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| MENTAL ILLNESS A VIEW | ||||||||||||||||
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This article will give a brief overview of psychotherapeutic techniques, their classification and how it is used. Psychotherapy: Defined by Wolberg. It is the treatment by physiological means, of problems of an emotional nature, in which trained person (therapist) deliberately establishes a professional relationship with the patient to 1. Remove, Modify or Retard Existing Symptoms 2. Mediate disturbed patterns of Behaviour 3. Promote Positive personality Growth and Development. --------------------------- Psychotherapy --------------------------- - Basically it is a treatment by listening to what the patient says and taking with him. - It involves communication between two individuals, the patient and therapist. - The patient encourage to express freely his fears, emotion and experiences. - The therapist may be a Psychiatrist, Psychologist, Psychiatric Social Worker or a trained Psychiatric Nurse. - Development of therapeutic Relationship - Understand the Patient�s Family & Cultural Background - Good Listener - Be Patient, Sympathetic, Understanding & Tactful - Interest & Concern for Patient�s Problems - Should not be upset with Patient�s selfish and irresponsible Behaviour - Not to emotionally involved with the patient and his Problems --------------------------- Counseling Vs Psychotherapy --------------------------- - Counseling professional assistance given to a variety of problems by discussion and advice. - Counseling can be given to healthy individuals also. - Counseling will not go into the depth of the problem or about the unconscious Mental Processes. - Psychotherapy � many techniques Ventilation, Abreaction, - Reassurance, Explanation, Suggestion, Persuation, Relaxation --------------------------- Types --------------------------- 1. Individual Psychotherapy 2. Group Psychotherapy 3. Family Psychotherapy 4. Psychoanalytic Psychotherapy 5. Hypnotherapy 6. Cognitive Therapy 7. Crisis Intervention 8. Behaviour Therapy 9. Relaxation Therapy --------------------------- Individual Psychotherapy --------------------------- - Encouraging him to discover for himself the reasons for his behaviour. - Listens to the patient and offers explanation and advise when necessary. - Problem Solving - Usually take place at regular intervals � Time � Weeks � Months - Neurotic Disorders, Stress Related Disorders, Alcohol, Drug Dependence, Sexual Disorders and Marital Disharmony. --------------------------- Group Therapy --------------------------- - Several people meet as a group with a therapist for the treatment of emotional and behavioural problems. - Patients usually 8 � 12 in number. - The individual feels more comfortable and confident in a group and will begin to talk about his problems & find other patient are willing to listen & give him advice. - Useful for persons with similar problem [Alcoholic, Dry Dependent] - Traditional group therapy � Psychodrama Role in group Therapy 1. Catalyst 2. Transference Object 3. Clarifier 4. Interpreter 5. Role Model & Resource Person 6. Supporter --------------------------- Family Therapy --------------------------- - Treating the family as a unit. Aim 1. To Change the Way � Family Interact 2. Helping the family members clarify & express their feeling, 3. Developing Mutual Understanding 4. Workout effective way to relating to one another Two Methods 1. Resolving Family Conflicts 2. Modifying Maladaptive Behaviour Indication 1. Marital Problem 2. Child � School Phobia, Mental Retardation 3. Adjustment Disorder 4. Alcoholism & Drug Dependence 5. Attempt Suicide --------------------------- Psychoanalytic Psychotherapy --------------------------- - Sigmund Freud Aim � Uncovering Conflicting, Unconscious Impulses through special techniques that include - Free Association - Dream Analysis - Transference - Hysteria, Neurotic Disorders & Personality Disorder --------------------------- Hypnotherapy --------------------------- Hypnosis is a psychophysiological, Altered state of consciousness induced by conditioning and skilled use of suggestions. 