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Outline.
Treatment
Complications / differential diagnosis.
prognosis
Conclusion.
Introduction.
In 1908 eugene blueler was the first man to coin the word schizophrenia from greek, 'skhizen' (split) and 'phren' (mind) meaning split personality.
Introduction cont
Blueler characterized schizophrenia as having 4 basic symptoms, ie the 4 'A's
Flattened affect, Autism,
Impaired association,
Ambivalence.
Introduction cont
Currently there is no generally accepted definition for schizophrenia but its know to be xterized by the ff;
hallucination(false perception)
delusion(false belief)
Introduction cont
Cognitive deficit
Occupational & social dysfunction.
Epidermiology.
Etiology.
Although the specific cause is unknown, its has been shown to have some biological basis, evidenced by alteration in the brain structure.
Enlargement of the ventricles
Etiology.
A combination of genetic and environmental factor play a role in the development of schiz,
Genetic factors
People with a family history of schizophrenia who suffer from transient psychosis has a 2040% chances of being diagnosed one year later.
Genetics cont
People with 1st degree relatives having schizo have 10% chance of developing the disease as against 1% in the general population.
People with both parents having schizophrenia have 40% chances of developing the disease. Monozygotic twins have a concordance of about 50% as against 10% in dizygotic twins.
Environmental
Some of the environmental factors found common among px with schizo are:
Maternal exposure to famine & influenza while pregnant. Low birth weight
Pathophysiology.
There are several hypothesis about neurochemical mechanism underlying schizophrenia. DOPAMINE
Over activity of dopamine at the D2 receptor is proposed due to the effect of anti dopamine drug (anti-psychotics) at ameliorating antipsychotic symptoms. In contrast reduced activity on D1 receptor manifest as deficit in working memory.
Pathophysiology cont..
GLUTAMATE
Reduced level of glutamate is proposed based on psychotic & cognitive symptoms generated in humans exposed to ketamine or phencyclidine which are non competitive antagonist at the glutamate receptor.
MUTATIONS
Mutation in various gene has been implicated in schizophrenia eg are DISC1, ERBB4, NRG1.
Pathophysiology cont
These mutations has also been noticed in other neuropsychiatric conditions, & some of these gene has been found to be beneficial for development. It must be emphasized that there are only working models and a true pathophysiology remains to be established.
Clinical presentation.
Schneilder's symptoms of first rank.
Clinical presentation
Currently could be grouped Into; positive , negative, disorganized and cognitive.
Clinical presentation
NEGATIVE (leads to poor motivation & diminished sense)
Clinical presentation.
DISORGANIZED/ BIZZARRE BEHAVIORS.
5= problem solving.
Symptoms of schizophrenia typically impair the ability to function & often markedly interfere with work, social relations & self care.
Clinical subtypes.
Crow (1985), described 2 syndromes of schizophrenia based upon a combination of clinical and neurobiological factors .
TYPE 1;
Acute onset, mainly positive symptoms & preserved social functions during remission. Has a good response to anti-psychotic drugs, associated with behavioral of dopamine over activity.
Treatment.
GOALS;
Reduce severity of psychotic symptoms . Prevent recurrence of symptomatic episodes & associated deterioration of function. Help patient function at the highest level possible. Treatment could be grouped into pharmacological and non pharmacological.
Pharmacological.
Pharmacology cont.
Pharmacology cont..
Because most of these patients do not have insight about there health condition, non compliance to medication do occur, hence the long acting depot could be used;
Fluphenazine decanoate 12.5-50mg (2-4wk) Fluphenazine enanthate 12.5-50mg (1-2wk) Haloperidol decanoate 25-150mg ( 3-5wk) Resperidone microshpere 25-50mg (2wk)
Pharmacological cont
Antipsychotics are effective in 70% of first episode cases.
After the drug is commenced it takes 6-8wks to achieve full remission, then maintenance is initiated with the lowest dose that prevents symptoms recurrence.
Side effect
Cost
Past Hx of favorable response to any drug.
Non pharmacological
Psychotherapy.
The goal of psychotherapy is to develop a collaborative relationship btw the patient, family & physician so that the patient can learn to understand and manage the illness, take drugs as prescribed and handle stress more effectively.
Complications
Suicide occur in about 10% of schizophrenic patients and is most common among the paranoid types because these patients retain the capacity for grief and anguish.
On the average, the illness reduce life expectancy by 10yrs.
Differential diagnosis.
Bipolar disorder.
Drug induced psychosis Delusional disorder Depression.
Prognosis.
This depends on ;
Type If associated with other mental disorders, eg OCD(poor), personality disorder (good) Adherence to medication. OVER ALL achieve significant & lasting improvement
Prognostic factors
Good factors
Poor factors
Poor premorbid fxn Early age of onset Insidious onset Disorganized type
Good premorbid fxn Late age of onset Sudden onset Paranoid type.
Women
Minimal cognitive impairment.
Men
Co-morbid substance abuse Repeated relapse.
Prognosis.
JOHN NASH a US mathematician and joint winner of the 1994 nobel prize for economic, suffered from schizophrenia.
His life has been a subject of the 2001academic award film 'a beautiful mind'.
conclusion
The cause of schizophrenia is unknown, but evidence for genetic component is strong. There is no cure for schizophrenia it could only be managed.
Reference.