Ms. RITIKA SONI ASSOCIATE PROFESSOR SNC, SHIMLA

1. SCHIZOPHERENIA
By: Ms. Ritika

3. INTRODUCTION:
Schizophrenia is a mental illness often
characterized by abnormal social behavior,
that:
- affects how a person thinks,
- feels and behaves.
The person finds it difficult to tell the
difference between real and imagined
experiences, to think logically, to express
feelings, or to behave appropriately.

4.  Discovered by Emil Kraepelin in 1896.
Called it- dementia praecox(Deterioration, early onset)
- Major depressive illness
He recognized the characteristics features of dementia praecox
Delusion
Hallucination
Disturbances of affect
Motor disturbances
● Eugen Bleuler (1911) – Swiss psychiatrist Called it Schizophrenia.
the word was derived from the Greek ‘skhizo’(split)and ‘phren’
(mind) meaning splitting of mind.
Recognized that schizophrenia consisted of a group of disorders
rather than a distinct identity.

5. Bleuler gave:
4 fundamental symptoms(4 A’s)
-Ambivalence
- Autism
- Affect disturbances
- Association disturbances
Accessory symptoms
- delusion
- hallucination
- negativism

6.  Kurt Schneider(1959)-also was influential on Schneider’s
First Rank symptoms(SFRS)
 Hallucinations
- Audible thoughts( 1st degree)
- voices heard arguing with in a group (2nd degree)
- voices commenting on one’s action(3rd degree)
 Thought alienation phenomenon
- thought withdrawal
- thought insertion
- thought broadcasting
 Passivity phenomenon
- made feelings
- made impulses and volition
 Delusional perception

7.  F20-F29- Schizophrenia, schizotypal and
delusional disorders.
F20.0– Paranoid
F20.1- Hebephrenic
F20.2- Catatonic
F20.3- Undifferentiated
F20.4- Post- schizopherenic depression
F20.5- Residual
F20.6- Simple
F20.7- other

8.  F21- Schizotypal
 F22-persistent delusional disorders
 F23- Acute and Transient psychotic disorders
 F24- Induced delusional disorders
 F25- Schizoaffective disorders
 F26- Other non-organic psychotic disorders
 F29- Unspecified

9.  Schizophrenia are characterized in general by
fundamental and characteristic distortion of
thinking, perception and by an inappropriate
affect. Delusion may affect thoughts and actions
that are often bizarre. Hallucinations, especially
auditory are common. Mood is often shallow.
Ambivalence may appear.
Acc. to ICD-10.
 It is a group of psychiatric symptoms
(syndrome) characterized by disturbance in
thinking, behavior, mood, gross distortion of
reality, withdrawal from social interaction,
disorganization and fragmentation of perception,
emotions.
Acc. To APA

10.  OCCURRENCE: occur in all types of society
and places. Prevalence rate varies from .3-
1%.
 Age: rare in childhood, age varies between
15-45 yrs.
 Gender ratio: incidence in males and female
is almost same.
 Social class: reviewed literature showed that
the incidence of schizophrenia is higher in
lower socioeconomic status group rather
than upper socioeconomic group.

11. PHASES
PREMORBID
PRODRO
MAL
ACTIVE
PSYCHOTIC
RESIDUAL

12.  BIOLOGICAL INFLUENCES:
Genetics: Studies shows that relatives of
individuals with schizophrenia have a much
higher probability of developing a disease rather
than general population.
Twin studies: the rate of schizophrenia among
monozygotic twins is four times that of dizygotic
twins.
Adoption studies: acc to investigators, children
who were born to mothers with schizophrenia
were more likely to develop the illness.
studies also indicate that children born to non-
schizophrenic parents, but reared by parents
affected with illness, do not seem to suffer from
schizophrenia.

13.  BIO-CHEMICAL INFLUENCES:
THE DOPAMINE HYPOTHESIS: This theory
suggest that schizophrenia may be caused by
an excess of dopamine-dependent neuronal
activity in the brain. This excess activity may
be related to increased production of
dopamine.
Pharmacological support for this
hypothesis exists. Amphetamines, which
increases level of dopamine, induce
psychotic symptoms.
Postmortem studies of brain of schizophrenic
individuals have reported a significant
increase in the average no. of dopamine
receptors.

