Tag: Schizophrenia

Schizophrenia-Negative symptoms


Schizophrenia-Negative symptoms


The symptoms of schizophrenia are divided into:

  1. Positive
  2. Negative
  3. Disorganization
  4. Motor

Negative Symptoms:

  • Negative symptoms represent loss of normal functions
  • Poor Prognostic Factor and Responds poorly to medications
  • Avolition – Loss of Will to indulge in goal-oriented tasks [ grooming, education, job]
  • Apathy, Anhedonia, Asociality, Alogia [Decrease in verbal communication]
  • Affective Flattening – Inability to understand emotions or to express one’s emotions
  • ↓ Dopamine in Mesocortical pathway [Ventral Segmental area to prefrontal cortex]

Schizophrenia-Positive Symptoms


Schizophrenia-Positive Symptoms


The symptoms of schizophrenia are divided into:

  1. Positive
  2. Negative
  3. Disorganization
  4. Motor

Positive symptoms:

  • Include – Delusions and Hallucinations
  • Good Prognostic Factor and Responds well to medications
  • Delusions – BIZZARE Delusions, M/C Delusion – Delusion of Persecution
  • Hallucination – M/C Auditory Hallucinations
  • Visual Hallucination if present may raise the suspicion of organic mental disease
  • ↑ Dopamine in Mesolimbic tract [Pathway from Ventral Segmental area to Nucleus accumbens]

Schizophrenia-Treatment


Schizophrenia-Treatment


Pharmacological treatment of schizophrenia includes antipsychotics/neuroleptics.

Both typical and atypical antipsychotics are used

Typical antipsychotics (1st gen):

  • Acts Via D2 Receptor Antagonism
  • Effective Against Positive Symptoms
  • Minimal Effect on Negative Symptoms
  • Causes More Extrapyramidal Side Effects

Atypical antipsychotics (1st gen):

  • Acts Via D2 & 5HT 2 Receptor Antagonism
  • Effective Against (+) and (-) Symptoms
  • Causes Less Extrapyramidal Side Effects
  • Causes Less other Side Effects

Schizophrenia-Prognosis


Schizophrenia-Prognosis


The prognostic factors of schizophrenia are:

Good Prognostic factors:

  • Acute / Abrupt Onset
  • Late Onset [Age > 35 Yrs.]
  • Catatonic & Paranoid
  • Female Sex
  • Prominent Positive Symptoms
  • Affective Symptoms [Depression]
  • Family History of Mood Disorder

Poor prognostic factors:

  • Insidious Onset
  • Early Onset [Age > 20 Yrs.]
  • Simple, Disorganized, Undifferentiated
  • Male Sex
  • Prominent Negative Symptoms
  • Absence of Affective Symptoms
  • Family History of Schizophrenia

Schizophrenia-Motor symptoms


Schizophrenia-Motor symptoms


The symptoms of schizophrenia are divided into:

  1. Positive
  2. Negative
  3. Disorganization
  4. Motor

Motor Symptoms:

  • Catatonia-Term given by Karl Kahl Baum
  • Stupor-Extreme hypoactivity or immobility and minimal response to stimuli
  • Excitement-Extreme Hyperactivity which is usually not goal directed
  • Posturing / Cataplexy-Spontaneous maintenance of posture for long periods of time
  • Waxy flexibility-Passive movements by examiner have plastic resistance
  • Automatic obedience-Excessive cooperation with examiner’s command despite unpleasant consequences
  • Echolalia-Mimicking examiner’s speech
  • Echopraxia-Mimicking examiner’s movements
  • Negativism-Refusal to accept examiner’s instructions or any attempts to move him
  • Grimacing-Maintenance of Odd facial expressions
  • Stereotypy-Spontaneous repetition of odd purposeless movements
  • Genehalten-Resistance to passive movements directly proportional to strength applied
  • Mannerisms-Spontaneous odd purposeful movements [Like Repeatedly saluting passerby]
  • Preservation-An induced movement which is senselessly repeated [Repeated tongue protruding]. Also sign of organic brain disorder or brain damage
  • Ambitendency-Inability to decide the desired motor movement

Schizophrenia-History


Schizophrenia-History


Schneiderian first rank symptoms-Given by Kurt Schneider to diagnose schizophrenia are:

  • Thought:
  1. Thought insertion
  2. Thought withdrawal
  3. Thought broadcast
  • Made:
  1. Made volition
  2. Made affect
  3. Made impulse
  • Auditory hallucination: Discussing/arguing, commenting, audible thoughts
  • Somatic passivity
  • Delusional perception

Etiopathogenesis of schizophrenia-Neuropathological factors


Etiopathogenesis of schizophrenia-Neuropathological factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Neuropathological Factors:

  • Cerebral Ventricle s – ↓ Cerebral Grey Matter and ↑ Lateral and 3rd Ventricle
  • Limbic System – ↓ Hippocampus, ↓ Amygdala, ↓ Para hippocampal Gyrus
  • Abnormalities of Prefrontal Cortex, basal ganglia and cerebellum
  • Neuronal Loss in MEDIAL DORSAL Nucleus of Thalamus

Schizophrenia-Epidemiology


Schizophrenia-Epidemiology


Prevalence of schizophrenia Incidence Rate 0.15-0.25 Per 1000
General population 1%
Non twin sibling of schizophrenic patient 8%
Dizygotic twin of schizophrenic patient 12%
Monozygotic twin of schizophrenic patient 47%
Child with 1 schizophrenic parent 12%
Child with both parents’ schizophrenic 40%
  • Usual Age of onset in Adolescence & Young Adulthood [If age > 45 then Late Onset]
  • Male= Female, However the onset is earlier in males
  • Prevalence more in LOWER SOCIO-ECONOMIC status
  • Body Type – Asthenic [Thin & Weak] > Athletic [Muscular] > Pyknic [Short – Fat]
  • Pyknic predisposed to manic depressive illness [Bipolar Ds]

Etiopathogenesis of schizophrenia-Genetic factors


Etiopathogenesis of schizophrenia-Genetic factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Genetic Factors:

  • Nine Linkage sites identified – 1q, 5q, 6p, 8p, 10p, 13q, 15q, 22q
  1. α- 7 nicotinic receptor
  2. DISC 1 [Disrupted in Schizophrenia]
  3. COMT [Catechol-o-methyl transferase]
  4. NRG 1 [Neuregulin 1]
  5. GRM 3 [Glutamate receptor metabotropic]
  6. RGS 4 [Regulator of G Signaling]
  7. DAOA [ D Amino Acid Oxidase Activator]

Etiopathogenesis of schizophrenia-Biochemical factors


Etiopathogenesis of schizophrenia-Biochemical factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Biochemical factors:

Dopamine Hypothesis – Excess of dopaminergic activity

Serotonin – Currently along with dopamine excess of serotonin is also considered

Other Neurotransmitter – GABA, NE, Ach, Nicotine, Glutamate

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