Schizophrenia: Major Psychiatric Illness

Historical Background:

“Schizophrenia” was first identified as a discrete mental illness by Dr. Emile Kraepelin in the 1887 AD  and differentiated psychiatric illness into 2 major groups.

• Dementia Precox
• Mani depressive illness( psychosis)

Eugen Bleuer’s Fundamental Symptoms of Schizophrenia: 4 A’s

The Swiss psychiatrist, Eugen Bleuler, coined the term, “schizophrenia” in 1911. He first  described the symptoms as “positive” or “negative.”. Bleuler changed the name to schizophrenia as it was obvious that Krapelin’s name was misleading as the illness was not a dementia  and could sometimes occur late as well as early in life.

• Ambivalence
• Autism
• Affective Flattening
• Association disorder

First Rank symptoms by Kurt Schneider

I. Hallucinations:

1. Audible thoughts/thought echo
2. Voices heard arguing
3. Voices giving running commentary

II. Thought Alienation Phenomenon

1. Thought withdrawal
2. Thought insertion
3. Thought broadcasting

III. Passivity Phenomenon

1. Made feelings
2. Made volition
3. Made impulses

IV. Delusional Perception

Epidemiology:

• Point prevalence of Schizophrenia is 0.5 to 1 %.
• The Incidence is about 0.5 in 1000 persons.

Clinical features

1. Autistic thinking
2. loosening of association,
3. thought blocking,
4. neologism,
5. paraphasias,
6. mutism,
7. perseveration,
8. verbigeration
9. Delusions: primary and secondary
10. Disorders Of Perception:Hallucinations
11. Disorders of Affect Disorders of Motor Behaviour
12. Negative Symptoms
13. Suicidal Tendency
14. Thought and speech Disorders

 

Clinical types:

• Simple Schizophrenia
• Hebephrenic Schizophrenia
• Catatonic Schizophrenia
• Residual Schicophrenia
• Undifferentiated Schizophrenia
• Post-schizophrenic depression

Bad Prognostic factors-

1. Insidious onset
2. neurological soft signs
3. past psychiatric history
4. history of violence
5. long duration of first illness
6. emotional blunting
7. social withdrawal
8. poor psychosexual functioning

Diagnostic Criteria:

According to DSM IV Text Revision I

” Two or more of the following is required with 6 months of duration of disease with at least 1 month of Active symptoms”

1. Delusion
2. Hallucinations
3. Bizzare Behaviour
4. Bizzare thoughts
5. Negative Symptoms

MANAGEMENT:

1. Pharmacological Treatment: Generally the treatment is continued for 6 months to 1 year for the first episode, for 1-2 year for subsequent episodes.Fluphenazine 25-30 mg IM every 2-3 weeks Penfluridol Flupenthixol Haloperidol

Adjuncts :Carbamazepine and benzodiazepines may have additional antipsychotic effects

Other AntiPsychotics:

• Chlorpromazine, Trifluperazine, Thiatexenes etc
• Atypical agents: Risperidone, Clozapine and Olanzepine

ECT ( Electroconvulsive Therapy)

Family Treatments

Vocational Rehab

Assertive Community Treatements ( ACT )

Miscellaneous Treatments Limbic Leucotomy Psychosocial Treatment.