Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves.

1. Presented By: Kishan Shaw
Student Id: 882f3eabf2a711e9b49f4b9232e7e48d
Affiliation: Banaras Hindu University
Schizophreni
a Fragmented Mind…!

2. Acknowledgement
I have taken efforts in this project. However, it would not have been
possible without the kind support and help of many individuals and
organizations. I would like to extend my sincere thanks to all of them.
I am highly indebted to Swayam for their guidance and constant supervision
as well as for providing necessary information regarding the (Academic
writing) project & also for their support in completing the project.
I would like to express my gratitude towards my parents & member of
Academic writing their kind co-operation and encouragement which
help me in completion of this project.
My thanks and appreciations also go to my colleague in developing the
project and people who have willingly helped me out with their abilities.

3. Schizophrenia
 Schizophrenia is a chronic and severe
mental disorder that affects how a
person thinks, feels, and behaves.
People with schizophrenia may seem
like they have lost touch with reality.
Although schizophrenia is not as
common as other mental disorders,
the symptoms can be very disabling.

4. Introduction:
 Schizophrenia is one of the most complex, chronic and challenging of
psychiatric disorders that affects how a person thinks, feels, behaves.
 It represents a heterogeneous syndrome of disorganized thoughts,
delusions, hallucinations, and impaired psychosocial functioning.
 It is classified separately from other disorders because it is not easily
categorized as an anxiety or mood disorder.
 Schizophrenia is characterized by the inability to separate reality from
and a non-reality.
 Schizophrenia patients often experience non-existent stimuli that create
perceptions of things that do not exist, such as voices.
 Symptoms may include: flat effect (exhibiting no emotion), delusions,
hallucinations, or disorganized thinking.

5. History of Schizophrenia
 Schizophrenia was actually first identified in 1887, but can be
traced back to thousands of years ago, which means that it has been
recurring throughout history.
 Schizophrenia was coined in 1911 by the Swiss psychiatrist, “Eugen
Bleuler”.
 The word schizophrenia comes from Greek roots, schizo meaning
split and phrenia meaning mind, to describe the fragmented
thinking of people with the disorder.

6. Information on Schizophrenia
 The symptoms of Schizophrenia usually begin between 15 and
25 years old for males, with females develop it later (around age
30).
 It is rare for a person to develop Schizophrenia before 10 years
of age and after 40 years of age.
 Schizophrenia occurs in all societies regardless of class, color,
religion, culture, etc.
 Onset in men is usually earlier (15-24) than in women (25-34).

7. Research Indications
 Schizophrenia is a disorder of the neuro-chemicals that transmit
messages between neurons in the brain and quantity of synapses.
 There are physical differences in the brain.
 There are differences in the cognitive processing of information.
 MRIs show significant changes in brain functioning for those with
schizophrenia.
 Genetic markers that can increase a person's risk for schizophrenia.
 Three major studies have shown teenagers under 15 who use
cannabis regularly, especially "skunk" and other more potent forms
of the drug, are up to four times more likely to develop
schizophrenia by the age of 26.

8. Causes of Schizophrenia:
 No one knows the exact cause of schizophrenia, but multiple possible
factors have been discovered.
 Genetics appear to play a part; someone is more likely to develop
schizophrenia if they have an identical twin with schizophrenia than if
they have a fraternal twin with schizophrenia.
 It occurs in 1 percent of the general population, but is seen in 10
percent of people with a first-degree relative (a parent, brother, or
sister) with schizophrenia.
 Women infected with the influenza virus during their pregnancy are
more likely to give birth to children who will develop the disorder.
 Schizophrenics’ brains also contain larger fluid-filled areas than their
healthy brain counterparts.

