Schizophrenia Definition Distortions of thinking and perception, plus affects that are inappropriate or blunted. The most important psychopathological phenomena include ••thoughtthought echo ••thoughtthought insertion or withdrawal ••thoughtthought broadcasting •• delusional perception and delusions of control ••influenceinfluence or passivity ••hallucinatoryhallucinatory voices commenting or discussing the patientpatient in the third person ••thoughtthought disorders and negative symptoms. Schizophrenia Schizophrenia is defined by ••aa group of characteristic positive and negative symptoms ••deteriorationdeterioration in social, occupational, or interpersonal relationships •• continuous signs of the disturbance for at least 6 months Positive and Negative Symptoms Negative Positive Alogia Hallucinations Affective flattening Delusions AvolitionAvolition--apathyapathyBizarre behaviour AnhedoniaAnhedonia--asocialityasociality Positive formal thought disorder Attentional impairment Andreasen N.C., Roy M.-A., Flaum M.: Positive and negative symptoms. In: Schizophrenia, Hirsch S.R. and Weinberger D.R., eds., Blackwell Science, pp. 28-45, 1995 F23 Acute and Transient Psychotic Disorders The criteria should be the following features: ••acuteacute beginning (to two weeks) ••presencepresence of typical symptoms (quickly changing “polymorphic symptoms”) ••presencepresence of typical schizophrenic symptoms. Complete recovery usually occurs within a few months, often within a few weeks or even days. The disorder may or may not be associated with acute stress, defined as usually stressful events preceding the onset by one to two weeks. F24 Induced Delusional Disorder A delusional disorder shared by two or more people with close emotional links. Only one of the people suffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usually disappear when the people are separated. The psychotic disorder of the dominant member of this dyad is mainly, but not necessarily, of schizophrenic type. The original delusions of dominant member and his partner are usually chronic, either persecutory or megalomanic. Genetics of Schizophrenia Many psychiatric disorders are multifactorial (caused by the interaction of external and genetic factors) and from the genetic point of view very often polygenically determined. Relative risk for schizophrenia is around: ••1%1% for normal population ••5.6%5.6% for parents ••10.1%10.1% for siblings ••12.8%12.8% for children Etiology of Schizophrenia The etiology and pathogenesis of schizophrenia is not known It is accepted, that schizophrenia is „the group of schizophrenias“ which origin is multifactorial: ••internalinternal factors ––genetic,genetic, inborn, biochemical ••externalexternal factors ––trauma,trauma, infection of CNS, stress Treatment of Schizophrenia The acute psychotic schizophrenic patients will respond usually to antipsychotic medication. According to current consensus we use in the first line therapy the newer atypical antipsychotics, because their use is not complicated by appearance of extrapyramidal sideside--effects,effects, or these are much lower than with classical antipsychotics. chlorpromazine, chlorprotixene, clopenthixole, conventional levopromazine, periciazine, thioridazine antipsychotics droperidole, flupentixol, fluphenazine, (classical fluspirilene, haloperidol, melperone, neuroleptics) oxyprothepine, penfluridol, perphenazine, pimozide, prochlorperazine, trifluoperazine atypical amisulpiride, clozapine, olanzapine, antipsychotics quetiapine, risperidone, sertindole, sulpiride.