Neurobyology Respons Schizophrenia & Other Psychotic Disorder

Dr Sabar P S, SpKJ

I. Schizophrenia
- Chronic - Debilitating mental disorder - Characterized: 1. loss of touch with reality 2. disturbance of though, behavior, appearance & speech 3. abnormal afect & 4. social withdrawal

Symptoms of schizophrenia
- Can be classified as positive or negative - Positive: additional to expected behavior (delusions, hallucinations, agitation & talkativeness) respond well to most typical antipsychotic - Negative: missing from expected behavior (lack motivation, social withdrawal, flattened affect, cognitive disturbance, poor grooming & poor speech content) respond better to atypical antipsychotic

Course
- 3 phases - 1. prodromal: occur prior to the first psychotic episode include: a. avoidance of social activities b. physical complaints c. new interest in religion, the occult or philosophy 2. psychotic phase: loses touch reality 3. residual phase: in touch reality but does not behave normally

Prognosis
Downhill course over years Suicide is common in patients with schizophrenia The prognosis is better & the suicide risk is lower, if the patients is older at onset of illness married has social relationships female has a good employment history has mood symptoms has positive symptoms has few relapses

Etiology
1. Genetic Group:
the general population 1% child who has one schizophrenic or sibling 12% child who has two schizophrenic parents 40% monozygotic twin of a schizophrenic person 50%
2. Chromosome 6, 8 & 13 3. No social or environmental factor causes

Neural pathology
1. Anatomy a. abnormalities of the frontal lobe b. lateral & third ventricle enlargement 2. Neurotransmitter & other abnormalities a. excessive dopaminergic activity
excessive number of dopamine receptors excessive concentration of dopamine hypersensitivity of receptors dopamine

b. serotonin hyperactivity

3. Eye movement are abnormal

Subtypes DSM-IV TR
Disorganized: - poor grooming & disheveled personal appearance - inappropriate emotional respon, disinhibition - onset before 25 years of age Catatonic: - stupor or agitation, lack of coherent speech - bizzare posturing (waxy flexibility) - rare since the introduction of antipsychotic agents

Cont

Paranoid: - delusions of persecution - better functioning & older age at onset than other subtypes
Undifferentiated: - characteristic of more than one subtype Residual: - one previous schizophrenic episode - subsequent residual symptoms but no psychotic symptoms

Treatment
Pharmacologic treatments antipsychotic agents typical atypical Psychological treatments, including individual, family & group psychoterapy are useful to provide long-term support & to foster compliance with the drug regimen

Other psychotic disorders

Brief psychotic disorder

Characteristic
symptoms lasting > 1 day but < 1 month often precipitating psychosocial factors

Prognosis
50%-80% recover completely

Cont (2)

Schizophreniform disorder Schizoaffective disorder Characteristics symptoms lasting 1 6 months symptoms of a mood disorder as well as psychotic symptoms Prognosis 33% recover completely Lifelong social & occupational impairment (somewhat higher overall level of functioning

Cont (3)

Delusional disorder

Characteristics
Fixed, persistent, nonbizzare delusional system

Prognosis
50% recover completely many have have relatively normal social & occupational functioning

Shared delusional disorder (folie deux)

Development of delusions in a person in a close relationship (e.g., spouse, child) with someone with delusional disorder (the inducer)

10%-40% recover completely when separated from the inducer