Schizophrenia: Difference between revisions
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== Definition/Description | == Definition/Description == | ||
Schizophrenia is | Schizophrenia is a psychiatric disorder that involves a range of cognitive, behavioral, and emotional dysfunction. It is characterized by delusions (fixed false beliefs), hallucinations, disorganization, unusual behavior, and withdrawal. It usually begins during young adulthood. | ||
Schizophrenia is associated with alterations in the structure and function of the brain and it is believed to be caused by hereditary, environmental, and unknown factors.<ref name="APA" /> | |||
= | It is possible to manage Schizophrenia with medication. Symptoms often fluctuate throughout a person’s life, and may periodically require hospitalization, however many people who have schizophrenia are able to work and have satisfying relationships<ref name=":0">Very Well Health [https://www.verywellhealth.com/schizophrenia-5078641 Schizophrenia] Available:https://www.verywellhealth.com/schizophrenia-5078641 (accessed 19.3.2022)</ref>. | ||
== Etiology == | |||
*It affects both males and females at an equal rate.<ref name="APA" /> | Genetics also plays a fundamental role : there is a 46% concordance rate in monozygotic twins; 40% risk of developing schizophrenia if both parents are affected. | ||
*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. <ref name="Kelly D">Kelly D. Treatment Considerations in Women with Schizophrenia. Journal of Women's Health. 2006; 15(10): 1132-1140.</ref> | |||
Several studies postulate that the development of schizophrenia results from abnormalities in multiple neurotransmitters, eg dopaminergic, serotonergic, and alpha-adrenergic hyperactivity or glutaminergic and GABA hypoactivity. | |||
The role of drug use and its contribution to schizophrenia has been suggested but it is often challenging to tease out to what degree drug use is a way to cope with the early effects of the condition before it is diagnosed or whether drug use contributes directly to schizophrenia.<ref name=":0" /><ref>Hany M, Rehman B, Azhar Y. Schizophrenia.[Updated 2020 Dec 8]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021.Available : https://www.ncbi.nlm.nih.gov/books/NBK539864/ (accessed 19.3.20220</ref> | |||
== Epidemiology == | |||
Schizophrenia affects approximately 1% of the general population. <ref name="APA">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. New York: APA; 2000.</ref> <ref name="Kelly D" /> | |||
*It affects both males and females at an equal rate.<ref name="APA" /> | |||
*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. <ref name="Kelly D">Kelly D. Treatment Considerations in Women with Schizophrenia. Journal of Women's Health. 2006; 15(10): 1132-1140.</ref> | |||
*Childhood onset, before age 12, and late adulthood onset are not as common. <ref name="Foster et al.">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.</ref> | *Childhood onset, before age 12, and late adulthood onset are not as common. <ref name="Foster et al.">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.</ref> | ||
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== Medical Management == | == Medical Management == | ||
Revision as of 07:05, 19 March 2022
Original Editors - Meghan Shafer from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Meghan Shafer, Admin, Kim Jackson, Lucinda hampton, Mariam Hashem, Shaimaa Eldib, WikiSysop, Tolulope Adeniji, 127.0.0.1, Elaine Lonnemann and Wendy Walker
Definition/Description[edit | edit source]
Schizophrenia is a psychiatric disorder that involves a range of cognitive, behavioral, and emotional dysfunction. It is characterized by delusions (fixed false beliefs), hallucinations, disorganization, unusual behavior, and withdrawal. It usually begins during young adulthood.
Schizophrenia is associated with alterations in the structure and function of the brain and it is believed to be caused by hereditary, environmental, and unknown factors.[1]
It is possible to manage Schizophrenia with medication. Symptoms often fluctuate throughout a person’s life, and may periodically require hospitalization, however many people who have schizophrenia are able to work and have satisfying relationships[2].
Etiology[edit | edit source]
Genetics also plays a fundamental role : there is a 46% concordance rate in monozygotic twins; 40% risk of developing schizophrenia if both parents are affected.
Several studies postulate that the development of schizophrenia results from abnormalities in multiple neurotransmitters, eg dopaminergic, serotonergic, and alpha-adrenergic hyperactivity or glutaminergic and GABA hypoactivity.
The role of drug use and its contribution to schizophrenia has been suggested but it is often challenging to tease out to what degree drug use is a way to cope with the early effects of the condition before it is diagnosed or whether drug use contributes directly to schizophrenia.[2][3]
Epidemiology[edit | edit source]
Schizophrenia affects approximately 1% of the general population. [1] [4]
- 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. [4]
- Childhood onset, before age 12, and late adulthood onset are not as common. [5]
Characteristics/Clinical Presentation[edit | edit source]
Diagnostic Criteria for Schizophrenia[4]:[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. [5] 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. [6]
- 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. [6]
- 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. [7]
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. [6]
- People with schizophrenia will experience a decrease in mental and physical function over time, which is part of the disease. [8]
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). [9]
- Attention Deficit Hyperactive Disoder with childhood onset. [5]
Medications[edit | edit source]
Typical Antipsychotics [6] [10][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 [6] [10][edit | edit source]
| 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 |
Medical Management[edit | edit source]
- For symptom management, using one of the medications listed in the above section is the treatment of choice. [5][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. [6]
- Prognosis for people who recieve treatment[6]:
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.[9] 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. [8] 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. [5]
- Differential diagnoses in adults include: bipolar disorder, depression, borderline personality disorder, mood disorders, schizoaffective disorder, schizofreniform, paranoia, and alcoholism. [6][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 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. New York: APA; 2000.
- ↑ 2.0 2.1 Very Well Health Schizophrenia Available:https://www.verywellhealth.com/schizophrenia-5078641 (accessed 19.3.2022)
- ↑ Hany M, Rehman B, Azhar Y. Schizophrenia.[Updated 2020 Dec 8]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021.Available : https://www.ncbi.nlm.nih.gov/books/NBK539864/ (accessed 19.3.20220
- ↑ 4.0 4.1 4.2 Kelly D. Treatment Considerations in Women with Schizophrenia. Journal of Women's Health. 2006; 15(10): 1132-1140.
- ↑ 5.0 5.1 5.2 5.3 5.4 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.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 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.
- ↑ 8.0 8.1 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.
- ↑ 9.0 9.1 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.
- ↑ 10.0 10.1 Drugs.com. Drug Information Online. 2010. Available at:http://www.drugs.com/. Accessed on February 27, 2010.
- ↑ Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso
