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== Definition/Description<br>  ==
== Definition/Description ==
[[File:Cloth embroidery by schizophrenic.jpeg|thumb|Cloth embroidery by schizophrenic]]
Schizophrenia is a psychiatric disorder that involves a range of [[Cognitive Impairments|cognitive]], behavioral, and [[Emotional Intelligence|emotional]] dysfunction. It is characterized by delusions (fixed false beliefs), hallucinations, disorganization, unusual behavior, and withdrawal. It usually begins during young adulthood.


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">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. New York: APA; 2000.</ref>  
* Schizophrenia is associated with alterations in the structure and function of the [[Brain Anatomy|brain]] and it is believed to be caused by [[Genetic Disorders|hereditary]], [[An Introduction to Environmental Physiotherapy|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>.


<br>
== Etiology ==
[[File:Chromosome-DNA-gene copy.jpg|thumb|Chromosome-DNA-gene copy]]
Genetics plays a fundamental role: there is a 46% concordance rate in monozygotic twins; 40% risk of developing schizophrenia if both parents are affected.


[[Image:Schizophrenia graphic high contrast1.jpg|Image:Schizophrenia_graphic_high_contrast1.jpg]]  
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.


== Prevalence<br> ==
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>


*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">Kelly D. Treatment Considerations in Women with Schizophrenia. Journal of Women's Health. 2006; 15(10): 1132-1140.</ref>  
== Epidemiology ==
*It affects both males and females at an equal rate.<ref name="APA" />  
[[File:Schizophrenia epi.png|right|frameless]]
*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>  
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>
*The prevalence among older adults is slightly higher than in younger age groups.<ref>Folsom DP, Lebowitz BD, Lindamer LA, Palmer BW, Patterson TL, Jeste DV. Schizophrenia in late life: emerging issues. Dialogues in clinical neuroscience. 2022 Apr 1.</ref>


== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==
[[File:It's All In Your Head (2).png|right|frameless]]
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.


'''&nbsp;&nbsp;&nbsp;&nbsp; Diagnostic Criteria for Schizophrenia'''<ref name="Kelly D" />:
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<ref name=":0" />.


&nbsp;&nbsp;&nbsp; &nbsp; &nbsp; 1.&nbsp; Two or more of the following symptoms during a 1 month period of time:<br>
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:


*''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 broadcasted to the rest of the world and that everyone can hear what they are thinking. <ref name="APA" />
# Delusions
*''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" />
# Auditory hallucinations
*''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 symptoms
*''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" /><br>
# Negative symptoms (e.g. reduced emotional expression)
*''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" /><br><br>2. Social or occupational dysfunction (ex. at work, in public, etc)<br><br>3. A duration of continuous symptoms for at least 6 months. <br><br>4. 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><br><br>'''Clinical Presentation'''
# Disorganised speech<ref>Radiopedia Schizophrenia Available: https://radiopaedia.org/articles/schizophrenia (accessed 20.3.2022)</ref>
*The person's symptoms are not always continuous; they may come and go at certain points in their life.&nbsp;
*Exacerbation of symptoms can be brough on by life stresses, such as, marriage, work, school, and other major lifechanging 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" />
*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>


== Associated Co-morbidities  ==
== Associated Co-morbidities  ==


*Depression. <ref name="APA" /><br>  
*[[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 Type 2|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 Disoder with childhood onset. <ref name="Foster et al." />
*[[Attention Deficit Disorders|Attention Deficit Hyperactive Disorder]] with childhood onset. <ref name="Foster et al." />
== Treatment / 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.


<u>Typical Antipsychotics</u> <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><br>
[[Cognitive Behavioural Therapy|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.


Drug Name&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Brand Name&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Side Effects
If an organic cause for psychosis is identified, it must be treated accordingly.


