SCHIZOPHRENIA




Sometimes called “the worst disease in the world”


Symptoms

Positive

Negative

delusions (may be paranoid)

blunt affect/ little emotion

hallucinations (mostly auditory)

reduced motivation, energy, level of functioning

disordered thought, speech and behavior

poor social skills, difficulty forming friendships

decreased problem solving skills



The course tends to be periods of severe positive symptoms (often necessitating hospitalization) alternating with periods of predominately negative symptoms where the patient is relatively normal. Schizophrenia tends to be progressive, with the “well” periods becoming shorter and less functional.


Cause and Onset

onset usually in college-age (late teens to mid 20s), men earlier than women

like most psych disorders, seems to be caused by a combination of genetic and environmental factors

approximately 1.5% of population has, men and women equal risk

family increases risk, identical twins have 50% concordance

a difficult pregnancy, including high-fever, flu infection or fetal hypoxia increases risk

brains of schizophrenics show enlarged ventricles, with less brain mass and lower brain metabolism than appropriate for age


Prognosis

poor, many are severely disabled (at least 50% unable to work or live independently)

most will never return to previous level of functioning, tends to be progressive

many will alternate between hospitalization and assisted living

a significant fraction of the homeless (at least 1/6) have schizophrenia


Types (relatively unimportant)

Paranoid: marked delusions and hallucinations of persecution and conspiracy

Catatonic: motor disorder (immobility to disorganized movement)

Disorganized: predominately disordered thought and negative symptoms

Hebephrenic: giggly, seems euphoric and friendly, especially poor prognosis

Schizoaffective disorder: patient has symptoms of schizophrenia and mood disorder


Treatment

Antipsychotics

High Potency

Low Potency

Atypical

Hadol

Thorazine

Clozaril

Stelazine

Mellaril

 

Trilafon

Loxitane

 

Navane

Moban



Side effects of antipsychotics

unmedicated schizophrenics also develop motor disorders, but if antipsychotics don’t cause motor disorders they at least worsen them.

Acute Dystonic Reaction

 (medical emergency)

 

occurs hours or days after initiating treatment in 1 to 8% of patients, especially young men

sudden painful muscle spasms, especially in the head and neck, causing protruding tongue (with drooling), fixed gaze and possible airway compromise because of spasmed larynx

 

Parkinsonian Syndrome

 

resembles Parkinson’s, occurs in up to 1/3 of patients

tremor (esp. of hands), decreased expression, slowed movement, rigid extremities, shuffling gait

 

Akathisia

 

up to 75% of patients develop mild akathisia

restlessness, physical agitation, inability to sit still

 

Akinesia

 

occurs weeks after initiating treatment

decrease in spontaneous movement and apathy

 

Tardive Dyskinesia (TD)

 

occurs after long-term treatment with antipsychotics (up to 70% will have mild TD)

involuntary, purposeless movements, including grimacing, chewing, lip smacking and writhing movements in the extremities

 

Neuroleptic Malignant Syndrome (medical emergency)

rigid immobile posture, high fever, tachycardia, dyspnea, diaphoresis

 

Other side effects

low BP, urinary retention, sedation and dry mouth



Drugs used to treat side-effects

Cogentin

Levodopa

Artane

Valium

Benadryl

Ativan

Kemadrin

Parlodel

Inderal






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