Schizophrenia Treatment

1. SCHIZOPHRENIA
Dr. Prasanna Prabhakar Khatawkar
M.B.B.S., D.P.M., F.A.G.E., D.N.B. (Psychiatry)
Consultant Psychiatrist
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2. HISTORY
• Emil Kraepelin : Manic Depressive Psychosis Vs.
Dementia Praecox.
• Eugen Bleuler : Schizophrenia (1911)
(Splitting of mind).
4 ‘As’- Abnormal Association.
Autism
Abnormal Affect
Ambivalence
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3. HISTORY ( cont’d )
• Thomas Szasz : Anti-Psychiatry.
“Schizophrenia is myth enabling the
society to handle deviant behaviors”.
• Non-disease Models : The societal reaction
theory “ A sane reaction to insane world”
• Kurt Schneider (1959) : First rank
symptoms.
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4. EPIDEMIOLGY
• Affects approximately 0.85 % of world’s
population.
• Incidence : 15-20 per one lack population
• Prevalence : 0.5-1.0 %
• Lifetime risk : 0.9 %
• Median age of onset : Males –28 years.
Females – 32 years.
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5. EPIDEMIOLGY ( cont’d )
• Increased incidence in-
- Lower socioeconomic class.
- In patients with H/O perinatal
injuries.
- Left handed individuals.
- In individuals with winter
births
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6. AETIOLOGY
• Genetic Theories
• Biochemical Theories.
• Family Theories.
• Social Theories.
• Psychological Theories.
• Neurological Structural abnormalities.
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7. GENETIC THEORIES
• Clustering seen in Families :
• Relationship with Pt. :
Parents
Siblings
Child of schizophrenic
Child of two schizophrenics
• Prevalence
5 %
10 %
14 %
46 %
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8. GENETIC STUDIES
• Twin studies - MZ : DZ Ratio 42% : 9%
• Adoption studies also prove the genetic
basis of the illness.
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9. BIOCHEMICAL STUDIES
• Dopamine over activity seen in Mesolimbic
pathway.
• Serotonin hyperactivity and hypo-activity ,
both have been discussed.
• Lack of evidence to support involvement of
other neurotransmitter systems.
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10. FAMILY THEORIES
• Double – bind theory (Bateson et al.) –
Parents convey two or more conflicting
messages.
• Marital skew and schism (Lidz et al.) –
Skew - Overprotective, intrusive parents.
Schism – Hostility between parents.
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11. FAMILY THEORIES ( cont’d )
• Life events and Expressed emotions
(Vaughn and Leff ) –
Hostility
Over involvement
Critical comments
Excessive warmth in emotions.
Spending > 35 hours in high EE
environment
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12. PSYCHOLOGICAL THEORIES
• Over-inclusive thought process (Cameron )-
Normal boundaries of concepts cannot be
maintained.
• Concrete thinking (Goldstein) – Inability to
think in abstract terms.
• Defective filter (Broadbent) – Inability to
filter out unnecessary sensory input.
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13. PSYCHOLOGICAL THEORIES (cont’d)
• Cognitive and linguistic deficits –
Information processing in controlled,
conscious tasks is impaired.
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14. NEUROLOGICAL STRUCTURAL
ABNORMALITIES
• Increased ventricular size.
• Increased periventricular fibrillary gliosis
(on postmortem).
• Associated various ‘soft’ signs ie.
Dysgraphaesthesia, gait abnormalities,
clumsiness etc. )
• Impaired dominant lobe functions.
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15. NEUROLOGICAL STRUCTURAL
ABNORMALITIES ( cont’d )
• Abnormal smooth eye pursuit tracking
patterns.
• Non-specific abnormalities on EEG and
evoked potentials.
• Non-specific biochemical changes in CSF
suggestive of viral infection and
immunological abnormalities.
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16. DIAGNOSIS (ICD-10)
• A. Thought alienation phenomenon.
• B. Delusion of control, passivity, delusional
perception.
• C. First and third person auditory
hallucinations.
• D. Bizarre delusions.
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17. DIAGNOSIS (ICD-10) – (cont’d )
• E. Hallucinations in other modalities.
• F. Thought block.
• G. Catatonic symptoms.
• H. Negative symptoms – apathy,paucity of
speech, blunting of affect, incongruity of
emotional response, social withdrawal
etc.
• I. Personality deterioration.
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18. TYPES OF SCHIZOPHRENIA
• Paranoid Schizophrenia
• Hebephrenic Schizophrenia
• Catatonic Schizophrenia
• Undifferentiated Schizophrenia
• Residual Schizophrenia
• Simple Schizophrenia
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19. HALLUCINATION
• Definition :
Hallucination is a false perception in
absence of adequate stimulation ,which is
not a sensory distortion or misinterpretation
but which occurs at the same time like as a
real perception.
It should be substantial,occurring in
objective space, clearly delineated, constant
and independent of will.
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20. DELUSION
• Definition :
False belief based on incorrect inferences of
external reality that is firmly held despite
objective and obvious contradictory
evidence or proof and despite the fact that
other members of community do not share
the belief.
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21. FORMAL THOUGHT DISORDERS
• Derailment
• Tangentiality
• Incoherence
• Loss of goal
• Metonyms
• Neologisms
• Flight of ideas
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22. FORMAL THOUGHT DISORDERS (cont’d )
• Circumstantiality
• Persevaration
• Thought block
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23. MANAGEMENT
• Somatic treatment methods :
- Pharmacological methods.
- MECT
• Non-pharmacological treatment methods.
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24. PHARMACOLOGICAL TREATMENT
• Antipsychotics
• Classification :
• Phenothiazines –
Aliphatic side chain – eg. Chlorpromazine
Piperazines – eg. Trifluoperazine
Piperadines – eg. Thioridazine
• Thioxanthenes - eg.Thiothixene
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25. PHARMACOLOGICAL TREATMENT
(cont’d )
• Dibenzoxapine - eg. Loxapine
• Dihydroindole - eg. Molindone
• Butrophenones – eg. Haloperidol
• Diphenylbutylpiperadine - eg. Pimozide
• Dibenzodiazepine - eg. Clozapine
• Dibenzothiazapine - eg. Quetiapine
• Benzisoxazole - eg. Risperidone
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26. PHARMACOLOGICAL TREATMENT
(cont’d )
• Thienobenzodiazepine - eg. Olanzapine
• Benzisothiazolyl Piperazine - eg.
Ziprasidone
• Benzamides - eg. Sulpiride
• Others – eg. Clopenthixole,
Sertindole
Zotepine
• DSS - eg. Aripierazole
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27. MODIFIED ELECTROCONVULSIVE THERAPY
• MECT
• ‘Modified’ means given under general
anesthesia
• Used in schizophrenia for acute agitation,
catatonic symptoms, presence of some
associated affective symptoms.
• Not important on management of chronic
cases.
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28. NON-PHARMACOLOGICAL TREATMENTS
• Psychological treatments
• Social treatments
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29. PSYCHOLOGICAL TREATMENT
• Social Skills Training
• Supportive therapy
• Counseling
• Token economy
• Cognitive – Behavioural Therapy
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30. PROGNOSIS
• 5 years prognosis ( with treatment )
55 % - Chronic course
45 % - Acute, improving course
49 % - Self- supporting
11 % - Chronically hospitalized
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31. THANK YOU
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