Schizophrenia

Clinic

• It is a mental Disease characterized by continuous or relapsing episodes of psychosis.
• Major symptoms include Hallucinations (typically hearing voices), Delusions, and Disorganized thinking.
• Other symptoms include Social withdrawal, Decreased emotional expression, and Apathy.
• Symptoms typically develop gradually, begin during young adulthood, and in many cases never become resolved.
• Most of them have other mental disorders, esp Substance use disorders, Depressive disorders, Anxiety disorders, and OCD.

Positive symptoms

• Delusions, hallucinations, and disorganized thoughts and speech, typically regarded as manifestations of psychosis.
• Hallucination (80% of Cases) most commonly involve hearing (Often hearing voices) but other senses maybe involved.
• Hallucination are also typically related to the content of the delusional theme.
• Delusions are bizarre or persecutory in nature.
• Thought disorders can include Thought blocking, and Disorganized speech.

The best rubrics are

• Delusion
• Hallucination
• Psychosis

Negative symptoms

Apathy includes

• Avolition: Lack of motivation, Blunted affect – showing flat expressions or little emotion
• Anhedonia: Inability to feel pleasure
• Asociality: Lack of desire to form relationships / Social withdrawal
• Diminished expression includes blunt affect
• Alogia: Poverty of speech

• In 50%, it is related to disrupted cognitive processing affecting memory and planning including goal-directed behavior.
• Avolition and anhedonia are seen as motivational deficits resulting from impaired reward processing.

The best rubric are

• Depression
• Altered Thought pattern

Cognitive symptoms

• Cognitive symptoms (70%) are most pronounced in early onset and late-onset illness. These are often evident long before the onset of illness in the prodromal stage.
• Cognitive deficits are core features and may be of Neurocognition (nonsocial) or of Social cognition.
  • Neurocognition is the ability to receive and remember information, includes verbal fluency, memory, reasoning, problem solving, speed of processing, and auditory and visual perception.
  • Mostly Verbal memory and attention are affected. Verbal memory impairment is associated with a decreased level of semantic processing (relating meaning to words).
  • Episodic memory. An impairment in visual perception that is consistently found in schizophrenia is that of visual backward masking. Visual processing impairments include an inability to perceive complex visual illusions.
  • Social cognition is concerned with the mental operations needed to interpret, and understand the self and others in the social world. This is also an associated impairment, and facial emotion perception is often found to be difficult. Facial perception is critical for ordinary social interaction.

Subtypes

Paranoid Schizophrenia

• Usually manifests itself in intense and nonsensical suspicions
• Auditory hallucinations that confirm their suspicions.
• Disorganized behavior and speech patterns, are usually not present
• NVCJD is good candidate.

Catatonic Schizophrenia

• Moving too much or too little.
  • Motionless and resist any attempts to move them, staying rigid and stationary.
  • Purposeless movement including repeat what others say over and over, and mimic the movements of those around them.
  • They may also make strange faces or body contortions, and engage in rocking, waving, or nail-biting.
  • Considering Rigidity, good candidates would be RBS and JE

Residual Schizophrenia

• Residual schizophrenics are not currently experiencing any of the more serious symptoms of schizophrenia, including no signs of hallucinations, disorganized speech, or catatonic behaviors.
• However, they will experience at least two minor symptoms, such as odd beliefs, trouble paying attention, withdrawing from society, and talking less.
• Considering Delusion and Altered thought pattern, Psychosis and Depression, the best candidate would be EBV and JE

Disorganized Schizophrenia

• Disorganized schizophrenia is primarily distinguished by “disorganized” symptoms such as disorganized speech, behavior, and inappropriate behavior. This can include resisting eye contact, the inability to make facial expressions, incoherence, and trouble beginning or finishing a task.

Undifferentiated Schizophrenia

• If somebody diagnosed with schizophrenia has trouble classifying themselves into any of the above subtypes but still experience symptoms, they will be labeled as someone with undifferentiated schizophrenia.

