PGMI ABADILLA ANGELA MARIE

SCHIZOPHRENIA SPECTRUM
AND OTHER PSYCHOTIC
DISORDERS
SCHIZOPHRENIA
 “Schizophrenia” was first used in  one of the most common
1910 by Swiss psychiatrist of the severe mental
Eugene Blueler. “splitting of the
mind.”
disorders
  schizophrenia is one of the
Early physicians to distinguish
four main categories of mental top 25 leading causes of
illness: frenzy, mania, disability
melancholy, and fatuity
(foolishness).
 19th century Emil Kraepelin
(1856–1926) dementia praecox
was characterized by early onset
of symptoms followed by a
progressive course culminating
in dementia
EPIDEMIOLOGY
INCIDENCE AND PREVALENCE
 Lifetime prevalence of
schizophrenia – 1%
 0.05% of total population –
treated for schizophrenia in
1 yr
 Only half of all the patients
obtain treatment
GENDER AND AGE
 equally prevalent in men
and women
 Onset: early in men
 More than half of all male
schizophrenia patients,
only one-third of all female
schizophrenia patients -
first admitted to a
psychiatric hospital before
age 25 years
GENDER AND AGE

 Peak age of onset:  Rare: before age 10 and

10 to 25 years for men after 60 years
25 to 35 years for women  Late onset: after age 45
 3-10% women – disease
onset after age 40
 90% of patients in
treatment for
schizophrenia are between
15 and 55 years old
REPRODUCTIVE FACTORS MEDICAL ILLNESS
 Persons with schizophrenia
 First degree biological have a higher mortality rate
relatives of persons with from accidents and natural
schizophrenia have a ten causes than the general
times greater risk for population
 Several studies have shown
developing the disease
than the general that up to 80 percent of all
population. schizophrenia patients have
significant concurrent medical
illnesses and that up to 50
percent of these conditions
may be undiagnosed.
INFECTION AND BIRTH SEASON
 more likely to have been
born in the winter and early
spring
 studies show that the
frequency of schizophrenia
is increased after exposure
to influenza – winter,
during 2nd trimester of
pregnancy
SUBSTANCE ABUSE
 Substance abuse is
common in schizophrenia
 lifetime prevalence of any
drug abuse - >50%
 lifetime prevalence of
alcohol – 40%

RACE AND RELIGION
 Jews are affected less often
than Protestants and
Catholics, and prevalence
is higher in non-white
populations.
SOCIOECONOMIC AND CULTURAL
FACTORS
 begins early in life;
 causes significant and long-
lasting impairments
 makes heavy demands for
hospital care; and requires
ongoing clinical care,
rehabilitation, and support
services, the financial cost
of the illness is estimated
to exceed
BIOCHEMICAL FACTORS

DOPAMINE HYPOTHESIS SEROTONIN

 Schizophrenia results  Serotonin excess as a cause of

from too much
dopaminergic activity  The robust serotonin
 Excessive dopamine
release in patients with
schizophrenia has been
linked to the severity of
positive psychotic
symptoms
both positive and negative
symptoms in schizophrenia
antagonist activity of
clozapine and other second-
generation antipsychotics
coupled with the effectiveness
of clozapine to decrease
positive symptoms in chronic
patients has contributed to the
validity of this proposition.
NOREPINEPHRINE GABA
 Anhedonia—the impaired  Some patients with
capacity for emotional schizophrenia have a loss
gratification and the of GABAergic neurons in
decreased ability to the hippocampus
experience pleasure  GABA has a regulatory
 A selective neuronal
effect on dopamine
degeneration within the activity, and the loss of
norepinephrine reward inhibitory GABAergic
neural system could neurons could lead to the
account for this aspect of
hyperactivity of
schizophrenic
dopaminergic neurons.
symptomatology
NEUROPEPTIDES GLUTAMATE

 Substance P and  Glutamate has been

neurotensin, are
localized with the
catecholamine and
indolamine
neurotransmitters and
influence the action of
these neurotransmitters
implicated because
ingestion of
phencyclidine, a
glutamate antagonist,
produces an acute
syndrome similar to
schizophrenia
ACETYLCHOLINE AND
NICOTINE
 Postmortem studies in
schizophrenia have
demonstrated decreased
muscarinic and nicotinic
receptors in the caudate-
putamen, hippocampus, and
selected regions of the prefrontal
cortex

