Schizophrenia: Difference between revisions
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Schizophrenia is "a chronic, more or less debilitating illness characterized by perturbations in cognition, affect, and behavior, all of which have a bizzare affect. "<ref name="APA" /> | Schizophrenia is "a chronic, more or less debilitating illness characterized by perturbations in cognition, affect, and behavior, all of which have a bizzare affect. "<ref name="APA" /> | ||
[[Image:Schizophrenia graphic high contrast1.jpg|Image:Schizophrenia_graphic_high_contrast1.jpg]] | [[Image:Schizophrenia graphic high contrast1.jpg|Image:Schizophrenia_graphic_high_contrast1.jpg]] | ||
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== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
''' | === Diagnostic Criteria for Schizophrenia<ref name="Kelly D" />: === | ||
# Two or more of the following symptoms during a 1 month period of time: | |||
**''Delusions:'' almost a universal symptom among schizophrenics. These delusions the person has are often gradiose ideas, thoughts of persecution, and the feeling that their thoughts are being broadcast to the rest of the world and that everyone can hear what they are thinking. <ref name="APA" /> | |||
**''Hallucinations'': auditory hallucinations are the most common type of hallucination. 80% of children with schizophrenia present with auditory hallucinations. <ref name="Foster et al." /> People can also experience visual, touch, taste, or smell hallucinations. These hallucinations are never comforting, but are very demanding of the person hallucinating. <ref name="APA" /> | |||
**''Disorganized speech'': This is also called "word salad." When the person speaks, their words make no sense at all and are in a very illogical order<ref name="APA" />. The average IQ of a person with schizophrenia is around 80-85 and it declines with aging. <ref name="Roberson C">Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.</ref> | |||
**''Catatonic behavior'': A state in which the person may give automatic obedience. They may also have increased muscle tension, hold their bodies in strange postures, and mimic the behaviors of others around them. <ref name="APA" /> | |||
**''Negative symtpoms'': decreased speech production, decreased goal oriented behaviors, lack of emotion, lack of motivation, unable to find pleasure in activities, and has a blunted personality. <ref name="Roberson C" /> | |||
# Social or occupational dysfunction (ex. at work, in public, etc) | |||
# A duration of continuous symptoms for at least 6 months. | |||
# Rule out differential diagnoses such as autism, mood disorder, depression, borderline personality disorder, bipolar disorder, alcoholism, etc. <ref name="Goodman CC">Goodman CC, Fuller KS. Pathology Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders Elsevier; 2009.</ref> | |||
=== Clinical Presentation === | |||
*The person's symptoms are not always continuous; they may come and go at certain points in their life. | *The person's symptoms are not always continuous; they may come and go at certain points in their life. | ||
*Exacerbation of symptoms can be brough on by life stresses, such as, marriage, work, school, and other major | *Exacerbation of symptoms can be brough on by life stresses, such as, marriage, work, school, and other major life-changing events. <ref name="APA" /> | ||
*There are 5 types of schizophrenia: paranoid, disorganized, catatonic, undifferentiated, and residual. Any person may be diagnosed with one or multiple types of schizophrenia. <ref name="Roberson C" /> | *There are 5 types of schizophrenia: paranoid, disorganized, catatonic, undifferentiated, and residual. Any person may be diagnosed with one or multiple types of schizophrenia. <ref name="Roberson C" /> | ||
*People with schizophrenia will experience a decrease in mental and physical function over time, which is part of the disease. <ref name="Senba et al.">Senba H, Imamura Y, Fukuda N, Sekine M, Kikuchi Y, Numao H. Guidelines for Physical Therapy in Physically Disabled Schizophrenic Patients. Journal of Physical Therapy Science. 2002; 14:15-20.</ref> | *People with schizophrenia will experience a decrease in mental and physical function over time, which is part of the disease. <ref name="Senba et al.">Senba H, Imamura Y, Fukuda N, Sekine M, Kikuchi Y, Numao H. Guidelines for Physical Therapy in Physically Disabled Schizophrenic Patients. Journal of Physical Therapy Science. 2002; 14:15-20.</ref> | ||
| Line 37: | Line 38: | ||
== Associated Co-morbidities == | == Associated Co-morbidities == | ||
*Depression. <ref name="APA" / | *Depression. <ref name="APA" /> | ||
*Suicide risk. 50% of people with schizophrenia attempt suicide. <ref name="APA" /> | *Suicide risk. 50% of people with schizophrenia attempt suicide. <ref name="APA" /> | ||
