Schizophrenia is a mental illness affecting 1 in 100 people during their lifetime.

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General Adult Psychiatry ­ I
I. Schizophrenia
II. Disorders related to schizophrenia
III. Mood disorders
A. Brief History1
?? 19th Century ­ All serious mental disorders seen as expressions of a
single entity
(Einheitpsychose, Griesinger) i.e. a unitary psychosis
?? Morel (1852) ­ proposed mental illnesses could be separated and
classified, based on
cause. Described démence précoce: starting in adolescence, withdrawal,
mannerisms, self-neglect and intellectual decline
?? Kahlbaum (1863) ­ described catatonia with characteristic motor
features (also
described hebephrenia and dementia paranoides)
?? Hecker (1871) ­ wrote an account of hebephrenia (very similar to our
?? Emil Kraeplin (1855-1926) ­ Argued against unitary psychosis.
Proposed division
into dementia praecox (`dementia' emphasises the importance he gave to
impairments and persisting disability) and manic-depressive psychosis
(episodic with
normal functioning in between).
Dementia praecox further divided into 3 subtypes: catatonic, hebephrenic
paranoid. Then later added 4th subtype: simple
Defined paraphrenia separately (started middle life, free from changes in
emotion and
volition seen in dementia praecox)
?? Eugen Bleuler (1857-1959) ­ proposed the name schizophrenia to
denote `splitting' of
psychic functions. More optimistic about outcome. Made distinction
fundamental symptoms:

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The 4 `A's:
?? Disturbances of Associations (thought disorder)
?? Affective flattening
?? Autism (social withdrawal)
?? Ambivalence (apathy)
And accessory symptoms:
o He believed these to be derived from loosening of associations
?? Hallucinations
?? Delusions
?? Catatonia
?? Abnormal behaviour
?? Kurt Schneider (1887-1967) - identified symptoms characteristic of
the disorder,
rarely found in other disorders. Not supposed to have central
role and not necessary nor sufficient for the diagnosis. Nor do they have
significance. (See box 1).…read more

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Somatic passivity (bodily sensation or function imposed by external
Delusional perception
?? Kasanin (1933) - described schizoaffective disorder
?? Leonard (1957) ­ Separated schizophrenia from cycloid psychoses
psychoses with good outcome)
Further sub-divided schizophrenia into systemic (catatonia, hebephrenia,
and non-systemic (affect-laden paraphrenia, schizophasia and periodic
?? Langfeldt (1961) ­ Differentiated schizophreniform states from true
associated with better prognosis
?? In Denmark and Norway ­ Delineated cases of psychosis arising from
stressful events:
reactive or psychogenic psychosis
B.…read more

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Anabaptist sect in the USA
Populations with higher rates include: Isolated communities in Sweden and
Finland, Afro-
Caribbeans in the UK, Catholics in Canada, Tamils of Southern India.
?? Some studies suggest that incidence may be falling in industrialised
although there is some doubt as to whether this is a genuine reduction in
rate or changing diagnostic criteria/inaccurate records.
?? Onset is characteristically between 15 and 45 years of age.…read more

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Companion to Psychiatric Studies, 7th edition, eds Johnstone,
Cunningham Owens, Lawrie, Sharpe, Freeman, p398
7 New Oxford Textbook of Psychiatry, eds Gelder, Lopez-Ibor Jr,
Andreason, 2000, p 591
8 Companion to Psychiatric Studies, 7th edition, eds Johnstone,
Cunningham Owens, Lawrie, Sharpe, Freeman, p393
GAP ­ I Diet II: 2008
?? Passivity phenomena
?? Hallucinations in any modality, but most commonly auditory ­ content is
?? Thought disorder
?? Affect ­ delusional mood in the prodrome, euphoria/anxiety/depression,
perplexity, incongruity, flattening (blunting)
?? Behaviour…read more

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Non-verbal auditory
34% 15%
Other (tactile, gustatory) 36% 16%
3rd person auditory
32% 16%
Olfactory hallucinations 27% 13%
Visual hallucinations 23% 11%
GAP ­ I Diet II: 2008
The Chronic Syndrome
Characterised by:
?? Reduced intensity of delusions and hallucinations
?? Underactivity, social withdrawal, lack of drive and volition
?? Inappropriate dress
?? Neglect of appearance and self-care
?? Deterioration of social behaviour
?? Slowness
?? Thought disorder
?? Blunted affect
?? Cognitive impairment
?? Movement disorder
Clinical Syndromes in Schizophrenia
Factor…read more

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Include social withdrawal, apathy, lack of drive, under-activity,
slowness, poverty of
speech and thought.
?? They tend to be more prominent in the chronic phase. Negative
symptoms can be
primary or secondary to depression, medication, institutionalization or
other life
?? Patients with primary negative symptoms have an earlier onset of
illness, tend to be
male and unmarried, have poor pre-morbid functioning, more motor
and more likely to be concordant if a twin.…read more

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Liddle (1987), using factor analysis, described 3 overlapping clinical
syndromes which he
linked with patterns of neuropsychological deficit and to regional cerebral
blood flow (see
Table 2). The most reproducible finding relates to psychomotor poverty.…read more

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Underactivity of
frontal cortex
Word generation
tasks, planning
Cognitive features
?? Impairments in all domains of learning and memory
?? Disproportionate involvement of semantic memory, working memory,
attention and
executive function
?? Major determinant of poor functional outcome.
?? Evidence of cognitive impairment in unaffected twins of schizophrenics,
some genetic contribution.
?? Cognitive deficits can be discerned from early childhood.…read more

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Subtypes of schizophrenia
?? Paranoid schizophrenia ­ delusions and hallucinations are prominent
features. This
is the commonest form.
?? Hebephrenic schizophrenia - Similar to disorganized type of DSM-IV.
Silly and
childish behaviour. Affective symptoms and thought disorder prominent,
and hallucinations fleeting but not elaborate and should not dominate the
picture. Negative symptoms occur early and contribute to poor prognosis.
?? Simple schizophrenia - Characterised by insidious onset, odd
behaviour, declining
social and occupational functioning. Absent positive symptoms and
negative symptoms.…read more


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