SCHIZOPHRENIA Kehinde Charles Onipede NHA NITMED TUTORIALS schizophrenia

SCHIZOPHRENIA Kehinde Charles Onipede NHA © NITMED TUTORIALS schizophrenia by K. C. Onipede 11/3/2020 1

OUTLINE • INTRODUCTION • HISTORIC VIEW • DIAGNOSIS • AETIOLOGICAL THEORIES • PRESENTATION • ASSESSMENT • TREATMENT schizophrenia by K. C. Onipede 11/3/2020 2

INTRODUCTION • Psychotic disorder • Meaning of schizophrenia – schiz (New Latin “split”) & phren (Greek “mind”) • A thought disorder that impairs judgement, behaviour, and ability to interpret reality • Lifetime prevalence of about 1% • Equal incidence in men and women • Peak age of onset: 15 – 25, women 25 - 35 schizophrenia by K. C. Onipede 11/3/2020 4

HISTORICAL VIEW • Morel (1856) – Demence Precoce : silent & withdrawn • Kahlbaum (1868) – Katatonie • Emil Kraeplin (1896) – manic-depressive insanity & dementia praecox • Eugen Bleuler (1911) – schizophrenia (splitting of the mind) • Kurt Schneider – symptoms of first rank • ICD & DSM schizophrenia by K. C. Onipede 11/3/2020 5

DIAGNOSIS • Based on taking a good history • No blood or urine test required to make diagnosis • Rely on diagnostic criteria schizophrenia by K. C. Onipede 11/3/2020 6

DSM V • A. 2 or more of the following, each present for a significant portion of time during a period of 1 month (or less if successfully treated). At least 1 must be (1), (2), or (3): • 1. delusions • 2. hallucinations • 3. Disorganised speech • 4. Grossly disorganized or catatonic behaviour • B. Depreciation in level of functioning (work, relationship, self care) • C. Continuous signs of disturbance persist for at least 6 months schizophrenia by K. C. Onipede 11/3/2020 7

DSM V ……… • D. Schizoaffective disorder and depressive or bipolar with psychotic features has been ruled out • E. Not attributed to Substance or medical illness • F. If there is history of autism spectrum disorder or communication disorder, diagnosis of schizophrenia is made if there is prominent delusion or hallucination schizophrenia by K. C. Onipede 11/3/2020 8

ICD 10 • F 20 • G 1. Either at least one of the syndromes, symptoms and signs listed below under (1) or (2) of the symptoms and signs listed under (2), should be present for most of the time during the episode of psychotic illness lasting for at least 1 month. • (1) At least 1 of the following: • A) thought echo, thought insertion or withdrawal, or thought broadcasting • B) delusion of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, action, or sensations; delusional perception. • C) hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some parts of the body schizophrenia by K. C. Onipede 11/3/2020 9

• (2) or at least 2 of the following • E) persistent hallucinations in any modality, • F) break or interpolations in the train of thought, resulting inherence or irrelevant speech, or neologism • G) catatonic behaviour, such as excitement, posturing, or waxy flexibility, negativism, mutism, and stupor • H) “negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses, social withdrawal • I) a significant and consistent change in the overall quality of some aspect of personal behaviour, manifests as lost of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal. schizophrenia by K. C. Onipede 11/3/2020 10

DIFFENTIAL DIAGNOSIS • Substance-induced psychotic disorder • Psychotic disorder due to medical condition • Mood disorder with psychotic features • Acute/transient (brief) psychotic disorder and schizophreniform disorder • Sleep related disorders • Delusional disorder • Dementia & delirium schizophrenia by K. C. Onipede 11/3/2020 11

AETIOLOGICAL THEORIES • 1. neurochemical abnormality hypothesis • Dopaminergic overactivity • Glutaminergic hypoactivity • Serotonergic overactivity • 2. the neurodevelopmental hypothesis • 3. disconnection hypothesis • 4. Other theories schizophrenia by K. C. Onipede 11/3/2020 12

EXAMINATION • Review of systems R/O Organicity • Mental state examination • Physical examination • Investigation – blood work-up, UDT, Urine test & brain scan schizophrenia by K. C. Onipede 11/3/2020 13

PRESENTATIONS OF PSYCHOTIC ILLNESS • Prodromal phase • 1 st presentation – late adolescent or early adult schizophrenia by K. C. Onipede 11/3/2020 14

INITIAL ASSESSMENT • Need for admission consideration • Suicidal or homicidal tendency • Lack of insight • Lack of psychosocial support • Need to address co-morbid condition schizophrenia by K. C. Onipede 11/3/2020 15

INITIAL TREATMENT • Antipsychotics • Injection at initial stage IM Haloperidol or IM Chlorpromazine • Immediate tranquilizer • IV Benzodiazepines • Note: 1 st line is oral medication schizophrenia by K. C. Onipede 11/3/2020 16

CONCLUSION • Recognise hallucination, delusion and disorganized speech and behaviour as hallmark of psychosis • Know the salient negative prodromal symptoms • Duration of illness • Functional impairment and distress • Antipsychotics as mainstay of treatment schizophrenia by K. C. Onipede 11/3/2020 17