case presentation on schizophernia with discussion

1. Case Presentation on Schizophernia
Presenter :
Dr Shubham Sadh
3rd Year PG Scholar
Guide:
Dr Suhas Kumar Shetty
Professor

2. Vital Data
• Name : ABC
• Age : 33 yrs
• Sex : Male
• Address :
• Religion : Hindu
• Education: Post
Graduation
• Occupation : business
• Marital status: Unmarried

3. PRESENT ILLNESS
loss of interest, lethargy and marked
reduction in physical and mental well being
since 6-7 years.

4. HISTORY OF PRESENT ILLNESS
• Informer – patient
• A 33 year old male c/o marked reduction in physical
and mental well being since 7years.
• Acc. To patient he was belittled by his sisters and
school mates for being obese which reduced his self
esteem and started performing poor in school works,
from childhood itself he started developing a feeling of
being left alone and was not able to tolerate even small
bullying.

5. • Later on he started feeling that all the people he
came across are talking about him behind his back.
• He also comments that people outside doesn’t
have manners. After completing pre-degree and
PGDC he started working as a trainee at auditory
office but left the job after 6 months with a feeling
of insecurity and joined a coffee trading company
but couldn’t hold on that job either.
• Later on he joined family business helping his
father.
• During the period of his pre degree he consulted a
psychiatrist at NIMHANS in 2008 as he was feeling
some kind of sexual abusement done on him by his
father and sister.

6. • He also complaints that he is intolerable to traffic and
noise.
• Informer – father
• Acc. To his father he was the young child of a non-
consaginous parents with two elder sisters both
unmarried.
• He was apparently healthy till his 8th standard.
• Later his school performance started becoming poor and
he showed less enthusiasm in all the other activities.
• Once his father remembers an incident that he stood
near the window and started abusing people walking
outside saying that they all intend to harm him.

7. • Then he was taken to a psychiatrist and was
under treatment thereafter.
• His studies improved thereafter and suddenly
one evening he shouted at his father that his
sister has been abusing him each night but on a
realistic account his sister was not at their
home.
• Later he lost interest in all activities and appear
anxious all the time.
• He was admitted here for better treatment of
his present condition.

8. • PAST HISTORY
N/H/O DM, HTN, infectious diseases, Disease related to eye, ear
& dental, head injury or surgery, meningitis.
• FAMILY HISTORY
His grand father had some sort of psychiatric illness details of
which are not known.
• TREATMENT HISTORY
Tab.Topaz 100mg OD
Tab. Schizopin 100mg BD
Not Underwent any ayurvedic treatments before

9. PERSONAL HISTORY
• Appetite – good
• Bowel – Regular (1-2/day)
• Micturition – (6-7 times/day) Straw colored urine
• Sleep – reduced
• Habits – Nil
• Allergy – For dust
• Diet - vegetarian

10. Vital Signs
• BP - 130/90mmHg
• Temperature – 98.6o F
• Pulse rate- 84/min
• Respiratory rate – 16/min

11. GENERAL EXAMINATION
• Built: well built, obese
• Nourishment: Well nourished
• Pallor : absent
• Icterus : absent
• Cyanosis: absent
• Clubbing: absent
• Lymphadenopathy: absent
• Edema: absent
• Facies : Normal

12. Systemic examination
• RS – NVBS heard, no additional sounds
• CVS – S1,S2 heard, no murmur/clicks
• GIT – Soft, non tender, no organomegaly,
tympanic note on percussion.

13. Mental Status Examination
• General appearance & behaviour:
well built, obese, pt. looks anxious, unhygienic,
inappropriate dressing.
Attitude towards examine was partially attentive.
Their was no eye contact, partially impaired comprehension.
Rapport was built only after repeated interrogations.
• Speech – spontanity noticed, pt. replies soon
before the question is finished.
Rate: Rapid
Vol: audible

14. • Mood and Affect:
Subjective Affect: lethargic, reduced interest
in all activities
Objective Affect: same
Mood was anxious
• Thought:
Stream of Thought: social in appearance
Content: loosing his charm day by day, world
is dangerous since 6years.

15. • Perception:
sister and father trying to harass and abuse
him.
• Cognition:
consciousness: present
attention: less
concentration: intact
intelligence: impaired
• Insight:
Grade 2(awareness of being ill)

16. • Judgement: impaired

17. Differential Diagnosis-
Modern Sciences
Bipolaraffectivedisorder
Delusionaldisorder
Depression
Mentaldisorderssecondarytogeneralmedical
conditions
Schizoaffectivedisorder

18. Diagnosis:
• Paranoid schizophrenia

19. SCHIZOPHRENIA
• Schizophrenia occurs with regular frequency nearly
everywhere in the world in 1 % of population and
begins mainly in young age (mostly around 16 to 25
years).
• Schizophrenia is defined by
– a group of characteristic positive and negative
symptoms
– deterioration in social, occupational, or
interpersonal relationships
– continuous signs of the disturbance for at least 6
months

20. History
• Emil Kraepelin: This illness develops
relatively early in life, and its course is
likely deteriorating and chronic;
deterioration reminded dementia
(„Dementia praecox“), but was not
followed by any organic changes of
the brain, detectable at that time.
• Eugen Bleuler: He renamed
Kraepelin’s dementia praecox as
schizophrenia (1911); he recognized
the cognitive impairment in this
illness, which he named as a
„splitting“ of mind.
• Kurt Schneider: He emphasized the
role of psychotic symptoms, as
hallucinations, delusions and gave
them the privilege of „the first rank
symptoms” even in the concept of the
diagnosis of schizophrenia.