*Chlorpromazine (Thorazine)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Nausea, dizziness, jitteriness, dry mouth, loss of appetite<br>
Treatment of co-existing disorders and with individual CBT ,family intervention and social support  <ref>Soundy A, Freeman P, Stubbs B, Probst M, Vancampfort D. The value of social support to encourage people with schizophrenia to engage in physical activity: an international insight from specialist mental health physiotherapists. Journal of Mental Health. 2014 Oct 1;23(5):256-60.</ref>is advocated, although no long-term evidence exists regarding its efficacy in preventing a psychotic episode or reducing its severity<ref name=":0" />.
*Haloperidol&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Haldol)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Trouble sleeping, dry mouth, GI upset, constipation<br>  
*Loxapine&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Loxitane)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Weight loss/gain, blurred vision, dry mouth, dizziness, trouble sleeping<br>
*Molindone&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Moban)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Increased saliva production, restlessness, dry mouth, constipation<br>  
*Perphenazine&nbsp;&nbsp; (Trilafon)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Nasal congestion, sleeplessness, tired feeling, vomiting, confusion<br>
*Thiothixene&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Navane)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Lightheaded, tired, diarrhea, headache, dry mouth, changes in appetite<br>
*Trifluperazine&nbsp;&nbsp;&nbsp;&nbsp; (Stelazine)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Mild agitation, trouble sleeping, headache, loss of appetite<br>


<br>  
== Physical Therapy Management  ==
[[File:Physiotherapy Exercise and Physical Activity Image.png|thumb|Physical Activity]]
Physical therapy can help manage any co-morbidities, side effects of medications, or help deal with the physical decline in function<ref>Stubbs B, Soundy A, Probst M, De Hert M, De Herdt A, Vancampfort D. Understanding the role of physiotherapists in schizophrenia: an international perspective from members of the International Organisation of Physical Therapists in Mental Health (IOPTMH). Journal of Mental Health. 2014 Jun 1;23(3):125-9</ref> as a part of multidisciplinary team MDT<ref>Andrew E, Briffa K, Waters F, Lee S, Fary R. Physiotherapists' views about providing physiotherapy services to people with severe and persistent mental illness: A mixed methods study. Journal of physiotherapy. 2019 Oct 1;65(4):222-9.</ref> . Physical therapy can also improve the patient's overall quality of life by increasing their mobility, strength, and independence in daily activities, which can positively impact their mental health.<ref>Probst M. Physiotherapy and mental health. Clinical physical therapy. 2017 May 31;230:59-68.</ref> It is important to incorporate physical therapy into the treatment plan for patients with Schizophrenia to address both their physical and mental health needs.


<u>Atypical Antipsychotics</u> <ref name="Roberson C" />&nbsp;<ref name="Drugs" />  
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" />I


Drug Name&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Brand Name&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Side Effects
In addition, regular monitoring of blood glucose levels and medication management can help prevent and manage diabetes in patients with schizophrenia. This highlights the importance of addressing physical health concerns in addition to mental health treatment for individuals with schizophrenia.  
 
*Aripiprazole&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Abilify)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Dizziness, drowsiness, headache, vomitting<br>
*Clozapine&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Clozaril)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Shortness of air, stiff muscles, numbness, seizure, chest pain, nausea<br>
*Olanzapine&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Zyprexi&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Weakness, pain, redness, swelling at injection site, dizziness, drowsiness<br>
*Paliperidone&nbsp;&nbsp;&nbsp;&nbsp; (Invega)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sore throat, weakness, redness, swelling, weight gain, dizziness<br>
*Quetiapine&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Seroquel)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Stomach pain, nasal congestion, constipation, dizziness, weight gain<br>
*Risperidone&nbsp;&nbsp;&nbsp;&nbsp; (Risperal)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Tremor, fever, stiff muscles, restlessness, trouble swallowing, fainting<br>
*Ziprasidone&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (Geodon)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Anxiety, pain at injection site, runny nose, constipation, restlessness<br>
 
== Diagnostic Tests/Lab Tests/Lab Values<br>  ==
 
There are no diagnostic tests or labs that will diagnose or help medically manage schizophrenia.
 
== Causes  ==
 
'''1. Genetics'''
 
*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" />
*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]]'''
 
<br>'''2. Neurodevelopmental'''<br>
 
*The physical structure of the brain is different in people with schizophrenia.&nbsp;
*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" />
 
== Systemic Involvement  ==
 
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 (current best evidence)  ==
 
*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" />
*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 (current best evidence)  ==
 
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." /> As previously stated, we cannot treat schizophrenia itself, but we will see patients for other medical reasons who are affected by this disorder.&nbsp;
 