1. Lessening the subject inhibitions & Reasoning 2. Heightening the ability to relax & his susceptibility to suggestion. Hypnosis is super concentration of the mind Steps of Hypnosis 1. Relaxation 2. Realisation of the cause of the problem 3. Removal of the cause of the problem 4. Rehabilitation 5. Reinforcement Application of Hypnosis 1. The problem & conflict, which deeply placed inside the mind 2. Neurotic Disorder � Hysteria, Phobia & Obsessive Compulsive Disorders 3. Induction of Labour & Dental surgery without Anaesthesia 4. Alter Unwanted Behaviour 5. Self � Hypnosis & Attain Relaxation 6. Psychosomatic Disorder --------------------------- Cognitive Therapy --------------------------- - Theory that Behaviour is Secondary to Thinking - Short � Term Psychotherapy - Mood & Feeling are influenced by our thoughts - Self Defeating & thinking � Depressed Mood - Self Deprecating - Correcting the distorted way of thinking - Mood Disturbances & Behaviour Change Corrected. - What we Think � Cognitive Content - How we Think � Cognitive Process Cognitive Triad 1. Negative View about Self 2. Negative View about the Environment 3. Negative View about the future. - Depression & Anxiety - Drug Abusers --------------------------- Crisis Intervention --------------------------- - Type of brief Psychological method of treatment for the persons who is in emotional crisis. Crisis � Sudden event in one�s life that disturbs the mental equilibrium during which the usual coping mechanisms fail. Criteria for Selection 1. Recent Traumatic situation produces Anxiety 2. Precipitating event that Intensified the Anxiety 3. Clear cut Evidence that Patient in Psychological Crisis 4. High Motivation to overcome the Crisis Technique - The Action Required is Rapid one. Focus on the Crisis & Precipitating Factors 1. Reassurance 2. Suggestion 3. Environmental Manipulation 4. Psychotropic Medication - One or two sessions may be sufficient - If needed brief Hospitalisation Most suitable for 1. Attempted Suicide 2. Post Traumatic Stress Disorder --------------------------- Behaviour Therapy --------------------------- - Based on Learning Theory - Learned to be unlearned - Unlearned to be learn Used in - Phobia - Obsessional Thought - Compulsive Behaviour - Schizophrenic Mannerisms - Eating Disorder - Smoking - Drinking - Sexual perversion Phobia 1. Systematic Desensitisation - Exposed slowly to a gradual hierarchy of Phobic objects or Situations. 2. Flooding - Forced to remain in the Phobic Situation until his Anxiety is exhausted 3. Implosion - Instructed to Imagine the Phobic Situation & remain in it until his Anxiety is exhausted Compulsive Acts 4. Modeling - Therapist carried out the act which patient is afraid of and require the patient to imitate. 5. Response Prevention - Therapist prevents the patient from avoiding unpleasant act or situation. 6. Thought Stopping - Prevent the patient from continuing to ruminate his obsessive thought by shouting �STOP� or inflicting mild pain on his arm with a rubber band. Schizophrenia or Mental Retardation 7. Operant Conditioning - Reward for desired behaviour � token economy punished for undesirable behaviour 8. Social Skills Training - Eye contact, Speaking Appropriately, Observing Simple Etiquette & Relating to People. Alcoholism & Sexual Deviations 9. Aversion Therapy - Drinking Alcohol � Electric Shock Disulfram Treatment - HCR - Aversion Treatment --------------------------- Relaxation Therapy --------------------------- - Anxiety & Stress Related Problems 1. Progressive Muscle Relaxation Technique (Jacobson) 2. Transcendental Meditations 3. Yoga Four Elements Needed 1. Quiet Environment 2. Mental Devices 3. Passive Attitude 4. Comfortable Position Relaxation Effect O2 Consumption Respiratory Rate Heart Rate Alpha Brainwaves Blood Pressure Blood Lactate Level BY DR.M.RAJARAM Psychiatry Clinical Examination Format with Examples Psychiatric Clinical Examination Basic Information Name, Age, Sex, Occupation, Address Identification Marks � Medico legal purpose Informant � to be reliable (who is staying with patient during the illness) Chief Complaints (as patient and relative say) General - Sleep Disturbances, Appetite, Appearance, Sex, Personal Relationship, Day to Day Activity, Behaviour. Schizophrenia - Talking to Self, Laughing to Self, Hearing Voices, Suspicious about Others, Not doing any job, Lack of Personal Care, Violent behavior, Suicidal Attempt, Somebody trying to kill him, Somebody watching him. Depression Reduced Activity, Not talking with Others, Crying Spells, Death Wish, Guilty Feeling, Worried about Future Life. Mania - Excessive Talk, increased Activity, Frequently Changing the Dress, Dressed Neatly, Talk about Superior power, Talk of Wealthiness, Talking that she is the God. Delusional disorders - Suspicious about Wife or Husband - Crawling sensation over the head or body Psychotic Symptoms - Hearing Voices, Suspicious about Others Neurotic Symptoms - Headache, vomiting, palpitation, Chest pain, Fear of Death, Fear of having some Illness, Fear to go to Crowded Place, Fear to Stay Alone, Fear to stay in Height Place, Repeated checking, Repeated washing, Repeated thought, multiple pain site. Hysterical Symptoms - Sudden fainting attack, H/O jerky movements for long time., Mute History of Present Illness - Onset - Sudden, gradual - Precipitating Factors - Course � Episodic, Progressive H/O Previous Illness - Past Psychiatric Consultation - Past Medical History Family History - Pedigree Chart - - Male Female � Mental Illness Died - Family Background - Parents and Siblings - Family History of Mental Illness Personal Life History A. Early Childhood 1. Developmental Mile Stones 2. Intrafamilial Relationship B. Middle Childhood 1. Friends 2. School C. Adolescence 1. Puberty 2. Psychosexual History 3. Dating & Peer Relationship 4. School Performance 5. Drug & Alcohol abuse D. Early Adulthood 1. Marital and Other Adult Relationship 2. Work History 3. Recreational & Vocational pursuits 4. military History 5. Prison History E. Middle and Old Adulthood 1. Changing Family constellation 2. Retirement 3. Loses 4. Aging - Birth, Childhood, Education Occupation, Marriage, Sexual Practice, Mental History (Female), Habits liked Alcohol, Drugs & Smoking, Religious Practices, Hobbies, Interests, Daily Activity) Pre morbid Personality - Reserved (Introvert) - Social (Extrovert) - Suspicious (Paranoid) - Perfectionist (Obsessive) - Hysterical - Antisocial - Aggressive - Frequent Mood Change (Cyclothymics) Mental Status Examination General Appearance & Behaviour - dressing, Care of Hair, Care of Nail - Personal Hygiene - Psycho Motor Activity - Touch of Surrounding or Not - Rapport Speech - Tone & Quantum of Speech - Relevant / Irrelevant - Coherent /incoherent - Neologism Mood & Emotional State - Affect � Reacting or Not - Subjective Mood - Objective Mood - Depressed, Irritate, Elated, Agitated, labile Mood Thought Form & Context Thought form - Circumstantialities - Derailment - Flight of Ideas - Neologism - Thought Block Thought Context - Delusions - Ideas of Reference - Obsessions - Preoccupation with Suicidal Ideas Perception - Illusion - Hallucinations Higher Functions 1. Alertness 2. Orientation a. Person b. Time c. Place 3. Attention and Concentration 4. Memory a. Immediate b. Recent c. Remote 5. Abstract Thinking 6. Judgment Insight - Whether the person knows that he is mentally ill or not and to what extent. Mood Disorders (Affective Disorder) Mood � Internal Emotional State of an Individual Mood Disorder � Excessive swing of Mood Normal � Mild Elation to Mild Depression depending on many factors. -------------------- Classification -------------------- 1. Manic Depressive Psychosis - Bipolar Affective Disorders 2. Endogenus Depression - Major Depression 3. Neurotic Depression - Dysthymic Disorder Depression It is the common cold of Psychiatric Illness, Commonly people says � Sad � Depressed � Down, Mood out, Dull, Lost of Interest & isolated. ======================================== Depression ======================================== � reaction to an event such as death of a loved one or Change in financial situation or it may come without any obvious external cause -------------------- Epidemiology -------------------- -Wide Spread Problem -Young and Old -Rich and Poor -Men & Women India � 1-6 % population 5 � 20 % Psychiatric Out Patient Age  30 � 50 Yrs. > 60 Yrs.  13 � 22 % Depression Female > Male -------------------- Major Depression -------------------- Presence of a. Depressed Mood b. Loss of Interest and Pleasure c. 4 or more of following symptoms Feelings of worthlessness or guilt Impaired Concentration Loss of Energy and Fatigue Thoughts Suicide Loss or increase of Appetite & Weight Insomnia or Excessive sleep Retardation or Agitation - Symptoms for atleast 2 weeks, Major Depression - Major Depression may present with or without psychotic symptoms. - Delusions, Hallucination & Bizaree Behaviour -------------------- Dysthymic Disorder -------------------- Depressed Mood � 2 Years Other Symptoms Or Sleep Or Appetite, Energy Self Esteem Poor Concentration & Hopelessness -------------------- Masked Depression -------------------- -------------------- Seasonal Depression � Winter -------------------- -------------------- Aetiology for Depression -------------------- Biological Factors Genetic Factors - Higher among the relatives of Individual Biochemical - Reduced Norepinephrine, Serotonin & Dopamine - Transposition of Sodium and Potassium Psychological Factors - Low Self-Esteem - Guilt - Lack of Support System - Lack of Clear Goals - Feelings of Failure - Inability to fulfill expectations - Separation or Object Loss Cognitive - Narrow negative attitude about self, environment & future, bad or inadequate judgement Behavioural - Hopelessness, Loss of positive reinforcement Socio Cultural Factors - Social Situations - Minority Group - Women in a male-dominant Occupation - Role Loss (Empty nest syndrome) Adverse Events - Injustice - Poverty - Unemployment Alcohol & Depression - Alcohol, Drug Abuse -------------------- Complications -------------------- Recover spontaneously after sometime some patient may so far His work & day to day activity suffer Loss in productivity & financial status Alcoholism or Drug Abuse Suicide -------------------- Management -------------------- Hospitalisation Indiacation: Severe Depression, Suicidal Tendencies Drug Therapy: Anti-Depressant Electro-Convulsive Therapy Psychotherapy - Problem Oriented, Positive Reinforcement, Family Therapy, Group Therapy & Cognitive Therapy Nursing Care in Depression Promote food intake & Sleep & Monitoring Food Intake & Drugs Take safety measures � In suicidal tendency Diminish feeling of loneliness Interaction focus on present & not the past � Reassurance Provide non-intellectual activities (Cleaning & Exercise) Strict record of Sleeping � Discourse sleep during daytime Health Education Family Education ======================================== Bipolar Disorders ======================================== - Mood swings from profound depression to extreme euphoria (Mania) with intervening period of normalcy. Mixed Manic Depressed ======================================== MANIA ======================================== It is mood disorder Patient excessively Happy & Energetic Usually occur as a part of Bipolar Very rarely mania alone occur (recurrently) Primary Mania  Affective or Mood Disorder Secondary Mania  Due to Organic Disorder -------------------- Aetiology -------------------- Biological Factors - Genetic Factors: Among the relative of Bipolar Disorders - Biochemical: Excessive Serotonin & Norepinephrine Psychological Factors - Faulty dynamics in the family system and disturbed ego development gives way to a strong id. -------------------- Clinical Features -------------------- Persistently Elevated, Expansive or Irritable Mood Inflated Self Esteem or Grandiosity Hyperactivity or Psychomotor Agitation Sleep Disturbance Pressure of Speech, More Talkative Flight of Ideas Distracted � Poor attention Span Pleasurable Activity � Spending, - Sexual Activity Dress in Bright Colour, Excessive Make Up & Jewellery Impaired Occupational Functioning Psychotic Symptoms Delusions, Hallucinations -------------------- Hypomonia -------------------- Euphoric, Elated, Dressing Colourfully, Cracking Jokes, Excessive Talk, Overactivity Manic Excitement Irritable, Excited, Violent -------------------- Management -------------------- Hospitalisation - Excited Drug Treatment - Anti-Psychotics - Anti-Manic - ECT Nursing Care Manic Patient Special attention to patient diet Drugs for restlessness & overactivity Emotional Needs _________________ �2005 DR.M.RAJARAM Mental Disorders - An Introduction What is Mental Illness ? It is the Disorder of Mind: Triad of Mind Cognition (or) Behaviour,Emotion, Conation or thought The Character of Medical Illness : 1. Person�s behaviour is causing distress & suffering to the Individual or Others. 2. Abnormal changes in one�s thinking, feeling, memory, perceptions and judgment � Change in talk & behaviour. 3. Abnormal behaviour cum disturbance in person�s day to day activity, job and Interpersonal relationship. �A person who is sad, bad or odd can be considered as mad, if these qualities cause problems to him & to others.� Signs & symptoms of Mental Illness Sudden onset Onset Gradual progressive Mild Cl. future Very severe I. General Behaviour 1. Sleep disturbance � Insomnia 2. Loss of appetite refusal of food a. intrest depression b. appetite c. time Mania d. Refuse to eat � paranoid 3. Personal appearance - Neglected, poor self care - schizophrenia - Neatly & colourful - mania - Appear seductive � Hysteria 4. Sex : - feel & lost their libido 5. Personel Relationship - Hostile, Angry - Withdrawn & aloof - Excited & unnecessary interferes 6. Interest in work hobbies & surrounding - May decline 7. Behaviour - Peculiarly, Irritate others, dangerous to himself, overactive, restless, 8. Disturbance in thinking - evident from his talk. - Excessive talk, Irrelevant talk, meaningless, Incoherent talk, thought block, thought Insertion, thought withdrawal, thought broadcasting. - Disorder of content of thought (Delusions) Delusion � false fixed Belief Character 1. Person convinced about a particular belief. 2. Cannot be corrected by reason or logic. 3. Not shared by members & same community Primary � arises from own Delusion Secondary � part of Psychiatric symptoms Types - Paranoid Delusion - Delusion of grandiose - Delusion of Jealousy or infidelity - Delusion of Control (Passivity phenomenon) - Hypochondriacal Delusion - Nihilistic Delusion II. Ideas of Reference - People around talk about him and make fun of him. III. Disturbance of Perception 1. Illusion � Misinterpretation (False perception of a real sensory stimulus. 2. Hallucination - False perception which occurs without an external stimulus - Auditory, Visual, Olfactory, Gustatory and Tactile - Normal � Hyponogagic & hypnopompic IV Disturbance of memory - Due to Lack of Interest, Agitation or Poor Registration. Amnesia : lack of memory for certain period of person walking life. HI, post ECI, Epilepsy. Dysamnesia or Paramnesia - damage to hippocampus & mammillary bodies - Confabulation � Alcoholic, Encephalitis. - filling up � memory gap. Organic memory impairment -Dementia V Consciousness - Awarness of surroundings confusion Disorientation VI. Disturbance of Affect or Mood - Mood � Internal Emotional state of an Individual - Affect � External expression of Emotional Context - Elation, Depression, Anxiety, Inappropriate affect, Apathy, Incongruous affect. VII. Distrubances Motor Activities. Catalepsy � Immobile position that is constantly maintained. Waxy Flexibility � person can be moulded into a position which is then maintained. Negativism � Motiveless resistance Stupor � Lack of reaction & unawareness of surroundings. Echoprasia � Pathological imitate of movements of one person by another. Posturing � Voluntary assumption of bizarre & maintaining it for long periods of time. Abnormality - Away from Normal - Statistically infrequent - It is not according to the Society�s Standard or expectation. - Maladaptive - produce personal distress - legally � not to judge � right or wrong. Biological Factors Psychological Factors Social Factors 1. Biological Factors - Genetic (Hereditary) � Twin studios - Biochemical � Neuro-transmitters � Dopamive, Serotomia, Acelzlchibica, Noepinepha, Epi*** -etc - Brain Damage - Infection, Injury, Intoxication, Tumours 2. Psychological Factors � Personality & Temperament - Early upbringing - Conflicts 3. Social Factors - Loss - Psychosocial Stress - Adversity - Poverty - Migration - Unemployment - Urbanisation General Classification of Mental Disorders Normal Classification According to ICD or DSM 1. Organic Mental Disorder - Delirium - Dementia 2. Functional (non-organic) Mental Disorders a. Psychotic Disorders - Schizophrenia - Mood Disorder - Delusional Disorder b. Neurotic Disorders - Anxiety Disorder - Phobic Disorder - Obsessive Compulsive Disorder - Hysteria - Hypochondriasis 3. Personality Disorders 4. Psychosexual Disorders 5. Stress related Disorders - Acute Stress Reaction - Post Traumatic Stress Disorder - Adjustment Disorder 6. Mental Disorders due to Psychoactive Substance Abuse - Alcohol Dependence - Other drugs Dependence 7. Psychosomatic Disorders 8. Child