14.  OTHER BIOCHEMICAL HYPOTHESIS:
Abnormalities in the neurotransmitters
norepinepherine, serotonin, acetylcholine,
GABA etc.
 PHYSIOLOGICAL INFLUENCES:A no. of physical
factors have been identified.
VIRAL INFECTION: Acc. To Sadock and Sadock:
an increased no. of physical anomalies at
birth, an increased rate of pregnancy, birth
complications, seasonality of birth consistent
with viral infection, seasonality of
complications.

15.  ANATOMICAL ABNORMALITY:
Structural brain abnormalities have been observed
in individuals with schizophrenia.
Ventricular enlargement
Sulci enlargement
Cerebellar atrophy
Intracranial atrophy
 HISTOLOGICAL CHANGES:
observed through microscopic level.
A ‘disordering’ of the pyramidal cells in the area
of hippocampus.
Alteration in hippocampal cells occur during 2nd
trimester of pregnancy due to influenza virus.

16.  PHYSICAL CONDITIONS:
Schizophrenia and epilepsy
Huntington’s disease
Birth trauma
Head injury in adulthood
Alcohol abuse
Cerebral tumor
CVA
 PSYCHOLOGICAL INFLUENCES:
Family relationship factors
Dysfunctional family system

17.  ENVIORNMENTAL INFLUENCES:
 Sociocultural factors:
Schizophrenia among lower socioeconomic
classes
Poverty
 Stressful life events:
 Other Psychological factors:
Impaired ego functioning
Mother infant relationship
Pathological communication
Vitamin deficiency theory: Vit B1, B6, B12,Vit. C

18.  THE DYNAMICS OF SCHIZOPHRENIA USING THE
TRANSACTIONAL MODEL OF
STRESS/ADAPTATION

19.  Precipitating factors
Predisposing factor
Genetic influences: family H/O schizophrenia
biochemical alterations
birth defects
Past experiences: prenatal exposure to
viral infection.
Existing conditions: abnormal brain structure
physical conditions-
epilepsy, brain tumor,
inadequate coping skills

20. cognitive appraisal
Primary appraisal( perceived threat to self concept)
secondary appraisal
Quality of response
Adaptive Maladaptive
Initial psychotic
episodes or
exacerbation of
symptoms
Hallucination Inapp. Affect
Delusion Apathy
social isolation and violence Autism

22. 1. PARANOID
SCHIZOPHRENIA:
The onset is insidious occur later in life.
The course is usually progressive in
nature. This type of schizophrenia is
characterized by extreme
suspiciousness. This type is having
following clinical features:
● Delusion of persecution,
reference, grandeur, control.
● Hallucinations are usually
have a persecutory or
grandiose.
● Stress will usually increase

23. Characterized by following clinical features :
● Disorganized thought process, incoherence,
loosening of association, delusion and
hallucinations are frequently changed.
● Emotionally disturbances
Example: Laughing at a funeral uncontrollably.
● Mannerism
‘Mirror Gazing’(for long periods of times)
Poor physical appearance
Hard to communicate with others.
Difficulty forming complete sentences because
of disorganized thoughts.
Worst prognosis
Sometimes trouble completing simple tasks

24.  catatonic excitement:
 increase psychomotor
activities
 Increase in speech production
 Stuporous catatonia:
 Extreme retardation of
psychomotor activities
 Delusion, hallucination are
usually present but are
usually not prominent.
 Catatonic signs
 Mixed

25. 4. UNDIFFERENTIATED:
● When symptoms are not
specific enough to fit into
one category/type
 When features of no
subtypes are fully present
5. SIMPLE SCHIZOPHRENIA:
It is difficult to diagnose. It is
characterized by :
- -ve symptoms
- vague hypochondriac
symptoms
- delusion and
hallucinations are
usually absent

26. 6. POST- SCHIZOPHRENIC DEPRESSION:
Schizophrenic patients develop depressive features with
in 12 months of an acute phase of schizophrenia.
7. ONEIROID SCHIZOPHRENIA:
Clouding of consciousness, disorientation, perceptual
disturbances with rapid shifting.
8. VAN GOGH SYNDROME:
Dramatic self mutilation occurring in schizophrenia has
been also called as van Gogh syndrome, after the name
of the famous painter Vincent van Gogh who had cut his
ear during the active phase of illness.
9. PFROPF SCHIZOPHRENIA:
with mental retardation.

