Schizophrenia: History, Etiology, Symptoms For NEET PG
Feb 10, 2023
Schizophrenia is considered an important topic for the NEET PG exam as it is one of the most commonly encountered psychiatric disorders and is frequently tested in medical exams, including NEET PG. A good understanding of the signs, symptoms, diagnosis, and management of schizophrenia is crucial from the exam point of view.
Read this blog further to get a quick overview of this important topic from psychiatry.
HISTORY
Here’s a brief history of schizophrenia -
Emil Kraepelin
One of the first person to classify the Psychotic disorder
Used the term ‘Dementia Praecox’ for Schizophrenia
Eugene Bleuler: Coined the term ‘Schizophrenia’
Proposed fundamental (primary) symptoms of schizophrenia (4 A’s of bleuler)
A - Autistic thinking and behaviour (Fantasy thinking and Withdrawn Behaviour)
A – Ambivalence (Inability to decide)
A - Affect disturbances (Disturbances of affect are there)
A - Association disturbances (Disturbances of association of thought is seen in Schizophrenia)
Kurt Schneider
Gave 11 Schneiderian first rank symptoms (SFRS)
If any of these symptoms are present diagnosis of schizophrenia is made
Three Thought phenomenon
Thought insertion
Thought withdrawal
Thought broadcast
Three made phenomenon (Something is imposed)
Made volition (someone is controlling the actions)
Made affect (someone is controlling the emotions)
Made impulse (someone is controlling the impulses)
Concept of ‘passivity’: Passivity experiences are those in which patient experiences that thought, emotions, actions or sensations are controlled/influenced by others (thought insertion and thought withdrawal are passivity phenomena)
Three Auditory Hallucinations
Voices Arguing or Discussing about the patient (Third person auditory hallucinations)
Voices giving running commentary
Voices saying thought aloud (thought echo)
Delusional perception: A delusion is attached to a normal perception in an un-understandable manner.
E.g.: I have a black pen in my hand. I am the poorest human being in the entire country.
Somatic passivity: Patient experiences somatic sensations and blames an external agency for the same
I am feeling a strange burning sensation in my elbow because some intelligence agency from other city is throwing radio-waves to my elbow
Important information
Third person auditory hallucinations
Patient is the third person in the conversation referred to as “He”
ETIOLOGY OF SCHIZOPHRENIA
Neurotransmitter hypothesis: Most acceptable
It says schizophrenia is caused by abnormality in the neurotransmitter
Dopamine hypothesis
Excessive levels of dopamine cause schizophrenia
In this case Dopamine antagonists must be useful in the treatment of schizophrenia
Dopamine and serotonin hypothesis
Excessive levels of Dopamine and Serotonin
New antipsychotics block dopamine and serotonin receptor (Atypical antipsychotics)
Genetic factor
This plays an important role in the development of schizophrenia
Linkage studies have been done
Many candidate genes have been identify
Most important: DiGeorge syndrome (22q11.2 deletion, Velocardiofacial syndrome): 30% them have schizophrenia
Schizophrenia Symptoms
Here are the positive and negative symptoms of schizophrenia -
1. Positive symptoms of schizophrenia (or psychotic symptoms)
Delusions
Hallucinations
First symptom that respond to medical management
Both of them respond well to medications and are good prognostic factors.
Important information
Positive symptoms are beyond the normal functioning of brain and these are due pathological cause generally.
Negative symptoms are usually the normal function of brain but because of the disease process they are being lost (Loss of functioning which is normal in other individuals).
2. Negative symptoms of schizophrenia
Avolition
Loss of drive for meaningful activities
E.g.: Student stays at home, stops taking bath, sleeps all day
Along with it another symptoms called “Apathy” is seen which means lack of concern
E.g.: Same student misses exams but does not care about it.
Anhedonia
Lack of pleasure
Inability to pleasure something that were pleasure in the past
Affective flattening (or emotional blunting)
Important information
They respond poorly to medications and are usually the poor prognostic factors
Disorganised speech and thinking (formal thought disorder)
4.Motor symptoms (Catatonic symptoms/Symptoms of conation)
Stupor (Stage just before coma)
Mutism and Achinesis is a feature of stupor
Immobility and minimal responsiveness
Posturing/Catalepsy
Maintenance of a posture for a prolonged period of time
Waxy flexibility
Flexible as wax
Initially some resistance is present, then movement starts to happen, feels like wax
Automatic obedience
Excessive cooperation (even though the consequences are not that pleasant)
Negativism
Opposite to automatic obedience refusal to accept examiners instructions
Echolalia: Repetition of examiner’s speech
Echopraxia: Mimicry of examiner’s behaviour
Grimacing: Maintenance of odd facial expressions
Stereotypy: Spontaneous, repetition of odd purposeless movements
Mannerisms
Spontaneous, repetition of semi- purposeful movements done in an exaggerated manner
E.g. Fixing/Combing hairs
Perseveration
Induced movement repeated beyond point of relevance
Patient will persist with the same response
SUICIDE IN SCHIZOPHRENIA
10% (in DSM-5 it is 5-6%)
20 – 40% patients with Schizophrenia attempt suicide
Suicide most common cause of premature & unnatural death in Schizophrenia
Suicide became higher
Immediately after admission
Immediately after discharge
Important information
Commanding hallucination
Person hear commands from the hallucinatory voices
E.g.: Voice telling him to jump off the terrace/balcony
TREATMENT
Antipsychotics are the first line treatment in the management of schizophrenia
Typical or first-Generation Antipsychotic
Atypical or second-Generation Antipsychotic
Mechanism
D2 antagonism
D2 and 5 HT2 antagonism
Effective Against
Positive symptoms
Positive and negative symptoms (primarily active against positive symptoms)
EPS
More Extrapyramidal side effects
Less extrapyramidal side effects (Not as strong blockers of dopamine receptors)
Metabolic side Effect
Less metabolic side effects
More metabolic side effects (Weight gain, ↑blood sugar, Dyslipidemia)
Treatment of Catatonia
Intravenous lorazepam
If doesn’t work, then ECT (Electroconvulsive therapy)
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