SCHIZOPHRENIA

PRESENTED BY:
SENG, SHENA H.
SIOCON, JEWRICH G.
UBAG, JAZZYLEENE M.
VESAGAS, CHRISTIAN JAY B.
 OVERVIEW

Schizophrenia is a serious mental

disorder in which people interpret
reality abnormally. Schizophrenia
may result in some combination of
hallucinations, delusions, and
extremely disordered thinking and
behavior that impairs daily
functioning, and can be disabling.
- Mayo Clinic 2020
 CASE SCENARIO
Chris is a 20-year-old Caucasian male who is in his second year of college. He is seeking
treatment due to persistent fears that campus security and the local police are tracking and surveilling
him. He cites occasional lags in his internet speed as evidence that surveillance devices are interfering
with his electronics. His intense anxiety about this has begun getting in the way of his ability to
complete schoolwork, and his friends are concerned – he says they have told him, “you’re not making
sense.”
Chris occasionally laughs abruptly and inappropriately and sometimes stops speaking mid-
sentence, looking off in the distance as though he sees or hears something. He expresses concern
about electronics in the room (phone, computer) potentially being monitored and asks repeatedly
about patient confidentiality, stating that he wants to be sure the police won’t be informed about his
treatment. His beliefs are fixed, and if they are challenged, his tone becomes hostile.

SYMPTOMS
•  Anxiety
•  Delusions
•  Hallucinations
•  Psychosis
 ASSESSMENT:
Subjective Cues
• Persistent fears

Objective Cues
• Anxiety
• Delusions
• Hallucinations
• Psychosis
• Changing voice tones
• Disorganized speech
• Changing moods
ANATOMY
HUMAN BRAIN
ANATOMY
HUMAN BRAIN
 PHYSIOLOGY

Brain
• The cerebrum is the center for consciousness, thought, memory,
sensory input, and motor input activity; it consists of two
hemispheres (left and right) and four lobes, each with specific
functions.
 Frontal Lobe: Important in problem solving, planning,
socializing, reasoning, and in motor speech and functions. 
 Temporal lobe: Wernicke area is located here, which is
responsible for understanding spoken and written language. The
temporal lobe is also an essential part of the social brain. It
processes sensory information for the retention of memories,
language, and emotions. It also plays a major role in hearing,
spatial, and visual perception. 
 PHYSIOLOGY

Limbic System: Functions for emotion, homeostasis,

learning and memory.  
Hippocampus: As part of the limbic system, it is
involved in emotion, orientation, learning, and memory
formation. 
Auditory System: For hearing and understanding
speech
Basal Ganglia: Accessory associated in motor function
posture, feelings, and integration of sensory
information.
 Parietal Lobe: coordinates and interprets sensory
information from opposite side of the body 
 Occipital Lobe: enables visual recognition, local
orientation and shape perception.
 PHYSIOLOGY
The thalamus further organizes cerebral function by transmitting
impulses to and from the cerebrum. It is also responsible for
primitive emotional responses, such a fear, and for distinguishing
between pleasant and unpleasant stimuli. 
Lying beneath the thalamus, the hypothalamus is an automatic
center that regulates blood pressure, temperature, libido, appetite,
breathing, sleeping patterns, and peripheral nerve discharges
associated with certain behavior and emotional expression. It also
helps control pituitary secretion and stress reactions.
The cerebellum or hindbrain, controls smooth muscle movements,
coordinates sensory impulses with muscle activity, and maintains
muscle tone and equilibrium.
The brain stem, which includes the mesencephalon, pons, and
medulla oblongata, relays nerve impulses between the brain and
spinal cord.
 PHYSIOLOGY

Dopamine

Dopamine is a type of neurotransmitter. Your

body makes it, and your nervous system uses
it to send messages between nerve cells.
That's why it's sometimes called a chemical
messenger. Dopamine plays a role in how we
feel pleasure. It's a big part of our unique
human ability to think and plan. 
PATHOPHYSIOLOGY
 PATHOGENESIS: SCHIZOPHRENIA

BRAIN STRUCTURE
GENETICS ENVIRONMENT PERINATAL DRUG USE
AND FUNCTION
FACTORS

A combination of genetics, brain

chemistry and environment contributes
to development of the disorder.

