Research Update Schizophrenia

What is Schizophrenia?

Schizophrenia is a deliberating mental disorder that changes the way a person thinks, acts, expresses emotions, perceives reality and relates to others in the social context. Although it affects equally men and women but onset is later among women as compared to men, with a high risk of comorbid diseases among the affected population. It has a prevalence of 1 percent among populations, with a family history of schizophrenia being the most significant risk factor in addition to location and season of birth, socioeconomic status, and maternal infections during pregnancy and at birth. Studies have found that genetics plays a major role in schizophrenic episodes, although severity and clinical manifestations have not reflected problems in different regions of the brain, or in different diseases that share similar phenotypic features.

 

Diagnosis of schizophrenia is based on both negative and positive symptoms, which singularly or combined have the potential to influence a patient’s thoughts, perception, speech, affect, and behaviors. Positive symptoms associated with schizophrenia include hallucinations, voices conversing with or about the patient, and delusions that are in most cases paranoid. Negative symptoms characteristic of this condition includes flattened affect, loss of sense of pleasure, loss of will or drive, and withdrawal from the social circles. In some cases, the condition is characterized by disorganized thought, which is mostly manifested in speech and behavior (can range from loose associations, multiple topics to muddled speech).  Since there exist five types of schizophrenia– paranoid, disorganized, catatonic, undifferentiated and residual with each characterized by different behaviors, no single sign or symptom is conclusively pathognomonic of schizophrenia.

Schizophrenia is deficient of any typical presentation, but in most cases it can be either abrupt or insidious, with most patients undergoing a prodromal phase marked by a slow and gradual development of symptoms. The symptoms can include social withdrawal, loss of interest in school or work, deterioration in hygiene and grooming, unusual behavior, or outbursts of anger. The differential diagnosis of schizophrenia may include brief psychotic disorder, delirium, delusional disorder, medical illness or medication-induced disorder for at least one month among others as they manifest in similar signs and symptoms. For instance, delirium can have features that are very similar to active schizophrenia symptoms, which makes it necessary to adopt changes in the diagnostic criteria for schizophrenia despite its stability and use over many years.

 

There exist effective pharmacologic treatments for schizophrenia, with chlorpromazine denoted as ‘neuroleptic’ (Thorazine) being the earliest form of treatment among humans while reserpine was used on laboratory animals. Although ‘neuropleptic’ is used to mean antipsychotic, it mostly refers to antipsychotics that confer an increased risk of extrapyramidal side effects, such as dystonic reactions (such as fixed upper gaze, neck twisting, facial muscle spasms), parkinsonian symptoms (such as rigidity, bradykinesia, shuffling gait, tremor), and akathisia (such as inability to sit still, restlessness, tapping of feet).

On the other hand, atypical antipsychotics (newer antipsychotics) that are related to less risk of extrapyramidal side effects are widely used and they include Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone and (Geodon) Aripiprazole. Non-adherence to schizophrenia is still a major concern among patients, thus the need for prescribers to be aware of potential adverse effects of antipsychotics and when they are likely to occur. Apart from antipsychotics, psychosocial treatments in the form of groups and families have been developed as therapies for persons with schizophrenia. Most importantly, understanding the potential course of schizophrenia can influence the recovery time as well as alleviate adverse effects associated with late hospitalizations, especially for patients with schizophrenia.

You have just read a summary of the research paper: Schultz, Stephen H., Stephen W. North, and Cleveland G. Shields. “Schizophrenia: a review.” American Family Physician 75.12 (2007): 1821-9.

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