Psychosis-Schizophrenia

PSYCHIATRY
Topic: PSYCHOSIS:
Schizophrenia
BY
Dr. ANDREW OKELLO, M.D
( M.B.B.S-University of Queensland, Australia,
PCME- Harvard University, USA, IMCI-WHO)
Faculty of Medicine
SOMALI INTERNATIONAL UNIVERSITY (SIU)
PSYCHOTIC DISORDERS
It is characterized by a significant loss of touch with
reality. (disorganized thoughts and perceptions)
- evidence can come from delusions or hallucinations
without insight into their pathological nature
- behaviour so disorganized that it is reasonable to
infer that there is a loss of touch with reality.
Organic psychosis: Has a biological pathology e.g
OBS
Functional psychosis: No biological pathology.
Complete loss of touch with reality. E.g Schizophrenia.
DIFFERENTIAL DIAGNOSIS OF
PSYCHOTIC DISORDERS
• General medical conditions: tumor, head
trauma, etc.
• Dementia/delirium
• Substance-induced psychosis
• Affective disorders: psychotic depression,
bipolar disorder - manic episode with psychotic
features
• Personality disorders: schizotypal, schizoid,
borderline, paranoid
• Primary psychotic disorder: schizophrenia,
schizoaffective.
SCHIZOPHRENIA
Schizophrenia is a thought disorder characterized by apathy, absence of
initiative (avolition), and affective blunting.
DSM-5 Diagnostic Criteria

A. Two (2)( or more) of the following, each present for a significant
portion of time during a 1 month period (or less if successfully treated)
• 1. Delusions
• 2. Hallucinations
• 3. Disorganized speech
• 4. Grossly disorganized or catatonic behaviour
• 5. Negative symptoms (affective flattening, alogia, avolition or
anhedonia)
NB; Only 1 symptom is required if:
• 1) Delusions are bizarre, or
• 2) Hallucinations consist of a voice keeping up a running commentary
on person’s behaviour/thoughts or two (or more) voices conversing
with each other
B. Decline in social and/or occupational functioning since the
onset of illness.
C. Continuous signs of illness for at least six months with at

least one month of active symptoms.
D. Schizoaffective disorder and mood disorder with

psychotic features have been excluded.
E. The disturbance is not due to substance abuse or a

medical condition
F. If history of autistic disorder or pervasive developmental

disorder is present, schizophrenia may be diagnosed only if
prominent delusions or hallucinations have been present for
one month.
Clinical Features
A. A prior History of Schizotypal or Schizoid personality traits
are always present.
B. Symptoms
1. Positive Symptoms: Hallucinations are most commonly
auditory or visual, but hallucinations can occur in any
sensory modality. Delusions. Disorganized behavior.
Thought disorder (is characterized by loose associations,
tangentiality, incoherent thoughts, neologisms, thought
blocking, thought insertion, thought broadcasting, and ideas
of reference.)
2. Negative symptoms; Poverty of speech (alogia) or
poverty of thought content. Anhedonia. Flat affect. Loss of
motivation (avolition). Attentional deficits. Loss of social
interest.
Clinical features Cont’d…
3. Depression;
4. Cognitive impairment; (including attention,
executive function, and particular types of memory)
contribute to disability and can be an obstacle in long-
term treatment. Atypical antipsychotics may improve
cognitive impairment.
C. The presence of tactile, olfactory or gustatory
hallucinations may indicate an organic etiology such as
complex partial seizures.
D. Sensorium is intact.
E. Insight and judgment are frequently impaired.
F. No single sign or symptom is pathognomonic of
schizophrenia.
Subtypes of Schizophrenia
1. Paranoid
- Preoccupation with one or more delusions (typically
persecutory or grandiose) or frequent auditory
hallucinations
- Relative preservation of cognitive functioning and affect;
onset tends to be later in life; thought to
- Have the best prognosis
2. Disorganized
• All of the following are prominent: disorganized speech
and behaviour; flat or inappropriate affect
• Poor premorbid personality, early and insidious onset,
and continuous course without significant remissions
…subtypes of SZ
3. Catatonic; Charaterized by t least two of: motor immobility
(catalepsy or stupor); Excessive motor activity (purposeless,
not influenced by external stimuli); Extreme negativism
(resistance to instructions/attempts to be moved) or mutism;
Peculiar voluntary movement (posturing, stereotyped
movements, prominent mannerisms); Echolalia or echopraxia.
• 4. Undifferentiated; . meets criteria for schizophrenia, but it

cannot be characterized as paranoid, disorganized, or catatonic
type.
5. Residual Type; is characterized by the absence of prominent

delusions, disorganized speech and grossly disorganized or
catatonic behavior and continued negative symptoms or two or
more attenuated positive symptoms.
Management of Schizophrenia
Pharmacological
- Acute treatment and maintenance
- Antipsychotics (PO and IM)
- Management of drug side effects
Psychosocial
Psychotherapy (individual, family, group): supportive, cognitive
behavioral therapy (CBT)
- Assertive community treatment
- Social skills training and employment programs
- Housing (group home, boarding home, transitional home)
Electroconvulsive therapy; is rarely used in the treatment of
schizophrenia, but may be useful when catatonia or prominent
affective symptoms are present.
Indications for hospitalization
• Psychotic symptoms that prevent the patient from
caring for his basic needs.
• Suicidal ideation, often secondary to psychosis,
usually requires hospitalization.
• Patients who are a danger to themselves or others
require hospitalization.
• Patients with command hallucinations to harm
self or others should be evaluated for hospitalization,
especially with a history of acting on hallucinations.
Prognosis
1/3 improve, 1/3 remain the same, 1/3 worsen
Good prognostic factors
• Acute onset
• Precipitating factors
• Good cognitive functioning
• Good premorbid functioning
• No family history
• Presence of affective symptoms
• Absence of structural brain abnormalities
• Good response to drugs
• Good support system
ANY QUESTIONS?
Read more about;
Pathophysiology, Etiology, and Epidemiology of
Schizophrenia.
Next Lesson: Prescriptions in Schizophrenia

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PSYCHIATRY

DSM-5 Diagnostic Criteria

C. Continuous signs of illness for at least six months with at

D. Schizoaffective disorder and mood disorder with

E. The disturbance is not due to substance abuse or a

F. If history of autistic disorder or pervasive developmental

• 4. Undifferentiated; . meets criteria for schizophrenia, but it

5. Residual Type; is characterized by the absence of prominent

Next Lesson: Prescriptions in Schizophrenia

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