dopamine

Problems with certain naturally

occurring brain chemicals, including
neurotransmitters glutamate
 Anatomic abnormalities Neurotransmitter system Newer Inflammation and immune
antipsychotic
abnormalities drugs block both function
dopamine D2
Neuroimaging studies show differences and serotonin (5-
Abnormalities of the dopaminergic system hydroxytryptami
between the brains of those with are thought to exist Immune function is
schizophrenia and those without this ne [5-HT])
disturbed
receptors.
disorder.
The first clearly effective antipsychotic drugs, chlorpromazine and
reserpine. Drugs that diminish the firing rates of mesolimbic
dopamine D2 neurons are antipsychotic, and drugs that stimulate Overactivation of the immune system (eg, from
MRI studies show anatomic these neurons (eg, amphetamines) exacerbate psychotic symptoms.
prenatal infection or postnatal stress) may result in
abnormalities in a network of
overexpression of inflammatory cytokines and
neocortical and limbic regions and
Hypodopaminergic activity in the mesocortical system, leading subsequent alteration of brain structure and function.
interconnecting white-matter tracts.
to negative symptoms, and hyperdopaminergic activity in the
mesolimbic system, leading to positive symptoms
Meta-analysis of studies using Elevated levels of proinflammatory
diffusion tensor imaging (DTI) Clozapine, perhaps the most effective antipsychotic agent, is cytokines that activate the
a particularly weak dopamine D2 antagonist. For example, kynurenine pathway
The changes in prefrontal lobes were schizophrenic
associated with increasing severity of patients Tryptophan is metabolized into
psychotic symptoms. kynurenic and quinolinic acids
NMDA antagonists, such as phencyclidine and
ketamine, can lead to psychotic symptoms in
healthy subjects. These acids regulate NMDA receptor activity
Schizophrenia was associated with structural and may also be involved in dopamine
brain abnormalities that progressed over time. regulation.

Some researchers consider schizophrenia, in

The abnormalities identified included loss of Insulin resistance and metabolic disturbances
large part, a hypoglutamatergic disorder.
whole-brain volume in both gray and white
matter and increases in lateral ventricular Inflammation might be related both to the psychopathology
volume. of schizophrenia and to metabolic disturbances seen in
patients with schizophrenia.
 ONSET SYMPTOMS

A diagnosis of schizophrenia often

follows the first episode of psychosis.

Cognitive symptoms
Psychotic symptoms Negative symptoms

• Difficulty processing information

• Hallucinations • Reduced motivation and difficulty planning, to make decisions
• Delusions beginning, and sustaining activities • Problems using information
• • Diminished feelings of pleasure in everyday immediately after learning it
Thought disorder
life • Trouble focusing or paying
• “Flat affect,” or reduced expression of
attention
emotions via facial expression or voice tone
• Reduced speaking

• Physical exam
• Tests and screenings. SCHIZOPHRENIA
• Psychiatric evaluation
• Diagnostic criteria for
schizophrenia
 LIFE THREATENING PATHWAY
TREATMENTS
SYMPTOMS MANIFESTED BY
1. Care programme approach (CPA)
THE PATIENT:
2. Acute episodes Management
Subjective Cues
• Crisis resolution teams (CRT)
• Persistent fears
• Voluntary and compulsory
If symptoms detention
Objective Cues left untreated • Advance statements
• Anxiety and did not 3. Antipsychotics
• Delusions comply all the • typical antipsychotics
• Hallucinations ff. treatments • atypical antipsychotics
• Psychosis
4. Psychological treatment
• Changing voice tones
• Cognitive behavioural therapy
• Disorganized speech
Can result in severe problems (CBT)
• Changing moods that affect every area of life. • Family therapy
• Arts therapy

Complications that
schizophrenia may cause or
be associated with include:

Suicide, suicide Anxiety Abuse of Inability to Financial Social Health and

disorders and Being Aggressive
attempts and alcohol or work or problems and isolation medical behavior
obsessive- victimized
thoughts of other drugs, attend homelessness problems
suicide compulsive including school
disorder (OCD). nicotine
Depression
 ANALYSIS
Signs and Symptoms of Schizophrenia that is manifested by Chris:
1. Speaking mid-sentence and changing voice tone (disorganized speech) –
Speaking mid-sentence means that you have trouble speaking in a fluid, or
flowing, way. You may say the whole word or parts of the word more than once,
or pause awkwardly between words. This is known as stuttering. You may
speak fast and jam words together, or say "uh" often.

