PREPARED BY – TANUSREE DEY

THE WORD SCHIZOPHRENIA

WAS COINEDIN 1908 BY THE
SWISS PSYCHIATRIST EUGEN
BLEULER. IT IS DERIVED FROM
THR GREEK WORDS SKHIZO
(SPLIT) AND PHREN (MIND).
 SCHIZOPHRENIA IS A
PSYCHOTIC CONDITION
CHARACTERIZED BY A
DISTURBANCE IN THINKING,
EMOTIONS, VOLITIONS AND
FACULTIES IN THE PRESENCE OF
CLEAR CONSCIOUSNESS, WHICH
USUALLY LEADS TO SOCIAL
WITHDRAWAL
 F20-F29 SCHIZOPHRENIA, SCHIZOTYPAL AND
DELUSIONAL DISORDERS
 F20 – SCHIZOPHRENIA
 F20.0 – PARANOID SCHIZOPHRENIA
 F20.1 – HEBEPHRENIC SCHIZOPHRENIA
 F20.2 – CATATONIC SCHIZOPHRENIA
 F20.3 – UNDIFFERENTIATED SCHIZOPHRENIA
 F20.4 – POST-SCHIZOPHRENIC DEPRESSION
 F20.5 – RESIDUAL SCHIZOPHRENIA
 F20.6- SIMPLE SCHIZOPHRENIA
F21 Schizotypal disorder
F22 Persistent delusional disorders
F22.0 Delusional disorder
F22.8 Other persistent delusional disorders
F22.9 Persistent delusional disorder, unspecified
F23 Acute and transient psychotic disorders
F23.1 Acute polymorphic psychotic disorder with
symptoms of schizophrenia
F23.2 Acute schizophrenia-like psychotic disorder
F23.3 Other acute predominantly delusional
psychotic disorders
F23.8 Other acute and transient psychotic
disorders
F23.9 Acute and transient psychotic disorder,
unspecified
F24 Induced delusional disorder

F25 Schizoaffective disorders

F25.0 Schizoaffective disorder, manic type
F25.1 Schizoaffective disorder, depressive
type
F25.2 Schizoaffective disorder, mixed type
F25.8 Other schizoaffective disorders
F25.9 Schizoaffective disorder, unspecified

F28 Other nonorganic psychotic disorders

F29 Unspecified nonorganic psychosis

 Paranoid schizophrenia is characterized
mainly by delusions of persecution,
feelings of passive or active control,
feelings of intrusion, and often by
megalomanic tendencies also. The
delusions are not usually systemized too
much, without tight logical connections
and are often combined with
hallucinations of different senses, mostly
with hearing voices.
 Disturbances of affect, volition and
speech, and catatonic symptoms, are
either absent or relatively inconspicuous.
Delusions of jealousy

Delusions of
referrence

Delusions of
control
 Hebephrenic schizophrenia is characterized
by disorganized thinking with blunted and
inappropriate emotions. It begins mostly in
adolescent age, the behavior is often
bizarre. There could appear mannerisms,
grimacing, inappropriate laugh and joking,
and sudden impulsive reactions without
external stimulation. There is a tendency to
social isolation.

 Usuallythe prognosis is poor because of the

rapid development of "negative" symptoms,
particularly flattening of affect and loss of
volition. Hebephrenia should normally be
diagnosed only in adolescents or young
adults.

 Denoted also as disorganized schizophrenia

 Catatonic schizophrenia is characterized
mainly by motoric activity, which might
be strongly increased (hyperkinesis) or
decreased (stupor), or automatic
obedience and negativism.
 We recognize two forms:
 productive form — which shows catatonic
excitement, extreme and often aggressive
activity. Treatment by neuroleptics or by
electroconvulsive therapy.
 stuporose form — characterized by general
inhibition of patient’s behavior or at least by
retardation and slowness, followed often by
mutism, negativism or by stupor.
 Psychotic conditions meeting the general
diagnostic criteria for schizophrenia but not
conforming to any of the subtypes in F20.0-
F20.2, or exhibiting the features of more than
one of them without a clear predominance of a
particular set of diagnostic characteristics.

