What is schizophrenia?

 Schizophrenia is a psychotic disorder characterized by

withdrawal from reality, illogical patterns of thinking,
delusions, and hallucinations, and accompanied in varying
degrees by other emotional, behavioral, or intellectual
disturbances. Schizophrenia is associated with dopamine
imbalances in the brain and may have an underlying genetic
cause.
 History of schizophrenia

 The word Schizophrenia  was coined by Eugen Bleuler in

1908, and was intended to describe the separation of
function between personality, thinking, memory and 
perception.
 One of the first to classify the mental disorders into
different categories was the German physician, 
Emile Kraepelin.
 Prevalence of schizophrenia
Affects nearly 1% of the entire population of the world

Late adolescence and early adulthood are peak

years for the onset of schizophrenia.
 Signs and symptoms

The most common early warning signs of

schizophrenia are:

•Social withdrawal
•Hostility or suspiciousness
•Deterioration of personal hygiene
•Flat, expressionless gaze
•Inability to cry or express joy
•Inappropriate laughter or crying
•Depression
•Strange use of words or way of speaking
Schizophrenic symptoms are classified as positive symptoms and
negative symptoms.
Positive symptom include:
•Hallucinations
Hallucination essentially is seeing, hearing, tasting, feeling,
or smelling something that is not there.
•Delusions
Persecutory Delusions: His/her boss is spying on them and
has installed secret’s camera’s.
•Delusion of Control: Aliens are controlling his/her
thoughts and him/her have no control over them.
Thought disorder
Neologisms :I got so angry I picked up a dish and threw it
at the geshinker.
 Negative symptoms:

•Lack of emotion - the inability to enjoy regular activities

(visiting with friends, etc.) as much as before.
•Low energy - the person tends to sit around and sleep much
more than normal
•Social isolation - person spends most of the day alone or only
with close family
•Alogia (difficulty or inability to speak)
 The Causes of Schizophrenia
Genetic causes of schizophrenia

While schizophrenia runs in families, about 60% of schizophrenics have no

family members with the disorder.

Environmental causes of schizophrenia

•Prenatal exposure to a viral infection
•Low oxygen levels during birth (from prolonged labor or premature birth)
•Exposure to a virus during infancy
•Early parental loss or separation
•Physical or sexual abuse in childhood

Brain chemical imbalances(Dopamine and glutamate)

The dopamine hypothesis
Dopamine is a neurotransmitter in the brain and has many functions including
important roles in behaviour and cognition, voluntary movement, motivation,
reward, sleep, mood, attention and learning.
Significant Loss of Brain Gray Matter

It moved across the brain like a

forest fire, destroying more
tissue as the disease progressed

Professor Paul Thompson,

UCLA
Schizophrenia Prevention tactics:
Information for Teens: How to Lower Your Risk for Schizophrenia

Don't use street drugs, and moderate any use of alcohol

Make an ongoing effort to develop your social skills as much as you can
Avoid social isolation
Make an ongoing effort to maintain friendships with adults
Make an extra effort to learn positive perspectives on the world
Make extra effort to learn how to deal with stress and anxiety
Seek Help from Qualified Psychologists and Psychiatrists if you have
problems coping

Relationship & Family Environment Factors

Build a relationship, or marry, a person with whom you can have a stable,
loving and (mostly) low-stress relationship
Make an extra effort to resolve differences. Learn conflict resolution skills
Treatment
Psychotherapy
Cognitive behavioural therapy(CBT) is used to target specific
symptoms and improve related issues such as self esteem, social
functioning, and insight.

Medications
Antipsychotics
The first, chlorpromazine, was developed as a surgical anaesthetic. It
was first used on psychiatric patients because of its powerful calming
effect.
 Classification of antipsychotics

Antipsychotics are into two groups:

•Typical or first generation antipsychotic. Eg:Haloperidol

•Atypical or second generation antipsychotic. Eg: olanzapine,
quetiapine.

•Dosage forms:
All are generally taken orally.
Often injected when refused in serious patients.

Haloperidol :Tablets: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg

Risperidone :Tablets: 0.25, 0.5, 1, 2, 3 and 4 mg.
Olanzapine: Tablets: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg and 20 mg
Side effects

•Tardive dyskinesia (involuntary jerking and facial

grimacing)
• Dystonia (involuntary muscle contractions that can
interfere with talking and eating).
•Other common side effects:
Dizziness
Irritability
Sedation
Insomnia
weight gain
increased appetite
low blood pressure
impaired judgment, thinking, and motor skills
impaired responses to senses
Seizure
The mechanism of action of Antipsychotics
Case study
•A 74-year-old man diagnosed with Parkinson's disease.
•L-Dopa (400 mg/day) and pramipexole (4 mg/day).
•He responded well to treatment but later developed dyskinesias.
•wherefore a treatment with amantadine (200 mg/day) was initiated.
He then rapidly developed severe delusions.
•Pramipexole and amantadine were stopped and quetiapine (125
mg/day) was added to the drug regimen, which led to marked
improvement of the mental state.
•However, motor symptoms became worse.

Conclusion
•Dopamine plays a key role in causing schizophrenic symptoms.
 Survey
Hiranandani hospital powai, and two private clinics in khar and santacruz.
Materials and Methods
Name three anti-psychotics most commonly prescribed by you and their
average dose.
In what percentage of cases do you prescribe typical anti-psychotics?
In what percentage of cases do you concurrently prescribe more than one anti-
psychotic?
•The three most commonly prescribed anti-psychotics were risperidone,
olanzapine, and haloperidol.
•In about 22% of the cases the psychiatrists used more than one anti-
psychotic in the same patient
•Our survey suggests that most of the psychiatrists are comfortable with
using the atypical anti-psychotic in most of their patients.
Limitations
It is important to consider the limitations of this survey. It included the
opinions of only 3 psychiatrists. Considering that there are about 3500
psychiatrists in India, this survey does not reflect the true prescription
pattern of all the psychiatrists in India.
Conclusion

•Schizophrenia is a complex disorder.

•Schizophrenia is an extensively investigated mental illness that is still
widely misunderstood.
• Its origins and mechanisms of action are continually being
investigated, providing mountains of research and almost as many
theories.
•Though antipsychotics are widely criticized for its side effects, it has
helped in reducing symptoms in many patients.

Hopefully, in the future, we will have learned to control, or even

eradicate, this devastating illness that cripples so many of our friends
and family members. Only experimentation and research will provide the
answer.