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In the last post, we saw how:
Schizophrics are more likely to suffer from medical conditions than the general population.
There are many talking points to be discussed in this study, top on the list is the relationship between education and belief in aetiology in schizophrenia.
Maintance prevents relapse in most patients and has been effective.
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Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for three consecutive months. This month will be dedicated to Schizophrenia. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Bipolar affective disorder. We are done looking at research work done in Nigeria on schizophrenia.
In this post, we are looking at this study that talks about Beliefs About the Cause of Schizophrenia Among Caregivers in Midwestern Nigeria. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
Epidemiology (Infective conditions, seasons and Sustance abuse)
Infection and Birth season
Schizophrenics tend to be born in the winter and early spring. Less of them are born in the spring and summer. In the US, those who live in the northern hemisphere are more likely to be schizophrenic if they are born between January and April. Between July and September, more schizophrenics are likely to be born in the southern hemisphere.
It is possible that it may be season specific due to viral infections of that season. It may also be due to diet choices during these seasons.
Some studies have related pregnancy and birth complications, being exposed to endemic viral diseases like influenza, starving during pregnancy, Blood group incompatibility, (Rh to be specific) and giving birth during winter as possible risk factors for schizophrenia.
The is of risks point to fetal brain pathology as the cause but nobody knows the pathophysiology of the condition.
From data collection, it shows that there is an increase in schizophrenia in the children of pregnant women who had influenza and typically this takes place in winter after 26 weeks of gestational age.
Another reason to validate this as a cause is because there are increased number of fetal anomalies at birth due to these viral infections and they lead to complicated births. There is also a noticeable collection of those with schizophrenia in certain areas and the admissions usually come at the same time.
This is known as the viral theory and it exists because it can account for the cluster of people who have schizophrenia from a particular area even without any brain inflammation.
Substance Abuse
It is common to find schizophrenics who abuse substances. About half of those with this condition will indulge in substance abuse. This is usually associated with an inability to be functional. A study found that 2 out of 5 patients abused alcohol in a lifetime.
When a patient abuses alcohol they are more likely to have a psychotic break and may need to be admitted to the hospital.
Schizophrenics also abuse street drugs like cannabis, patients were six times more likely to abuse it in a study.
Practitioners should be very careful especially if stimulants because there is a higher risk of psychosis with the use of these drugs.
Nicotine is also another drug of concern. It has been found that close to 90% of patients who have this condition abuse this drug. These causes problems, the first is that it brings about smoking-related issues and the next is that it causes a reduction in the blood concentration of antipsychotics.
There has also been a genetic link to the nature of nicotine-binding sites in schizophrenics.
Nicotine however has been used to treat cognitive decline in those with the condition while handling Parkinsonism seen in schizophrenia. Nicotine has also been documented to reduce positive symptoms of schizophrenia.
Conclusion
People illustrations by Storyset
The study has shown that there are a lot of beliefs that are carried by society concerning schizophrenia. All though who were not educated believed in the supernatural and the majority of those who were educated believed in supernatural causes. Even though this looks as if education did not play role in changing people's belief in the supernatural, we need to note that there was a noticeable effect
More of the caregiver of male schizophrenics thought that the cause of schizophrenia was due to natural causes and those who took care of females endorsed the supernatural causes.
If people started to believe in the natural causes of schizophrenia they will also start presenting early for treatment and it will improve treatment response.
The best way to make sure people receive the treatment they need is with mass education and information being disseminated…similar to what we are doing here on medic vibes.
In addition to giving out this information, it would be good to have treatment available as early as possible.
The doctors should also try to have the knowledge of the belief system work for the families of the affected.
If the community is evolved in giving mental health services, there is a better chance that the whole community will receive the message.
To make sure the patients get the best treatment, working with faith heals to get referrals from them is also very important.
Treatment
For Poor Response
After placing patients on treatment for Acute Schizophrenia, there will be a noticeable improvement in the patient's symptoms and 60% of patients will go into a phase where there will only be a few symptoms appearing. The remaining patients will not go into this phase and it is important to know to what extent this is the case.
Some will need to be admitted for a long time because they simply do not easily get better and others will only have psychotic symptoms appearing.
Before labelling these patients as poor responders, they should be placed on a trial period to ensure that it is not because of non-compliant. Patients may show improvement within this period and these same patients will get better over the next 3 to 6 months.
It can be helpful to also check the blood concentration of these drugs to be sure the patient is getting adequate doses. Haloperidol, clozapine, and fluphenazine are among some of the more common drugs used.
When plasma levels are low, it might be the case that they are not compliant. Or maybe they are partially compliant, but you want them to follow their treatment.
Another possibility is that they are what is known as a rapid metaboliser or the drug is not being taken up by the gut and increasing the dose could give good results.
If the patient is still not responsive, increasing the dose above the therapeutic dose may be helpful but in most cases, this is the case. It is usually best to change the drug when the effect is not seen as such.
Patients who are responsive to the typical Dopamine Receptor antagonist (DRA) usually do not respond as well to others. If they are changed to Serotonin Dopamine Agonists (SDA) it will be more beneficial for them.
If a patient is not responsive to DRA they usually do well with clozapine. Clozapine was also more effective in studies done to compare antipsychotics for severe psychosis.
Questions
- What did you learn about Schizophrenia?
Conclusion
It has been found that there is a relationship between infectious diseases, the seasons and schizophrenia, also it is known that misuse of substances.
Informing the general public on the cause of schizophrenia with any means will help change the results in treatment.
For those who have poor response to acute management there are therapy options for them.
References
- Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
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- NCBI