*Diabetes Mellitus (as a result of the medication). <ref name="Sernyak et al.">Sernyak MJ, Leslie DL, Alarcon RD, Losonczy MF, Rosenbeck R. Association of Diabetes Mellitus with Use of Atypical Neuroleptics in the Treatment of Schizophrenia. American Journal of Psychiatry. 2002; 159(4): 561-566.</ref> | *Diabetes Mellitus (as a result of the medication). <ref name="Sernyak et al.">Sernyak MJ, Leslie DL, Alarcon RD, Losonczy MF, Rosenbeck R. Association of Diabetes Mellitus with Use of Atypical Neuroleptics in the Treatment of Schizophrenia. American Journal of Psychiatry. 2002; 159(4): 561-566.</ref> | ||
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== Medications == | == Medications == | ||
=== Typical Antipsychotics <ref name="Roberson C" /> <ref name="Drugs">Drugs.com. Drug Information Online. 2010. Available at:http://www.drugs.com/. Accessed on February 27, 2010.</ref> === | |||
{| class="wikitable" | |||
Drug Name | !Drug Name | ||
!Brand Name | |||
!Side Effects | |||
|- | |||
|Chlorpromazine | |||
|(Thorazine) | |||
|Nausea, dizziness, jitteriness, dry mouth, loss of appetite | |||
|- | |||
|Haloperidol | |||
|(Haldol) | |||
|Trouble sleeping, dry mouth, GI upset, constipation | |||
|- | |||
|Loxapine | |||
|(Loxitane) | |||
|Weight loss/gain, blurred vision, dry mouth, dizziness, trouble sleeping | |||
|- | |||
|Molindone | |||
|(Moban) | |||
|Increased saliva production, restlessness, dry mouth, constipation | |||
|- | |||
|Perphenazine | |||
|(Trilafon) | |||
|Nasal congestion, sleeplessness, tired feeling, vomiting, confusion | |||
|- | |||
|Thiothixene | |||
|(Navane) | |||
|Lightheaded, tired, diarrhea, headache, dry mouth, changes in appetite | |||
|- | |||
|Trifluperazine | |||
|(Stelazine) | |||
|Mild agitation, trouble sleeping, headache, loss of appetite | |||
|} | |||
=== Atypical Antipsychotics <ref name="Roberson C" /> <ref name="Drugs" /> === | |||
Drug Name Brand Name Side Effects | Drug Name Brand Name Side Effects | ||
{| class="wikitable" | |||
!Drug Name | |||
!Brand Name | |||
!Side Effects | |||
|- | |||
|[[Aripiprazole in the Treatment of Psychoses|Aripiprazole]] | |||
|(Abilify) | |||
|Dizziness, drowsiness, headache vomiting | |||
|- | |||
|Clozapine | |||
|(Clozaril) | |||
|Shortness of air, stiff muscles, numbness, seizure, chest pain, nausea | |||
|- | |||
|Olanzapine | |||
|(Zyprexi) | |||
|Weakness, pain, redness, swelling at injection site, dizziness, drowsiness | |||
|- | |||
|Paliperidone | |||
|(Invega) | |||
|Sore throat, weakness, redness, swelling, weight gain, dizziness | |||
|- | |||
|Quetiapine | |||
|(Seroquel) | |||
|Stomach pain, nasal congestion, constipation, dizziness, weight gain | |||
|- | |||
|Risperidone | |||
|(Risperal) | |||
|Tremor, fever, stiff muscles, restlessness, trouble swallowing, fainting | |||
|- | |||
|Ziprasidone | |||
|(Geodon) | |||
|Anxiety, pain at injection site, runny nose, constipation, restlessness | |||
|} | |||
== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
| Line 76: | Line 122: | ||
== Causes == | == Causes == | ||
=== Genetics === | |||
*5% of schizophrenics have a first generation family member with schizophrenia as well. <ref name="APA" /> | *5% of schizophrenics have a first generation family member with schizophrenia as well. <ref name="APA" /> | ||
*In the case of identical twins and schizophrenia, there is a 50% chance that if one twin has schizophrenia, the other twin will have it as well. <ref name="APA" /> | *In the case of identical twins and schizophrenia, there is a 50% chance that if one twin has schizophrenia, the other twin will have it as well. <ref name="APA" /> | ||
*The image below is a graph that shows the rates of relatives with schizophrenia among people with schizophrenia.<ref name="Corocan C">Corocan C, Cadenhead K, Vinogradov S. Schizophrenia Prevention-Risk Reduction Approaches. http://schizophrenia.com. Updated 2004. Accessed February 14, 2010.</ref> <br>'''[[Image:Schizophrenia.risks.jpg]]''' | *The image below is a graph that shows the rates of relatives with schizophrenia among people with schizophrenia.<ref name="Corocan C">Corocan C, Cadenhead K, Vinogradov S. Schizophrenia Prevention-Risk Reduction Approaches. http://schizophrenia.com. Updated 2004. Accessed February 14, 2010.</ref> <br>'''[[Image:Schizophrenia.risks.jpg]]''' | ||
=== Neurodevelopmental === | |||
*The physical structure of the brain is different in people with schizophrenia. | *The physical structure of the brain is different in people with schizophrenia. | ||