27.  Schizoaffective disorder
 Brief psychotic disorder
 Delusional disorder
 Erotomanic delusion
 Grandiose type
 Jealous type
 Persecutory type
 Somatic type
- Shared psychotic disorder- “Folie a deux”
-Psychotic disorder due to a general medical
condition.
-Substance induced psychotic disorder.

29. Positive
 Content of thought
 Form of thought
 Perception
 Sense of self
Negative
 Affect
 Impaired interpersonal
functioning and
relationship to external
world
 Psychomotor behavior
 Associated features-
 Anhedonia

30.  Delusion
 Delusion of
persecution:

31.  Delusion
of
Grandeur

32.  Delusion of
Reference

34. Excessive
demonstration of or
obsession with religious
ideas and behavior.

35. Extreme suspiciousness
of others and of their
actions .
e.g: “I won’t eat this
food, I know it has been
poisoned”.

36. Individual believes that his
or her thoughts have control
over specific situations or
people.
Eg. , the mother who
believed that if she scolded
her son , he would be taken
away from her.
Mostly in children: “it is
raining because the sky is
sad”

37.  Associative looseness
 Neologisms( I m going in new uniphorum of my
friend )
 Abstract thinking
 Clang association: choice of word is governed by
sounds. Formation OF RHYMING..E.G: “ IT IS
VERY COLD. So i M COLD AND BOLD”. “THE GOLD
HAS BEEN SOLD”
 Word salad- group of words r formed
 Circumstantialities
 Tangentiality
 Mutism
 Perseveration

38.  Hallucination
o Auditory
o Visual
o Tactile
o Gustatory-taste
o Olfactory- smell
 Illusion

41.  Echolalia
 Echopraxia
 Depersonalization- feeling of unaware about
himself.

42.  AFFECT – inappropriate affect
- flat affect
 Apathy
 Avolition
 Ambivalence

43.  IMPAIRED INTERPERSONAL RELATIONSHIP
 Autism
 Deteriorated appearance
 PSYCHOMOTOR BEHAVIOR
 Anergia
 Waxy Flexibility
 ASSOCIATED FEATURE
 Anhedonia : inability to experience pleasure

44. 1.SOMATIC TREATMENT
a)Pharmacological treatment
b)ECT
2. PSYCHOSOCIAL TREATMENT AND
REHABILITATION

45.  Typical antipsychotic agents:
Chlorpromazine - 40-400 mg
Fluphenazine - 2.5-10 mg
Haloperidol - 1-100 mg
Thioridazine - 150-800 mg
Perphenazine - 12-64 mg

46.  Atypical antipsychotic agents:
Aripiprazole - 10-30 mg
Clozapine - 300-900 mg
Olanzapine - 5-20 mg
Risperidone - 4-8 mg
Ziprasidone - 40-160 mg

47. 1. Psycho education- Helps in establishing a good therapeutic relationship
with the patient.
2. Group psychotherapy- problem solving
- communication skills
3. Family therapy – are also provided social skills training to enhance
communication and decrease unfamiliar tension.
4. Milieu therapy – treatment in a living, learning or working environment
at day care hospital and half way homes.
5. Individual psychotherapy..
6. Psychosocial rehabilitation- activity therapy
- vocational training

48.  Risk for self-directed or other-directed
violence related to suspiciousness, increasing
anxiety and agitation.
 Disturbed thought process related to
disruption in cognitive activities as evidenced
by delusional thinking, suspiciousness.
 Disturbed sensory perception:
auditory/visual related to panic anxiety,
withdrawal in to self as evidenced by
inappropriate responses, listening pose, rapid
mood swings, poor concentration.

49. 1. Townsand MC., Textbook of psychiatric nursing, edn ,7th
edn, Pp-
2. Ahuja N., Textbook of psychiatry, edn – 6th , published by
jaypee brothers, Pp-58-73.
3. Dr.kapoor Bimla, psychiatric nursing, edn -5, published by
kumar publishing house, New Dehli , Pp-148-156.
 http://schizophrenia.emedtv.com/schizophrenia/types-
of-schizophrenia-p2.html
 http://www.schizophrenia.com/presentations/stanford.
05/stanpres/