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Scheiner’s first rank symptoms of schizophrenia (SFRS)

Kurt Schneider in 1960 given these symptoms and level them as First rank, that ,If these symptoms are present , there is a high chance of illness being schizophrenia.

There are total 11  first rank symptoms:
  1. Made phenomena:  Made Emotion, Made Action, Made Impulse
  2. Thought phenomena: Thought insertion, Thought withdrawal, Thought Broadcasting
  3. Perception phenomena: Thought echo, Running commentary, voices arguing (3rd person auditory hallucination (It is the most characteristic hallucination of schizophrenia)
  4. Somatic passivity: Body is passive recipient of some sensation.
  5. Delusional perception - No delusion but it is a type of primary delusion (perception normal but meaning is Delusional).
In psychiatry there are four type Primary delusions: 
  1. Delusional Memory
  2. Delusional Perception
  3. Delusional mood
  4. Sudden delusional idea.
Classification of Schizophrenia
>1 Month Schizophrenia >6 month Schizophrenia
1-6 Months Schizophreniform disorder
< 1 Month
Acute Psychosis
Acute and transient psychotic disorder
< 1 Months                
Acute Psychosis (Brief psychotic disorder)

For all MCQ’S purpose we follow DSMIV (now DSM V)
Usual age of onset of schizophrenia »20 years, late teens, late adolescence.
Late age of onset >45 yrs of age. 
Different types of schizophrenia are:
Paranoid schizophrenia
  1. Predominantly delusion and hallucination
  2. Specially in late onset variety
  3. Most Common type
  4. Personality is usually intact
  5. Good prognosis schizophrenia
Catatonia schizophrenia
  1. Mutism
  2. Echolalia- Echo of language
  3. Rigidity
  4. Echopraxia- Echo of movement
  5. Waxy flexibility (catalepsy)
  6. Posturing
  7. Treatment of choice:- of choice ECT+ Antipsychotic
* Best prognosis schizophrenia
Hebephrenia or disorganized schizophrenia
- Silly smiles
- Early onset (» 13-14 year of age)
- Mirror gazing
* Worst prognosis schizophrenia
Simple schizophrenia
- Only negative symptom, no positive symptoms.
Undifferentiated schizophrenia
If symptoms cannot be included in other category’s.
In past there are various named schizophrenia e.g.
  1. Propf schizophrenia
    Mental retardation earlier + now schizophrenia
  2. Van-Gogh schizophrenia
    Schizophrenia + self mutilation behavior
  3. Nuclear schizophrenia
    Catatonia + Hebephrenia
  1. Genetic hypothesis
    1. Probably in Mono zygotic twin or both suffering from schizophrenia – 46 – 48%
    2. Dizygotic twin or single parent schizophrenia or first degree relative suffering from schizophrenia
    3. Normal population prevalence is < 1%  (0.85%).
  2. Biochemical Factor
    • Dopamine hypothesis is the most accepted hypothesis for schizophrenia, There is hyperactivity of dopaminergic system . This hypothesis is supported by:
      1) Amphetamine and cocaine which release dopamine in central synapses induce schizophrenia like symptoms:
      2) Antipsychotic drugs control the schizophrenic symptoms by blocking dopamine (D2) receptors. However, the dopamine hypothesis has been questioned also as Homo vanillic acid (HVA the principal metabolite of dopamine) is not elevated and prolactin level is not decreased (Dopamine has inhibitory action on prolactin release).
    • Other neurotransmitters involved are: - Increased serotonin , Decreased GABA, variable change (Increased or decreased) glutamate, and increased norepinephrine.
    1. Dopamine increase at D2 receptor located mostly at mesocortical, Nigrostriatal & tubulo-infundibular area
    2. Serotonin increase at frontal areas (Prefrontal Cortex)
  3. Environmental factors:
    Environmental factors and stress are important in precipitating schizophrenia in many individuals. These factors are:-
    1. Socioeconomic - Low socio-economic status. Industrialization; Immigration; familes with high expressed emotions.  Nuclear families: Schisms & skewed families: and pseudomutul & pseudohostile families.
    2. Drugs :- Drugs causing schizophrenia like state are amphetamine (most common causative drug) , LSD, Phencyclidine, ketamine, Mescaline, Cocaine, Cannabis (marijuana).
    3. Metabolic & Neurological disorders: - Schizophrenia like symptoms may occur in Huntington's chorea (early stage), homocystinuria, acute intermittent porphyria. Wilson's disease and hemochromatosis
  4. Family theories of Schizophrenia
    1. Schism – No communication between patients so that child is confused
    2. Skew – Role reversal of parents so that mother is dominant , aggressive & father is passive.
    3. Double bind – Two messages being sent to the child in one sentence so that the child does not know what to follow.
There is no role of family dynamics in the etiology of schizophrenia but exacerbation & relapse of symptoms are higher in schizophrenia in families with Expressed Emotions (Emotions expressed by family members towards suffering patient ).

Prevalence Of Schizophrenia:
  1. Incidence1-5 /10,000 / year
  2. General population: 1%
  3. Sibling affected: 8%
  4. Single parent affected: 11%
  5. Both parents affected: 40%
  6. Dizygotic twin: 12%
  7. Monozygotic twin: 47%
Course And Prognosis (Outcome)
20% make a full recovery from the acute illness and have no relapses
35% recover completely but have repeated relapses with full recovery each time 35% have recurrent acute episodes with incomplete recovery each time. They are left with negative symptoms which become more disabling after each relapse 10% have a rapid downhill course from the outset and have persistent positive and negative symptoms.
Suicide in schizophrenia
Suicide is the single leading cause of premature death among people with schizophrenia. Suicide attempts are made by 20-50% of the patients, with long term rates of suicide estimated to be 10-13%. These numbers reflect an approximately 20 fold increase over the suicide rate in the general population. The most important factor for suicide is the presence of major depression.
Good Prognostic Factors Poor Prognostic Factors
Late Onset
Younger age of onset
Catatonic features
Disorganized type
Pyknic Built
Asthenic built
No Family history
Family history present
Acute onset
Chronic type
Affective features present
or atypical Feature Present
Blunting of affect
Type I
Type II  

Acute and transient Psychotic disorders (A.T.P.D)
  1. Onset = abrupt to acute
  2. Recovery occurs within one month
  3. If it persists for > 1 months, then we need to reevaluate so as to classify it under a diagnostic category
  4. Schizophreniform disorder: symptoms of psychosis more than 1 month but less than 6 months
Schizo affective disorders
The symptoms of schizophrenia and mood disorders are Prominently Simultaneously present within the same episode for Most of time of disorder. It is of following types:-
  1. Schizoaffective Disorder, manic type
  2. Schizoaffective Disorder, depressive type
  3. Schizoaffective Disorder, mixed type
T/t will depend on the symptomatology

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