Schizophrenia

By: Dr Taher Abdelraheem

Professor of Psychiatry
Sohag University
Schizophrenia (Latin word) means:

Schiz =Split & Phrenia=mind.

It differs from split (multiple)

personality.
1)defeintion:
A group of disorders characterized by :

1-Positive symptoms (added) delusions, hallucinations

and agitation.

2-Negative symptoms (subtracted) affective flattening,

social withdrawal, apathy,

poverty of thought and content of speech.

2)Epidemiology:

1-Lifetime prevalence: 1 %.

2-Age:

The peak ages of onset :

Males: 10 to 25 .

Females: 25 to 35

3-Gender: Equal.
3)Aetiology:
I-Genetic Factors:
Child with one parent with schizophrenia (12%)

Child of two parents with schizophrenia (40%)

Dizygotic twin of a schizophrenia patient (12%)

Monozygotic twin of a schizophrenia patient (47%)

II-Biochemical theories:
Dopamine Hypothesis:

Dopaminergic hyperactivity, proved by:

Efficacy of dopamine receptor antagonists .

I. DSM-IV-TR Diagnostic Criteria for Schizophrenia:

A-Characteristic symptoms:

Two (or more) of the following.

1-Delusions

2-Hallucinations

3-Disorganized speech
4-Disorganized or catatonic behavior

5-Negative symptoms, i.e., affective flattening, a logia, or a volition

B-Social/occupational dysfunction

C- Duration:

At least 6 months.
d) Schizoaffective and mood disorder
exclusion.

e) Substance/general medical
condition exclusion
II-Diagnostic Criteria for
Schizophrenia Subtypes:

a)Paranoid type
i- Delusions.

ii-Frequent auditory hallucinations.

b) Disorganized type

i-Disorganized speech.

ii-Disorganized behavior.

iii-Flat or inappropriate affect.

c) Catatonic type (At least two of the following):

1-Motoric immobility (waxy flexibility).

2-Excessive motor activity (excitement).

3- Negativism

maintenance of a rigid posture against attempts to be

moved).
4- Stupor.

5- Mutism.

6-Echopraxia.

.Automatic obedience-7
d) Undifferentiated type
The criteria are not met for the

Paranoid,

Disorganized,

or Catatonic type.
e) Residual type

A)Absence of

prominent delusions,

hallucinations,

disorganized speech,

and grossly disorganized or catatonic behavior.

Clinical picture
Paranoid Type

Mainly delusions of persecution or grandeur .

Later age of onset (late 20s or 30s ).

Patients are typically tense, suspicious, and sometimes

aggressive.
Disorganized Type

Marked regression of

Emotional responses and

Social behavior (loudly laughing without reason)

Abnormal behavior.

Earlier age of onset: before 25.

3. Catatonic Type

Catatonic stupor mutism,

Negativism and echopraxia.

Automatic obedience.

Bizarre posturing, waxy flexibility and rigidity .

Catatonic excitement
4. Undifferentiated Type

Not meet the criteria of paranoid, disorganized, or catatonic

type.

5. Residual Type

Absence of a complete set of active symptoms

 Mental Status Examination

I- Appearance:

Screaming, agitation or immobility (catatonia)

Poorly grooming, fail to bathe,

Dress much too warmly for the prevailing temperatures

II-Behavior :

Violent (usually in response to hallucinations).

Or catatonic behavior (waxy flexibility and echopraxia).

III-Mood and Affect :

Reduced emotional response (Flat or blunted affect).

Or inappropriate emotions
IV-Perceptual Disturbances:

i-Hallucinations

Auditory :the most common hallucinations.

ii-Illusions:

False perception of an existing stimulus.

V-Thought:

i-Thought Content

Delusions of persecution, grandiosity, or somatic delusions.

ii- Form of Thought:

loose associations,

circumstantiality,

neologisms
iii-Thought stream:

Flight of ideas.

Thought blocking.

Poverty of thought content.

iv-Thought control:

Thought broadcasting, insertion or withdrawal.

VI-Sensorium and Cognition:

Orientation

Oriented to person, time, and place.

Disorientation→ medical or neurological brain disorder.

VII-Judgment and Insight:

Poor judgment and insight.

:Pharmacologic treatment of schizophrenia

Antipsychotics

Typical Antipsychotics: (since 1960)

Chlorpromazine(neurozine)

Fluphenazine → Modicate

Haloperidol (safinace)
A typical antipsychotics

.i-Risperidone

.ii-Olanzapine

.iii-Clozapine

.iv-Qutiapine

.v-Aripeprazole
Thank you