ANALYSIS: Schizophrenia can cause you to have trouble concentrating and

maintaining your train of thought, which may manifest itself in the way that
you speak. You may respond to queries with an unrelated answer, start
sentences with one topic and end somewhere completely different, speak
incoherently, or say illogical things.

Common signs of disorganized speech include:

• Loose associations 
• Neologisms 
• Perseveration 
• Clang 
 ANALYSIS
2. He expresses concern about electronics in the room (phone, computer)
potentially being monitored and asks repeatedly about patient confidentiality,
stating that he wants to be sure the police won’t be informed about his
treatment. (Delusion) - false and fixed belief of Chris that are not based in
reality.

ANALYSIS: A delusion is a firmly-held idea that a person has despite clear and
obvious evidence that it isn’t true. Delusions are extremely common in
schizophrenia, occurring in more than 90% of those who have the disorder.
Often, these delusions involve illogical or bizarre ideas or fantasies, such as:
• Erotomanic 
• Grandiose
• Jealous
• Persecutory
• Somatic
• Mixed
In our case, the patient is experiencing Delusion of Persecution or
Persecutory.
 ANALYSIS
3. Looking off in the distance as though he sees or hears something
(Hallucination)- These usually involve seeing or hearing things that don't exist.

ANALYSIS:
More than 70% of people with schizophrenia get visual hallucinations, and
60%-90% hear voices. But some may also smell and taste things that aren't
there. These often occur when you misinterpret your own inner self-talk as
coming from an outside source. Schizophrenic hallucinations are usually
meaningful to you as the person experiencing them. Many times, the voices are
those of someone you know, and usually they’re critical, vulgar, or abusive.
• Auditory hallucinations 
• Visual hallucinations 
• Olfactory hallucinations 
• Tactile hallucinations 

In our case, the patient is experiencing Auditory and Visual Hallucination.

 ANALYSIS
[Link] laugh abruptly and inappropriately and mood swings
(disorganized behavior) - This may show in a number of ways, from childlike
silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard
to do tasks. Behavior can include resistance to instructions, inappropriate or
bizarre posture, a complete lack of response, or useless and excessive
movement.
ANALYSIS:
This is called paradoxical laughter which is an indicative of an unstable mood,
often caused by the pseudobulbar affect, which can quickly change to anger
and back again, on minor external cues.
Schizophrenia disrupts goal-directed activity, impairing your ability to take care
of yourself, your work, and interact with others. Disorganized behavior appears
as:
• A decline in overall daily functioning
• Unpredictable or inappropriate emotional responses
• Behaviors that appear bizarre and have no purpose
• Lack of inhibition and impulse control
In our case, the patient is experiencing unpredictable or inappropriate
emotional responses
 ANALYSIS

[Link] Fear (Anxiety) - fear that the campus security and the
local police are tracking and surveilling him

ANALYSIS: According to the result of a study conducted by Cambridge

Organization, majority of patients (62%) with Schizophrenia were
diagnosed with at least one comorbid anxiety disorder. With this, they
therefore conclude that anxiety disorders are common in patients with
schizophrenia.
The mentality of patients with schizophrenia is altered and this
alteration might make the environment hostile, might at times evoke
the sensation of being trapped by a predator, and might be the cause
of the anxiety that accompanies them.
 ANALYSIS

[Link] - The word psychosis is used to describe conditions that

affect the mind, where there has been some loss of contact with
reality.

ANALYSIS: Schizophrenia is a mental illness that causes psychosis as

it actually affects how our brain work.
 ANALYSIS

How to Diagnose Schizophrenia?

Diagnosis of schizophrenia involves ruling out other mental health

disorders and determining that symptoms are not due to substance
abuse, medication or a medical condition. Determining a diagnosis of
schizophrenia may include:
• Physical exam
• Tests and screenings
• Psychiatric evaluation
• Diagnostic criteria for schizophrenia
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