 These receptors play a role in

the regulation of
neurotransmitter systems
involved in cognition, which is
impaired in schizophrenia
THE CLINICAL PRESENTATION
 No clinical sign or  The appearance of a
symptom is patient with
pathognomonic for schizophrenia can
schizophrenia range from that of a
 every sign or symptom completely disheveled,
seen in schizophrenia screaming, agitated
occurs in other person to an
psychiatric and obsessively groomed,
neurologic disorders completely silent, and
immobile person.
  Other odd behaviors
 poorly groomed, fail to
bathe, and dress too include tics,
warmly for the stereotypies,
prevailing mannerisms, and,
temperatures. occasionally,
echopraxia, in which
patients imitate the
posture or the behavior
of the examiner.
  Neurologic signs and
Localizing and
nonlocalizing neurologic symptoms correlates with
signs are more common in increased severity of
patients with illness, affective blunting,
schizophrenia than in and a poor prognosis.
 Abnormal neurologic signs
other psychiatric patients
 Nonlocalizing signs include include tics, stereotypies,
dysdiadochokinesia, grimacing, impaired fine
astereognosis, primitive motor skills, abnormal
reflexes, and diminished motor tone, and abnormal
dexterity. movements
 schizophrenia have an
elevated blink rate
DIAGNOSIS
 based on observation and
description of the patient
 Abnormalities are often
present on most
components of the
mental status
examination.
 No pathognomonic signs
or symptoms.
TYPES
SUBTYPES FROM PREVIOUS
CATATONIC TYPE VERSIONS OF DSM
 The classic feature of the  Previous versions of the
catatonic type is a marked DSM described subtypes of
disturbance in motor schizophrenia based
function; this disturbance predominantly on the
may involve stupor, clinical features.
negativism, rigidity,  These were: paranoid,
excitement, or posturing. disorganized, catatonic,
undifferentiated, and
residual subtype. DSM-5 no
longer includes these.
TREATMENT
 antipsychotic
medications are the
mainstay of the
treatment for
schizophrenia
 Psychosocial
intervention
TREATMENT

ANTIPSYCHOTIC

 first-generation dopamine  Typical antipsychotics, or

receptor antagonists and dopamine receptor
the second-generation antagonists
agents such as serotonin–  High-potency agents are
dopamine antagonists such more likely to cause
as risperidone and extrapyramidal side effects
clozapine. such as akathisia, acute
dystonia, and
pseudoparkinsonism
Biological Therapies

PSYCHOSOCIAL THERAPIES
 Social Skills Training
 Family-Oriented Therapies
 Case Management
 Assertive Community Treatment
 Group Therapy
 Cognitive Behavioral Therapy
 Individual Psychotherapy
 Personal Therapy
 Dialectical Behavior Therapy
 Vocational Therapy
 Art Therapy
 Cognitive Training
Schizophreniform disorder
 By definition, patients
with schizophreniform
disorder have the
symptoms for at least
a month and return to
their baseline state
within 6 months
 Better prognosis
TREATMENT FOR
SCHIZOPHRENIFORM
 Recurrent episode –
give prophylaxis
 Psychotic symptoms
can usually be treated
by 3-6 months of
antipsychotic drugs
 Psychotherapy
Brief psychotic disorder
 psychotic condition
that involves the
sudden onset of
psychotic symptoms
 lasts 1 day or more but
less than 1 month
 Brief psychotic
disorder is an acute
and transient psychotic
syndrome.
Schizoaffective disorder
 Mood symptoms  Better prognosis than
develop concurrently
Schizophrenia and
with symptoms of
worse than mood
schizophrenia, but
disorder
delusions or
hallucinations must be
present for 2 weeks in
the absence of
prominent mood
symptoms during some
phase of the illness.
TREATMENT FOR SCHIZOAFFECTIVE
DISORDER
 Mood stabilizers are a  Maintenance: dosage
mainstay of treatment can be reduced to a low
for bipolar disorders to middle range to
and schizoaffective avoid adverse effects
disorder and potential effects
 carbamazepine was on organ systems
superior for
schizoaffective
disorder
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