Schizophrenia: Difference between revisions

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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.  
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 [[Substance Use Disorder|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>
The role of [[Substance Use Disorder|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 name=":1">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 ==
== Epidemiology ==
Line 44: Line 44:
*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>  
*Attention Deficit Hyperactive Disorder with childhood onset. <ref name="Foster et al." />
*Attention Deficit Hyperactive Disorder with childhood onset. <ref name="Foster et al." />
== Medical Management  ==
A comprehensive plan required in the treatment of schizophrenia. It should include prescription antipsychotics, counseling, support from loved ones, and possibly hospitalization for flare-ups. There is no cure for the condition, but symptoms can be managed with treatment.


== Medications  ==
The mainstay of treatment is antipsychotic medications; options vary between oral, as well as short or long acting IM therapy. Unfortunately antipsychotic therapy is not effective in the treatment of negative symptoms or cognitive dysfunction.


=== Typical Antipsychotics <ref name="Roberson C">Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.</ref> <ref name="Drugs">Drugs.com. Drug Information Online. 2010. Available at:http://www.drugs.com/. Accessed on February 27, 2010.</ref> ===
Cognitive behavioral therapy (CBT) and the use of art and drama therapies help counteract the negative symptoms of the disease, improve insight, and assist relapse prevention.
{| class="wikitable"
!Drug Name
!Brand Name
!Side Effects
|-
|Chlorpromazine &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
|(Thorazine)&nbsp;
|Nausea, dizziness, jitteriness, dry mouth, loss of appetite
|-
|Haloperidol
|(Haldol)&nbsp;
|Trouble sleeping, dry mouth, GI upset, constipation
|-
|Loxapine
|(Loxitane)&nbsp;
|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&nbsp;
|(Navane)&nbsp;&nbsp;
|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" />&nbsp;<ref name="Drugs" /> ===
If an organic cause for psychosis is identified, it must be treated accordingly.
{| class="wikitable"
!Drug Name
!Brand Name
!Side Effects
|-
|[[Aripiprazole in the Treatment of Psychoses|Aripiprazole]]&nbsp;
|(Abilify)&nbsp;
|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)&nbsp;
|Tremor, fever, stiff muscles, restlessness, trouble swallowing, fainting
|-
|Ziprasidone
|(Geodon)
|Anxiety, pain at injection site, runny nose, constipation, restlessness
|} 
 
== 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" />
Treatment of co-existing disorders and with individual CBT and family intervention is advocated, although no long-term evidence exists regarding its efficacy in preventing a psychotic episode or reducing its severity<ref name=":0" />.
*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. <ref name="Roberson C" />  
*Prognosis for people who recieve treatment<ref name="Roberson C" />:<br>10% have 1 or 2 episodes and then completely recover<br>55% will have chronic symptoms<br>35% will have intermittent episodes.


== Physical Therapy Management  ==
== Physical Therapy Management  ==
Physical therapy can help manage any co-morbidities, side effects of medications, or help deal with the physical decline in function.


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.&nbsp;<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> As previously stated, we cannot treat schizophrenia itself, but we will see patients for other medical reasons who are affected by this disorder.&nbsp;
A significant percentage of patients with schizophrenia die from cardiovascular disease, and diabetes affects 6% of people with schizophrenia. Educating patients on the importance of modifying risk factors such as increasing exercise, healthier diets, and smoking cessation will decrease their risk of cardiovascular problems and reduce the mortality rate.<ref name="Sernyak et al." /> <ref name=":1" />


== Differential Diagnosis  ==
== Differential Diagnosis  ==


*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">Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.</ref><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]
 
 
 
{{#ev:youtube|PURvJV2SMso}}<ref>Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso</ref>
{{#ev:youtube|PURvJV2SMso}}<ref>Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso</ref>


Revision as of 06:57, 21 March 2022

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, 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 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]

Schizophrenia can cause a variety of dysfunctions. A common feature is a lack of insight. It can be difficult for someone to recognize that they have the condition with family members, close friends, or coworkers identify the symptoms first.

Schizophrenia usually begins when a person is in their 20’s, but it can start sooner during the teen years or later in adulthood. Symptoms can flare up, gradually becoming more severe over time. Loved ones etc may report eg agitation, neglect of personal hygiene, unusual appearance in the way a person dresses or grooms, withdrawal from others, delusional fear that others are conspiring or communicating in a secret way[2].

The diagnostic criteria for schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 6 is identified as the presence of two out of five (for at least six months) of the following:

  1. Delusions
  2. Auditory hallucinations
  3. Catatonic symptoms
  4. Negative symptoms (e.g. reduced emotional expression)
  5. Disorganised speech[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 Disorder with childhood onset. [5]

Medical Management[edit | edit source]

A comprehensive plan required in the treatment of schizophrenia. It should include prescription antipsychotics, counseling, support from loved ones, and possibly hospitalization for flare-ups. There is no cure for the condition, but symptoms can be managed with treatment.

The mainstay of treatment is antipsychotic medications; options vary between oral, as well as short or long acting IM therapy. Unfortunately antipsychotic therapy is not effective in the treatment of negative symptoms or cognitive dysfunction.

Cognitive behavioral therapy (CBT) and the use of art and drama therapies help counteract the negative symptoms of the disease, improve insight, and assist relapse prevention.

If an organic cause for psychosis is identified, it must be treated accordingly.

Treatment of co-existing disorders and with individual CBT and family intervention is advocated, although no long-term evidence exists regarding its efficacy in preventing a psychotic episode or reducing its severity[2].

Physical Therapy Management[edit | edit source]

Physical therapy can help manage any co-morbidities, side effects of medications, or help deal with the physical decline in function.

A significant percentage of patients with schizophrenia die from cardiovascular disease, and diabetes affects 6% of people with schizophrenia. Educating patients on the importance of modifying risk factors such as increasing exercise, healthier diets, and smoking cessation will decrease their risk of cardiovascular problems and reduce the mortality rate.[7] [3]

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. [8][1]

Resources[edit | edit source]

[9]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. New York: APA; 2000.
  2. ↑ 2.0 2.1 2.2 2.3 Very Well Health Schizophrenia Available:https://www.verywellhealth.com/schizophrenia-5078641 (accessed 19.3.2022)
  3. ↑ 3.0 3.1 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. ↑ 4.0 4.1 Kelly D. Treatment Considerations in Women with Schizophrenia. Journal of Women's Health. 2006; 15(10): 1132-1140.
  5. ↑ 5.0 5.1 5.2 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. ↑ Radiopedia Schizophrenia Available: https://radiopaedia.org/articles/schizophrenia (accessed 20.3.2022)
  7. ↑ 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. ↑ Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.
  9. ↑ Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso
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