9.  Genetics – “runs in the family”

10.  Prenatal Damage
* Malnutrition
* Viruses
 Environment
* Family Stress
* Poor Social Interactions
* Infections or Viruses at an early age
* Trauma at an early age

11.  Neurotransmitters (Biological)
* too much dopamine, low levels of
serotonin and glutamate
 Brain Abnormalities (Biological)
* reduced number of neurons
* enlarged ventricles
* thalamus abnormalities
 Reinforcement of a bizarre behavior
(Behaviorists)

12. Risk Factors
There are several factors that contribute to the risk of developing schizophrenia.
 Genes and environment: Scientists have long known that schizophrenia sometimes runs in
families. However, there are many people who have schizophrenia who don’t have a family
member with the disorder and conversely, many people with one or more family members with
the disorder who do not develop it themselves.
Scientists believe that many different genes may increase the risk of schizophrenia, but that no
single gene causes the disorder by itself. It is not yet possible to use genetic information to
predict who will develop schizophrenia.
Scientists also think that interactions between genes and aspects of the individual’s environment are
necessary for schizophrenia to develop. Environmental factors may involve:
Exposure to viruses
Malnutrition before birth
Problems during birth
Psychosocial factors

13.  Different brain chemistry and structure: Scientists think that an imbalance
in the complex, interrelated chemical reactions of the brain involving the
neurotransmitters (substances that brain cells use to communicate with
each other) dopamine and glutamate, and possibly others, plays a role in
schizophrenia.
Some experts also think problems during brain development before birth
may lead to faulty connections. The brain also undergoes major changes
during puberty, and these changes could trigger psychotic symptoms in
people who are vulnerable due to genetics or brain differences.
 Drug abuse:
Drugs don't directly cause schizophrenia, but studies have shown drug
misuse increases the risk of developing schizophrenia or a similar illness.
Certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may
trigger symptoms of schizophrenia in people who are susceptible.
Using amphetamines or cocaine can lead to psychosis, and can cause a
relapse in people recovering from an earlier episode.

14.  Pregnancy and birth complications
Research has shown people who develop schizophrenia are more likely to have experienced
complications before and during their birth, such as:
a low birth weight
premature birth
a lack of oxygen (asphyxia) during birth
It may be that these things have a subtle effect on brain development.
 Triggers
Triggers are things that can cause schizophrenia to develop in people who are at risk.
These include:
Stress
The main psychological triggers of schizophrenia are stressful life events, such as:
Bereavement, losing your job or home, Divorce, the end of a relationship, physical, sexual
or emotional abuse
These kinds of experiences, although stressful, don't cause schizophrenia. However, they can
trigger its development in someone already vulnerable to it.

15. Signs and Symptoms
Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases,
children have schizophrenia too.
The symptoms of schizophrenia fall into three categories: positive, negative, and
cognitive.
 Positive symptoms: “Positive” symptoms are psychotic behaviors not
generally seen in healthy people. People with positive symptoms may “lose
touch” with some aspects of reality.
 Symptoms include:
Hallucinations
Delusions
Thought disorders (unusual or dysfunctional ways of thinking)
Movement disorders (agitated body movements)
Catatonia (Purposeless abnormal motor activity or aggressive behavior)

16. Positive symptoms

17.  Negative symptoms: “Negative” symptoms are associated with
disruptions to normal emotions and behaviors. Symptoms
include:
“Flat affect” (reduced expression of emotions via facial expression
or voice tone)
Alogia : Reduced speech
Avolition : Inability to begin & sustain activities
Anhedonia : Inability to experience pleasure in everyday life
Asociality : Withdrawal from social contacts
Reluctance to perform everyday tasks

18. Negative symptoms:

19. Cognitive symptoms:
 For some patients, the cognitive symptoms of schizophrenia are
subtle, but for others, they are more severe and patients may
notice changes in their memory or other aspects of thinking.
Symptoms include:
Poor “executive functioning” (the ability to understand
information and use it to make decisions)
Trouble focusing or paying attention
Problems with “working memory” (the ability to use information
immediately after learning it)

20. Types of Schizophrenia:
 Paranoid schizophrenia:
Paranoid schizophrenia is characterized mainly by delusions of
persecution, feelings of passive or active control, feelings of
intrusion, and often by megalomania tendencies also. The
delusions are not usually systemized too much, without tight
logical connections and are often combined with hallucinations of
different senses, mostly with hearing voices.
Flattening or incongruity of affect, volition and catatonic symptoms,
or incoherent speech must not dominate the clinical picture, although
they may be present to a mild degree. With duration of at least one
month.

