SCHIZOPHRENIA – SYMPTOMS
SCHIZOPHRENIA – SYMPTOMS & TYPES
SYMPTOMS:
Divided into symptom complexes,
- Positive symptoms (or psychotic symptoms).
- Negative symptoms.
- Disorganization symptoms
- Motor symptoms (catatonic symptoms)
POSITIVE/PSYCHOTIC SYMPTOMS:
- Responds well to medications.
- Marked as good prognostic factor.
- Cause:
- Due to dopamine excess in mesolimbic tract (neural pathway from ventral segmental area to nucleus accumbens).
- 2 symptoms included –
- Delusions & hallucinations.
1. Delusions:
- Delusion of persecution – Most common.
- Bizarre delusions – Important type.
- Considered physically impossible & culturally implausible (or ununderstandable).
2. Hallucinations:
- Auditory hallucinations – Most common.
- Visual hallucinations – 2nd most common.
NEGATIVE SYMPTOMS:
- Represent loss of normal function.
- Responds poorly to medications.
- Bad prognostic factor.
- Cause:
- Due to decreased dopamine activity in mesocortical pathway (neural pathway from ventral segmental area to prefrontal cortex).
Symptoms list:
- Avolition –
- Loss of will or drive to indulge in goal-directed activities.
- Grooming & hygiene, education & occupational activities.
- Apathy – Loss of concern for an idea or task or results.
- Anhedonia – Loss of ability to drive pleasure from activities or relationships.
- Asociality – Indifference to social relationships & decrease in drive to socialize.
- Affective flattening (or blunting): Inability of patient to understand emotions of others & inability to express own emotions.
- Alogia – Decrease in verbal communication.
DISORGANIZATION SYMPTOMS:
- Symptoms include:
- Formal thought disorder – Loss of organization of thought.
- Disorganized behavior –
- Odd & inappropriate behavior breaking social norms.
- Inappropriate affect – Affect not in sync with social situation.
MOTOR/CATATONIC SYMPTOMS:
- “Catatonic” term coined by “Karl Kahlbaum”.
Symptoms include,
- Stupor – Extreme hypoactivity or immobility.
- Excitement – Extreme hyperactivity (non-goal oriented).Posturing/catalepsy – Spontaneous maintenance of posture for long periods of time.
- Waxy flexibility- On passive movement on patient, plastic resistance felt resembling bending of soft wax.
- Automatic obedience – Excessive cooperation with examiner’s commands despite unpleasant consequences.
- Echolalia – Mimicking of examiner’s speech.
- Echopraxia- Mimicking of examiner’s movements.
- Grimacing –Maintenance of odd facial expressions.
- Stereotypy – Spontaneous repetition of odd, purposeless movements (Strange movements of fingers repeatedly).
- Gegenhalten – Resistance to passive movement (Opposed to strength applied).
- Mannerisms – Spontaneous repetition of odd, purposeful movements.
- Perseveration – Senselessly repeated induced movement (Only on instruction) – Sign of brain damage (Organic brain disorders).
- Ambitendency – Inability to decide desired motor movement.
TYPES:
According to ICD-10,
Paranoid schizophrenia –
- Most common type.
- Dominated by hallucinations and delusions.
- Late-onset & good prognosis.
- Usually preserved personality.
Catatonic schizophrenia –
- Dominated by catatonic (motor) symptoms.
- Best prognosis.
Hebephrenic (disorganized) schizophrenia –
- Dominated by prominent disorganization symptoms & negative symptoms.
- Early onset & bad prognosis.
- Severe deterioration of personality (patient is not able to maintain hygiene, social interaction is inappropriate, odd behaviors are present).
Undifferentiated schizophrenia –
- Not conforming to any of above subtypes or exhibiting features of more than one of them.
Residual schizophrenia –
- Characterized by progression from an early stage (with prominent delusions and hallucinations) –> Later stage (Reduced delusions & hallucinations & prominent negative symptoms).
Simple schizophrenia –
- Prominent negative symptom.
- No positive symptoms.
- Worst prognosis.
Post-schizophrenic depression –
- Depression episode starts after resolution of schizophrenic symptom
- Has increased risk of suicide.
Exam Important
- Positive symptoms (or psychotic symptoms) of schizophrenia responds well to medications.
- Positive symptoms (or psychotic symptoms) in schizophrenia are marked as good prognostic factor.
- Positive symptoms (or psychotic symptoms) of schizophrenia are due to dopamine excess in mesolimbic tract (neural pathway from ventral segmental area to nucleus accumbens).
- Positive symptoms (or psychotic symptoms) in schizophrenia includes delusions & hallucinations.
- Delusion of persecution is the most common delusion in schizophrenia.
- Special type of delusions in schizophrenia are bizarre delusions.
- Auditory hallucinations is the most common in schizophrenia followed by visual hallucinations.
- Negative symptoms of schizophrenia represent loss of normal function.
- Negative symptoms of schizophrenia responds poorly to medications & is marked as a bad prognostic factor.
- Negative symptoms of schizophrenia are caused due to decreased dopamine activity in mesocortical pathway (neural pathway from ventral segmental area to prefrontal cortex).
- Negative symptoms include avolition, apathy, anhedonia, asociality, affective flattening/blunting & alogia.
- The term “Catatonic” was coined by “Karl Kahlbaum”.
- Stupor is extreme hypoactivity or immobility.
- Grimacing is maintenance of odd facial expressions.
- Stereotypy is spontaneous repetition of odd, purposeless movements Eg., Strange movements of fingers repeatedly.
- Perseveration is a sign of brain damage (Organic brain disorders).
- Ambitendency is inability to decide desired motor movement.
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