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selfexplanatory.2022
Saba Parvin Haque
M.Sc. Life Sciences
(Specialization in Neurobiology)
from “Sophia College”
(Autonomous), Mumbai.
Behavioral disorder
What is Schizophrenia?

Source: https://youtu.be/H1blxu9S94s
 Who is affected?
1. Schizophrenia affects about 1% of
the population.
2. Several studies indicate that the
incidence of schizophrenia is
higher in men.
3. In women usually occurs between
25-35 years of age and in men
usually occurs between 15-25
years of age.
4. 3.5 million Americans have
schizophrenia
Types of Schizophrenia
 Ref: (Munawar et al., 2021)

Figure: Symptoms, factors involved, and current therapeutics in schizophrenia. A combination of genetics,
epigenetics, environmental factors, including gut microbiota, resulting in the prognosis of the illness.
Schizophrenia involves variable symptoms having limited therapeutic options. On the left side of the figure, solid
arrows indicate the potential etiology (genetics, epigenetics and gut microbiota dysbiosis) of schizophrenia and
the dotted arrows are representing bi-directional relation of gut microbiota in health and disease.
What causes Schizophrenia

Source: https://images.app.goo.gl/1vfca6JX6XWFd9A47 Source: https://images.app.goo.gl/iQvSa8HN2TkzyWJE7

Source: https://images.app.goo.gl/iQvSa8HN2TkzyWJE7
Source: https://images.app.goo.gl/iQvSa8HN2TkzyWJE7
 Symptoms: 1. Positive Symptoms
1. Delusion
2. Hallucination
3. Thought Disorder
4. Movement disorder
All Schizophrenia
affected persons are
Dangerous to
themselves or others.
Violent Behavior
Symptoms: 2. Negative Symptoms
Symptoms: 3. Cognitive Symptoms
Symptoms: 4. Affective Symptoms

Source: (Morrissette & Stahl, 2011)

Source: https://images.app.goo.gl/oVXR8CzoG9FxyVfP6
Potential Therapeutics
Psychotherapy involves:
(i) individual psychotherapy,
(ii) cognitive behavior therapy (CBT) or
(iii) cognitive enhancement therapy
(CET)

Antipsychotic Medications:
• Olanzapine (zyprexa)
• Risperidone (risperdal)
• Quetiapine (seroquel)
• Ziprasidone (geodon)
Ref: (Munawar et al., 2021)
 Ref: (Munawar et al., 2021)

Figure: Types, mechanism of action, and side effects of first-generation and second-
generation antipsychotics.
Source: https://images.app.goo.gl/iQvSa8HN2TkzyWJE7
 Case study
https://images.app.goo.gl/kvgNjLx1iL1Q12gL9

https://images.app.goo.gl/qekzKiRjRXGRfjYz8
https://images.app.goo.gl/hmJ4mUmuctVDhZLs7 https://images.app.goo.gl/FcxP91eGuPy8fN9YA

https://images.app.goo.gl/6naXkYqy2bgjKk9E6 https://images.app.goo.gl/zqJu4jEbQG34phkb https://images.app.goo.gl/rfjittRAFWEFnrnb6

9
 Case study
• This case study is about a 14-year-old boy, who is educated up to class 6, belonging to a family of middle socioeconomic status.
• He lives in an urban area and it was brought with complaints of academic decline since 3 years and hearing voices for the past 2 years.
• This boy was born out of a nonconsanguineous marriage, an unplanned, uneventful, but wanted pregnancy.
• From his early childhood, he was exposed to aggressive behavior of his father, who often attempted to discipline him so toward that child it was abusive
and aggressive.
• When the child was around 10 year old, their parents got divorced due to marital problems and domestic violence.
• So the child and her mother moved to maternal grandparents’ home and his school was also changed.
• Within a year of this, it was observed a decline in his academic performance with handwriting deterioration, and irritable and sad behavior was noted.
• Complaints from school were often received by her mother where the child was found engaged in fist fights and undesirable behavior.
• He also preferred individual activities and resented to eat with the rest of the family.
• There was no history suggestive of depressive cognitions at that time.
• A private psychiatrist was consulted who treated him with sodium valproate up to 400 mg/day for nearly 2 months which led to a decline in his irritability
and aggression.
• The diagnosis was delay and the medications were gradually reduced and stopped.
• Over the next 1 year, he also started hearing voices that fulfilled dimensions of commanding type of auditory hallucinations.
• He suspected that family members including his mother collude with the unknown persons, whose voices he heard and believed it was done to tease him.
• He eventually dropped out of school and was often found awake till late night, seen muttering to self, shouting at persons who were not around.
 https://images.app.goo.gl/UvdHMw9YhKBeM6c99 https://images.app.goo.gl/7i5KbBFnTMSFe7DY9

❑ He had remarkable physical features of elongated face with large ears.

