John Mar D.

Dangane

CPH SCHIZOPHRENIA

BMLS-3B

Overview Schizophrenia is a severe, lifelong brain disorder characterized by a breakdown of thought processes and by poor emotional responsiveness. People who have it commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, may hear voices, see things that aren't there or believe that others are reading or controlling their minds, and it is accompanied by significant social or occupational dysfunction. No one is sure what causes schizophrenia, but your genetic makeup and brain chemistry probably play a role. Medicines can relieve many of the symptoms, but it can take several tries before you find the right drug. You can reduce relapses by staying on your medicine for as long as your doctor recommends. With treatment, many people improve enough to lead satisfying lives. Who it affects In a sense, people with schizophrenia lose touch with reality and do not know which thoughts and experiences are true and real, and which are not. Schizophrenia develops in about 1 in 100 people. It can occur in men and women. The most common ages for it first to develop are 15-25 in men and 25-35 in women. People with a family history of schizophrenia who suffer a transient or self-limiting psychosis have a 2040% chance of being diagnosed one year later. Cause of the disease The causes of schizophrenia, like all mental disorders, are not completely understood or known at this time. Many diseases, such as heart disease, result from interplay of genetic, behavioral and other factors, and this may be the case for schizophrenia as well. Scientists do not yet understand all of the factors necessary to produce, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness. Estimates of heritability vary because of the difficulty in separating the effects of genetics and the environment. The greatest risk for developing schizophrenia is having a first-degree relative with the disease (risk is 6.5%); more than 40% of monozygotic twins of those with schizophrenia are also affected. It is likely that many genes are involved, each of small effect and unknown transmission and expression. Many possible candidates have been proposed, including specific copy number variations, NOTCH4, and histone protein loci. A number of genome-wide associations such as zinc finger protein 804A have also been linked. There appears to be significant overlap in the genetics of schizophrenia and bipolar disorder. Assuming a hereditary basis, one question from evolutionary psychology is why genes that increase the likelihood of psychosis evolved, assuming the condition would have been maladaptive from an evolutionary point of view. One theory implicates genes involved in the evolution of language and human nature, but to date such ideas remain little more than theoretical in nature.

Environmental factors associated with the development of schizophrenia include the living environment, drug use and prenatal stressors. Parenting style seems to have no major effect, although people with supportive parents do better than those with critical or hostile parents. Living in an urban environment during childhood or as an adult has consistently been found to increase the risk of schizophrenia by a factor of two, even after taking into account drug use, ethnic group, and size of social group. Other factors that play an important role include social isolation and immigration related to social adversity, racial discrimination, family dysfunction, unemployment, and poor housing conditions. A number of drugs have been associated with the development of schizophrenia, including cannabis, cocaine, and amphetamines. About half of those with schizophrenia use drugs and/or alcohol excessively. The role of cannabis could be causal, but other drugs may be used only as coping mechanisms to deal with depression, anxiety, boredom, and loneliness. Factors such as hypoxia and infection, or stress and malnutrition in the mother during fetal development, may result in a slight increase in the risk of schizophrenia later in life. People diagnosed with schizophrenia are more likely to have been born in winter or spring (at least in the northern hemisphere), which may be a result of increased rates of viral exposures in utero. Cost to society This is very important. Often the key worker plays a vital role. However, families, friends and local support groups can also be major sources of help. The burden of mental illness on health and productivity throughout the world has long been underestimated. Data developed reveal that mental illness, including suicide, accounts for over 15% of the burden of disease in established market economies. Classification of the disease Schizophrenia is among the most debilitating and complex of the psychoses. An Approximately 1% of the world population is afflicted with this mental illness. It is a noncommunicable disease that can be acute or chronic. Acute Schizophrenia does not seem to run in families. It may occur at anytime during life, usually in response to a major emotionally traumatic event, particularly responsive to antipsychotic medication and typically does not recur. Chronic schizophrenia typically first appears in late adolescence and goes into periodic remission. As patient ages, the psychotic episodes get longer and more severe in duration and the remissions get shorter and more infrequent. It also usually responds well to anti-psychotic medication. Prevention strategy Currently the evidence for the effectiveness of early interventions to prevent schizophrenia is inconclusive. While there is some evidence that early intervention in those with a psychotic episode may improve short term outcomes, there is little benefit from these measures after five years. Attempting to prevent schizophrenia in the prodrome phase is of uncertain benefit and therefore as of 2009 is not recommended. Prevention is difficult as there are no reliable markers for the later development of the disease. However, some cases of schizophrenia could be delayed or possibly prevented by discouraging cannabis use, particularly among youths. Individuals with a family history of schizophrenia may be more vulnerable to cannabis induced psychosis. And, one study found that cannabis induced psychotic

disorders are followed by development of persistent psychotic conditions in approximately half of the cases. Theoretical research continues into strategies that might lower the incidence of schizophrenia. One approach seeks to understand what happens on a genetic and neurological level to account for the illness, so that biomedical interventions can be developed. However, multiple and varied genetic effects each of small size, interacting with the environment, makes this difficult. Alternatively, public health strategies could selectively address socioeconomic factors that have been linked to higher rates of schizophrenia in certain groups, for example in relation to immigration, ethnicity or poverty. Population-wide strategies could promote services to ensure safe pregnancies and healthy growth, including in areas of psychological development such as social cognition. However, there is not enough evidence to implement such ideas at the current time, and a number of the broader issues are not specific to schizophrenia. Community support services including drop-in centers, visits by members of a community mental health team, supported employment and support groups are common. Some evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizophrenia. REFERENCES: http://en.wikipedia.org/wiki/Schizophrenia http://psychcentral.com/lib/2006/what-causes-schizophrenia/ http://www.emedicinehealth.com/schizophrenia/page11_em.htm#Prevention http://www.patient.co.uk/health/Schizophrenia.htm http://www.purgatory.net/merits/schizo.htm