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Schizophrenia

Schizophrenia is characterized by disturbances (for at least 6 months) in thought content and form, perception, affect, language, social activity, sense of self, volition, interpersonal relationships, and psychomotor behavior. The DSM-IV recognizes catatonic, paranoid, disorganized, residual, and undifferentiated schizophrenia.

Schizophrenia affects approximately 0.85% of individuals worldwide, with a lifetime prevalence of 1 % to 1.5%. Onset of symptoms usually occurs during late adolescence and has an insidious onset and poor outcome. It can progress to social withdrawal, perceptual distortions, chronic delusions, and hallucinations.

This disorder produces varying degrees of impairment. As many as one-third of schizophrenic patients have just one psychotic episode and no more after that. Some patients have no disability between periods of exacerbation; other patients need continuous institutional care. The prognosis worsens with each acute episode.

Causes

Researchers haven't identified the cause or causes of schizophrenia, although they believe genetic factors play a role. About 1 percent of the general population develops schizophrenia compared with 10 percent of those with a close family relative who has the disease. Chemical or subtle structural abnormalities in the brain may contribute to causing this illness.

Schizophrenia has a higher incidence among lower socioeconomic groups, possibly related to downward social drift or lack of upward socioeconomic mobility, and to high stress levels, possibly induced by poverty, social failure, illness, and inadequate social resources. Gestational and birth complications, such as Rh factor incompatibility, prenatal exposure to influenza during the second trimester, and prenatal nutritional deficiencies, have been associated.

Symptoms

A person with schizophrenia may feel anxious and confused. A sufferer may seem distant, detached, or preoccupied. Sometimes they may sit motionless and silent for hours.

Alternatively, a schizophrenic may move about constantly, always occupied, wide awake, vigilant, and alert. Prolonged extremes of depression and elation are not uncommon.

Some people with schizophrenia experience hallucinations. The most common form of hallucination is the hearing of voices.

People with schizophrenia also have delusions - false or irrational beliefs. Some can be quite bizarre, for instance that people on television are broadcasting the sufferer's thoughts aloud to other people.

People with paranoid schizophrenia believe they are being persecuted.

Often a schizophrenic patient's thinking is affected by the disorder. The person may not be able to think straight, or to concentrate.

People with schizophrenia also have trouble expressing their emotions. They may appear inconsistent, manic or emotionally stunted.

Treatment

In schizophrenia, treatment focuses on meeting both the physical and psychosocial needs of the patient based on his previous level of adjustment and his response to medical and nursing interventions. Treatment typically includes a combination of drug therapy, long-term psychotherapy for the patient and his family, vocational counseling, and the use of community resources.

The primary treatment (for more than 30 years), antipsychotic drugs (sometimes called neuroleptic drugs) appear to work by blocking postsynaptic dopamine receptors. These antipsychotic drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, as well as relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may also be prescribed to control associated signs and symptoms.

Some antipsychotic drugs cause numerous adverse reactions, several of which are irreversible. Most experts admit that patients who are withdrawn, isolated, or apathetic show little improvement after this drug treatment.

High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low in potency. Haloperidol decanoate, fluphenazine decanoate, and fluphenazine enanthate are depot formulations that are implanted I.M., resulting in gradual release over a 30-day period, thus improving compliance.

Risperidone (Risperdal) and Olanzapine (Zyprexa) are atypical and antipsychotic agents used to treat both the positive and negative symptoms of schizophrenia. Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of signs and symptoms without the usual adverse effects. However, clozapine can cause drowsiness, sedation, excessive salivation, hyperglycemia, tachycardia, dizziness, seizures, and agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia.

Routine blood monitoring is essential to detect the estimated 1 % to 2% of all patients taking clozapine who develop agranulocytosis. If the disorder is caught in the early stages, agranulocytosis is reversible.

Clinicians disagree about the effectiveness of psychotherapy in treating schizophrenia. Although a patient who has experienced a single acute psychotic episode may respond, psychotherapy is often futile in a patient with a long history of chronic disease. Nonetheless, some doctors use it as an adjunct to reduce loneliness, isolation, and withdrawal and enhance productivity.

Other studies suggest that psycho-education and social skills training are more productive approach for the chronic schizophrenic. Besides improving under­standing of the disorder, these methods teach the patient and his family coping strategies, effective communication techniques, and social skills such as grocery shopping.

Because schizophrenia is so disruptive to the family, all members may require psychotherapy. Family therapy can reduce guilt and disappointment as well as improve acceptance of the patient and his bizarre behavior.

Prevention

The best way to prevent relapses is to continue to take the prescribed medication. Because side effects are one of the most important reasons why people with schizophrenia stop taking their medication, it is very important to find the medication that controls symptoms without causing side effects. Always talk to your doctor about any adjustments in your medications, or your wish to discontinue them


 

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