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Schizophrenia Types (Schizophrenia means "Fragmented Mind"…

- - - - common form
      - prominent hallucination/delusions
      - could develop at later age compared to other types
      - speech & emotions may be unaffected
      - risk of suicidal or violent behavior under influence of delusions
      - clinical feature: delusions of persecution, reference, grandeur, control etc..
        hallucination have persecutory or grandiose content
      - personality deterioration is much less than seen in other types
      - onset is usually insidious, occurs in 3rd/4th decade as compared to other types. Course is progressive and complete recovery does not occur
    - - behavior disorganised and without purpose
      - pranks, giggling, health complaints, mannerisms are common
      - delusions and hallucinations are fleeting
      - develops between 15-25
      - features: marked thought disorder, incoherence and severe loosening of associations;
        emotional disturbances - inappropriate affect, mannerisms, disinhibited behavior, poor self-care and hygiene
      - onset is insidious , usually in 2nd decade. course is progressive and downhill.
        Has one of the worst prognoses among the various subtypes of schizophrenia
    - - Rare
      - Risk for malnutrition, exhaustion or self injury
      - unusual movements, switching between extremes from over-activity to stillness
      - unable to talk
      - disturbance of motor behavior
      - 3 clinical forms
        
        excited catatonia
        
        features
        
        increase in psychomotor activity, ranging from restless, agitation, excitement, aggressiveness
        
        increase in speech production with increased spontaneity, pressure of speech, incoherence and loosening of associations
        
        not affected due to external environmental factors.
        affected due to inner stimuli (thoughts and impulses)
        
        this excitement can lead to severe complications like rigidity, hyperthermia and dehydration known as acute lethal catatonia or pernicious catatonia
        
        stuporous catatonia
        
        extreme retardation of
        psychomotor function
        
        delusions are not prominent but maybe present
        
        clinical feautres
        
        mutism - absence of speech
        
        rigidity - maintenance of rigid posture
        
        negativism - motiveless resistance to all commands and attempts to be moved
        
        posturing - Voluntary assumption of an inappropriate
        and often bizarre posture for long periods of time
        
        Stupor - Akinesis (no movement) with mutism but
        with evidence of relative preservation of conscious
        awareness
        
        Echolalia - Repetition, echo or mimic king of phrases
        or words heard
        
        Echopraxia - Repetition, echo or mimic king of actions
        observed
        
        Waxy flexibility - Parts of body can be placed in
        positions that will be main tained for long periods of
        time, even if very uncomfortable
        
        Ambitendency - conflicting impulses
        and tentative actions are made, but no goal
        directed action occurs
        
        Other signs such as mannerisms, stereotypies (verbal
        and behavioural), automatic obedience (commands
        are followed automatically, irrespective of their
        nature) and verbigeration (incom pre hensible speech).
        
        catatonia alternating
        between excitement and stupor
        
        common with fea tures
        of both excited catatonia and stuporous catatonia
        alternatingly
      - The onset of catatonic schizo phrenia is usually
        acute, usually in the late 2nd and early 3rd decade. The
        course is often episodic and recovery from the episode
        is usually complete
    - - some characteristics of paranoid, hebephrenic or catatonic but does not fit completely in one of these
    - - past history of psychosis but having only negative symptoms
      - important to rule out antipsychotic-induced
        negative symptoms as well as negative symptoms
        secondary to associated depression, organic brain
        disease or institutionalisation
    - - difficult to diagnose
      - characterised by an early onset (2nd decade)
      - very insidious
        and progressive course
      - presence of characteristic
        ‘negative symptoms’ of residual schizophrenia
      - vague hypochondriacal features, a drift down the social
        ladder, and living shabbily and wandering aimlessly
      - Delusions and hallucinations are usually absent
    - - Some schizophrenic patients develop depressive
        features within 12 months of an acute episode of
        schizophrenia
      - depressive features develop in the
        presence of residual or active features of schizophrenia
        and are associated with an increased risk of suicide
    - - Pseudoneurotic Schizophrenia
        
        described by Hoch and Polatin
        
        initial phases, there are predominant
        neurotic symptoms that last for years and show
        a poor response to treatment
        
        3 classical features
        
        pananxiety - free-floating anxiety which hardly ever
        subsides
        
        pan-neurosis - (almost all neurotic symptoms
        may be present
        
        pansexuality - constant preoccupation
        with sexual problems
      - Schizophreniform Disorder
        
        duration is less than
        6 months and prognosis is usually better than that of
        schizophrenia
      - Oneiroid Schizophrenia
        
        By Mayer-Gross, this is a subtype of schizophrenia with an acute onset, clouding of consciousness, disorientation, dream-like states, and perceptual disturbances with rapid shifting
      - Van Gogh Syndrome
        
        Dramatic self-mutilation
        
        named after Vincent Van Gogh
      - Late Paraphrenia
        
        by Sir Martin Roth, this is a disorder which occurs late in life, usually in the sixth decade
        
        more common in women, especially unmarried or
        widowed women
        
        Delusions of persecution are seen, with bizarre and fantastic content
        
        Hallucinations of all kinds present
        
        Intelligence and social judgement outside the arena of persecutory delusions are usually normal
        
        At present, this syndrome is placed under paranoid
        schizophrenia, late onset type
      - Pfropf Schizophrenia
        
        syndrome of schizophrenia occurring in the presence of mental retardation.
        
        behavioural disturbances are much more prominent than delusions and hallucinations
        
        types
        
        Type I - characterised by positive symptoms
        
        supposed to have acute presentation, good response to medication and good outcome
        
        Type II - characterised predominantly by negative symptoms
        
        theorised to be chronic
        
        has poor response to medication and poor outcome
        
        very few patients have pure Type I or II
- - - - Marked inability to decide for or
        against
    - - Withdrawal into self
    - - Disturbances of affect such as
        inappropriate affect
    - - Loosening of associations;
        thought disorder