精神分裂症教案 Subject Psychiatry Teacher LIU Tie-qiao Target Clinical Medicine Teaching place The second classroom Chapters Chapter 5.section 1 Teaching hour 100 minutes Content Schizophrenia Date 2004 【Purpose and requirement】 1.To master the concepts,the main clinical features,diagnosis and differential diagmosis,treatnent and prevention principles of schizophrenia. 2.To understand the main classification and prognosis of schizophrenia. 3.To understand the etiology and pathogenesis of schizophrenia. 4.To understand the concepts and clinical features of other psychotic disorders. 【Key points of teaching】 The concepts.the main clinical features,diagnosis and differential diagnosis. treatment and prevention principles of schizophrenia. 【Difficult points of teaching】 1.The etiology,diagnosis and differential diamnosis of schizophrenia. 2.The identification of psychiatric symptoms. 【Type of teaching】 New knowledge teaching. 【Teaching nothod】 Bilinguistic teaching.lecture and heuristic nethod. 【Teaching aid】. Multinedia nix and lantern slide. 【Contemt and step of teaching】
精神分裂症教案 Subject ： Psychiatry Teacher ： LIU Tie-qiao Target ： Clinical Medicine Teaching place ： The second classroom Chapters : Chapter 5, section 1 Teaching hour ： 100 minutes Content ： Schizophrenia Date ：2004 【Purpose and requirement】 1. To master the concepts, the main clinical features, diagnosis and differential diagnosis, treatment and prevention principles of schizophrenia. 2. To understand the main classification and prognosis of schizophrenia. 3. To understand the etiology and pathogenesis of schizophrenia. 4. To understand the concepts and clinical features of other psychotic disorders. 【Key points of teaching】 The concepts, the main clinical features, diagnosis and differential diagnosis, treatment and prevention principles of schizophrenia. 【Difficult points of teaching】 1. The etiology,diagnosis and differential diagnosis of schizophrenia. 2. The identification of psychiatric symptoms. 【Type of teaching】 New knowledge teaching. 【Teaching method】 Bilinguistic teaching, lecture and heuristic method. 【Teaching aid】 Multimedia mix and lantern slide. 【Content and step of teaching】
1.Introduction.(6min) 2 Etiology of schizophrenia.(10min) 3.Clinical features of schizophrenia.(30min) 4.The diagnosis and differential diagnosis of schizophrenia.(12min) 5.Treatment and prevention of schizophrenia.(20min) 6.Other psychotic disorders.(14min) 7.Summary and discussion.(8min) CHAPTER 5 SECTION 1 SCHIZOPHRENIA 1.Introduction. 1.1 The definition of Schizophrenia 1.2 Epidemiology Prevalence and Incidence.Age of onset,Gender.Outcone evaluation 1.3 History Morel (1857):Demence precoce Hecker (1871)Hebephremia Kzhlbaun (1874)Catatonia Kraepelin(1896):dementia praecox E.Bleuler(1911):schixophrenia M.Bleuler:4A symptoms Schneider:first rank symptoms 2.Etiology. 2.】Genetics Studies method The results of fanily studies The results of twin studfes The results of adoption studies Molecular genetic studies:Two main approaches:linkage analysis:Candidate gene approaches
1. Introduction. (6min) 2. Etiology of schizophrenia. (10min) 3. Clinical features of schizophrenia. (30min) 4. The diagnosis and differential diagnosis of schizophrenia. (12min) 5. Treatment and prevention of schizophrenia. (20min) 6. Other psychotic disorders. (14min) 7. Summary and discussion. (8min) CHAPTER 5 SECTION 1 SCHIZOPHRENIA 1. Introduction. 1.1 The definition of Schizophrenia 1.2 Epidemiology Prevalence and Incidence, Age of onset, Gender, Outcome evaluation 1.3 History Morel（1857）: Demence precoce Hecker（1871）: Hebephrenia Kzhlbaum（1874）: Catatonia Kraepelin(1896): dementia praecox E.Bleuler(1911): schizophrenia M.Bleuler: 4A symptoms Schneider: first rank symptoms 2. Etiology. 2.1 Genetics Studies method The results of family studies The results of twin studies The results of adoption studies Molecular genetic studies: Two main approaches; linkage analysis; Candidate gene approaches
