Schizophrenia

SCHIZOPHRENIA 4 TYPES

Schizophrenia 4 types:
How schizophrenia starts?
Schizophrenia is a mental disorder and a chronic heterogeneous syndrome of disorganized and bizzor (abnormal) thoughts, delusions, hallucinations, Inappropriate effect and invade psychological functioning. It is most commonly seen between the ages of 16-30 years.

 

EPIDEMIOLOGY: The prevalence of schizophrenia i.e. the number of cases in a population approaches about the incidence of 1-5 cases per 10,000 cases per year. The percentage of general population effected is 0.85% and the primary related habits having schizophrenia is 5%,sibling affected-8%, Single parent affected-11%, both the parents affected-40%, dizygotic twins-12%, monozygotic twins-47%.

 

CLASSIFICATION:
The different types of schizophrenia include:
1. Paranoid schizophrenia.
2. Catatonic schizophrenia.
3. Hebephrenic schizophrenia.
4. Simple schizophrenia.
PARANOID SCHIZOPHRENIA: This is the most common type of schizophrenia and a late onset variety. This predominately involves delusions, hallucinations. The patients with this type of schizophrenia are suspicious about other people with no reason, and this makes them hard to hold a job, have friendships and even to consult a doctor. The symptoms include fear, anxiety, unable to differentiate and tell what’s real and what’s not real.
CATATONIC SCHIZOPHRENIA: This type of schizophrenia is very rarely seen. It includes periods where the individual moves very little and will not respond to the instructions. The symptoms for this type include mutism (complete absence of speech), echolalia (mimicking of phrases or the words heard), rigidity (maintenance of rigid posture), echophraxia (mimicking of action observed).
HEBEPHRENIC SCHIZOPHRENIA: It is also  known as disorganized schizophrenia. This type might lead to a difficulty in concentrating and maintaining a train of thought which would reflect in the train of thought. The symptoms include silly smiles, mirror gazing, responds to the questions with unrelated answers. A very worst progress is seen in this type. It is most commonly seen in the patients with 14-14 years of age.

SIMPLE SCHIZOPHRENIA: It’s the earliest onset when compared to other types because it is considered to begin in childhood in few patients. The symptoms include negative thoughts, a motivation, and a socialization.

T.J. Crow in 1980 classified the schizophrenia into 2 types:
                TYPE 1
                TYPE 2
        Acute onset
        In acute onset
        Precipitating factors(specific event that trigger the onset of the disease)
        No precipitating factors are seen
        Positive symptoms are seen.
        Negative symptoms are seen
        Emotions are preserved
        Emotions are not preserved
        No family history
        Family history is observed
        Ct or MRI findings are not found.
        CT and MRI findings are found.
        Good progress is observed.
        Poor progress
 According to DSM 5 a criterion, the schizophrenia is divided into 3 categories. They are:
1. Schizophrenia                   = seen for >6months
2. Schizophreni form disorder=seen for 1-6 months.
3. Acute psychosis                  =seen for <1 year        
What are the symptoms of Schizophrenia?
The symptoms are Categorized into 3 types.
1. Positive symptoms.
2. Negative symptoms.
3. Cognitive symptoms. 
Positive symptoms
Hallucinations
Delusions
Violence
Negative symptoms:
Amotivation (lack of motivation)
Asociality (poor expression of emotion)
Alogia (absence of language)
Attention deficient
Anhedonia (lack of pleasure)
Cognitive symptoms
Lack of executive memory
Impaired attention
Impaired working memories
What are the Causes of Schizophrenia?
GENETIC INHERITANCE:
The chance of developing this syndrome is less than 1% when there is no H/O schizophrenia in family.
CHEMICAL IMBALANCE IN THE BRAIN: Few researches have proved that the reason for developing schizophrenia is an imbalance of dopamine, a neurotransmitter and also few other neurotransmitters like serotonin is also involved. The schizophrenic patients with abnormal brain can have higher whole blood 5 hydroxy tryptamine concentration.
Dopaminergic Hypothesis: Psychosis may result from the hyper or hypo activity of dopamine. The positive symptoms may be more closely associated with the dopamine receptor hyperactivity in the meso caudate. And the negative symptoms may be more closely related to the hypo activity of dopamine in the prefrontal cortex.
Environmental Factors: Even though there is no definite proof, many reasons are the exposure to toxins, bacterial or viruses, socio-economic factors which are the cause for the development of the disease.
Drug Induced Schizophrenia: Some of the mild-altering drugs known as psychoactive or psychotropic drugs such as methamphetamine or LSD are more likely to get schizophrenia. Even marijuana also has an similar risk. If you intake the drugs more often in day to day life, the symptoms like hallucinations, delusions, inappropriate emotions and trouble thinking are most commonly seen.
Examples: LSD, ketoamine, cocaine, cannalins, rarely anti-Parkinson’s drugs.
How Schizophrenia is Diagnosis?
It is mostly diagnosed by observing the actions of the patients.
The other diagnosing tests include:
Blood test    
Imaging studies: CT scan, MRI
Psychological evaluation: A specialist will assess the patients mental state by asking and observing about moods, thoughts, hallucinations, attention and suicidal traits
The patient must have at least two of the following symptoms to diagnose it as schizophrenia.
1. Delusions
2. Hallucinations
3. Disorganized behavior
4. Negative symptoms seen for more than a month
5. Patient not interested to attend schools or to do everyday    tasks.
Treatment: The most effective treatment for the patient of schizophrenia is the combination of the medication and psychological counseling. An outermost care should be taken in an outpatient setting and the best should be carried out by a multidisciplinary team. The psycho-social rehabilitation is the most necessary part of the treatment.
The medication involves the anti-psychosis drugs, which are used to treat acute psychosis and reduce the risk of future psychosis episodes. Risperidone (risperdal)-It shows its action by inhibiting the dopamenergic D2 receptors and sertonergic 5-HT 2A receptors in brain and helps to control schizophrenia. The side effects include weight gain and increased levels of glucose in blood. Olanzapine (Zyprexa)-It can be used to treat both new onset disease and also for long term maintenance. It mainly involves the antagonism of dopamine and serotonin receptors. The side effects are common as that of risperidone. 
The other medications include clozapine, haloperidol. The patient must continue to take medications even if the symptoms are subsided otherwise they reappear again. This disease will take a longer time to recover.
PROGNOSIS:
GOOD PROGNOSTIC FACTORS
POOR PROGNOSTIC FACTORS
Late onset
Younger age of onset
Catatonic features
Disorganized type
No family history
Family history is positive
Acute onset
Chronic onset
Type 1 schizophrenia
Type 2 schizophrenia
 
                                                                                        Prepared by:
                                                                                    M. Keerthi kumari

 

Leave a Reply