Schizophrenia is a group of disorders characterized by disturbance in language,perception,cognition and behaviour.
Causes:-
A number of factors have been identified that predispose to, or precipitate, or sustain schizophrenia. They are:
•Schizophrenia can be transmitted genetically.
•Family environment can influence the course of the illness. A highly emotional family environment contributes to relapses.
•Psychological stresses like adverse life events.
•A viral vector or early developmental abnormalities in some case.
•Some cases of schizophrenia are associated with increased cerebral ventricular size,indicating that schizophrenia is accompanied by brain atrophy.
•Schizophrenia syndrome can be associated with temporal lobe epilepsy, Huntington's chorea, cerebral tumours and demyelinating diseases.This is known as symptomatic schizophrenia.
•Schizophrenia is associated with a functional overactivity in the dopaminergic neuronal systems in the mesolimbic and mesocortical areas.
Types:-
There are four major types of schizophrenic disorders-catatonic, disorganised, paranoid and undifferentiated.
Schizophrenic patients may also be classified as type I or type II.
• Type I patients have a predominance of "positive" symptoms, normal ventricular size and a good response to antipsychotic drugs.
•Type II patients have a predominance of "negative" symptoms, increased ventricular size and have a poor response to antipsychotic drugs.
Clinical Features:-
Clinical manifestations can be considered under three headings; the first-rank symptoms (which strongly suggest a diagnosis of schizophrenia), other symptoms of lower diagnostic significance and the negative symptoms.Groups I and Group
II together form the positive symptoms.
First rank symptoms
•Thought insertion
•Thought broadcasting
•Passivity feelings
•Auditory hallucinations
•Delusional perceptions
Other symptoms
•Catatonia
•Thought disorder
•Neologisms
•Delusions-grandiose, paranoid sexual or religious
•Visual, tactile, olfactory or gustatory hallucinations
•Affective change
Negative symptoms
•Social withdrawal
•Poverty of speech
•Flatness of affect
Management:-
Neuroleptic Drugs (Antipsychotic Drugs)
. It is conventional to start with chlorpromazine 100 mg thrice daily, gradually building up the dose to a maximum of 1500 mg daily or until symptoms subside. Higher doses may be required if the patient is aggressive or agitated.
•When symptoms have improved, it is usual to reduce the dose or change over to long-acting intramuscular neuroleptics(e.g. fluphenazine 20-100 mg or flupenthixol 40-200 mg once in 2 weeks).
•Antipsychotic drugs block both D1 and D2 groups of dopamine receptors. This results in high incidence of extrapyramidal features with their use. They also block adrenergic and cholinergic receptors and cause a number of side effects. A rare adverse effect is neuroleptic malignant syndrome.
•Newer antipsychotics include clozapine,risperidone and olanzapine. Though efficacy is similar to older drugs, these are better tolerated.
Social Measures
•These patients do best in an environment that has a regular, and predictable routine. Positive symptoms are exacerbated in highly charged emotional situations while negative symptoms are induced in environments that are understimulating.