Schizophrenia
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:
- Delusions
- Auditory hallucinations
- Catatonic symptoms
- Negative symptoms (e.g. reduced emotional expression)
- 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]
Medications[edit | edit source]
Typical Antipsychotics [8] [9][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 [8] [9][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. [8]
- Prognosis for people who recieve treatment[8]:
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. [10] 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. [8][1]
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. New York: APA; 2000.
- ↑ 2.0 2.1 2.2 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 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 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.
- ↑ Radiopedia Schizophrenia Available: https://radiopaedia.org/articles/schizophrenia (accessed 20.3.2022)
- ↑ 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 8.2 8.3 8.4 Roberson C. Schizophrenia. The Alabama Nurse. August 2009: 6-8.
- ↑ 9.0 9.1 Drugs.com. Drug Information Online. 2010. Available at:http://www.drugs.com/. Accessed on February 27, 2010.
- ↑ 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.
- ↑ Schizophrenia-causes, symptoms, diagnosis, treatment and pathology. Available from: https://www.youtube.com/watch?v=PURvJV2SMso