*These particular people have been found to have cortical atrophy, ventricular dilation (particularly the third ventricle), and overall have a smaller brain size. <ref name="APA" /><ref name="Roberson C" /><ref name="Kelly D" /> | *These particular people have been found to have cortical atrophy, ventricular dilation (particularly the third ventricle), and overall have a smaller brain size. <ref name="APA" /><ref name="Roberson C" /><ref name="Kelly D" /> | ||
| Line 91: | Line 135: | ||
Depending upon the specific type of schizophrenia, they can experience muscle tension or spasms throughough the body. <ref name="Roberson C" /> Due to the fact that this disorder affect the mind and how a person sees or thinks, it can have varied effects on the rest of the person's body. | Depending upon the specific type of schizophrenia, they can experience muscle tension or spasms throughough the body. <ref name="Roberson C" /> Due to the fact that this disorder affect the mind and how a person sees or thinks, it can have varied effects on the rest of the person's body. | ||
== Medical Management | == Medical Management == | ||
*For symptom management, using one of the medications listed in the above section is the treatment of choice. <ref name="Foster et al." /><ref name="APA" /> | *For symptom management, using one of the medications listed in the above section is the treatment of choice. <ref name="Foster et al." /><ref name="APA" /> | ||
| Line 99: | Line 143: | ||
== Physical Therapy Management == | == Physical Therapy Management == | ||
Physical therapy cannot treat the schizophrenia itself. However, it can help manage any co-morbidities, side effects of medications, or help deal with the physical decline in function. Diabetes affects 6% of people with schizophrenia, and this is an area that physical therapy can contribute.<ref name="Sernyak et al." /> Education on diet, exercise, and skin checks would be very beneficial to these people. Also, people with schizophrenia see a decline in physical function as they age, more so than the average person. They may experience bone/joint disease, fractures, decline in brain function, parkinsonism, cerebrovascular accident, spinal cord disorders, amputations, etc. <ref name="Senba et al." /> As previously stated, we cannot treat schizophrenia itself, but we will see patients for other medical reasons who are affected by this disorder. | Physical therapy cannot treat the schizophrenia itself. However, it can help manage any co-morbidities, side effects of medications, or help deal with the physical decline in function. Diabetes affects 6% of people with schizophrenia, and this is an area that physical therapy can contribute.<ref name="Sernyak et al." /> Education on diet, exercise, and skin checks would be very beneficial to these people. Also, people with schizophrenia see a decline in physical function as they age, more so than the average person. They may experience bone/joint disease, fractures, decline in brain function, parkinsonism, cerebrovascular accident, spinal cord disorders, amputations, etc. <ref name="Senba et al." /> As previously stated, we cannot treat schizophrenia itself, but we will see patients for other medical reasons who are affected by this disorder. | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
| Line 105: | Line 149: | ||
*Differential diagnoses in children include: ADHD, conduct disorder, asperger's, borderline personality disorder, and childhood depression. <ref name="Foster et al." /> | *Differential diagnoses in children include: ADHD, conduct disorder, asperger's, borderline personality disorder, and childhood depression. <ref name="Foster et al." /> | ||
*Differential diagnoses in adults include: bipolar disorder, depression, borderline personality disorder, mood disorders, schizoaffective disorder, schizofreniform, paranoia, and alcoholism. <ref name="Roberson C" /><ref name="APA" /> | *Differential diagnoses in adults include: bipolar disorder, depression, borderline personality disorder, mood disorders, schizoaffective disorder, schizofreniform, paranoia, and alcoholism. <ref name="Roberson C" /><ref name="APA" /> | ||
== Resources == | == Resources == | ||
[https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-6-10 Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature] | [https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-6-10 Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature] | ||
Revision as of 16:29, 22 May 2019
Original Editors - Meghan Shafer from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Meghan Shafer, Admin, Kim Jackson, Mariam Hashem, Lucinda hampton, Shaimaa Eldib, WikiSysop, 127.0.0.1, Elaine Lonnemann, Wendy Walker and Tolulope Adeniji
Definition/Description[edit | edit source]
Schizophrenia is "a chronic, more or less debilitating illness characterized by perturbations in cognition, affect, and behavior, all of which have a bizzare affect. "[1]
Image:Schizophrenia_graphic_high_contrast1.jpg
