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Schizophrenia
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Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social or occupational dysfunction

Sign and symptoms

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Positive symptoms

Delusion (paranoid in nature) (in the form of voice) disorders, wild thought, irritational conclusion

Hallucination Thought

Some time the feeling that thoughts are inserted or withdrawn by outside

Abnormal

behavior, such as stereotype and occasionally aggressive

Negative

symptoms
from social contact of emotional response

Withdrawal Flattening

Etiology and pathogenesis of schizophrenia


Genetic

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and environmental

Environmental

factors associated with the development of schizophrenia include the living environment, drug use and prenatal stressors. 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.

drug

Theories
Dopamine

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theory ( Carlson noble prize 2000) excess of dopamine and cocaine like drugs release Dopamine in the brain and can produce acute schizophrenic episode in human. release causes specific pattern of stereotype behavior. agonist drugs like apomorphine and bromocriptine produces similar effect in animals. antagonists (resepine) are effective in controlling positive sign of schizophrenia

Amphetamine

Dopamine

D2

Dopamine

Glutamate theory
NMDA

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receptors antagonists like phencyclidine, ketamine produce psychotic symptoms ( hallucination and thought disorder). glutamate concentration and desensitization of glutamate receptors.
OTHER

Reduces

THEORIES

Other 5HT

transmitters like 5HT and noradrenaline dysfunction and 5 HT antagonist.

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Prenatal 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.

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Risk factors
Family

history fetal hypoxic brain damage age of mother during pregnancy abuse of birth complications

Potential History

Advanced Birth

during the winter month marital life socioeconomic class environment, environmental stress

Substance Single Lower Urban

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Treatment goal and objective


Treatment

include psychotherapy as well as pharmacotherapy.


GOALS Minimize

symptoms of schizophrenia

Improve

quality of life and social/occupational functioning relapse and hospitalization adverse effect of medication

Prevent Minimize Prevent

suicide attempts or self harm

Pharmacotherapy antipsychotic medication


Two First

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types of medication generation --- typical antipsychotic generation ---- atypical antipsychotic

Second

Choice of medication depend on patients previous experience with antipsychotic medication, adverse effect etc.. to medication is not immediate and maximum treatment response may take 6 months or longer. on response to medication, current medication should be maintained for minimum 6 months.

Response

Typical antipsychotic medication


Agent CPZ Dose range Sedation Examples ------equivalent (mg/day) EPS

Anticholinergic Orhtostatic side effects hypotensio n

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Chlorpr 100 omazin e Trifluop 5 erazine Thiorid 100 azine Perphe 10 nazine Fluphe 2 nazine

3001000 5-15

+++

++ ++

+++

+++ +

300800 16-64

+++ ++

+++

+++ +

++ +

5-20

+++ +

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Typical antipsychotic
MOA blockage Also

of dopamine receptor

have activity at histamine, muscarinic and alpha receptors

efficacy

Various

typical antipsychotic have similar efficacy equivalent doses are described using chlorpromazine equivalent
Adverse

effect

mentioned in table

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Extrapyramidal side effect


Acute

dystonia sudden muscle spasm in eye neck, face and throat muscles. occurs within hours of initiation of medication or increasing the dose include use of anticholinergic agents like benztropine and diphenhydramine , if ineffective benzodiazepines can be used. motor restlessness , internal agitation

Management

Akathisia----

Unable

to sit still, occurs within days to few months after initiation of therapy. dose reduction, lipophilic beta-

Treatment---

pseudoparkinsonism
Idiopathic Mask

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parkinsonism

like face , rigidity or pill rolling tremor within 1-3 months or increase in dose.

Occur

Treatment

change to atypical antopsychotic , decrease dose and /or adding anticholinergic drug
Dykinesia

Face,

tongue, hips etc stopping antipsychotic. malignant syndrome ---

Treatment

Neuroleptic

uncommon

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Atypical antipsychotics
Medicat Dose ion rang (mg/da y) Clonaze150pam 600 Risperi 10-30 done Olanze 10-30 pine Quetiaz 300epam 800 Ziprasi 120-

Sedatio EPS anticholin Orthost Weight n ergic atic gain effect hypote nsion +++ 0 +++ +++ +++ + ++ ++ 0 +++ 0 + + + ++ 0 0 + + ++ ++ ++ +++ ++ ++

MOA Dopamine

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antagonist, also block 5HT


ADR

ref --- table

Oral

disintegrating tablet--- resperdone and olanzepine formulation-----ziprasidone and olanzepine

Parenteral

tranquilization ---- patient with aggressive or severe agitate ---- parentral form of chlorpromazine, fluphenazine and haloperidol

Rapid

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Management
The

primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social supports. Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) involuntarily. Some evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizophrenia

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Management and medicines


The

first-line psychiatric treatment for schizophrenia is antipsychotic medication can reduce the positive symptoms of psychosis in about 714 days. however fail to significantly ameliorate the negative symptoms and cognitive dysfunction

which

Antipsychotics