Professional Documents
Culture Documents
Epidemiology
Aetiology
1. BIOLOGICAL FACTORS
Genetic
1. BIOLOGICAL FACTORS
Neuropathology
Injuries
Infections
Substance Use
2. PSYCHOSOCIAL FACTOR
Social
Theory
Pathologic
al Family
Relationsh
ip
1.
2.
3.
.
Clinical Features
Three dimensions:
1. Negative symptoms: psychomotor
poverty- social withdrawal, poverty of
speech (alogia), restricted affect, decreased
in spontaneity in talk and movement
(avolition)
2. Positive symptoms: reality distortionhallucinations, delusions
3. Disorganized thought, speech, and behavior
Symptoms Ranking
To differentiate schizophrenia from other forms of psychosis,
Kurt Schneider listed the psychotic symptoms that are
particularly characteristic of schizophrenia.
Schneiders First Rank Symptoms (FRS):
1. Hearing thought spoken aloud/ First person hallucination
2. Third person hallucination
3. Hallucination of running commentary
4. Somatic passivity
5. Delusional perception
6. Possession of thought- thought withdrawal, insertion,
broadcast
7. Made action- Action/complex behavior of being control
1.
2.
3.
B. Social/occupational dysfunction
C. Duration: Continuous sign of illness for at
least 6 months, including 1 month active
phase
D. Exclude schizoaffective and mood
disorders
E. Exclude substance /general medical
condition
F. If history of autism or communication
disorder of childhood onset is present,
additional diagnosis of schizophrenia is
made only if prominent delusions or
hallucinations and other required
symptoms present for at least 1 month
Specify if
First episode, currently in acute episode
First episode, currently in partial remission
First episode, currently in full remission
Multiple episodes, currently in acute episode
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous
Unspecified
With catatonia
Defaulted medication
Adverse life events
Substance abuse
Living with high EE family
Subtypes of Schizophrenia
Prognosis
1.
2.
3.
4.
5.
6.
7.
8.
Early onset
Poor social support
Negative symptoms
Family history
Gradual onset
Male
Many relapses
Poor premorbid functioning
(social functioning)
1.
2.
3.
4.
5.
6.
7.
8.
Later onset
Good social support
Positive symptoms
Mood symptoms
Acute onset
Female
Few relapses
Good premorbid functioning
Management
hours/day
Augmentation
anxiolytics (benzodiazepine), mood stabilizers
1. Pharmacology
Typical neuroleptic/ antipsychotic
Atypical neuroleptic
Depot preparation
1.
2.
3.
4.
5.
2. Psychosocial Treatment
/Psychiatric Rehabilitation
Behaviour therapy
Family therapy
Group therapy
Vocational rehabilitation/ occupational
therapy
Social skill training
Psychoeducation/ health education
Cognitive remedial therapy (CRT)
Crisis support /management
Assertive community management
(ACT)
3. Others
DSM V diagnosis
Specify if
With marked stressors
The symptoms occur in response to events
Without marked stressors
The symptoms does not occur in response to
events.
With postpartum onset
Onset is during pregnancy or within 4 weeks
postpartum.
With catatonia
Management
Brief hospitalization
Supportive psychotherapy
Course of antipsychotics for
psychosis itself and/or
benzodiazepines for agitation
SCHIZOPHRENIFORM
DISORDER
Schizoaffective disorder
By wei li ;p
NUMBER 1
NUMBER 2
NUMBER 3
NUMBER 4
Criteria A for
Schizophrenia
A distinctive period of
abnormally and persistently
elevated, expansive or irritable mood
and abnormally and persistently
increased goal directed activity or
energy
lasting a least one week
Most of the day
Nearly everyday
Criteria A depression
Catatonia
Clinical picture dominated by 3 or more
1. Stupor
2. Catalepsy like stone no feel
3. Waxy flexibility like wax
4. Mutism
5. Negativism
6. Posturing
7. Mannerism
8. Stereotypy
9. Agitation not by external stimuli
10. Grimacing
11. Echolalia
12. Echopraxia
Psychotic?
Give as of schizophrenia
if needed add on some anxiolytic
Primary options
alprazolam: 0.25 mg orally (immediate-release) three times
daily initially, increase gradually according to response,
maximum 4 mg/day
OR
clonazepam: 0.25 mg orally twice daily initially, increase
gradually according to response, maximum 4 mg/day
OR
diazepam: 2-10 mg orally two to four times daily
OR
buspirone: 7.5 mg orally twice daily initially, increase
gradually according to response, maximum 60 mg/day
Antidepressant
Depressed?
Primary options
fluoxetine: 20 mg orally once daily initially, increase
gradually according to response, maximum 80 mg/day
OR
paroxetine: 20 mg orally once daily initially, increase
gradually according to response, maximum 50 mg/day
OR
citalopram: 20 mg orally once daily initially, increase
gradually according to response, maximum 40 mg/day
OR
sertraline: 50 mg orally once daily initially, increase
gradually according to response, maximum 200 mg/day
OR
mirtazapine: 15 mg orally once daily initially, increase
gradually according to response, maximum 45 mg/day
Mood stabiliser
Manic?
Primary options
lithium: 300 mg orally (immediate-release) two to three times
daily initially, increase gradually according to response and
serum drug level, maximum 2400 mg/day
OR
carbamazepine: 200 mg orally (extended-release) twice daily
initially, increase gradually according to response and serum
drug level, maximum 1600 mg/day
OR
valproate semisodium: 250 mg orally three times daily initially,
increase gradually according to response and serum drug
level, maximum 60 mg/kg/day (monitor carefully if dose >45
mg/kg/day)
OR
lamotrigine: dose may depend on what drugs a patient is
currently on; consult specialist for guidance on dose
Delusional Disorders
Prognosis
50%-full recovery
20%-reduced symptoms
30%-no change
Types of Delusional
Disorder
Erotomanic type
Delusion revolves around love. (the persons delusion is
Grandiose type
Inflated self worth (the persons delusion is the
Somatic type
Physical delusion (the persons delusion involves bodily
functions or sensations)
Persecutory type
Delusion of being persecuted (the persons delusion
Jealous type
Delusion of unfaithfulness
Mixed type
More than one of the above
Treatment
Pharmacological
Anti-psychotic medication
Non-pharmacological
Psychotherapy
Cognitive therapy
Supportive therapy
Insight-oriented therapy