Schizophrenia

* The schizophrenic syndrome usually begins between late adolescence and early adulthood

* Three syndromes cardinals dissociation, autism, paranoid delusions.

* Dissociative syndrome: is not pathognomonic of schizophrenia; It is the loss of cohesion and unity of personality

* Morbid Rationalism: incoherent explanation of actual concrete events

* Catatonia: psychomotor attitude essentially of inertia and negativity; mutism, stupor sometimes hyperkinesia (sudden motor impulse)

* Paranoid delirium: delirium poorly structured, fuzzy, not systematized, sometimes devoid of particular thematic or changing thematic focus. The most common themes are depersonalization, often printing accompanied by physical changes or body dysmorphic disorder; delusions of persecution, influence, parentage ….

mental automatism (flight of thought imposed thoughts echoes of thought, influence syndrome)

* Positive Symptoms: delusions; hallucinations; disorders of formal thought (illogicality, inconsistency, diffluence, tangentiality); bizarre or disorganized behavior (eccentric; stereotyped; aggressive …).

* Negative symptoms: poverty of speech; flat affect; amimie; anhedonia and social withdrawal; apathy and alteration of the will; attention deficit disorder; listlessness.

* Deficit table (dementia) is gradually in a few years; it is particularly to be feared in the hebephrenia. The demonstrations are the predominant affective flattening, the listlessness and disorganization.

* Stabilization: the most frequent progressive profile (50%) especially in case of paranoid schizophrenia and Schizoaffective

* The complete or almost complete remission is possible (25% of cases)

* Schizophrenia resistant to neuroleptics -> interest of clozapine: Leponex®

1- Dissociative syndrome:

A- DISCORDANCE INTELLECTUAL:

– Stereotypies (echolalia; palilalie)

– Dam (sudden suspension of speech

– Fading (progressive extinction of speech)

– Loss of privacy of thought …

– Morbid Rationalism

– Disorders of the meaning of words; neologism; schizophasia … ..

B- DISCREPANCY EMOTIONAL:

– Emotional ambivalence: love and hate

– Quirk Presence

– Emotional detachment; impenetrability

– Blunting of affect and life force (athymhormia)

– Sexual Regression (autoérotisme, deviation)

C- DISCORDANCE PSYCHOMOTOR:

– Uncertainty gestures

– Automatic movements

– Mannerism

– Paramimies (grimaces, smiles unmotivated, paradoxical mimicry)

– Stereotyped movements (rocking the head; ambulation)

2- Clinical forms:

A- PARANOID SCHIZOPHRENIA:

– This is the typical form of the description of schizophrenia

– Delirium often paranoid theme of persecution or influence, and hallucinations are prominent. Delirium tends to be lost.

– Conceptual disorganization and discrete or absent negative symptoms.

– Depressive symptomatology atypical 2nd plane

B- Hebephrenic SCHIZOPHRENIA:

– Starts insidiously (adolescence).

– Dissociative syndrome is predominant with poor or absent delirium.

– Emotional blunting and disorganization in 1st plan

– There is frequently a mannerism

– The mood seems shallow and inappropriate

– Tendency to relational and social isolation

C- OTHER FORMS:

* Catatonic schizophrenia: catatonic attitude; oneiroid state

* Héboïdophrénie: impulsive behavior (crime, drugs); discordance and progressive impoverishment ideational

* Simple Schizophrenia: progressive onset of a global reduction of social performance of the individual; loss of interest; inactivity and social withdrawal. dissociative syndrome moderate with no major disturbances during the thought. very stereotyped activity.

NB: the hebephrenia (or disorganized schizophrenia) is the classic early dementia