Psychiatric Disorders - Autism - Developmental disorders - Mental Retardation - Attention Defecit Disorders - Emotional Disorders - Habit Disorders 9. Other Disorders - Eating Disorder - Sleep Disorder - Disorders of Memory - Epilepsy & Psychiatric - Psychiatric Disturbances in Women - Psychiatric Disturbances in Adolescence - Psychiatric Disturbances in Old Age Schizophrenia - Overview of this common psychiatric disorder It is most common Psychotic Disorder - 50% of patients in all Mental Hospital Admission. It is Greek Word - Schizo � Split - Phrenic � Mind - Split Mind Definition - It is a functional Psychosis - Disturbances in Thinking, Emotion, Volition & Perception. - Clear Consciousness Epidemiology - Prevalent in all cultures and all part of the world - 3 to 4 / 1000 in any community - 1 % of general population in lifetime - 2/3 of cases 15 � 30 yrs - Lower Social Classes Etiology Biological Psychological Social Biological - Genetic Factors Monozygotic twin of Schizophrenic - 47 Child of Two Schizophrenic Parents - 40 Dizygotic twin of a Schizophrenic Parents - 12 - Bio Chemical Factors Dopamine Hypothesis (Dopamine) Transmethylation Hypothesis (Abnormal Transmethylation of Catecholamines) Indolamine Hypothesis (Defect in metabolism of Indolamine � Serotonin) Psychological - Withdrawn and Social Contact - Ego Boundary Disturbances Social & Environmental - Family with lot of conflict - Communication of parents with Children - Low Social Class Positive Symptoms Clinical Features Negative Symptoms Positive Symptoms - Delusions - Hallucinations - Aggression - Agitation - Suspiciousness - Hostility - Excitement - Grandiosity - Conceptual Disorganization Negative Symptoms - Apathy - Withdrawal - Avolition - Blunted Affect - Stereotyped Thinking - Artificial Gestures - Lack of Spontaneity Thought Disturbance Condensation � Ideas are mixed, not necessarily logical Displacement � Associated Idea, not correct one Symbolisation � Abstract thoughts are replaced by concrete ones. Over Inclusive Thinking � Irrelevant thoughts are incorporated into the speech. - Neolologism Incoherence and Mutism - Thought Block - Delusion � Disturbance content of thought - Delusions of Persecutions - Delusions of Grandeur Austism - Slow Progressive withdrawal from reality Volitional Disturbance - Deterioration in will power, drive and ambition - Apathy � Self Neglect Affect Disturbances - Flattening or Blunt affect Perceptional Disturbances - Hallucinations Behavioral Changes Withdrawal Changes ↓ Withdrawal from reality into fantasy ↓ Increase Apathy ↓ Stupor or Catatonic Stupor Reverse � Catatonic Excitement - Echolalia, Echopraxia, Negativism - Poor Personal Hygiene - Lack of Insight Types of Schizophrenia 1. Paranoid 2. Hebephrenic 3. Catatonic 4. Residual 5. Undifferentiated 6. Simple Paranoid Schizophrenia - Persecutory or Grandiose Delusions together with associated jealous - Hallucinations - Unfocussed Anxiety, Anger, Argumentativeness and Violence - Doubts about Gender Identity Hebephrenic Schizophrenia - Incoherence and Flat, Incongruous or Silly Effect - 15 � 25 Years - Extreme Social Impairment, Poor Pre morbid Personality, Early Insidious Onset and a Chronic Course without Significant remissions. Catatonic Schizophrenia - Psychomotor Disturbance - Catatonic Stupor or Rigidity - Catatonic Excitement - Catatonic Posturing - Negativism Residual Schizophrenia - Atleast one episode of Schizophrenia in the past but without Prominent Psychotic Symptoms at present. - Emotional Blunting, Social Withdrawal, Eccentric Behaviour, Illogical Thinking & Loosening Associations. Undifferentiated Schizophrenia - Prominent Psychotic Symptoms that cannot be classified in any Category Simple Schizophrenia - Insidious Onset, Progressive Development of Odd Behaviour, Wandering Tendency, Self-Absorbed, Idle and Aimless Activity Course of Illness Sub chronic - Less than 2 years at least 6 Months - From the beginning patient show signs of Illness more or less continuously Chronic - Duration > 2 Years Good Prognosis - Later Onset, Precipitating Factors, Acute Onset, Pre morbid personality, Affective (Depression) Symptoms, Paranoid Catatonic, Married, Family History of Mood Disorders, Good Support Care, Positive Symptoms Management 1. Somatic (Physical Therapies) a. Antipsychotic Medications b. ECT 