2.2 The neurodeveloprent hypothesis Concepts Some findings are compatible with the neurodevelopment hypothesis of schixophrenia 2.3 Biochenical studies The dopamine hypothesis 5-HT hypothesis Amino acids in Schizophremia 2.1 Personality characteristics 2.5 Psycho-social and environmental factors Stress-diathesis model Perinatal factors 3.Clinical features 3.1 Prodroeal syndrone 3.2 The acute syndrone Disorders of sensation Disorders of perception Thinking disorder:(1)disorders of the thinking form (2)delusion (primary delusion and secondary delusion) Ahnormalities of nood Abnormalities of volition Abnormalities of behavior Orientation and insight Neurological soft signs and the neurodevelopeent origin Cognitive dysfunction 3.3 The chronic syndrone In contrast with the positive symptons of the acute schizophrenia,the chronic syndrome is characterized by thought disorder and the negative symptoms
2.2 The neurodevelopment hypothesis Concepts Some findings are compatible with the neurodevelopment hypothesis of schizophrenia 2.3 Biochemical studies The dopamine hypothesis 5-HT hypothesis Amino acids in Schizophrenia 2.4 Personality characteristics 2.5 Psycho-social and environmental factors Stress-diathesis model Perinatal factors 3. Clinical features 3.1 Prodromal syndrome 3.2 The acute syndrome Disorders of sensation Disorders of perception Thinking disorder: (1) disorders of the thinking form (2) delusion (primary delusion and secondary delusion) Abnormalities of mood Abnormalities of volition Abnormalities of behavior Orientation and insight Neurological soft signs and the neurodevelopment origin Cognitive dysfunction 3.3 The chronic syndrome In contrast with the positive symptoms of the acute schizophrenia, the chronic syndrome is characterized by thought disorder and the negative symptoms
The most striking feature is weakened volition that is lack of drive and initiative 3.4 Subtypes of schixophrenia Clinical features im Simple-schizophrenia Clinical features in Hebephrenie schizophrenia Clinical features in Catatonia schizophrenia Clinical features in Paranoid schizophrenia Clinical features in Undifferentiated schixophrenia Other type schizophrenia Post-schixophrenic depression Residual schizophremia Chronie schizophrenia Type I and type II schizophrenia 3.5 Course and prognosis The feature of course Predictors of course and prognosis 4.Diagmosis and differential diagnosis 4.I CCVD-3 diagnostic criteria Symptoa criteria Severity criteria Course criteria Exclusion criteria 4.2 Differential diagnosis Some neurosis Mood disorder Psychotie disorder due to a general medical or neurological condition &substance-induced psychotic disorder Personality disorder Other psychosis:including Reactive psychosis.Paranoid psychosis, Schizo-affective disorder and
The most striking feature is weakened volition that is lack of drive and initiative. 3.4 Subtypes of schizophrenia Clinical features in Simple-schizophrenia Clinical features in Hebephrenic schizophrenia Clinical features in Catatonia schizophrenia Clinical features in Paranoid schizophrenia Clinical features in Undifferentiated schizophrenia Other type schizophrenia Post-schizophrenic depression Residual schizophrenia Chronic schizophrenia Type I and type II schizophrenia 3.5 Course and prognosis The feature of course Predictors of course and prognosis 4. Diagnosis and differential diagnosis 4.1 CCMD-3 diagnostic criteria Symptom criteria Severity criteria Course criteria Exclusion criteria 4.2 Differential diagnosis Some neurosis Mood disorder Psychotic disorder due to a general medical or neurological condition &substance-induced psychotic disorder Personality disorder Other psychosis: including Reactive psychosis, Paranoid psychosis, Schizo-affective disorder and
