Schizophrenia

Schizo = Splitting
Phrenia = Mind

Definition
• Thought disorder that impairs judgement, behavior & ability to interpret reality which symptoms
present for at least 6 months

Incidence
• Incidence: 1%
• Schizophrenia patients commit suicide: 10%

Most common

Gender Male Female

Age 15 – 25 y/o 25 – 35
Young adult Adult

History
• Hallucination – Most common: Auditory
• Delusions – Most common: Bizarre
• Disorganized speech
• Disorganized behavior
• Catatonic behavior
• Negative symptoms
• Social & occupational dysfunction

MSE
• Saccadic eye movements
• Hypervigilance -  anxiety

Investigation

Brain Imaging Result

CT scan • Lateral & 3rd ventricular enlargement
•  Cortical volume – a/w presence of negative
symptoms, neuropsychiatric impairment, 
neurological sign, poor premorbid adjustment
MRI •  cerebral vertical
PET scan • Hypoactivity of frontal lobe
• Hyperactivity of basal ganglia

Positive symptoms (Psychotic symptoms)

Positive symptoms = New features
• Delusions – false belief that strongly believe by patient & make patient not to change his mind, even if
there is evidence against it
» Control
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• Hallucinations – sensation that not there
» Vision
» Auditory
• Disorganized speech – Word salad
• Disorganized behavior – Bizarre, no purpose behavior
» Ex wearing a sweat shirt under a hot sun
• Catatonic behavior – Movement & posture
» Reluctant to move

Negative symptoms = Reduction or removal of normal process , Ex :  Emotion or Loss of interest

** These symptoms respond poorly to traditional anti-psychotic (ex haloperidol) but respond well to
“atypical” agents (ex risperidone, olanzapine, aripiprazole, paliperidone, quetiapine, or ziprasidone)
(Secrets)
• Flat affect – Inappropriate response
• Anhedonia
• Alogia – poverty of speech
• Avolition –  Motivation to do something
• Poor attention

Cognitive symptoms – memory, learning, understanding

• Need specific test

Phases of schizophrenia

Prodromal phase
• Withdrawn

Active
• Severe symptoms

Residual phase
• Cognitive symptoms

Diagnosis (DSM V)

Need at least 1
• Delusions
• Hallucinations
• Disorganized speech
2 out of following
• Delusions
• Hallucinations
• Disorganized speech
 • Disorganized behavior
• Negative symptoms
Ongoing for 6 months
Not another condition – ex drug abuse

Causes
• Unknown  Theory: Dopamine + Abnormal serotonin level
• Genetic
• Autoimmune
• Prenatal infection

Most common
• Gender : Male

Treatment
• Antipsychotic medication
• Multidisciplinary
» Therapy

Features of schizophrenia that suggest poor prognosis (Not respond to treatment)

• Poor premorbid functioning (most important)
• Family history of schizophrenia
• Early onset
• Negative symptoms
• No triggering factor
• Poor support system
• Marital status : Single, divorced or widowed

Good prognosis
• Good premorbid functioning (most important)
• Family history of mood disorder
• Late onset
• Positive symptoms
• Has triggering factor
• Good support system
• Marital status : Married

Differential diagnosis
• Substance induced
• Epilepsy
• Other psychotic disorder – Schizoaffective disorder, Brief reactive psychosis, delusional disorder
• Mood disorder
• Medical – HIV, corticosteroid, tumor
• Personality disorder
Reference
• Osmosis
• USMLE Step 2 Secrets