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Neurobyology Respons
Schizophrenia
&
Other Psychotic Disorder
Dr Sabar P S, SpKJ
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I. Schizophrenia- Chronic
- Debilitating mental disorder
- Characterized:
1. loss of touch with reality
2. disturbance of though, behavior, appearance &
speech
3. abnormal afect &
4. social withdrawal
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Symptoms of schizophrenia
- Can be classified as positive or negative
- Positive: additional to expected behavior
(delusions, hallucinations, agitation &
talkativeness)
respond well to most typical antipsychotic
- Negative: missing from expected behavior
(lack motivation, social withdrawal,flattened affect, cognitive disturbance,
poor grooming & poor speech content)
respond better to atypical antipsychotic
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Course
- 3 phases
- 1. prodromal: occur prior to the first psychotic
episode
include: a. avoidance of social activities
b. physical complaints
c. new interest in religion, the
occult or philosophy
2. psychotic phase: loses touch reality3. residual phase: in touch reality but does not
behave normally
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Prognosis
Downhill course over years
Suicide is common in patients with schizophrenia The prognosis is better & the suicide risk is lower, if
the patients is older at onset of illness
marriedhas social relationships
female
has a good employment history
has mood symptoms
has positive symptoms
has few relapses
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Etiology
1. Genetic
Group:
the general population 1%
child who has one schizophrenic or sibling 12%
child who has two schizophrenic parents 40%monozygotic twin of a schizophrenic person 50%
2. Chromosome 6, 8 & 13
3. No social or environmental factor causes
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Neural pathology
1. Anatomy
a. abnormalities of the frontal lobeb. lateral & third ventricle enlargement
2. Neurotransmitter & other abnormalitiesa. excessive dopaminergic activity
excessive number of dopamine receptors
excessive concentration of dopamine
hypersensitivity of receptors dopamineb. serotonin hyperactivity
3. Eye movement are abnormal
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Subtypes DSM-IV TR
Disorganized: - poor grooming & disheveled personal
appearance
- inappropriate emotional respon,
disinhibition
- onset before 25 years of age
Catatonic: - stupor or agitation, lack of coherent
speech
- bizzare posturing (waxy flexibility)
- rare since the introduction of
antipsychotic agents
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Cont
Paranoid: - delusions of persecution
- better functioning & older age atonset than other subtypes
Undifferentiated: - characteristic of more than one
subtype
Residual: - one previous schizophrenic episode
- subsequent residual symptoms but nopsychotic symptoms
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Treatment
Pharmacologic treatments
antipsychotic agents
typical
atypical
Psychological treatments, including individual,family & group psychoterapy are useful to provide
long-term support & to foster compliance with thedrug regimen
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Other psychotic disorders
Brief psychotic disorder
Characteristic
symptoms lasting > 1 day but < 1 month
often precipitating psychosocial factors
Prognosis
50%-80% recover completely
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Cont (2)
Schizophreniform disorder
Schizoaffective disorder
Characteristics
symptoms lasting 1 6 months
symptoms of a mood disorder as well as
psychotic symptoms
Prognosis
33% recover completely
Lifelong social & occupational impairment
(somewhat higher overall level of functioning
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Cont (3)
Delusional disorder
Characteristics
Fixed, persistent, nonbizzare delusionalsystem
Prognosis
50% recover completely
many have have relatively normal social &occupational functioning
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Shared delusional disorder
(folie deux)
Development of delusions in a person in a close
relationship (e.g., spouse, child) with someone
with delusional disorder (the inducer)
10%-40% recover completely when separated
from the inducer