21.  Hebephrenic schizophrenia:
Hebephrenic schizophrenia is characterized by disorganized thinking
with blunted and inappropriate emotions. It begins mostly in
adolescent age, the behavior is often bizarre. There could appear
mannerisms, grimacing, inappropriate laugh and joking, pseudo
philosophical brooding and sudden impulsive reactions without
external stimulation. There is a tendency to social isolation.
Denoted also as disorganized schizophrenia.
Behavior is disorganized and without purpose
Thoughts are disorganized, difficult to understand by others
Pranks, giggling, health complaints, grimacing and mannerisms are
common
Delusions and hallucinations are fleeting
Usually develops between 15-25, with duration of at least one month.

22.  Catatonic schizophrenia:
Catatonic schizophrenia is characterized mainly by motor activity,
which might be strongly increased (hype kinesis) or decreased
(stupor), or automatic obedience and negativism.
Rarer than other types
At risk for malnutrition, exhaustion or self-injury
Unusual movements, often switching between extremes of over- activity
and stillness
Unable to talk (Catatonia) For a period of at least two weeks.

23.  Undifferentiated schizophrenia:
Psychotic conditions meeting the general diagnostic criteria for
schizophrenia but not conforming to any of the subtypes in F20.0-
F20.2, or exhibiting the features of more than one of them without
a clear predominance of a particular set of diagnostic characteristics.
Some characteristics of paranoid, hebephrenic or catatonic
schizophrenia, but does not obviously fit one of these type.

24.  Post-schizophrenic depression:
A depressive episode, which may be prolonged, arising in the aftermath
of a schizophrenic illness. Some schizophrenic symptoms, either
„positive“ or „negative“, must still be present but they no longer
dominate the clinical picture.
These depressive states are associated with an increased risk of suicide.

25.  Residual schizophrenia:
A form of schizophrenia that is characterized by a previous diagnoses of
schizophrenia, but no longer having any of the prominent psychotic
symptoms. There are some remaining symptoms of the disorder
however, such as eccentric behavior, emotional blunting, illogical
thinking, or social withdrawal.
Past History of psychosis but only having negative symptoms.

26.  Simple schizophrenia:
Simple schizophrenia is characterized by early and slowly developing
initial stage with growing social isolation, withdrawal, small activity,
passivity, a volition and dependence on the others.
Simple-type schizophrenia is a sub-type of schizophrenia as defined in
the International Classification of Diseases (ICD-10). It is not
included in the current Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). Simple-type schizophrenia is characterized by
negative ("deficit") symptom, such
as avolition, apathy, anhedonia, reduced affect display, lack of
initiative, lack of motivation, low activity; with absence
of hallucinations or delusions of any kind. Slowly progressive
development over a period of at least one year

27. Complication:
 Depression: Depression afflicts approximately half of schizophrenic
patients. Sadly, it is not always recognized or treated. It can significantly add
to the suffering of the person. Additionally, co morbid depression increases
the risk of suicide in schizophrenic.
 Anxiety : Many individuals with schizophrenia also have an anxiety
disorder, such as social anxiety disorder, PTSD, generalized anxiety disorder,
OCD or panic disorder. In fact, research suggests between 30% and 85% of
people with schizophrenia have had an anxiety disorder at some point in
time.
 Suicide : Suicide is one of the primary causes of death for individuals with
schizophrenia. There are several factors which contribute to suicide risk in
schizophrenia which include psychotic symptoms, such as voices telling the
person to kill himself, substance abuse, recent diagnosis of schizophrenia and
co morbid depression.

28.  Substance Abuse & Smoking: Substance abuse is a form of self-
medication for many people with psychiatric disorders. Unfortunately,
when patients use substances such as alcohol or street drugs it can
make their symptoms worse. They are also less likely to continue
taking their medications when they abuse substances.
 Violence: While the media often depicts schizophrenic patients as
violent, they are not necessarily more prone to violence than the
general population. That being said, some factors can increase the risk
of violent behavior in individuals with schizophrenia, such as
delusions or command hallucinations, a history or violent acts or
using alcohol or drugs.
 Self-injury: Self-injury, especially bizarre types of self-mutilation, is
not uncommon with schizophrenia. Hallucinations and delusions can
cause them to harm themselves in ways which can be very serious,
such as attempting to remove a finger or other body part.

