I- Introduction-Definition :
The term schizophrenia designates a heterogeneous group of’conditions with a common semiological core, usually starting at’adolescence and usually progressing to personality disorganization.
Schizophrenia is characterized by chronic delusions:
– L’existence d’a discordance syndrome
– L’deficit evolution.
II- Epidemiology :
- Affection ubiquitaire, it affects all races and cultures.
- The sex ratio is 1.
- Usually begins between 15 and 35 years.
- Incidence : 0.1 at 0.7 %.
III- etiopathogeny :
We admit that’there is a genetic predisposition to’origin’neuroendocrine dysfunction.
These genetic factors weaken the CNS by their action on brain neurotransmission (including dopaminergic and serotonergic systems)
Environmental factors intervene as precipitating and s’associated with genetic predisposition.
A- genetic factors :
Alteration of the short arm of chromosome 5 (trisomy or polymorphism) ; this chromosome carries the gene responsible for dopamine receptors Dl.
B- biochemical factors : Hyperdopaminergie.
highlighted by the’observation of the’aggravating action of dopaminergic antagonists (L-dopa, LSD, amphetamines) Schizophrenia; and from the’reducing action of schizophrenic symptoms of neuroleptics, dopamine antagonists by blocking postsynaptic receptors
C- factors encephalic :
Hypofunction atrophy of the frontal lobes.
Increased dopamine receptors in the central cores.
Atrophy of the corpus callosum.
D- psychopathological and sociocultural factors :
It exists, in the schizophrenic, impaired perception of reality internal and external, perception of his body and time.
Disturbances of intra-family communication : relationship of the double link ; resistance to change; absent father and domineering mother, ambivalent sometimes repulsive sometimes hyper protective.
IV- Clinique :
A- The beginning forms or modes of’Entrance :
1- acute forms :
a / puff delusional or primary delusional experience :
Evokes a delirious puff but the’schizophrenic development is suspected in the face of prognostic signs :
- gradual onset
- Poverty thymic disorders
- Poverty of delirium which n’is not polymorphic
- Resistance to treatment
- family history of schizophrenia
- Premorbid schizoid personality’ l’of or schizotypal.
b / Manic Episode or atypical depressive :
- Lack of harmony with the affects coldness
- Oddities behavior
- inconsistency ideas
- mass anxiety,
c / Other forms :
- confounding access
- Forensic acts, unmotivated and brutal (attempted suicide or running away).
2- progressive forms :
L’onset of symptoms is insidious, more difficult diagnosis :
- intellectual performance drop (school or work), without prior difficulties.
- religious craze massive and exclusive.
- Changing the character and emotions.
- Behavioral disorders (anorexia, substance addiction, wandering …)
- nickname neurotic manifestation (obsessionnelles, phobic or hysterical)
B- Phase d’state :
1- Syndrome mismatch or dissociative :
C’is the underlying disorder of schizophrenia.
The discrepancy or dissociation reflects the loss of cohesion intrapsychical.
It affects intellectual spheres, emotional and behavioral :
a / Intellectual mismatch :
- Relaxation of ideational associations giving disorganized thinking.
- Disorders of the course of thought : ideational dams and fadings.
- Disorders of thought content : morbid rationalism, verbal stereotypies, illogical ideas and abstract.
- Language is disorganized with neologisms, verbal pulses, answers next, mutism or schizophasia.
b / Emotional dissonance :
- Ambivalence affective
- paradoxical and inappropriate emotional reaction (unmotivated laughter, Parathymies such as laughter in a sad situation.
- emotional numbing and athymhormia.
- emotional indifference.
c/ Behavioral discordance :
- stereotypies gestural
- Paramimies (grimaces, paradoxically mimicry)
- Listlessness and carelessness
2- syndrome delusional (type description: paranoid delusions) :
- Typically, c’is a fuzzy and poorly systematized rich delirium.
- Themes are multiple : persecution, influence, megalomaniacal, mystical-religious, hypocondriaque…
- The mechanisms : hallucinatory, interpretative, intuitive or imaginative.