== Alternative/Holistic Management (current best evidence)<br>  ==
 
Alternative management is used more for building social and employment skills rather than symptom control. Vocational rehab is a good alternative for people with schizophrenia who have difficulty holding down a job. Negative beliefs are liked to poor employment rates, so vocational rehab helps to build job skills and cognitive abilities. <ref name="Davis et al.">Davis LW, Lysaker P, Lancaster RS, Bryson GJ, Bell MD. The Indianapolis Vocational Intervention Program: A Cognitive Behavioral Approach to Addressing Rehabilitation Issues in Schizophrenia. Journal of Rehabilitation Research and Development. 2005; 42(1): 35-36.</ref>


== 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 Syndrome|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|bipolar disorder]], depression, borderline personality disorder, mood disorders, schizoaffective disorder, schizophreniform, paranoia, and [[alcoholism]]. <ref name="Roberson C">Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.</ref><ref name="APA" />
 
== Viewing ==
== Case Reports  ==
This 8 minute video outlines most aspects of Schizophrenia.{{#ev:youtube|PURvJV2SMso}}<ref>Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso</ref>
 
[http://www.nutritionandmetabolism.com/content/6/1/10 www.nutritionandmetabolism.com/content/6/1/10]<br>
 
== Resources <br>  ==
 
Here is an informational video that describes the diagnostic process and how to recognize schizophrenia.<br> {{#ev:youtube|-_kl_5xaBfY}}  
 
<br>  
 
AnswersTV. Do I Have Schizophrenia. 2008. Available at: http://www.youtube.com/user/AnswersTV. Accessed February 27, 2010.<br>
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
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<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>  
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== References  ==


see [[Adding References|adding references tutorial]].
== References ==


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Latest revision as of 16:49, 2 April 2023

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]

Cloth embroidery by schizophrenic

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]

Chromosome-DNA-gene copy

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 epi.png

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]
  • The prevalence among older adults is slightly higher than in younger age groups.[6]

Characteristics/Clinical Presentation[edit | edit source]

It's All In Your Head (2).png

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[7]

Associated Co-morbidities[edit | edit source]

Treatment / 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 ,family intervention and social support [9]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 Activity

Physical therapy can help manage any co-morbidities, side effects of medications, or help deal with the physical decline in function[10] as a part of multidisciplinary team MDT[11] . Physical therapy can also improve the patient's overall quality of life by increasing their mobility, strength, and independence in daily activities, which can positively impact their mental health.[12] It is important to incorporate physical therapy into the treatment plan for patients with Schizophrenia to address both their physical and mental health needs.

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.[8] [3]I

In addition, regular monitoring of blood glucose levels and medication management can help prevent and manage diabetes in patients with schizophrenia. This highlights the importance of addressing physical health concerns in addition to mental health treatment for individuals with schizophrenia.

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, schizophreniform, paranoia, and alcoholism. [13][1]

Viewing[edit | edit source]

This 8 minute video outlines most aspects of Schizophrenia.

[14]

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. ↑ Folsom DP, Lebowitz BD, Lindamer LA, Palmer BW, Patterson TL, Jeste DV. Schizophrenia in late life: emerging issues. Dialogues in clinical neuroscience. 2022 Apr 1.
  7. ↑ Radiopedia Schizophrenia Available: https://radiopaedia.org/articles/schizophrenia (accessed 20.3.2022)
  8. ↑ 8.0 8.1 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.
  9. ↑ Soundy A, Freeman P, Stubbs B, Probst M, Vancampfort D. The value of social support to encourage people with schizophrenia to engage in physical activity: an international insight from specialist mental health physiotherapists. Journal of Mental Health. 2014 Oct 1;23(5):256-60.
  10. ↑ Stubbs B, Soundy A, Probst M, De Hert M, De Herdt A, Vancampfort D. Understanding the role of physiotherapists in schizophrenia: an international perspective from members of the International Organisation of Physical Therapists in Mental Health (IOPTMH). Journal of Mental Health. 2014 Jun 1;23(3):125-9
  11. ↑ Andrew E, Briffa K, Waters F, Lee S, Fary R. Physiotherapists' views about providing physiotherapy services to people with severe and persistent mental illness: A mixed methods study. Journal of physiotherapy. 2019 Oct 1;65(4):222-9.
  12. ↑ Probst M. Physiotherapy and mental health. Clinical physical therapy. 2017 May 31;230:59-68.
  13. ↑ Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.
  14. ↑ Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso
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