Early Detection of Psychoses and Schizophrenia

in Primary Health Service and It’s Management

Mahar Agusno
Learning objective:

 After learning this lecture it is expected that

the student will understand
 How to detect psychoses and schizophrenia in the
earliest phase
 provide prompt management

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Introduction

 Epidemiology
 In 2000 WHO found the prevalence and incidence of
schizophrenia to be roughly similar
(24 million  2011).
 Male 1.4 x female
 Onzet in male 25 y, female 27 y
 Occurs at similar rates worldwide
 It causes +1% of worldwide disability & resulted in 20,000
deaths in 2010.

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Problem
 Most of major mental disorders known by the family after 1 y, seek
treatment to healers first and go to mental hospitals after their
condition becomes chronic (+ 4-5 y)
 There are too many neglected chronic psychotic ill people
 Case of psychotic patient who was placed in chained still many due to
some reasons including:
 Difficult to access mental health services
 Family collapse (economic and affective) especially after the 3 rd
hospitalization

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 This woman has been lived in pasung for 20 y (Jember, Rabu, 27 April 2011)

Estimation people live in pasung in Indonesia 200.000

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Impact of failure of mental health service 
failure of mental health education/training

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 Burden of life due to mental disorders measured with DALY
(disability-adjusted life years ) in Indonesia in 2000 about
12,3%, higher than burden of life due to ischemic heart
disease, CVD, and tuberculosis (WHO & World Bank 1996)

 Understanding of the community to psychotic or major mental

disorders is stigmatized.
 Stigma  mentally ill people are brought to the healer

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 Primary care for mental health promotes
respect of human rights:
 Mental health services delivered in primary
care minimize stigma and discrimination.
 They also remove the risk of human rights
violations that often occur in mental hospital
hospitals.

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Problem
Progression of Schizophrenia

Risk factors-----Prodromal phase ----------------- aktive phase-- remisision---aktive phase ------------residual & depression phase

 Schizophrenia and psychoses started with prodromal

phase -- active and remissions and and end with residual
phase.
  Health personel in primary care should be
competence in case finding & holding in prodrome phase
 Prodromal phase can be lasted for years before active
phase before active phase when patient was brought to
medical profession gg Skizofrenia & psikotik
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Prodromal phase of Schizophrenia

 Isn’t always recognisable. Schizophrenia is usually very

difficult to detect in its early stages before the
hallucinating or exhibiting of odd behaviour.
 Prodromal schizophrenia usually occurs one to two years
before the onset of psychotic symptoms.
 There aren’t any specific symptoms, people usually have
during this stage but anxiety, difficulty making decisions,
social isolation, attention and concentration problems and
decrease cognitive function, are what people usually report
to have started with.


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Problem
Types of groups in prodromal schizophrenia:

 Problems with perception, communication and unusual

thoughts that get progressively worse.
 Experience regular but not consistent psychotic
thoughts.
 Have a sibling, child or parent with schizotypal
personality disorder. Have had substantial declines
in work, school, relationships, or general
functionality in daily life.

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Schizophrenia have early warning signs:

 Extreme reaction to criticism

 Social withdrawal
 Deterioration of personal hygiene
 Forgetful; unable to concentrate
 Oversleeping or insomnia
 Flat, expressionless gaze
 Depression
 Inability to cry or express joy
 Inappropriate laughter or crying
 Odd or irrational statements
 Hostility or suspiciousness
 Strange use of words or way of speaking

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Treatment

 Treatment in the early stage of schizophrenia is

important to prevent poor outcome
 Pharmacotherapy: low dosage of anti psychotic
 Non Pharmacotherapy: supportif therapy, maintenance
therapeutic environment

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

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