21. 4 A (Bleuler)
• Bleuler maintained, that for the diagnosis of schizophrenia are
most important the following four fundamental symptoms:
– affective blunting
– disturbance of association (fragmented thinking)
– autism
– ambivalence (fragmented emotional response)
• These groups of symptoms, are called „four A’ s” and Bleuler
thought, that they are „primary” for this diagnosis.
• The other known symptoms, hallucinations, delusions, which are
appearing in schizophrenia very often also, he used to call as a
“secondary symptoms”, because they could be seen in any other
psychotic disease, which are caused by quite different factors —
from intoxication to infection or other disease entities.

22. 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
• 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

23. The left brain is diagnosed with
schizophrenia. The brain on the
right is healthy. The
schizophrenic’s fluid-filled areas
are larger.
Johan and Ad van Bennekom are
identical twins, both diagnosed with
schizophrenia.

24. Types of Schizophrenia
• There are five types of schizophrenia:
– Catatonic – little to no movement, possibly a vegetative state
– Disorganized – common archetype of schizophrenia;
disorganized thinking, flat effect, inappropriate emotions or
behavior
– Paranoid – common archetype of schizophrenia; delusions,
hallucinations, false beliefs of grandeur
– Residual – long-term schizophrenia where most symptoms have
disappeared, negative symptoms (detractions from normal
behavior) often remain such as flat effect or a refusal to talk
– Undifferentiated – does not fit in one of the above categories
because the patient suffers from symptoms of multiple types

25. Schizophrenic Delusions
• A delusion is a false belief
• Some common schizophrenic delusions include:
– Being cheated
– Being harassed
– Being poisoned
– Being spied upon
– Being plotted against
• Most delusions are very grandiose and involve the
patient at the center of some large plot or scheme

26. Schizophrenic Hallucinations
• A hallucination is a nonexistent stimulus that is perceived as
real
• The most common schizophrenic hallucination is hearing
voices, however the patient may also have visual
hallucinations where they see a person or object that does
not exist
• Hallucinated voices often interact with the patient:
– By commenting on their behavior
– By ordering them to do things
– By warning of impending dangers
– By talking to other voices about the patient

27. COURSE OF ILLNESS
• Course of schizophrenia:
– continuous without
temporary improvement
– episodic with progressive
or stable deficit
– episodic with complete or
incomplete remission
• Typical stages of
schizophrenia:
– prodromal phase
– active phase
– residual phase

28. Clinical Picture
• Diagnostic manuals:
– lCD-10 („International Classification of Disease“,
WHO)
– DSM-IV („Diagnostic and Statistical Manual“,
APA)
• Clinical picture of schizophrenia is
according to lCD-10, defined from the
point of view of the presence and
expression of primary and/or secondary
symptoms (at present covered by the
terms negative and positive symptoms):
– the negative symptoms are represented by
cognitive disorders, having its origin probably in
the disorders of associations of thoughts,
combined with emotional blunting and small or
missing production of hallucinations and
delusions
– the positive symptom are characterized by the
presence of hallucinations and delusions

29. Positive and Negative Symptoms
Negative Positive
Alogia Hallucinations
Affective flattening Delusions
Avolition-apathy Bizarre behaviour
Anhedonia-asociality Positive formal thought
disorder
Attentional impairment

30. Treating Schizophrenia
• Antipsychotic drugs have been effective in treating the
symptoms of schizophrenia
• Unfortunately, these drugs can also have some mild side
effects including drowsiness, weight gain, jitters,
movement problems, and muscle contractions
• A possible long-term side effect of antipsychotic drugs is
a condition called tardive dyskinesia where patients will
develop uncontrollable movements
• Another treatment is atypical antipsychotic drugs which
have less side effects and can better treat patients not
treated effectively by the normal drugs
• Therapy and counseling are also effective in improving
behavior as well as creating a system of support for the
patient in their family and friends

31. Famous People With Schizophrenia
John Nash – Nobel Prize
winner
Syd Barret – guitarist for
Pink Floyd Mary Todd Lincoln –
wife of Abraham Lincoln

32. Nash’s two main
delusions as seen in the
movie

33. CONCLUSION
• Early detection and
treatment has the
best
results/response to
treatment.
• Per patients, once
you have
schizophrenia you
have it for life. The
best you can hope
for is control.

34. “If you talk to God,
you are praying;
if God talks to you,
you have schizophrenia”
THANK YOU