Friday, 18 May 2018

Schizophrenia -Subtypes, Symptoms and Epidemiology

Schizophrenia Definition



The term Schizophrenia is derived from Greek which literally means 'split mind' (Schizo means to 'split' and phren means 'mind'). 


The term Schizophrenia was coined by the Swiss Psychiatrist Eugen Bleuler in 1908. Schizophrenia is different from Multiple Personality Disorder which is a Dissociative disorder. 

Previously the term 'Dementia praecox' is used for this illness.


schizophrenia causes


Clinical features of Schizophrenia 
  •  Schizophrenia is a 'Psychotic' disorder.

  • Psychosis is a condition in which the patient has experiences that do not have any basis in reality.

  • The two main psychotic phenomena are Hallucinations and Delusions.

Hallucinations
  • A hallucination is a sensory perception in the absence of sensory stimulus.

  • It can occur in any of the five sensory modalities: auditory, visual, somatic, olfactory and gustatory.

  • Most common type of Psychosis is an Auditory hallucination.

  • For example: 
    • Hearing voices from outside one's head (even when the patient is alone).

Delusions

A delusion is a false, fixed belief held by the patient with absolute conviction, despite evidence to the contrary and not shared by others from the patient's family or cultural group.

 In Schizophrenia, delusions usually have a persecutory theme for example:
    • 'My neighbor or someone trying to poison me.'

    • 'My movements are being monitored by the cameras, wherever I go.'

Sometimes they have a grandiose theme for example:

    • I am immortal.

    • I am the richest person in the world.



Positive and Negative Symptoms of Schizophrenia 

Positive Symptoms:

  •  Includes Hallucinations, Delusions and Thought Disorder.

  • Seen in the acute phase of the illness.

  • Tend to respond well to an antipsychotic treatment.

Negative Symptoms:

  • Include lack of motivation, lack of speech, poor self-care, etc.

  • Seen in the chronic phase of the illness.

  • Tend to respond well to treatment.

Main subtypes of Schizophrenia 



Paranoid Schizophrenia 

Hebephrenic Schizophrenia 

Catatonic Schizophrenia 

Simple Schizophrenia 

Clinical features of Paranoid Schizophrenia 

 Paranoid Schizophrenia is the main subtype of Schizophrenia that the doctors encounter in clinical practices.

 Duration for a diagnosis of Paranoid  Schizophrenia is one month. Some of the main clinical features are mention below:
  • Delusions, hallucinations and thought disorder are prominent.

  • Examples of delusional themes: persecution, jealousy, and grandiosity.

  • Examples of hallucinatory themes: commenting/discussing, threatening, bodily sensations.

  • Thought disorder manifest as incoherent and irrelevant speech.

Clinical features of Hebephrenic Schizophrenia 


  •   Incoherent, disjointed, rambling speech.

  • Aimless behavior rather than goal-directed.

  • Delusions and hallucinations are either absent or not prominent.

( Duration for a diagnosis of Hebephrenic Schizophrenia is one month.)


Clinical features of Catatonic Schizophrenia

Catatonic stupor is one if the most dramatic presentation, in a stupor the patient is mute or immobile.

 Duration for a diagnosis of catatonic schizophrenia is 2 weeks. Other catatonic signs include:
  • Posturing

  • Waxy flexibility

  • Negativism

  • Command automatism

  • Excitement

Clinical features of Simple Schizophrenia

The predominance of negativism symptoms are as follows:
  • Social withdrawal

  • Loss of motivation

  • Aimlessness

  • Apathy

  • Flattering of effect
A marked decline in social functioning and absence of positive symptoms.


Duration for a diagnosis of simple schizophrenia is 1 year.


Epidemiology of Schizophrenia
  •  Lifetime prevalence is about 1%.

  • Annual incidence is about 0.02 per 1000.

  • Lifetime risk may be about 40 percent higher in males.

  • The peak age of onset: 15 to 24 in males; about 5 to 10 years later in females.

Etiology of Schizophrenia

The exact cause of Schizophrenia is unknown. The general consensus from research is that there is a combination of different factors which include:
    • Genetic factors

    • Other biological factors

    • Psychological factors

    • Social (environmental) factors.


Other helpful resources-

Schizophrenia Treatment

NIMH


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