Schizophrenia Black Box

Four stages:

1. Free-will
   • Human-being has free will around the axis of self.
   • "Free-will" make and support "Self".
   • So self is not a meaningful identity without free-will.
   • You make yourself by your thinking / behaviors. Probably you imitate someone, then what makes these thinking / Behaviors, yours? Of course your free-will.
   • This is your identity, therefore you are caring it Uninterruptedly
   • Free-will did not exist from the beginning, therefore you make it through evolution since you need it.
   • It is vital for your survival so anything that threatens it is considered an emergency.
   • That's why hallucinations of RBS is so wild, since this virus attack the center of you, which is your self-identity.
   • This is the state of Delirium and if it is not solved, it would be push you to the state of Paranoid mania. In this stage the patient have transient Hallucination with or without Delusions.
   • Here Alum is the best choice
2. Paranoia
   • The second stage would be Paranoid Schizophrenia. In this stage thought pattern is destroyed.
   • Hyos and lach is the best
3. The patient loose his movement control which is named Catatonic Schizophrenia.
   • Since his movement system is intact, he has purposeless movement which is named Stereotypy or purposeless immobility which is incorrectly named Rigidity.
   • Cupr and Plb are the first choice
4. The end stage of this sinister story is Hebephrenic Schizophrenia. in this stage the patient enters a persistent disorganizing of will which is the meaning of skhizein= split phrēn= mind.

	RBS	JE	EBV	NVCJD
Psychosis	+++	+++	+++	+++
Auditory H				+++
Depression		+++	+++	+++
Altered Pattern of thought	+++	+++	+++
Behavioral change	+++	+++	+++	+++
Cognition impaired	+++	+++	+++	+++
Memory weakness	+++	+++	+++	+++
Rigidity	+++	+++
Sub types	Catatonic	Catatonic Residual	Residual	Paranoidal

Remedies

Syph

Lach – For High Degree of Suspiciousness

• Top-Grade Medicine
• Paranoid delusions: High suspicion of being poisoned, of being harmed and of being followed by enemies.
• There is suspicion in an extreme degree towards everything.
• Sensation of being under some superhuman power
• Delusion of persecution
• Wish to isolate themselves, aversion to work
• Marked loquacity, the prominent symptom is continuously talking with quick jumps from one subject to another unrelated subject.
• Repetition of the same words over and over again

Anac – Auditory Hallucinations

• He hears voices: The voices are mostly of spirits or dead people.
• A few patients narrate that the voices say that they are going to die soon.
• The spirits call their name and command them to follow them.
• The voices inside them speak in abusive language.

• Extreme sadness,
• Absent-mindedness / Forgetfulness
• Suspicion
• Aversion to work
• Desire to swear and curse are
• Feeling that everything is a dream and nothing is real.
• Excessive anger at the slightest offense.

Hyos– Delusion of Being Poisoned

• Someone is going to poison them, so they avoid eating or drinking.
• His family members are keeping a watch over them all the time. 
• Patient does things that appear foolish.
• Laughing loudly at everything is also markedly present.
• An impulse to strike and bite others may also arise along with delusions.
• Unintelligible chattering can also appear.
• Patient feels that others are making some planning and plotting against them.

Bar-c – Person is being Talked About

• Other people are talking about them
• They are being made fun of and people always laugh at them
• Difficulty in concentration and confusion of mind.
• Childish behavior

Stram- Talk with Imaginary Spirits

• They can talk with spirits. They conversate with imaginary people
• They are under the influence of these spirits
• They are in communication with God
• Feeling of restlessness attends this talking with spirits and imaginary people. 
• Delusions of the presence of multiple persons in the room. He sees people coming out of all corners of the chamber.
• Patients hear voices that scold them
• A firm belief that he is going to die soon. So they start to give directions for their funeral.
• Constant praying and recitation of religious rhymes
• Disorganized speech / Continuous talking/ Incomprehensible speech

Phos

• Grandiose delusion: Extra-gated idea of self-importance
• Over sensitiveness
• Depression