do the voice ever talk to each other,about
you?
 Do the voice ever say aruning commentary
on what you are doing. Do they ever echo
what you are thinking? How do you explain?
Congnitive state
 Essentially normal
 Concentration and abstract thought
deficits---acutely psychotic or chronic
negative sysptoms.
Self-appraisal
 Insight lost
 Assessing self-appraisal is essential in
determining What management approaches
are possible.
volitional behavior disorder
 abulia
Subtypes of schizophrenia base
on symptoms
 1.Paranoid type
 2.Disorganized schizophrenia, also known
as hebephrenia
 3.Catatonic type
Paranoid type:
 Delusions or auditory hallucinations are
present, but thought disorder, disorganized
behavior, or affective flattening are not.
Delusions are persecutory and/or grandiose,
but in addition to these, other themes such
as jealousy, religiosity, or somatization may
also be present.
Disorganized type:
 Named hebephrenic schizophrenia in the
ICD. Where thought disorder and flat affect
are present together. With prominent
negative symptoms and poor outcome.
Catatonic type:
 The subject may be almost immobile or
exhibit agitated, purposeless movement.
Symptoms can include catatonic stupor
and waxy flexibility.
schizoaffective
 Positive sysptoms first rank sysptoms are
combined(+) with prominent mood
disturbance manic or depressed
 Long-term outcome tends to be better than
in schizophrenia.
Delusional disorder
 Gradual onset of systematized delusion
,without hallucinations or thought disorder.
Drug-induced psychosis
 Sudden onset and resolves over a few days
after drug withdrawn.amphetamine-like
drugs,ecstasy( 摇头丸）
 Distinguish from drug-induced relapse of
Schizophrenia .
Organic psychoses
 which in most cases is some organic
disease of the brain
Onset
 23 in man,28 in woman.< 40 or > 16
 Several months,with noticeable social
withdrawal , non-specific anxiety and
change in behaviour, delusions and
hallucinations.
Causes
 Genetic and environmental.
 Risk increased 15-fold in first-degree
relative has Sch 。
 40% concordance rate in identical.
 Obstetric complications,childhood head

injury and childhood encephalitis.
Precipitating factors
 Stressful life events
 Street drug use
Maintaining factor
 Family environment.hight expressed
emotion (EE)
 Poor compliance
 Street drug use

Etiology
 Biological factors
1 ． genetics
2 ． The neurodevelopmental hypothesis
3 ． Changes in brain structure
4 ． Biochemical abnormalities
 Personality factors
 Psycho-social factors
47
dopamine hypothesis
 Overactivity of dopamine.in mesocortical.
 Clozapine is block-ade of dopamine D2
receptors
Structural brain changes
 CT and MRI :mild non-progressive
enlargement of lateral cerebral ventricles.
 Cortical grey matter and the limbic system
thalamus have slight less brain tissue.
Management
 Physical examination
 Antipsychotic drug (typical and atypical)
 Education
 Care
Maintenance after the first episode
 >2years,in severe organic psychosis
 Acute relapse need reinstatement , change
or increase drug.
Common causes of relapse
 Non-compliance with drug treatment
 Discontinuation ,reduction ,of drug.
 Street drug use
 Family stress , high expressed emotion.
 Life event
 Childbirth.
Maintenance of chronic
schizophrenia
 Clozpine for difficulty patient
 Cognitive-behaviour therapy for
hullucination and dlusions.
 Rehabilitation for negative symptoms
content
 Definition and epidemiology
 Symptoms
 Causes,onset and course
 Management
Overview
 Hallucinations,
 Delusions
 Dysfunction symptoms : apathy lack of volition.
 Begins in late adolescence and early adulthood
 Often relapse.
 After relapse dysfunction levels increasing
 A strong genetic component.

 Concordance rate in identical twins is 40%.
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Schizophrenia

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schizophrenia

First affiliated hospital

 seeing, hearing, tasting, smelling, or feeling

fixed, false belief.

 The person speech lose the usual logical

 Blunted affect (mood)

 Loss of normal willpower

grandiose , religious or hypochondriacal.

 Do you hear them with your ears? or is in

 Obstetric complications,childhood head

 Street drug use

 Street drug use

 Family stress , high expressed emotion.

 Causes,onset and course

 Dysfunction symptoms : apathy lack of volition.

 Begins in late adolescence and early adulthood

 After relapse dysfunction levels increasing

 A strong genetic component.

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