 This subgroup represents also the former

diagnosis of atypical schizophrenia.
A depressive episode, which may be
prolonged, arising in the aftermath of a
schizophrenic illness. Some schizophrenic
symptoms, either “positive” or
“negative”, must still be present but they
no longer dominate the clinical picture.
 These depressive states are associated
with an increased risk of suicide.
A chronic stage in the development
of schizophrenia with clear
succession from the initial stage
with one or more episodes
characterized by general criteria of
schizophrenia to the late stage with
long-lasting negative symptoms and
deterioration (not necessarily
irreversible).
 Simple schizophrenia is characterized by
early and slowly developing initial stage
with growing social isolation, withdrawal,
small activity, passivity, avolition and
dependence on the others.
 The patients are indifferent, without any
initiative and volition. They not expressed
the presence of hallucinations and
delusions.
 According to lCD-10 this disorder is
characterized by eccentric behavior
and by deviations of thinking and
affectivity, which are similar to that
occurring in schizophrenia, but
without psychotic features and
expressed symptoms of
schizophrenia of any type.
 Includes a variety of disorders in which
long-standing delusions constitute the
only, or the most conspicious, clinical
characteristic and which cannot be
classified as organic, schizophrenic or
affective.
 Their origin is probably heterogeneous,
but it seems, that there is some relation
to schizophrenia.
A disorder characterized by the
development of one delusion or of the
group of similar related delusions, which
are persisting unusually long, very often
for the whole life.
 Other psychopathological symptoms —
hallucinations, disturbance of thoughts
etc. are not present and are excluding
this diagnosis.
 It begins usually in the middle age.
 Thecriteria should be the following
features:
 acute beginning (to two weeks)
 presence of typical symptoms (quickly
changing “polymorphic symptoms”)
 presence of typical schizophrenic symptoms.

 Complete recovery usually occurs within a

few months, often within a few weeks or
even days.
 Thedisorder may or may not be
associated with acute stress, defined as
usually stressful events preceding the
onset by one to two weeks.
 A delusional disorder shared by two or more
people with close emotional links. Only one of
the people suffers from a genuine psychotic
disorder; the delusions are induced in the
other(s) and usually disappear when the people
are separated.

 The psychotic disorder of the dominant member

of this type is mainly, but not necessarily, of
schizophrenic type. The original delusions of
dominant member and his partner are usually
chronic.
 Episodic disorders in which both affective
and schizophrenic symptoms are
prominent (during the same episode of
the illness or at least during few days) but
which do not justify a diagnosis of either
schizophrenia or depressive or manic
episodes.
 Patients suffering from periodic
schizoaffective disorders, especially with
manic symptoms, have usually good
prognosis with full remissions without any
remaining defects.
A - BIOLOGICAL THEORIES
 i. BIOCHEMICAL THEORIES
 Ii. NEUROSTRUCTURAL THEORIES
 Iii. GENETIC THEORIES
 iv. PERINATAL RISK FACTOR
 B – PSYCHODYNAMIC THEORIES
 i. DEVELOPMENTAL TNEORIES
 Ii. FAMILY THEORIES
 C – VULNARABILITY STRESS MODEL
 D – SOCIAL FACTORS
EUGENE BLEULER CITED SYMPTOMS REFFERED
TO AS BLEULER’S 4 A’s’ THEY ARE FOLLOWING
–
 AFFECTIVE DISTURBANCE
 AUTISTIC THINKING
 AMBIVALENCE
 ASSOCIATIVE LOOSENESS
POSITIVE SYMPTOMS NEGATIVE SYMPTOMS
 DELUSIONS  AFFECTIVE
 HALLUCINATIONS FLATTENING OR
 EXCITEMENT OR
BLUNTING
AGITATION  AVOLITION - APATHY

 HOSTILITY  ATTENTIONAL

 AGGRESSIVE
IMPAIRMENT
BEHAVIOR  ANHEDONIA

 SUSPICIOUSNESS  ALOGIA

 IDEAS OF
REFFERENCE
 POSSIBLE SUICIDAL
TENDENCIES
THOUGHT AND SPEECH DISORDER –
 AUTISTICTHINKING
 LOOSENING OF ASSOCIATIONS
 THOUGHT BLOCKING
 NEOLOGISM
 POVERTY OF SPEECH
 POVERTY OF IDEATION
 ECHOLALIA
 DELUSIONS OF VARIOUS KIND
DISORDERS OF PERCEPTION –
 AUDITORY AND VISUAL HALLUCINATIONS

