SCHIZOPHRENIA

Definition

Schizophrenia is a syndrome of unknown etiology characterized by disturbance in

cognition, emotion, perception, thinking, and behavior. Schizophrenia is well
established as a brain disorder, with structural and functional abnormalities
visible in neuroimaging studies and a genetic component , as seen in twin studies.
This disorder is usually chronic, with a course encompassing a prodromal phase,
an active phase, and residual phase. The active phase has symptoms such as
hallucination, delusions, disorganized thinking. The prodromal and residual phase
are characterized by attenuated forms of active symptoms, such as old beliefs and
magical thinking, as well as deficits in self care and interpersonal relatedness.

Epidemiology

Incidence and prevalence. In the united states, the lifetime prevalence of

the disease is about 1%, which means that 1 in 100persons will develop the
disorder during his or her lifetime.
Gender and age. Equally prevalent between men and women , usually
onset is earlier in men. Peak age of onset is between 15 and 35 years (50%
of cases occur before age 25)
Infection and birth season. Persons born in winter are more likely to
develop t disease than those born in spring or summer. Increase in babies
born who have influenza during pregnanc.
Etiology

I. Genetic .The greater risk for developing schizophrenia is having a

first degree relative wit of the disease more than 40% of
monozygotic twins. 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 variation, NOTHC4, and histone protein loci.

II. Biological
Dopamine hypothesis . schizophrenic symptoms may results from
increased limbic dopamine activity and decreased frontal dopamine
activity. Dopaminergic pathology my be secondary to abnormal
receptor number or sensitivity or abnormal dopamine release.

Norepinephrine hypotheis. Increased norepinephrine levels in

schizophrenia lead to increase sensitization to sensory input.

GABA hypothesis. Decreased GABA activity results in increased

dopamine activity.

III. Psychosocial and environmental

Family factors. Patients whose families have high level of express
emotion have higher relapse rate. Express emotion has been defined
as any overly involved, intransive behavior, be it hostile and critical.
Sign and symptom

Individuals with schizophrenia may experience hallucinations, delusion, and

disorganized thinking and speech. Social withdraw, sloppiness od dress and
hygiene, and loss of motivation and judgment . There is observable pattern of
emotional difficulty, foe example lack of responsiveness. Impairment in social
cognition is associated with schizophrenia, as symptoms of paranoia. Difficulties
in working and long term memory, attention, executive functioning, and speech
pf processing.

Positive symptom

Delusions
Disordered thoughts and speech
Tactile
Auditory
Visual
Olfactory and gustatory hallucinations .

Negative symptom

Flat expression or litte emotion

Poverty of speech
Inability to experience pleasure
Lack of desire to form relationship
Lack of motivation
Laboratory and Psychological tests

A. EEG. Most schizophrenic patients have normal EEG findings, but some have
decreased alpha and increased theta and delta activity, paroxysmal
abnormalities, increased sensitivity to activation procedures.
B. Endocrinological studies. In some patients decreased level of luteinizing
hormone and follicle stimulating hormone, diminished release of prolactin
and growth hormone following stimulation by gonadotrophin releasing
hormone.
C. Neuropsychological testing. Schizophrenic paitents have lower IQ when
compared with normal persons. Decline in IO occurs with progression with
illness.

Pathophysiology

A. Neuropathology
Decreased number of neurons
Increased gliosis
Disorganization of neuronal architecture
Degeneration of limbic system especially the amygdala, hippocampus
and cingulate cortex.
Abnormal function in basal ganglia and cerebellum.

B. Brain imaging
Computed tomography. Enlargement of the lateral and third
ventricles. Atrophy of the cerebellar vermis and decreased
radiodensity of brain parenchyma.
Magnetic resonance imaging. Ventricles in monozygotic twins with
schizophrenia are larger than those of unaffected siblings.
Cerebral blood flow. Decreased resting levels of frontal blood flow,
increased parietal blood flow, decreased whole blood flow.
Differential diagnosis

Bipolar disorder
Borderline personality disorder
Drug induced psychosis
Delusion disorder
Social anxiety disorder
Schizotypal personality disorder.

Treatment

First generation antispychotics. The classic antipsychotic drugs often effective in

the treatment of positive symptoms. Example

Chlorpromazine
Fluphenazine
Mesoridazine
Haloperidol
 Second generation antipsychotics. Provide potent 5-TH receptor blockade.
Improves two classes of disabilities typical of schizophrenia.

1. Positive symptoms such as hallucination, delusions, disordered

thought, agitation
2. Negative symptoms such as withdrawal, flat affect, achedonia, poverty
of speech. They cause less extrapyramidal effects, do not elevate
prolactin levels. As a group, these agents can be highly sedating and
cause weight gain in excess of that associated with dopamine receptor
antagonists . Example
Aripiprazole
Clozapine
Quetiapine
Riseperidone
Olanzapine

Management

i. Primary treatment of schizophrenia is antipsychotic medication often in

combination. Schizophrenia is usually a chronic illness, and long term
treatment with antipsychotic medication. During dosage reduction,
patients and their families must be educated to recognize and eport
warning signs of replase, including insomnia, anxiety, withdrawal, and odd
behavior.
 Conclusion
Schizophrenia is a mental disorder often characterized by abnormal social
behavior and failure to recognize what is real. Genetics and early environment, as
well as psychological and social process, appear to be important contributory
factors. The mainstay treatment is antipsychotic medication, which primarily
suppresses dopamine receptor activity. Counseling, job training and social
rehabilitation are aslo important treatment.
 REFERENCE
1. Picchioni mm, murray RM( JULY 2007) SCHIZOPHRENIA . BMJ 335 doi:
10.1136/bmj. 39227
2. Baucum T, kilian R(2006). Psychology. Hauppauge, N.Y BARRON p 182 ISBN
9780764134210
3. Internet
4. Reference of behavior and disorders