Schizophrenia

From the Greek roots skhizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-;
"mind") is a psychiatric diagnosis that describes a neuropsychiatric and mental disorder
characterized by abnormalities in the perception or expression of reality.

It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or

disorganized speech and thinking with significant social or occupational dysfunction.

Onset of symptoms typically occurs in young adulthood, with around 0.4–0.6% of the
population affected. 15-25y/o for MEN, 25-35y/o for WOMEN

Diagnosis is based on the patient's self-reported experiences and observed behavior.

No laboratory test for schizophrenia currently exists.

Studies suggest that genetics, early environment, neurobiology, psychological and

social processes are important contributory factors; some recreational and prescription
drugs appear to cause or worsen symptoms. Current psychiatric research is focused on
the role of neurobiology, but no single organic cause has been found. As a result of the
many possible combinations of symptoms, there is debate about whether the diagnosis
represents a single disorder or a number of discrete syndromes. (in short, is not defined
as a single disease but thought as a syndrome r disease process that includes many
signs and symptoms)

Despite its etymology, schizophrenia is not the same as dissociative identity disorder,
previously known as multiple personality disorder or split personality, with which it has
been erroneously confused. (not characterized by changing personality)

Etiologies:

NATURE
Genetics
Neuroanatomical
Frontal lobe abnormalities
Temporal lobe abnormalities
Neurotransmitter abnormalities
Viral infections
NURTURE
Dysfunctional relationships in early life and adolescents
Dysfunctional parenting or family dynamics
DSM-IV-TR criteria for schizophrena:

1. Characteristic symptoms: Two or more of the following, each present for much of
the time during a one-month period (or less, if symptoms remitted with treatment).
* Delusions
* Hallucinations
* Disorganized speech, which is a manifestation of formal thought disorder
* Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently)
or catatonic behavior
* Negative symptoms: Blunted affect (lack or decline in emotional response),
alogia (lack or decline in speech), or avolition (lack or decline in motivation)

If the delusions are judged to be bizarre, or hallucinations consist of hearing one

voice participating in a running commentary of the patient's actions or of hearing two or
more voices conversing with each other, only that symptom is required above. The
speech disorganization criterion is only met if it is severe enough to substantially impair
communication.

2. Social/occupational dysfunction: For a significant portion of the time since the onset
of the disturbance, one or more major areas of functioning such as work, interpersonal
relations, or self-care, are markedly below the level achieved prior to the onset.
3. Duration: Continuous signs of the disturbance persist for at least six months. This
six-month period must include at least one month of symptoms (or less, if symptoms
remitted with treatment).
4. Schizoaffective and mood disorders are not present and are not responsible for the
signs and symptoms.
5. Not caused by substance abuse or general medical disorder.

Manifestations:
POSITIVE
 Includes delusions, auditory hallucinations, and thought disorder, and are
typically regarded as manifestations of psychosis
NEGATIVE
 Includes flat or blunted affect and emotion, poverty of speech (alogia), inability to
experience pleasure (anhedonia), lack of desire to form relationships (asociality),
and lack of motivation (avolition).

Types of schizophrenia
* Paranoid type: Where delusions and hallucinations are present but thought
disorder, disorganized behavior, and affective flattening are absent.
* Disorganized type: Named hebephrenic schizophrenia in the ICD. Where thought
disorder and flat affect are present together.
* Catatonic type: The subject may be almost immobile or exhibit agitated,
purposeless movement. Symptoms can include catatonic stupor and waxy flexibility.
 * Undifferentiated type: Psychotic symptoms are present but the criteria for
paranoid, disorganized, or catatonic types have not been met.
* Residual type: Where positive symptoms are present at a low intensity only.

Management
Neuroleptics or Antipsychotic
 Address the positive signs and symptoms and have less effects on the positive
symptoms
 Best taken after meals for better absorption
 Regularly assess for the client’s blood pressure before administration for it may
cause hypotension
 Therapeutic effect is usually seen after 2-4weeks.
 Side effects involve the ff: extra-pyramidal symptoms(acute dystonia, pseudo
parkinsonism, akathisia) tardive dyskinesia, neuroleptic malignant syndrome and
agranulocytosis
 Other side-effects:weight gain and sedation

Electro Convulsive Therapy

 Used to treat depression in selected groups, such as those who are not
responding to certain medication
 Also those who are suicidal, catatonic and those waiting for the effect of certain
medications.
 It involves the application of electrodes to the head of the patient to deliver an
electrical impulse to the brain that can cause momentary seizure to correct
chemical imbalance.
 The following drugs are given before the procedure: methohexital
sodium(brevital), sucinylcholine(anectine), atropine sulfate