1. Schizophrenia
Emmanuel Okenyi

2. D A P S I C A M P

4. Definition
‘A [psychotic] disorder of the mind that affects how one thinks, feels and behaves. It’s symptoms can be positive or negative’
Royal College of Psychiatrists
Greek – “split mind”
NOT SPLIT PERSONALITY
“split from reality”

5. Aetiology
Multifactorial: genetic and environmental GENETICS 40-50% concordance with monozygotic twins OBSTETRIC COMPLICATIONS pre-eclampsia, perinatal infection, hypoxic brain damage ILLICIT DRUG USE – can produce psychotic symptoms cannabis – increases risk in susceptable individuals; adolescents are at greatest risk as they are at a critical neurodevelopmental stage. EXPRESSED EMOTION & STRESS living in an overbearing household increases risk of relapse following discharge. Stress can illicit psychotic symptoms but does not cause schizophrenia.

6. Pathophysiology
Dopamine Hypothesis: Alteration in dopamine systems in certain brain regions; extra DA receptors. Mesolimbic tracts  positive symptoms Mesocortical tracts  negative symptoms Overactive thalamus Other theories: serotonin overactivity; glutamate dysregulation
DA overactivity: hard to tell difference between internal and external stimuli  hallucinations
Overactive thalamus during hallucinations – filters incoming sensory info

7. Signs & Symptoms Positive: ‘adding’ to the experience Hallucinations
Auditory, visual, tactile, olfactory
Delusions: fixed false belief
Grandeur, achievement, passivity
Thought interference
insertion, withdrawal, broadcast.

8. Signs & Symptoms Negative: ‘subtract’ from normal function
Reduced personal function
Neglect of hygiene
Toneless voice
Apathy and withdrawal from loved ones

9. Investigations
LABS Bloods: FBC, TFTs, U&Es, LFT, CRP Urine: MSU and drug screen IMAGING CT head – rule out organic pathology e.g. epilepsy (hallucinations), brain tumour, stroke. EEG Other: MSE, collateral history.

10. Complications
Patients are at greater risk to themselves than to others.
Suicide
Self neglect – think about other common (non-psychiatric) conditions they might have.
Homelessness
Poverty
Isolation
Unemployment

11. Alternative Diagnoses
Organic disorder
Substance misuse
Dementia in the elderly
Epilepsy
Severe mood disorder: depression; mania.

12. Management

13. Management First-line tx – check NICE Guidelines
Newer atypicals: olanzapine, risperidone.
Rapid tranquilization for severe, acute psychotic episode (BDZs).
Socio-psychological approaches
Cognitive Behavioural Therapy (CBT)
Family Therapy
Social skills training
Art therapy
Rapid tranq if they are a danger to themselves and others.

14. Prognosis GOOD  POOR  Female Sudden onset Lack of family history
Good social support
Absence of substance abuse
Mainly positive symptoms
Male
Slow, insidious onset
Family history
Isolated
Substance abuse
Mainly negative symptoms
greater risk of suicide

15. Questions

16. Psychiatry for Intermediates