1. Schizophrenia

admin

1 year ago

छिन्नमानस (SCHIZOPHRENIA)

या आजारामध्ये विनाकारण भीती वाटणे, चारित्र्याबद्दल संशय घेणे, शिवीगाळ करणे, मारहाण करणे, वेगवेगळे भास होणे, कानात आवाज ऐकू येणे, स्वतःशीच बडबड करणे, विनाकारण हसत राहणे किंवा रडणे, एकांतात बसून राहणे, कोणाशीही मिळून मिसळून न राहणे, अंघोळ न करणे, स्वतःची काळजी न घेणे , कचरा गोळा करणे इत्यादी लक्षणे दिसून येतात.

In this condition patient gets unknown fear, Suspiciousness towards peoples as talking about him planning something in food to kill him or her. Patients becomes aggressive / abusive / assaultive / gets hearing of voices in absence of anyone, mattering to self, smiles / weeps without reason.

EUGEN BLEULER: Coined the term as “SCHIZOPHRENIA” (Split Brain)ss

There is dispute of relation between Thought, Emotion and Behavior (TEB)

Epidemiology: Life time Prevalence is 1%

Age of onset : Men – 10 to 25 yrs. Women- 25 to 35 yrs. M:F- 1 :1

Those who born in winter and early spring having more risk as compare to summer and late spring.

Reproductive factors: First degree biological relatives of Patient have a 10 times risk.

ETIOLOGY

Exact Etiology Is Not Known .

Theories:-

Biological Theory.
Genetic Theory.
Psychosocial Theory.
Neurobiology: Dysfunction in.
Limbic system
Frontal cortex
Cerebellum
Basal ganglia may involve in pathological process.

Neuropathology: Decrease in size of brain including Amygdala , Hippocampus and Para hippocampal gyrus .

Few studies showed increase number of D2 Receptors in Caudate , Putamen.

NEUROIMAGING:

MRI Brain: Reduction in volume of Hippocampus, Amygdala , Para hippocampal Gyrus.
CT Scan : Lateral and Third Ventricular Enlargement and Reduction in cortical volume
MRS: Lower levels of Phosphomonoesters and Inorganic Phosphate.

Higher levels of Phosphodiesters and ATP.

NAA-N acetyl aspartate-marker of neuron –low in Hippocampus and Frontal lobes.
PET(Glucose and Cerebral blood flow) : Hypoactivity of Frontal lobes and Hyperactivity of Basal ganglia.
EEG : Decreased alpha activity. Increased theta and delta activity.
EYE MOVEMENT DYSFUNCTION : 50-85 % pts of Schizophrenia has abnormal eye movement suggestive of Frontal lobe pathology (Hypothesis).
Psychoneuroimmunology : Abnormal Cellular and Humoral reactivity of neurons.
Psych neuroendocrinology: Decreased concentration of LH, FSH etc.

Change in Neurotransmitter levels like…

Dopamine.
Serotonin.
Norepinephrine.
GABA.
Glutamate.
Neuropeptides.
(Cholecystokinin, Neurotensin Etc.)

Genetic Factors

Abnormality:

in long arm of chromosomes

i.e.5,6 ,8,11,18 & 22 and short arm of 9 and X chromosome

Prevalence :

General population: 1 %.
Monozygotic twin of Schizophrenia Patient : 47 %
Dizygotic twin of Schizophrenia Patient : 12 %
Nontwin sibling of Schizophrenia Patient : 8 %
Child with one Schizophrenia Patient : 12%
Child with both Schizophrenia Patient : 40 %

PSYCHOSOCIAL FACTORS

Learning theories: Children learn irrational reactions and ways of thinking by imitating parents who have their own emotional problems.
Schism Family : If one parent is close to a child of opposite sex.
Skewed Family : Power struggle between two parents and resulting dominance of one parent.
Social theories: Industrialization and Urbanization have major effect on timing of onset and severity of illness

PHASES OF ILLNESS

Prodromal phase: Back pain, neck pain, somatic complaints. No Active Psychotic symptoms.
Acute Phase: Florid psychotic phase with active symptoms like delusions or hallucinations etc.
Post Acute Phase: Phase begins once the acute symptoms reduce in severity or remit. It lasts for about 6 months.
Stable or Maintenance Phase: Symptoms are stable.

CLINICAL FEATURES

No Any Sign Or Symptom Is Path gnomic Of Schizophrenia

PREMORBID SIGNS AND SYMPTOMS

Premorbid signs and symptoms appear before the prodromal phase of illness.
Prodromal signs and symptoms are parts of evolving disorder.
In Premorbid history- Patient has usually Schizoid or Schizotypal personalities. They may enjoy watching movies or television or listening to music instead of attending social activities.
Illness can start with symptoms like Headache, Back and muscle pain, weakness or digestive problems. Later can get positive or negative symptoms.
Eugen Bleuler :- Described symptoms as
Fundamental (Primary ):- 4 A’s

Association (Looseness)

Affect

Autism

Ambivalence

7. Secondary( Accessory):- Delusion and Hallucination

Kurt Schneider Criteria for Schizophrenia

First Rank Symptoms:

Audible Thoughts.
Voices Commenting.
Voices arguing or discussing or both.
Thought control.
Delusional Perceptions.

Second Rank Symptoms:

Other disorder of Perceptions.
Sudden delusional Ideas.
Perplexity.
Dysphoric and Euphoric mood changes.

Sir T. J. Crow — Positive Symptoms

Hallucinations:- Auditory, Visual, Tactile, Olfactory, Gustatory.
Delusions:- Persecution/ Reference, Delusion of being controlled, Thought Broadcasting/ Thought Withdrawal, Thought Insertion/ Thought Reading
Bizarre behavior :- Aggressive/agitated behavior, Repeated / Stereotyped behavior
Positive formal thought disorder :- Tangentiality, Circumstantiality, Pressure of speech, Clanging, Derailment Etc..

Negative Symptoms

Affective flattening:- Unchanging facial expression, Decreased spontaneous movements, Poor eye contact, Inappropriate affect.
Alogia :- Poverty of speech, blocking.
Avolition /Apathy:- Poor grooming and hygiene, Impersistance at work or school.
Anhedonia/A sociality:- Recreational interests, activities, Sexual interest,, Closeness, Relationship with friends & peers.
Attention:- Social Inattentiveness, Inattentiveness during testing

TYPES OF SCHIZOPHRENIA

Paranoid Type:- Preoccupied with one or more delusion and frequent Auditory hallucinations. Classically Delusion of persecution.
Disorganized (Hebephrenic):- Disinhibited or Disorganized behavior.
Catatonic Schizophrenia:- Marked disturbance in motor function.

Characterized by, Negativism, Catatonic excitement, Waxy flexibility, Mutism. Echolalia, Echopraxia.

Undifferentiated type: Can not differentiate. May get mixed presentation.
Residual Schizophrenia:- Absence of active symptoms but evidence of some disturbances or symptom.

OTHER SUBTYPES OF SCHIZOPHRENIA

Simple Schizophrenia :- Progressive development for a least one year of all of the following-
Marked decline in occupational or academic functioning.
Gradual appearance and deepening of negative symptoms such as affective flattening, alogia or avolition.
Poor interpersonal Support, social isolation or social withdrawal.
Oneroid Schizophrenia :- Dreamlike state in which Patients is deeply perplexed and not fully oriented to time and place.
Pseudo neurotic Schizophrenia :- Pan anxiety , Panphobia , Pan ambivalence, Obsessions and Compulsions
Early onset Schizophrenia :- Children
Late onset Schizophrenia :- >45 yrs.