3- hallucinatory syndrome :
hallucination psychosensorial (acousticoverbale, olfactory, tactile and coenesthetic, taste)
- The syndrome of’mental automatism and’influence : made of’imperative psychosensory hallucinations; d’psychic hallucinations (type flight of thought, devinement thought, echoes of thought …); d’motor automation (d-type’imposed acts, d’verbal automatisms) ; associated with delirium’influence.
4- autism :
It means the loss of contact with reality schizophrenic.
C’is a progressive retreat of the subject into his inner world with a major disinvestment from reality which aggravates the’patient isolation.
V- The clinical forms :
classically, describes 2 forms of schizophrenia :
*/ positive schizophrenia or Type I : productive symptoms are the’ plan (delirium, hallucinations and agitation)
*/ negative schizophrenia or type II : negative symptoms are the’ plan (withdrawal, psychomotor retardation, Clinophilie, athymhormie)
A- paranoid schizophrenia :
- The most frequent, correspond au type I.
- C’is the typical form of description, combining the most complete mismatch, delirium, hallucinations and autism.
- L’evolution takes place in spurts called fertile moments.
B- schizophrenia hebephrenic (or disorganized form) :
- earlier onset (15-25 years) and more insidious.
- Correspond au type II, deficit with withdrawal and aboulie
- The clinical picture is dominated spoke mismatch ; delirium is poor and inconsistent.
- May s’associated with a catatonic syndrome producing the hebephreno-catatonic form with stupor, catalepsy and negativism.
C- schizophrenia or schizoaffective disorder Dysthymic :
Combines schizophrenic and mood symptoms during the same access. This can be manic, depressive or mixed.
D- simple schizophrenia :
Delusions and hallucinations are exceptional, the clinical picture is dominated spoke mismatch.
E- residual schizophrenia :
C’is a form of’chronic progression of schizophrenia to lasting negative symptoms; it is evoked before a period of’at least 1 year during which the negative symptoms summers plan.
WE- Differential diagnosis :
- The delirious
- Chronic delusions (PHC, Paranoia, paraphrénie)
- A brain pathology (brain tumor, head trauma, epilepsia temporal, degenerative disease)
- Bipolar disorder
- anxiety disorders
VII- Evolution :
Without treatment : l’spontaneous evolution is deficient towards an impoverishment of delirium and loss of intellectual faculties.
Under treatment : there has been
- A decrease in the’continuous evolution.
- Increased pauci symptomatic forms.
- A disappearance terminal catatonic forms.
- L’appearance of forms with reorganizations of the obsessive type.
The real cure is exceptional.
VIII- Treatment :
L’hospitalization is indicated in case of’psychomotor agitation, significant behavioral problems, therapeutic refusal, intense depressive decompensation or high anxiety.
A- chemotherapy :
- Neuroleptic classic incisive (Haldol, Moditen, Piportil, Loxapac) and new generations are
- now increasingly used for leer (Risperdal, Zyprexa, Ability) : their main effect is
- antipsychotic, against delirium, hallucinations and mismatch.
- The sedative neuroleptics (Nozinan, Largactil) : their main effect is sedative against’psychotic anxiety and’psychomotor agitation.
- The IM is used at the beginning and then orally relay.
- Blood test, cardiac, hepatic and renal primarily neuroleptic treatment.
- The treatment’maintains, Throughout the course will be the lowest effective dose, to determine for each patient.
B- Resistant forms :
- Defined by’absence of clinical remission despite the use of 2 neuroleptics effective dosages for 6 weeks.
- Indication : either clozapine (Leponex) controlled FNS ++ ; either’electroconvulsivothérapie.
C- L’electroconvulsive therapy or tremor therapy :
- In resistant forms neuroleptics.
- In the catatonic forms.
- In food refusal featuring life-threatening.
D- psychotherapy :
- institutional psychotherapies :for the purpose of rehabilitation and social reintegration (occupational Therapy, therapeutic apartments, Sheltered workshops.
- systemic psychotherapy : in reinsurance profit, reorganization of the psychotic self and reorganization distortions of intra-family communication (Therapies supports, PIP, family therapy, group and TCC therapies).
Dr. Seghir's course – Faculty of Constantine