Schizophreniform illness. 5.Treatment and prevention 5.1 Treatment of acute episode of schizophrenia 5.1.1 Pharmacotherapy Antipsychotic nedications The dosage of antipsychotic medication should be in the range of 300-800 mg CPZ equivalents per day for a ninimun of 6 weeks. The dosage should remain in the lower end of the range in patients experiencing their rirst acute episode. Choice of drugs To monitor plasm levels of drugs To deal vith side effect 5.1.2 ECT treatnent 5.2 Treatment recomrendations Should continue to receive this medication for at least I year. Should gradually reduce the dosage,such as a 10%5 reduction of primary dosage every 6 weeks. Antipsychotic maintenance therapy should be strongly considered to persons who have bad compliance with medication. Persoas with syuptons of anxiety.depression.or hostility should receive a trail of adjunctive pharmcotherapy. 5.3 Psychological treatment Individual and group therapies Support,education,behavior and cognitive skill training Fanily treatnent Vocational services Case managenent
Schizophreniform illness. 5. Treatment and prevention 5.1 Treatment of acute episode of schizophrenia 5.1.1 Pharmacotherapy Antipsychotic medications The dosage of antipsychotic medication should be in the range of 300-800 mg CPZ equivalents per day for a minimum of 6 weeks. The dosage should remain in the lower end of the range in patients experiencing their first acute episode. Choice of drugs To monitor plasma levels of drugs To deal with side effect 5.1.2 ECT treatment 5.2 Treatment recommendations Should continue to receive this medication for at least 1 year. Should gradually reduce the dosage, such as a 10% reduction of primary dosage every 6 weeks. Antipsychotic maintenance therapy should be strongly considered to persons who have bad compliance with medication. Persons with symptoms of anxiety, depression, or hostility should receive a trail of adjunctive pharmacotherapy. 5.3 Psychological treatment Individual and group therapies Support, education, behavior and cognitive skill training Family treatment Vocational services Case management
Assertive comunity treatnent (ACT)prograns 6.Other psychotic disorders 6.I Paranoid nental disorder 6.2 Acute and transient psychosis Schixophrenia-like psychosis Travelling psychosis Delusional episode 6.3 Induced delusional disorder 6.4 Schixoaffective psychosis 7.Surnry and discussion 【Reference naterial】 I.Michsel Gelder.Dennis Gath,Richard Mayou,te al.Oxford Textbook of Psychiatry.3th edition.Oxford Medical Publications.1996. 2.Sadock,B.J..Sadock,Y.A:Kaplan Sadock's Comprehensive Textbook of Psychiatry.7th.Edition. Lippincott Willians Wilkins,Philadelphia,2000. 【Writing desig】 See the lantern slide. 【Surmary after class】 1.Question:Bow to identify symptons of schizophrenia? 2.What are you going to do if you face the patients with schizophrenia and their families?
Assertive community treatment (ACT) programs 6. Other psychotic disorders 6.1 Paranoid mental disorder 6.2 Acute and transient psychosis Schizophrenia-like psychosis Travelling psychosis Delusional episode 6.3 Induced delusional disorder 6.4 Schizoaffective psychosis 7. Summary and discussion 【Reference material】 1. Michael Gelder, Dennis Gath, Richard Mayou, te al. Oxford Textbook of Psychiatry.3th edition. Oxford Medical Publications.1996. 2. Sadock, B. J., Sadock, V. A: Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 7th. Edition. Lippincott Williams & Wilkins, Philadelphia, 2000. 【Writing design】 See the lantern slide. 【Summary after class】 1. Question: How to identify symptoms of schizophrenia? 2. What are you going to do if you face the patients with schizophrenia and their families?