Schizophrenia

Epidemiology
1. According to WHO, Schizophrenia is affecting 23 million people around the world
2. The incidence is 1.5 per 10,000 people
3. Out of 23 million people, 12 million are males (affects males more than females)
4. Schizophrenia usually appear in young age people (males between 18 and 25 while females between 25 and 35)
5. Schizophrenia is considered as one of the top 15 causes of disability worldwide
Etiology
1. 1. First-degree relatives of persons with schizophrenia is 10%
  2. If both parents have schizophrenia is 40%
  3. 10% for dizygotic twins and 40-50% for monozygotic twins
2. Dysregulation of information in the brain
  1. Involvement of different neurotransmitters: dopamine, Glutamate, Serotonin
  2. Structural and neurological abnormalities
  3. Psychological factors Social and environmental influence
  4. Other factors: endocrine, infectious, autoimmune, traumatic
  5. Role of genetic factors
Pathophysiology and Biological Basis
1. Enlarged Ventricles w/ reduced size of
  1. S. temporal gyrus
  2. Parahippocampal, entorhinal, and hippocampal cortex
  3. Middle frontal lobe
2. Abnormal brain structures
  1. Middle Frontal cortex linked with more negative symptoms
  2. Anterior cingulate gyrus
  3. Basal ganglia
3. Decreased metabolism
  1. Pre frontal and frontal cortex
4. Theories
  1. Dopamine
    1. Dopamine agonist caused psychosis
    2. Potency of antipsychotics correlate with better treatment
    3. Hyperactivity is mesolimbic and hypoactivity is mesocortical
  2. Serotonin and NE
  3. Glutamate
    1. Agonists of glutamate receptors are working as treatments
  4. Neurodevelopmental causes / Prenatal / Perinatal
Symptoms
1. Negative
  1. Alogia / Affective flattening / Avolition-apathy / Anhedonia-asociality / Attentional impairment
2. Positive
  1. Hallucinations
    1. Types
      1. Visual hallucinations / Auditory hallucinations / Olfactory hallucination / Tactile hallucination / Gustatory hallucination / General somatic hallucination
  2. Bizarre behaviour
  3. Delusions
    1. Persecutory delusions
      1. A set of delusional conditions in which the affected persons believe they are being persecuted
  4. Formal thought disorder
Criteria
1. Two (or more) of the following, each present for a significant portion of time during a 1‐month period (or less if successfully treated)
  1. At least one of these must be (1), (2), or (3): 1. Delusions / 2. Hallucinations / 3. Disorganized speech (eg, frequent derailment or incoherence) / 4. Grossly disorganized or catatonic behavior / 5. Negative symptoms (ie, diminished emotional expression or avolition)
2. Marked disturbances ‐work, interpersonal relationships, or self‐care
3. Childhood period‐there is failure to achieve expected level of interpersonal, academic, or occupational functioning
4. An episode of the disorder lasts at least one month but persists for 6 months (schizophrenic disorder) and less than 6 months (Schizophreniform Disorder)
5. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
6. The disturbance is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition
7. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month
Investigation
1. Mental State Examination (MSE)
Treatment
1. Pharmacological
  1. Typical antipsychotic drugs (First generation)
    1. Chlorpromazine / Thioridazine / Perphenazine / Fluphenazine / Thioridazine / Haloperidol / Thiothixene
  2. Atypical antipsychotic Drugs (Second generation)
    1. Risperidone / Clozapine / Olanzapine / Quetiapine / Aripiprazole
2. Psychological
  1. Psychoeducation
  2. Behavior therapy
  3. Cognitive therapy
Prognosis
1. Better outcome
  1. Late onset of symptoms / Female / Positive symptoms are dominant / Having a good social support
2. Worse outcome
  1. Early onset of symptoms / Male / Negative symptoms are dominant / Patients is socially isolated / Extensive family history

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Schizophrenia

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	Created by Moza Almualla almost 6 years ago