Schizophrenia

Schizophrenia

Chronic illness characterised by disordered thinking and the inability to comprehend reality  delusions, auditory hallucinations and disturbances in speech. Affects up to 1% of population.
Usually begins in adolescence  progresses to chronic disabling disorder.

Aetiology:
Genetic factors play a role.
Dopamine hypothesis – dopamine excess or overactivity in mesolimbic pathway (antipsychotic block dopamine receptors)

Clinical features:
Onset usually between 15 and 45 years.
Classic symptoms (Bleuler’s 4 A’s) – Autism (withdrawal from reality into a fantasy word), Ambivalence (conflicting ideas and feelings), Affective incongruity (thoughts and affects are dissociated eg smiling when talking about sad things), Associative loosening (lack of logical connection between thoughts).
Initial symptoms – often described as a ‘loner’; behaviour thought to be eccentric;
Established symptoms – delusions; hallucinations; altered perception; agitation; tension; paranoia; catatonic state of mind; lack of motivation; poor self-care; social withdrawal
Acute episodes – delusions (typically persecutory, religious or grandiose) and hallucinations (auditory more common than visual) predominate

Course – typically long term with episodic acute exacerbations with intervals of partial remission.

Types:
1) Paranoid – preoccupation with delusions and hallucination. Mistrustful of others – sometimes hostile
2) Disorganised speech and behaviour
3) Catatonic – motor dysfunction (ranges from near stuporous to excessive activity) – tend to be resistance to interaction
4) Undifferentiated – does not meet criteria of paranoid, disorganised or catatonic types (symptoms are vague)

Crow classification:
Type 1 – acute onset; hallucinations; delusions; better prognosis and response to neuroleptics
Type 2 – chronic; poorer prognosis and response to neuroleptics

Clinical course – 10-20% regress and does not recur; 30-35% recur with full recovery between; 30-35% recur with progressively worse episodes; 10-20% worsen without recovery

Management:
Antipsychotic/neuroleptic medication
Psychotherapy and counselling
Community care

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