Can disorganized schizophrenics be treated successfully?



1 Pathological mental disorders EXAMPLE SCHIZOPHRENE DISORDERS Dr. P. Grampp 1

2 Brain dysfunction What is schizophrenia? Disturbance in thinking Disturbance in feeling Disturbance in willing More than 6 months Disturbance in perception Disturbance in behavior Disturbance in communication Dr. P. Grampp 2

3 What is schizophrenia not! Split personality Caused by a childhood trauma to blame! No result of wrong behavior or personality. Caused by bad parents, by poverty. P. Grampp 3

4 Exclusion criteria If the patients also meet the criteria for a manic or depressive episode, the criteria listed above must have occurred before the mood disorder occurred.The disorder cannot be assigned to an organic brain disease or to alcohol or substance intoxication, an addiction or withdrawal syndrome P. Grampp 4

5 types of schizophrenia Hebephrenia / disorganized Emotional equalization, speech disorders, insanity Paranoid schizophrenia Delusion, hallucinations Disorders of self-consciousness (ego disorder) Catatonia Schizophrenia Movement problems Disorders of will, control Residual schizophrenia Lack of zest for life, adyamy, laxity, etc. P. Grampp 5

6 Other types of undifferentiated schizophrenia postschizophrenic depression Schizophrenia simplex Dr. P. Grampp 6

7 Common Symptoms Hallucinations (physical disturbance of the senses), ego disturbance, spreading of thoughts, abnormal assignments of meaning Emotional flattening, decreased facial expressions Unable to plan or carry out plans. Delusional: Feeling persecuted, believing that you are significant. The language is impoverished and devoid of content. Can't pursue any goals in life. Disorganized thinking, chaos in the head, cannot form coherent thoughts. Plus symptoms Lose lust for life (anhedonia) Minus symptoms Dr. P. Grampp 7

8 Causes Genetic factors Living conditions (stress, infections in early life) Neurochemical balance disorders: Dopamine overactivity Dr. P. Grampp 8

9 Diagnosis ICD 10 Thought sounding, thought input or deprivation of thoughts, spreading of thoughts Control or influencing mania, feeling of what has been done, delusional perceptions Commenting or dialogical voices Persistent culturally inappropriate and completely unrealistic delusion Persistent hallucinations of every sensory modality Tearing off thoughts, hesitancy, aggravated stereotypes, agitation, symptoms such as agitation , Negativism Mutism, stupor Negative symptoms such as apathy, impoverishment of speech, flattened or inadequate affects DSM IV delusion Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms Dr. P. Grampp 9

10 ICD 10 At least one of the following symptoms: sounding out thoughts, inputting thoughts, depriving them of thoughts, spreading thoughts. Voices commenting on or dialogical delusions, talking about the patient or other voices coming from certain parts of the body persistent culturally inappropriate, bizarre delusion, such as being able to control the weather or being in contact with aliens Dr. P. Grampp 10

11 ICD 10 Or at least two of the following characteristics Persistent hallucinations of each sensory modality, daily for at least one month, accompanied by fleeting or indistinct delusional thoughts without a clear affective involvement or accompanied by long-lasting overvalue ideas neologisms, tearing off thoughts or insertions in the flow of thoughts, leading to lost or In addition, catatonic symptoms such as excitement, postural stereotypes or waxy flexibility (Flexibilitas cerea), negativism, mutism and stupor lead to negative symptoms such as conspicuous apathy, speech impoverishment, flattened or inadequate affects. P. Grampp 11

12 Epidemiology Worldwide prevalence of 0.5-1.5% 10 country study by the WHO 0.2-0.4 new cases per 1000 residents per year in 10% of schizophrenics Suicide attempts Chronic course 27% after the first 47% after the 4th relapse Dr. P. Grampp 12

13 Differential diagnoses Organic damage to the brain Intoxication, infections of the brain, dementia - Alzheimer's Z.n. Accidents (including mental disorders) Drug addiction Problem of a second illness Severe affective disorders E.g. delusional depression (E.g. in the case of extended suicide) Mania, bipolar illnesses Dr. P. Grampp 13

14 Schizophrenia course Dr. P. Grampp 14

15 Course continuous (no symptom remission) episodic with increasing development of negative symptoms in the illness intervals with persistent but not increasing negative symptoms in the illness intervals (remitting) complete remission other course of practically complete remission between the psychotic episodes incomplete complete Dr. P. Grampp 15

16 Duration of the untreated psychosis A delayed and incomplete remission of the symptoms a longer need for inpatient treatment a higher risk of relapse a lower compliance a higher burden on the family an increased expressed emotion level an increased risk of comorbidities and suicide a greater burden on the work and training situation a weaker one supportive network increased substance abuse and delinquent behavior possible cerebral pathophysiological changes higher treatment and follow-up costs Dr. P. Grampp 16

17 year old suicide risk during the first 6 months after diagnosis suicide attempt before current psychosis depressive symptoms unpleasant drug side effects (akathisia) Dr. P. Grampp 17

18 Prodromi Risk factors Psychotic illness in the family Early adolescence and adulthood Low level of premorbid adjustment Vulnerable personality (schizoid or schizotypic) Stressful life events Consumption of psychotropic substances Prodromal symptoms Reduced concentration and attention Reduced motivation Sleep disorders Depressed mood and feelings of anxiety Social withdrawal Increased distrust Dr. P. Grampp 18

19 Risk factors for relapses Insufficient compliance Medication status: Maintenance dose insufficient Age of onset Period of untreated disease prior to initial diagnosis Response rate different according to type of schizophrenia Gender: Men suffer more relapses than women Insufficient support from the social environment Doctor-patient relationship unsatisfactory Social status before the onset of the disease Dr. P. Grampp 19

20 Compliance Insufficient due to lack of insight into the disease Negation of symptoms Substance abuse Rejection of drugs in general Unpleasant side effects Dr. P. Grampp 20

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23 Strategies for relapse prevention Early diagnosis Clarification of the social environment Therapy with atypical antipsychotics Reintegration measures Maintenance therapy in the dose that led to remission Regular check-ups by the attending psychiatrist in cooperation with relatives Dr. P. Grampp 23

24 Typical medications are: Olanzapine Zyprexa Blockade of dopamine and serotonin receptors Sedation and weight gain Risperidone Risperdal Blockade of dopamine and serotonin receptors, less sedation Clozapine Clozaril Rarely NW in the range of motion: Weight gain, sedation Quetiapine Seroquel Drugs before blood count changes Analogous to Dr. P. Grampp 24

25 Fundamental side effects Parkinsonoid tremors (tremor), stiffness of the limbs (rigidity) Facial rigidity Dystonia Tension in the neck, neck and body area (early morning) Slow involuntary movements, i.b. in the area of ​​the facial muscles (late dysk.) restlessness sitting and unsteady standing weight gain skin sensitivity Dr. P. Grampp 25

26 Non-drug therapy Conversations Psychotherapy Share decion making Behavioral training Family therapy Psychoeducation Dr. P. Grampp 26