Professional Documents
Culture Documents
Department of psychology
The first affiliated hospital of ZZU
Huirong guo
Preface
♦ schizophrenia is much the most difficult
to define and describe
over the past 100 years, many widely divergent
concepts of schizophrenia have been held in
different countries by different psychiatrists
Radical differences of opinion persist to the
present day
Preface
♦ a simple comparison between two basic
concepts-acute schizophrenia and chronic
schizophrenia
in acute schizophrenia the predominant clinical
features are delusions, hallucinations and interference
with thinking. Features of this kind are often called
’positive’ symptoms
the main features of chronic schizophrenia are apathy,
lack of drive, slowness, and social withdrawal. These
features are often called ‘negative’ symptoms
Epidemiology
♦ The lifetime prevalence of schizophrenia is
usually estimated to be between 0.5% and
1%
♦ Incidence rates are considerably lower than
prevalence rates and are estimated to be
approximately 1 per 10,000 per year
Etiology
♦ Genetics
♦ Neurological abnormalities
♦ Biochemistry and
psychopharmacological factors
♦ Psychosocial factors
Genetics -Family studies
Paranoid schizophrenia
Undifferentiated schizophrenia
(1) Conditions meeting the general symptom
criteria of schizophrenia with marked positive
psychotic symptoms;
(2) The clinical feature does not satisfy the full
criteria of any of the subtypes mentioned above;
(3) This type is also called mixed type or
unclassified type
Treatment
♦ Antipsychotic drugs
Treatment of acute schizophrenia
Treatment after the acute phase
Interaction of maintenance treatment
and social treatment
ECT
Antipsychotic drugs
♦ Treatment of acute schizophrenia
The effectiveness of antipsychotic medication in
the treatment of acute schizophrenia has been
established by several well-controlled, doubled-
blind studies( the NIMH collaborative project (Cole et
al. 1964) compared chlorpromazine, fluphenazine, and
thioridazine with placebo. Three-quarters of the patients
receiving antipsychotic treatment for six weeks
improved, whatever the drug, whilst a half of those
receiving placebo worsened )
Antipsychotic drugs
Treatment of acute schizophrenia
Drug treatment has most effect on the positive
symptoms of schizophrenia, such as hallucinations
and delusions, and least effect on the negative
symptoms
The various antipsychotic drugs do not differ in
therapeutic effectiveness, although their side-
effects vary
Antipsychotic drugs
♦ Treatment after the acute phase
It has also become clear that some chronic
schizophrenics do not respond even to long-term
medication, and that others remain well without drugs
Since long-continued antipsychotic madication may
lead to irreversible dyskinesias, it is important to
known how long such treatment needs to be given
Hogarty and Ulrich (1977) reported that, over a three-
year period, maintenance anti-psychotic medication
was 2.5 to 3 times better than the placebo in
preventing relapses of schizophrenia, depot injections
are more successful than continued oral medication
Antipsychotic drugs
♦ Treatment after the acute phase
Schooler et al. (1980) found that depot injections
offered no such advantage
Davis et al (1980), in the long-term management of
schizophrenia there is no difference in the usefulness
of the various antipsychotic drugs available
Interaction of maintenance
treatment and social treatment
♦ Since both medication and social casework
appear effective in the management of
schizophrenia, it is reasonable to enquire
whether the two kinds of treatment interact
Hogarty et al. (1974) studied the use of ‘major role
therapy’ (i.e. social casework) with and without
drugs. Given alone, social casework had only a small
effect in reducing relapse rate; combined with
medication, it had a larger effect
Interaction of maintenance
treatment and social treatment
♦ In a study of the effect of adding day
hospital treatment to continued medication,
Linn et al (1980) found that day care
conferred extra benefit on patients when it
was of low intensity and based on
occupational therapy, but not when it
included more active treatments such as
group therapy
ECT
In the treatment of schizophrenia, the
indications for ECT are catatonic stupor
and severe depressive symptoms
accompanying schizophrenia. The effects
ECT are often rapid and striking in both
these conditions
Some clinical cases
A 31-year-old male vocational nurse