Prevalence[edit | edit source]
- Schizophrenia affects approximately 1% of the general population. [1] [2]
- It affects both males and females at an equal rate.[1]
- Average onset is in the late teens/early adult years. Males tend to start between the ages of 17-20. Women are generally diagnosed a little later in their twenties. [2]
- Childhood onset, before age 12, and late adulthood onset are not as common. [3]
Characteristics/Clinical Presentation[edit | edit source]
Diagnostic Criteria for Schizophrenia[2]:[edit | edit source]
- Two or more of the following symptoms during a 1 month period of time:
- Delusions: almost a universal symptom among schizophrenics. These delusions the person has are often gradiose ideas, thoughts of persecution, and the feeling that their thoughts are being broadcast to the rest of the world and that everyone can hear what they are thinking. [1]
- Hallucinations: auditory hallucinations are the most common type of hallucination. 80% of children with schizophrenia present with auditory hallucinations. [3] People can also experience visual, touch, taste, or smell hallucinations. These hallucinations are never comforting, but are very demanding of the person hallucinating. [1]
- Disorganized speech: This is also called "word salad." When the person speaks, their words make no sense at all and are in a very illogical order[1]. The average IQ of a person with schizophrenia is around 80-85 and it declines with aging. [4]
- Catatonic behavior: A state in which the person may give automatic obedience. They may also have increased muscle tension, hold their bodies in strange postures, and mimic the behaviors of others around them. [1]
- Negative symtpoms: decreased speech production, decreased goal oriented behaviors, lack of emotion, lack of motivation, unable to find pleasure in activities, and has a blunted personality. [4]
- Social or occupational dysfunction (ex. at work, in public, etc)
- A duration of continuous symptoms for at least 6 months.
- Rule out differential diagnoses such as autism, mood disorder, depression, borderline personality disorder, bipolar disorder, alcoholism, etc. [5]
Clinical Presentation[edit | edit source]
- The person's symptoms are not always continuous; they may come and go at certain points in their life.
- Exacerbation of symptoms can be brough on by life stresses, such as, marriage, work, school, and other major life-changing events. [1]
- There are 5 types of schizophrenia: paranoid, disorganized, catatonic, undifferentiated, and residual. Any person may be diagnosed with one or multiple types of schizophrenia. [4]
- People with schizophrenia will experience a decrease in mental and physical function over time, which is part of the disease. [6]
Associated Co-morbidities[edit | edit source]
- Depression. [1]
- Suicide risk. 50% of people with schizophrenia attempt suicide. [1]
- Diabetes Mellitus (as a result of the medication). [7]
- Attention Deficit Hyperactive Disoder with childhood onset. [3]
Medications[edit | edit source]
Typical Antipsychotics [4] [8][edit | edit source]
| Drug Name | Brand Name | Side Effects |
|---|---|---|
| Chlorpromazine | (Thorazine) | Nausea, dizziness, jitteriness, dry mouth, loss of appetite |
| Haloperidol | (Haldol) | Trouble sleeping, dry mouth, GI upset, constipation |
| Loxapine | (Loxitane) | Weight loss/gain, blurred vision, dry mouth, dizziness, trouble sleeping |
| Molindone | (Moban) | Increased saliva production, restlessness, dry mouth, constipation |
| Perphenazine | (Trilafon) | Nasal congestion, sleeplessness, tired feeling, vomiting, confusion |
| Thiothixene | (Navane) | Lightheaded, tired, diarrhea, headache, dry mouth, changes in appetite |
| Trifluperazine | (Stelazine) | Mild agitation, trouble sleeping, headache, loss of appetite |
Atypical Antipsychotics [4] [8][edit | edit source]
Drug Name Brand Name Side Effects
| Drug Name | Brand Name | Side Effects |
|---|---|---|
| Aripiprazole | (Abilify) | Dizziness, drowsiness, headache vomiting |
| Clozapine | (Clozaril) | Shortness of air, stiff muscles, numbness, seizure, chest pain, nausea |
| Olanzapine | (Zyprexi) | Weakness, pain, redness, swelling at injection site, dizziness, drowsiness |
| Paliperidone | (Invega) | Sore throat, weakness, redness, swelling, weight gain, dizziness |
| Quetiapine | (Seroquel) | Stomach pain, nasal congestion, constipation, dizziness, weight gain |
| Risperidone | (Risperal) | Tremor, fever, stiff muscles, restlessness, trouble swallowing, fainting |
| Ziprasidone | (Geodon) | Anxiety, pain at injection site, runny nose, constipation, restlessness |
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
There are no diagnostic tests or labs that will diagnose or help medically manage schizophrenia.