❑ Non-cooperation for mental state examination, and aggressive and violent behavior were noted.
❑ He was observed to be muttering and laughing to self.
❑ His mood was irritable, speech was laconic, and he lacked insight into his illness.
 Case study
• Another psychiatrist was consulted and he diagnosed that he is suffering schizophrenia and treated inpatient for 2 weeks with risperidone 3 mg, olanzapine 2.5 mg, and oxcarbazepine 300 mg/day
observed some improvement in his symptoms.
• Significant weight gain with the medication lead to poor compliance which further led to relapse within 3 months of discharge.
• Due to Frequent aggressive episodes over the next 1 year has resulted in multiple hospital admissions.
• Finally he was admitted for diagnostic clarification and rationalization of his medications.
• He had remarkable physical features of elongated face with large ears.
• Non-cooperation for mental state examination, and aggressive and violent behavior were noted.
• He was observed to be muttering and laughing to self.
• His mood was irritable, speech was laconic, and he lacked insight into his illness.
• The physical investigations done on this case are shown in this table:
• They reduced the medication and only kept him on aripiprazole 30 mg/day and added lurasidone 40 mg twice a day and discharged him with residual negative symptoms only.
• But his hallucinations and aggression reappeared within 2 weeks of discharge and was readmitted.
• This time eight sessions of bilateral modified electroconvulsive therapy were administered and he was put on aripiprazole 30 mg/day, chlorpromazine 600 mg/day, sodium divalproex 1000 mg/day,
and trihexyphenidyl 4 mg/day.
• ECT is defined as bilateral or uni- lateral. In bilateral ECT, one electrode is placed on the left side of the head, the other on the right side. Bilateral Electroconvulsive Therapy refers to the placement
of electrodes on both sides of the head during the administration of electroconvulsive treatments (ECT). Bilateral is considered more effective and is used more commonly than unilateral and
bifrontal placement.
• Dietary modifications in view of weight gain were also suggested. In the past 6 months, no episodes of violence came to their notice.
• However, poor socialization, lack of motivation, apathy, weight gain subsequent to psychotropic medications, and aversion to start school are still unresolved.
 References
• Home. (2024, April 18). https://www.who.int/
• NIMH » Home. (2024, April 18). Y. https://www.nimh.nih.gov
• Health News - Medical News Today. (n.d.). https://www.medicalnewstoday.com
• Home. (2024a, April 18). The Pharmaceutical Journal. https://pharmaceutical-journal.com/
• The role of the gut microbiome in the development of schizophrenia. (2021, August 1). ScienceDirect.
https://linkinghub.elsevier.com/retrieve/pii/S0920996420300864
• Munawar, N., Ahsan, K., Muhammad, K., Ahmad, A., Anwar, M. A., Shah, I., al Ameri, A. K., & al Mughairbi, F. (2021). Hidden Role of Gut
Microbiome Dysbiosis in Schizophrenia: Antipsychotics or Psychobiotics as Therapeutics? International Journal of Molecular Sciences,
22(14), 7671. https://doi.org/10.3390/ijms22147671
• Akhondzadeh S. (2019). Microbiome and Schizophrenia. Avicenna journal of medical biotechnology, 11(4), 269.
• Kelly, J. R., Minuto, C., Cryan, J. F., Clarke, G., & Dinan, T. G. (2021). The role of the gut microbiome in the development of schizophrenia.
Schizophrenia Research, 234, 4–23. https://doi.org/10.1016/j.schres.2020.02.010
• Aneja, J., Singhai, K., & Paul, K. (2018). Very early-onset psychosis/schizophrenia: Case studies of spectrum of presentation and management
issues. Journal of family medicine and primary care, 7(6), 1566–1570. https://doi.org/10.4103/jfmpc.jfmpc_264_18
• Morrissette, D. A., & Stahl, S. M. (2011). Affective symptoms in schizophrenia. Drug Discovery Today. Therapeutic Strategies, 8(1–2), 3–9.
https://doi.org/10.1016/j.ddstr.2011.10.005
Thank You