DISORDER OF AFFECT –
 APATHY
 EMOTIONAL BLUNTING
 ANHEDONIA
 INAPPROPRIATE EMOTIONAL RESPONSE

DISORDER OF MOTOR BEHAVIOR –

 THERE CAN BE EITHER AN INCREASE OR DECREASE IN
PSYCHOMOTOR ACTIVITY
 MANNERISMS
 GRIMACING
 DECREASE SELFCARE
 POOR GROOMING
OTHER FEATURES –
 DECREASE FUNCTIONING IN WORK, SOCIAL
RELATIONS AND SELF-CARE
 LOSS OF EGO BOUNDARIES
 LOSS OF INSIGHT
 POOR JUDGEMENT
 SUICIDE CAN OCCUR
A. PHARMACHOTHERAPY –
 ATYPICAL ANTIPSYCHOTICS – CLOZAPINE,
RISPERIDONE, OLANZAPINE, QUETIAPINE,
ZIPRASIDONE
 ANTIDEPPESANTS
 MOOD STABILIZERS
 BENZODIAZEPINES
B. ECT
C. PSYCHOLOGICAL THERAPIES –
 GROUP THERAPY
 BEHAVIOR THERAPY
 SOCIAL SKILL TRAINING
 COGNITIVE THERAPY
 FAMILY THERAPY
D. PSYCHOSOCIAL REHABILITATION
 OBSERVE BEHAVIOR PATTERN, POSTURING,
PSYCHOMOTOR DISTURBANCE, APPEARANCE,
HYGIENE
 IDENTIFY THE TYPE OF DISTURBANCE THE
PATIENT IS EXPERIENCING
 NOTE THE EFFECT AND EMOTIONAL TONE OF
THE PATIENT
 ASSESS FOR CONTENT OF DELUSIONAL
THINKING
 ASSESS FOR ABILITY TO PERFORM SELF-CARE
ACTIVITY
 DETERMINE ANY SUICIDAL INTENT OR RECENT
ATTEMPTS THAT MAY HAVE BEEN MADE.
 DISTURBED THOUGHT PRECESS RELATED TO
INABILITY TO TRUST, PANIC ANXIETY,
POSSIBLE HEREDITARY OR BIOCHEMICAL
FACTORS EVIDENCED BY DELUSIONAL
THINKING, EXTREME SUSPICIOUSNESS OF
OTHERS.

 INEFFECTIVE HEALTH MAINTENANCE RELATED

TO INABILIYU TO TRUST, EXTREME
SUSPICIOUSNESS EVIDENCED BY POOR DIET
INTAKE, INADEQUATE FOOD AND FLUID
INTAKE, DIFFICULTY IN FALLING ASLEEP.
 SELF-CAREDEFICIT RELATESD TO
WITHDRAWAL, REGRESSION, PANIC
ANXIETY,INABILITY TO TRUST EVIDENCED BY
DIFFICULTY IN CARRYING OUT TASKS
ASSOCIATED WITH HYGIENE, DRESSING,
GROOMING, EATING, SLEEPING AND
TOILETING

 POTENTIALFOR VIOLENCE SELF DIRECTED OR

AT OTHER RELATED TOCOMMAND
HALLUCINATIONS EVIDENCED BY PHYSICAL
VIOLENCE, DESTRUCTION OF OBJECTS IN THE
ENVIRONMENT OR SELF-DESTRUCTIVE
BEHAVIOR
 RISKFOR LIFE-THREATENING INJURY RELATED TO
COMMAND HALLUCINATIONS EVIDENCED BY
SUICIDAL IDEAS, PLANS OR ATTEMPTS.

 SOCIALISOLATION RELATED TO INABILITY TO

TRUST, PANIC ANXIETY, DELUSIONAL THINKING,
EVIDENCED BY WITHDRAWAL, SAD, DULL AFFECT,
EXPRESSION OF FEELING OF REJECTION OF
ALONENESS IMPOSED BY OTHERS