Psychiatry 精神病学 Wang Keqin Jining Medical College Jining Medical College
Chapter 5.Schizophrenia Jining Medical College
5.1 Definition and epidemiology Learning objectives You should: o know the definition of schizophrenia o know the epidemiology of schizophrenia. Jining Medical College
5.1.1 Definition of Schizophrenia Schizophrenia is a clinical syndrome of variable,but profoundly disruptive, psychopathology that involves cognition, emotion,perception,and other aspects of behavior. The expression of these manifestations varies across patients and over time,but the effect of the illness is always severe and is usually long- lasting. Jining Medical College
5.1.2 Epidemiology Table 10 The epidemiology of schizophrenia Epidemiology Characteristics Incidence (rate of new cases) 2 new cases per 10 000 population per year Prevalence(number of existing cases) 1 in 200 people Global rates Similar in all countries studied,with apparently higher rates in some subgroups, e.g.Black Caribbeans in the UK Social class Incidence equal in all social classes Sex Men and women equal Peak age at onset 18-25 years;in men;20-28 years in women Family history Present in one third of cases
5.2 Symptoms Learning objectives You should: know the positive and negative symptoms of schizophrenia know about first rank symptoms have the ability to assess key aspects of mental state in schizophrenia. Jining Medical College
5.2.1 The symptoms of schizophrenia Positive symptoms Catatonia Social Occupational Negative symptoms Affective flattening Delusions Alogia Disorganized speech Avolition Hallucinations Anhedonia Work Cognitive symptoms Interpersonal/Mood symptoms Anxiety Attention Executive functions Agitation (eg,abstraction) Dysphoria Memory Helplessness Self-care Hostility Suicidality
A.Positive symptoms -Hallucinations Hallucinations are defined as false perceptions in the absence of a real external stimulus. Hallucinations in schizophrenia may involve any of the sensory modalities. The most common are auditory hallucinations in the form of voices,which occur in 60-70%of patients diagnosed with schizophrenia. No single type of hallucination is specific to schizophrenia,and the duration and intensity are probably most important diagnostically. Jining Medical College
Positive symptoms Auditory hallucination
Mental state examination:asking about auditory hallucinations Auditory hallucination Question Auditory hallucination in general Do you ever seem to hear things when no-one is around? (Open question) Are they voices? Hallucinations are heard with the ears,like Do you hear them with your ears,like you are hearing my normal speech voice now?Or is it in your mind?Where does the voice come from? Patients can describe the characteristics of the How many voices are there?Do they say pleasant or unpleasant voices:their number,loudness,location,content things?How loud are they?How often do they happen? Voices talking to one another about the patient Do the voices ever talk to each other,about you? ('He is a clever person')are called third person auditory hallucinations,one of the first rank symptoms A voice doing a running commentary('She is going Do the voices ever say a running commentary on what up the stairs now)or a voice echoing thoughts, you are doing?Do they ever echo what you are thinking? called echo de la pensee,are first rank symptoms Insight or self-appraisal How do you explain the voices? Jining Medical College