SCHIZOPHRENIA

Diagnostic features
(any one or at least from two groups or only for simple schizo & only this >1y is adequate)

1. Behaviour
 Catatonic

o Stupor - marked decrease reactivity to the environment, spontaneous movements, activity

o Mutism -
o Excitement - apparently purposeless motor activity, not due to external stimuli
o Posturing - voluntary assumption and maintenance of inappropriate / bizarre postures
o Waxy flexibility - maintenance of limbs and body in externally imposed positions
o Negativism - apparently motiveless resistance to all instructions and attempts to move
o Rigidity - maintenance of a rigid posture against efforts to move
o Command automatism- automatic compliance with commands
o Perservation of words and phrases

2. Speech
 Incoherent – due to breaks / interpolations of train of thought
 Irrelevant ““ ““
 Neologism ““ ““
3. Thought
 Delusions
o Control / influence / passivity
o Reference
o Delusional perception
o Thought insertion / withdrawal / broadcasting
o Persistent delusions – e.g. grandiosity – (superhuman powers, high identity)
4. Perception
 Hallucinations
o Auditory
 Thought echo
 Running commentary
 3rd person
 Coming from body
o Persistent hallucinations of any modality when
 Associated with fleeting / half-formed delusions / persistent overvalued ideas
 Occurring everyday for months
5. Negative symptoms (exclude depression and neuropathic medication)
 Marked apathy (emotional)
 Paucity of speech
 Blunt / incongruent mood
 Social withdrawal
 Low social performance
6. Significant + constant change in quality of some aspect of personal behaviour manifest as

 Loss of interest  Self-absorbed attitude

 Aimlessness  Social withdrawal
 Idleness (lazy)

D/D

 Schizophrenia
 Schizoaffective disorder – Ask about symptoms of depression and mania
 Depression/mania with psychotic symptoms
 Delusional disorder – Usually has systematized delusions
 Substance abuse – especially about cocaine
  Organic brain pathology – TLE, SLE, endocrine disease- Cushing, thyroid, metabolic disease, Infections
 Dementia

Describe the risks to the patient and to others

Predisposing, precipitating and maintaining factors for the disease

 Complications of pregnancy, delivery and the neonatal period

 Delayed walking and neuro-developmental difficulty

Prognosis

Good prognostic factors Poor prognostic factors

Sudden onset Insidious onset
Short episode Long episode
No previous psychiatric history Previous psychiatric history
Paranoid type Hebephrenic
Prominent negative symptoms
Older age at onset Young age at onset
Female Male
Married Single
Good psychosexual adjustment Poor
Good previous personality Abnormal pre morbid personality
Good work record Poor work record
Good social relationships Social isolation

Types

Paranoid Hebephrenic Catatonic Residual

Commonest
Delusions – persecutory, reference, Prominent thought disorganization Prominent Prominent
grandiose, bodily change, love, jealousy Rambling, incoherent speech, perseveration psychomotor negative
Auditory hallucinations – persecutory, Pranks, giggling, self-satisfied disturbance symptoms for a
commanding, without verbal form Associated with early negative symptoms (one or more of duration of at
(whistle, hum, laugh) Prominent affective changes catatonic features) least 1 year.
Other hallucinations – Delusions & hallucinations – fleeting, At least one
Smell, taste, sexual/somatic fragmentary clear Schizo
Thought disorganization, catatonic and Irresponsible unpredictable behaviour / episode in past.
negative symptoms not prominent mannerism, solitary, empty feelings No dementia
Volition disturbed

Post schizophrenic depression

 Schizophrenia (meeting criteria) within last 12 months - only depression as diagnosis

 Some symptoms of schizophrenia still present (not meeting criteria) - Schizophrenia / Schizoaffective
 Depressive features fulfilling the criteria for last 2 weeks - No depression