29. Diagnosis:
 Diagnostic Criteria For Schizophrenia : It includes the criteria in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),
published by the American Psychiatric Association.
 Medical History : A thorough medical history is the first step in the
diagnosis of schizophrenia. This may be done to find other problems that
could be causing symptoms and to check for any related complications.
 Blood Tests & Imaging : A Complete Blood Count (CBC) test is helpful
to monitor general health and rule out other conditions that may have
been responsible for the symptoms. A blood test can provide accurate
information about the involvement of recreational drugs. In some cases,
certain imaging techniques such as Magnetic Resonance Imaging (MRI)
or Computed Tomography (CT) scan may aid in the diagnosis.

30.  Psychiatric Evaluation : A doctor or mental health professional
checks mental status by observing appearance, demeanor and
asking about thoughts, moods and awareness. A person may be
diagnosed if they have at least 2 of the following symptoms
usually over a month :
Delusions
Hallucinations
Disorganized behavior
Disorganized speech and thought processes
Catatonic behavior, presenting as strong daze or hyperactivity
Negative symptoms, impaired normal function

31. Prognosis:
 There is no known cure for Schizophrenia. Fortunately, there
are effective treatments that can reduce symptoms, decrease the
likelihood that new episodes of psychosis will occur, shorten the
duration of psychotic episodes, and in general, offer the
majority of people the possibility of living more productive and
satisfying lives.
 With the proper medications and supportive counseling, the
ability of schizophrenic persons to live and function relatively
well in society is excellent.

32. Management:
 Hospitalization:
During crisis periods or times of severe symptoms, hospitalization may be
necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.
 Psychosocial Interventions:
Individual therapy : Psychotherapy may help to normalize thought patterns. Also,
learning to cope with stress and identify early warning signs of relapse can
help people to manage their illness.
Social skills training : This focuses on improving communication, social
interactions and improving the ability to participate in daily activities.
Family therapy : This provides support and education to patient families.
Vocational rehabilitation and supported employment : This focuses on helping
people with schizophrenia prepare for, find and keep jobs

33.  Electroconvulsive Therapy
For adults with schizophrenia who do not respond to drug therapy,
electroconvulsive therapy (ECT) may be considered. ECT may be
helpful for someone who also has depression.
The indications for ECT in schizophrenia are :
Catatonic stupor & uncontrolled catatonic excitement.
Acute exacerbations not controlled with drugs.
Risk of suicide, homicide or danger of physical assault.
 Cognitive Behavioral Therapy
CBT aims to help to identify the thinking patterns that are causing to
have unwanted feelings & behavior and learn to replace this
thinking with more realistic and useful thoughts.
Most people require between 8 and 20 sessions of CBT over the space
of 6 to 12 months. CBT sessions usually last for about an hour.

34. Clinical Management:
 The APA guidelines treatment recommendations for patient
with schizophrenia divide the treatment into 3 phases :
1. Acute Phase (Initial Presentation) 4 to 8 weeks : Defined by
acute psychotic episode
2. Stabilization Phase (Early symptom remission) as long as 3
months : Constitutes a time – limited transition to continuing
treatment
3. Stable Phase (Maintenance treatment) : Involves stable
treatment
APA guideline refers to the American Psychiatric Association.

36. Clinical Challenges:
 Lack of Education
 Lack of Access to Effective Health Care
 Lack of funding for Schizophrenia and related diseases
 Hopelessness and shame
 Substance use disorders are common in people with
schizophrenia
 Insight can be impaired leading people with schizophrenia to
refuse treatment
 Adherence to treatments can be irregular

37.  How can I help someone I know with schizophrenia?
Caring for and supporting a loved one with schizophrenia can be hard. It
can be difficult to know how to respond to someone who makes
strange or clearly false statements. It is important to understand that
schizophrenia is a biological illness.
 Here are some things you can do to help your loved one:
 Get them treatment and encourage them to stay in treatment
 Remember that their beliefs or hallucinations seem very real to them
 Tell them that you acknowledge that everyone has the right to see
things their own way
 Be respectful, supportive, and kind without tolerating dangerous or
inappropriate behavior
 Check to see if there are any support groups in your area

38. Thank
You …!