2. Psychological Treatment a. Hospitalisation b. Psychotherapy c. Rehabilitation � Social, Vocational d. Aftercare � Day Treatment, Halfway Homes It is most common Psychotic Disorder - 50% of patients in all Mental Hospital Admission. It is Greek Word - Schizo � Split - Phrenic � Mind - Split Mind Definition - It is a functional Psychosis - Disturbances in Thinking, Emotion, Volition & Perception. - Clear Consciousness Epidemiology - Prevalent in all cultures and all part of the world - 3 to 4 / 1000 in any community - 1 % of general population in lifetime - 2/3 of cases 15 � 30 yrs - Lower Social Classes Etiology Biological Psychological Social Biological - Genetic Factors Monozygotic twin of Schizophrenic - 47 Child of Two Schizophrenic Parents - 40 Dizygotic twin of a Schizophrenic Parents - 12 - Bio Chemical Factors Dopamine Hypothesis (Dopamine) Transmethylation Hypothesis (Abnormal Transmethylation of Catecholamines) Indolamine Hypothesis (Defect in metabolism of Indolamine � Serotonin) Psychological - Withdrawn and Social Contact - Ego Boundary Disturbances Social & Environmental - Family with lot of conflict - Communication of parents with Children - Low Social Class Positive Symptoms Clinical Features Negative Symptoms Positive Symptoms - Delusions - Hallucinations - Aggression - Agitation - Suspiciousness - Hostility - Excitement - Grandiosity - Conceptual Disorganization Negative Symptoms - Apathy - Withdrawal - Avolition - Blunted Affect - Stereotyped Thinking - Artificial Gestures - Lack of Spontaneity Thought Disturbance Condensation � Ideas are mixed, not necessarily logical Displacement � Associated Idea, not correct one Symbolisation � Abstract thoughts are replaced by concrete ones. Over Inclusive Thinking � Irrelevant thoughts are incorporated into the speech. - Neolologism Incoherence and Mutism - Thought Block - Delusion � Disturbance content of thought - Delusions of Persecutions - Delusions of Grandeur Austism - Slow Progressive withdrawal from reality Volitional Disturbance - Deterioration in will power, drive and ambition - Apathy � Self Neglect Affect Disturbances - Flattening or Blunt affect Perceptional Disturbances - Hallucinations Behavioral Changes Withdrawal Changes ↓ Withdrawal from reality into fantasy ↓ Increase Apathy ↓ Stupor or Catatonic Stupor Reverse � Catatonic Excitement - Echolalia, Echopraxia, Negativism - Poor Personal Hygiene - Lack of Insight Types of Schizophrenia 1. Paranoid 2. Hebephrenic 3. Catatonic 4. Residual 5. Undifferentiated 6. Simple Paranoid Schizophrenia - Persecutory or Grandiose Delusions together with associated jealous - Hallucinations - Unfocussed Anxiety, Anger, Argumentativeness and Violence - Doubts about Gender Identity Hebephrenic Schizophrenia - Incoherence and Flat, Incongruous or Silly Effect - 15 � 25 Years - Extreme Social Impairment, Poor Pre morbid Personality, Early Insidious Onset and a Chronic Course without Significant remissions. Catatonic Schizophrenia - Psychomotor Disturbance - Catatonic Stupor or Rigidity - Catatonic Excitement - Catatonic Posturing - Negativism Residual Schizophrenia - Atleast one episode of Schizophrenia in the past but without Prominent Psychotic Symptoms at present. - Emotional Blunting, Social Withdrawal, Eccentric Behaviour, Illogical Thinking & Loosening Associations. Undifferentiated Schizophrenia - Prominent Psychotic Symptoms that cannot be classified in any Category Simple Schizophrenia - Insidious Onset, Progressive Development of Odd Behaviour, Wandering Tendency, Self-Absorbed, Idle and Aimless Activity Course of Illness Sub chronic - Less than 2 years at least 6 Months - From the beginning patient show signs of Illness more or less continuously Chronic - Duration > 2 Years Good Prognosis - Later Onset, Precipitating Factors, Acute Onset, Pre morbid personality, Affective (Depression) Symptoms, Paranoid Catatonic, Married, Family History of Mood Disorders, Good Support Care, Positive Symptoms Management 1. Somatic (Physical Therapies) a. Antipsychotic Medications b. ECT 2. Psychological Treatment a. Hospitalisation b. Psychotherapy c. Rehabilitation � Social, Vocational d. Aftercare � Day Treatment, Halfway Homes e. Education about the Illness for Patients and families By DR.M.RAJARAM |
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