Causes[edit | edit source]
Genetics[edit | edit source]
- 5% of schizophrenics have a first generation family member with schizophrenia as well. [1]
- In the case of identical twins and schizophrenia, there is a 50% chance that if one twin has schizophrenia, the other twin will have it as well. [1]
- The image below is a graph that shows the rates of relatives with schizophrenia among people with schizophrenia.[9]
File:Schizophrenia.risks.jpg
Neurodevelopmental[edit | edit source]
- The physical structure of the brain is different in people with schizophrenia.
- These particular people have been found to have cortical atrophy, ventricular dilation (particularly the third ventricle), and overall have a smaller brain size. [1][4][2]
Systemic Involvement[edit | edit source]
Depending upon the specific type of schizophrenia, they can experience muscle tension or spasms throughough the body. [4] Due to the fact that this disorder affect the mind and how a person sees or thinks, it can have varied effects on the rest of the person's body.
Medical Management[edit | edit source]
- For symptom management, using one of the medications listed in the above section is the treatment of choice. [3][1]
- Psychotherapy combined with medication is very effective in the prevention of deterioration. Therapy is also used to teach social and behavioral skills. With the use of individual sessions, group therapy, and family therapy, certain behaviors are positively reinforced in order to help the person achieve a sense of self worth. [4]
- Prognosis for people who recieve treatment[4]:
10% have 1 or 2 episodes and then completely recover
55% will have chronic symptoms
35% will have intermittent episodes.
Physical Therapy Management[edit | edit source]
Physical therapy cannot treat the schizophrenia itself. However, it can help manage any co-morbidities, side effects of medications, or help deal with the physical decline in function. Diabetes affects 6% of people with schizophrenia, and this is an area that physical therapy can contribute.[7] Education on diet, exercise, and skin checks would be very beneficial to these people. Also, people with schizophrenia see a decline in physical function as they age, more so than the average person. They may experience bone/joint disease, fractures, decline in brain function, parkinsonism, cerebrovascular accident, spinal cord disorders, amputations, etc. [6] As previously stated, we cannot treat schizophrenia itself, but we will see patients for other medical reasons who are affected by this disorder.
Differential Diagnosis[edit | edit source]
- Differential diagnoses in children include: ADHD, conduct disorder, asperger's, borderline personality disorder, and childhood depression. [3]
- Differential diagnoses in adults include: bipolar disorder, depression, borderline personality disorder, mood disorders, schizoaffective disorder, schizofreniform, paranoia, and alcoholism. [4][1]
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. New York: APA; 2000.
- ↑ 2.0 2.1 2.2 2.3 Kelly D. Treatment Considerations in Women with Schizophrenia. Journal of Women's Health. 2006; 15(10): 1132-1140.
- ↑ 3.0 3.1 3.2 3.3 3.4 Foster KA, Swartz L, Jager W. The Clinical Presentation of Childhood Onset Schizophrenia: A Literature Review. South African Journal of Psychology. 2006; 36(2): 299-318.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.
- ↑ Goodman CC, Fuller KS. Pathology Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders Elsevier; 2009.
- ↑ 6.0 6.1 Senba H, Imamura Y, Fukuda N, Sekine M, Kikuchi Y, Numao H. Guidelines for Physical Therapy in Physically Disabled Schizophrenic Patients. Journal of Physical Therapy Science. 2002; 14:15-20.
- ↑ 7.0 7.1 Sernyak MJ, Leslie DL, Alarcon RD, Losonczy MF, Rosenbeck R. Association of Diabetes Mellitus with Use of Atypical Neuroleptics in the Treatment of Schizophrenia. American Journal of Psychiatry. 2002; 159(4): 561-566.
- ↑ 8.0 8.1 Drugs.com. Drug Information Online. 2010. Available at:http://www.drugs.com/. Accessed on February 27, 2010.
- ↑ Corocan C, Cadenhead K, Vinogradov S. Schizophrenia Prevention-Risk Reduction Approaches. http://schizophrenia.com. Updated 2004. Accessed February 14, 2010.
- ↑ Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso
