Psychiatry >
Schizophrenia

Schizophrenia is a serious mental disorder in which people interpret reality abnormally”

  • An illness characterised by the co-occurrence of at least two of the following symptoms:
    • Delusions
    • Hallucinations
    • Disorganised speech
    • Disorganised/catatonic behaviour or negative symptoms (eg anhedonia, attention deficit, avolition, impoverishment of speech and language)
  • Symptoms occur for a significant period of time during a 1-month period and associated with continuous problems over at least a 6-month period.
  • Often described as a type of psychosis – the person may not always be able to distinguish their own thoughts and ideas from reality
Risk Factors
  • Family history
  • Increasing paternal age
  • Obstetric complications
    • Low birth weight
    • Premature labour
    • Asphyxia
  • Cannabis use
  • Stress
Aetiology
  • The exact cause is unknown but is thought to be due to a number of biological, psychological and social factors
Pathophysiology
  • Increased dopaminergic activity in the median temporal lobe/mesolimbic system
Clinical Presentation
  • Positive symptoms:
    • Hallucinations (most commonly auditory) – where someone sees, hears, smells, tastes or feels things that don’t exist outside their mind
    • Delusions – a belief hed with complete conviction, even though it’s based on a mistaken, strange or unrealistic view
    • Confused thoughts – have trouble keeping track of their thoughts and conversations
    • Change in behaviour – disorganised, unpredictable
  • Negative symptoms:
    • Avolition – lack of motivation or ability to do tasks/activities that have a purpose (eg paying bills, personal hygiene)
    • Anhedonia – lack of interest in life and activities that are usually pleasurable 
    • Lack of concentration
    • Social withdrawal – less likely to initiate conversations and feeling uncomfortable with people
Investigations
  • Clinical diagnosis based on patient/family interviews
Management
  • Psychological intervention:
    • CBT
  • Pharmacological intervention:
    • Start on an anti-psychotic immediately after diagnosis
    • Discussing the benefits and side effects of each drug including metabolic, extrapyramidal, cardiovascular and hormonal side effects
Complications
  • Suicide tendency is one of the most dangerous complications – the lifetime risk of suicide is around 5%.
  • Other complications include anxiety disorders, depression, alcohol/drug abuse, financial problems

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