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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

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