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M.I. Pyrogov Vinnitsa National Medical University
Chair of Psychiatry and Addictology
SCHIZOPHRENIA
Abstracts of lecture
Lecturer: Associated Professor, PhD Teklyuk S.V.
Vinnytsya 2009 y.
Plan of the lecture
1. Definition of schizophrenia.
2. Aetiology.
3. Epidemiology.
4. Pathogenesis.
5. Clinical features of schizophrenia:
1) Negative symptoms of schizophrenia.
2) Positive symptoms of schizophrenia.
3) Classification of schizophrenia.
4) Schizoaffective disorder
5) Differential diagnosis
6) Patterns of outcome in schizophrenia.
7) Effects of schizophrenia on the family.
8) Treatment:
 antipsychotic drugs;
 electro-convulsive therapy;
 social treatment and rehabilitation;
 psychotherapy.
6. Course and prognosis.
List of recommended literature
Basic literature.
1. Concise Oxford Textbook of Psychiatry. M. Gelder, D. Gath, R.Mayou. –
Oxford; New York; Tokyo; Oxford University Press, 2007. – 953 p.
2. Modern Synopsis of Psychiatry. A.M. Freedman, H.I. Kaplan, B.J. Sadock. –
USA, 1982. – 433 p.
3. Psychiatric Dictionary / 5th ed. R.J. Campbell. – Oxford; New York; Oxford
University Press, – 1981. – 693 p.
4. Psychopatology and addictive Disorders / Ed. By Meyer. - New York; London,
1986. – 283 p.
5. Psychiatry: course of lecture /Ed.by V.S. Bitensky. – Odessa, 2005. – 336 p.
6. Zimbardo Ph.G. Psychology and Life. - USA, 19991. – 189 p.
Additional literature.
1. Brundtland G.H. Mental health in the 21st century // Bulletin of the World
Helth Organization. – 2000. - №87. – Р. 411.
2. Desjarlais R., Eisenberg L., Good B. et al. World Mental Health: Problems
and Priorities in Low-Income Countries. – New York: Oxford University
Press, 1995. – 144 p.
3. Marsella A., Kleinman A., Good B. Cross-cultural studies of depressive
disorders. An overview. Culture and depression. – Berkley: University of
California Press, 1985. – 213 p.
4. Mulrow C.D., Williams J.W. Jr., Trivedi M., et al. Treatment of depression:
newer pharmacotherapies. Rockville, MD: Agency for Health Care Policy and
Research, 1999. – 253 р.
5. Murray C.J.L., Lopez A.D. The global burden of disease: a comprehensive
assessment of mortality and disability from disease, injuries and risk factors in
1990 and projected to 2020. Cambridge, MA: Harvard University Press, 1996. –
68 p.
6. Kielholz P. Masked Depression. — Berne, 1973. – 97 p.
7. Lopez-Ibor J. J. The Present Status of Psychotropic Drugs / Ed. by A. Cerletti,
F. J. Bove. - New York, 1999. - 519 p
8. Preskorn, S.H. Outpatient management of depression: A guide for the Primarycare
practitioner/
S.H.
Preskorn.
-
Wichita;
Kansas:
Professional
Communications,Inc., 1994. - 147 p.
9. Ustun T.B., Sartorius N. Mental Illness in General Health Care. An
International Study. – Chichester: John Willey @ Sons Ltd, 1995. – 336 p.
Schizophrenia is a chronic mental disorder, which includes obligatory (negative) and additional
(positive) symptoms, often takes a progredient course and leads to specific abulioapathetic
dementia. Schizophrenia has a special place among the other mental disorders because of its
comparative frequency and serious psychological and social consequences (some patients develop
a deep psychological defect which leads to disability).
The history of studies of schizophreni a ascends to the end of the XIX century. The first study
of the disorder was done by an outstanding German psychiatrist Emil Kraepelin, he named the
disorder "the early dementia" (dementia praecox). The Swiss psychiatrist Eugen Bleuler continued
his work at the beginning of the XX century. In his book "The Early Dementia or the Group of
Schizophrenia" Bleuler described its main (first-rank) symptoms and forms, and suggested the
new name of the disorder, which is used still.
Aetiology. The aetiology of schizophrenia is not understood completely, but there are several
theories concerning the probable causal factors of this disorder. The majority of authors agree
that it is an illness with hereditary predisposition. Schizophrenia sometimes develops in people
with organic brain damage. In many cases it starts after some additional harmful influence, which
acts as a trigger mechanism and precipitates the onset of the disorder. Such harmful factors
include psychological trauma, psychoactive substances abuse, in rare cases — physical illness,
overstrain or child delivery. In many cases, though, schizophrenia develops in the absence of any
obvious trigger factors. Sometimes the patients have specific premorbid personality features, like
lack of close social relationships, reserve, and emotional coldness.
Suggested Factors in the Aetiology of Schizophrenia:
Predisposing
Precipitating (trigger)
Genetic
Acute life stress
Social circumstances (child-rearing practice)
Maintaining
Chronic life stress
Family emotional reactions
Evidence for Inheritance. Schizophrenia is more common in the families of schizophrenic
patients than in the general population (where the lifetime risk is a little less than 1%), Thus
among the siblings of schizophrenics the risk is about 14%; among the children of one
schizophrenic parent it is about 13%, and among the children of two schizophrenic parents it is
about 37%. Twin studies indicate that a major part of this familial loading is likely to be due to
genetic rather than to environmental factors. The striking finding is that among monozygotic
twins the concordance rate (the frequency of schizophrenia in the sibling of the affected twin) is
consistently higher (about 50%) than among dizygotic twins (about 17%). Adoption studies
confirm the importance of genetic factors: the likelihood of developing schizophrenia in children
who have been separated at birth from a schizophrenic parent and brought up by nonschizophrenic adoptive parents is no less than that in children brought up by their own
schizophrenic parent.