1. SCHIZOPHRENIA-IN A NUTSHELL
• What is Schizophrenia?
• What are positive and negative symptoms?
• What is Crowe’s classification of
Schizophrenia?

2. Key points – a brief history
• Schizophrenia was first clearly identified in the 1890s.
• Its characteristic features were an early onset and a
chronic course.
• Kraepelin described two characteristic
psychopathological processes.
• Bleuler introduced the concept of primary and
secondary symptoms.
• Who coined the word Schizophrenia?
• What are the 4 As of Bleuler?
.

3. Schneider’s first-rank symptoms of
schizophrenia
• Thought insertion, withdrawal or broadcasting : The experience of one’s thoughts
being put into or taken out of one’s head, or broadcast to others. Collectively
known as ‘thought interference’
• Passivity experiences :Experience that one’s thoughts or actions are physically
being controlled by an external force: ‘made actions’
• Delusional perception :A normal perception followed suddenly by a seemingly
unrelated, fully formed delusion
• Echo de la pensée: Hallucination of a voice repeating one’s own thoughts Rare
• Running commentary Hallucination describing one’s current actions
• Third-person auditory hallucinations Voices describing patient as ‘he’ or ‘she’
• What is hallucination?
• What is delusion?

4. Well-established predictors of
Good outcome Poor outcome
outcome
Demographic Female • Married • Male • Single • developed
developing country country
Genetic Family history of mood Family history of schizophrenia
disorder Symptoms
Onset: Acute onset , Life event at Slow onset • Long duration of
onset untreated psychosis • Onset
under 17 years old
Psychosocial • Good response to treatment High expressed emotion •
• Substance misuse • Poor
Prompt treatment adherence to treatment
symptoms Good Schizoid traits • Negative
• premorbid adjustment symptoms • Obsessions •

5. Key points – genetics
Having a close relative with schizophrenia increases one’s own risk 15-fold.
Identical twins show a 45% concordance rate.
Individual vulnerability genes exist. Genes are each of small effect and act additively.
So far, 4– 6 susceptibility genes have been identified(neuregulin-1&dysbindin), some
of which also predispose to bipolar disorder. There are likely to be 15– 20 genes in all.
VCFS-22q11 deletion 1 copy(25%)
What are the prognostic factors in Schizophrenia?
What are the diagnostic criteria?
What are the types?
What are the genes causing Schizophrenia?(VCFS?)

6. Key points – developmental
theories and environmental
factors
• Early neurodevelopmental, non-genetic risk factors exist for schizophrenia.
• Birth complications increase the child’s risk of schizophrenia in later life
fourfold.
• Psychosocial risk factors are being re-established as important risk factors.
• Cannabis use appears to increase the risk of schizophrenia as well as
relapse.
• Evidence for specific gene– environment interactions is beginning to
emerge.
• Winter Births
• Post Viral
• Migration
• urbanization
• Faulty parenting-(Schism and skewed)
• What is the etiology of Schizophrenia?
• What are the risk factors for Schizophrenia?

7. Key points – neurochemistry
• The dopamine hypothesis remains the major neurochemical
hypothesis of schizophrenia.
• Positive symptoms are hypothesized to be due to increased activity
of the mesolimbic dopamine pathway.
• Negative symptoms are hypothesized to be due to decreased
activity of the mesocortical dopamine pathway.
• Altered glutamate activity may be involved in the pathophysiology
of negative and positive symptoms and cognitive impairments.
• Disturbances in the cholinergic and GABAergic systems have been
hypothesized to underlie cognitive impairments in schizophrenia.
• What are the neurochemicals implicated in Schizophrenia?
• What are the neural pathways implicated in Schizophrenia?
• .

8. Key points – pharmacological
treatment
• The depot forms of conventional and second-generation antipsychotics are useful
for patients who are non-adherent to their medications.
• Clozapine is the only second-generation antipsychotic that is effective for positive
symptoms resistant to conventional antipsychotics.
• Second-generation antipsychotics other than clozapine have become the first-line
treatments for acute psychotic episodes and maintenance therapy.
• Conventional and second-generation antipsychotics are relatively effective for
treating secondary, but not primary, negative symptoms.
• Conventional antipsychotics have limited effects on the cognitive impairments of
schizophrenia.
• Second-generation antipsychotics may have modest benefits for multiple cognitive
processes.
• Typical antipsychotics-DA(Se: EPS)
• Atypical antipsychotics-SDAs(Se: Metabolic syndrome)
• What are the drugs used to treat Schizophrenia?
• What are depot injections?

9. Key points – psychosocial interventions
and non-drug treatments
• Family interventions are known to be effective in reducing
relapse.
• Cognitive-behavioural therapy (CBT) in addition to drug
treatment reduces persistent positive symptoms. CBT can
also abort relapses if targeted at early signs.
• Motivational intervention techniques can reduce street
drug use and enhance treatment compliance.
• Compliance therapy
• Vocational Rehabilitation
• Cognitive remediation reduces some cognitive deficits in
chronic schizophrenia.
• What are the non pharmacological ways of managing
Schizophrenia?

10. Key points – early intervention
Duration of untreated psychosis is usually 3– 6 months.
The longer the delay in treatment the worse the clinical
outcome.
Early detection has been shown to be possible.
Second-generation drugs are preferred.
Treatment of prodromal cases with cognitive-behavioural
or drug therapy may prevent or delay schizophrenia.
What is the importance of Duration of Untreated
psychosis?