What Is Schizophrenia?

GLOBAL MEDICAL EDUCATION PRESENTS WHAT IS SCHIZOPHRENIA? WHAT IS SCHIZOPHRENIA Schizophrenia is a serious chronic psychiatric illness. There is no single symptom that defines schizophrenia. Usually patients have "positive symptoms" including: Delusions Fixed false beliefs not amenable to reasoning and not culturally explained. Hallucinations Perceptual disturbances like hearing voices, feeling the presence of others, etc. V Disorganized speech Incoherence, difficulty organizing thoughts, etc. Y Disorganized behavior or “negative symptoms" The illness affects ONE 100 Avolition, apathy, amotivation, etc. There is marked impairment in: Y Self-care V Work in Interpersonal relationships as a consequence of the illness. individuals globally. The TERM SCHIZOPHRENIA was coined by Eugen Bleuler a Swiss psychiatrist to denote SCHIZO (split) & PHRENE (mind). It is often mistakenly confused with split personality which is inaccurate. is usually between: ONE IN TEN AGE OF 16 ONSET cases start after the age of 40 and shows up earlier in males. SCHIZOPHRENIA "PRODOME": 90% of patients with schizophrenia experience a "prodromal phase" The symptoms include attenuated forms of the symptoms of schizophrenia. 35% About of patients who have "prodome" will go on to develop schizophrenia. • Intervening early in the "prodome" can potentially prevent schizophrenia or improve its outcome. HOW IS SCHIZOPHRENIA DIAGNOSED? The diagnosis is based on a thorough longitudinal history from the patient and family members since patients may have no insight into their psychotic symptoms and may deny them. A thorough mental status and physical exam is necessary to confirm the diagnosis and rule out secondary causes (like medical illnesses, drugs, medications etc.) of psychotic symptoms particularly in patients with sudden onset of symptoms. Neuroimaging is usually The results of the evaluation not necessary in most may lead to the patient being patients to make a diagnosed with one of these subtypes of schizophrenia: first episode diagnosis. Laboratory tests are usually normal although drug screens may multiple episodes be positive. continuous unspecified WHAT ARE THE MAIN CHANGES IN DSM-5 FOR SCHIZOPHRENIA? • Schizophrenia is now part of schizophrenia spectrum (includes schizophrenia, schizotypal personality disorder and schizophreniform disorder) and other psychotic disorders category. • Two out of five symptoms (one must be delusions, hallucinations or disorganized speech) are now required. • Bizarre delusions alone are not sufficient for a diagnosis of schizophrenia. • The previous subtypes of schizophrenia like paranoid, catatonic, disorganized, undifferentiated and residual have been eliminated. • New course specifiers have been added after the illness has been present for at least one year. These include single episode, multiple episodes, continuous, and unspecified. Presence of catatonia and current severity of symptoms are also specifiers. KE SUICIDE AND SCHIZOPHRENIA About RISK FACTORS INCLUDE: 18% O younger age, males comorbid substance abuse of patients will commit suicide. non-adherence to treatment delusions of persecution UIOLENCE AND SCHIZOPHRENIA Most patients with schizophrenia are not violent. However schizophrenia is overrepresented in individuals who commit violent crimes. RISK FACTORS INCLUDE: C Younger male Y Prior agressive behavior E Substance abuse E First episode E Delusions of threat Non-adherence or being spied upon to medications E Cultural and language barriers E Anger issues C Access to firearms WHAT CAUSES SCHIZOPHRENIA? A combination of genetic and environmental factors contribute. 50% Schizophrenia runs in FAMILIES If you have a first degree relative with schizophrenia your risk of developing the illness is risk of schizophrenia in IDENTICAL TWINS. ENUIRONMENTAL FACTORS implicated include: 10 TIMES O Exposure to malnutrition or certain viruses (influenza, rubella, or respiratory) prior to birth O Obstetric complications or hypoxia during birth O Social adversity greater. Patients with schizophrenia have rare genetic mutations but no single gene has been implicated. Traumatic brain injury in those at genetic risk Excessive cannabis use MYTHS ABOUT SCHIZOPHRENIA: 1 Schizophrenia is a progressive disease in all patients. 2 Most patients with schizophrenia are violent. 3 Recovery is not possible in schizophrenia. 4 Patients with schizophrenia have a "split personality" 5 Bad parenting can cause schizophrenia. 6 Patients with schizophrenia do not need medications. HOW CAN SCHIZOPHRENIA BE TREATED? INITIAL TREATMENT: Most patients will benefit from a combination of medications and psychosocial treatments. HOSPITALIZATION: Atypical antipsychotics (so Patients with severe psychosis, called because they are less those that are suicidal or homicidal likely to cause parkinsonian side effects compared to the older or conventional and those with comorbid substance abuse or uncontrolled medical antipsychotics) like aripiprazole, asenapine, illnesses may need to be hospitalized. lurasidone, olanzapine, quetiapine, risperidone, ziprasidone, are the treatments of choice. Many patients may need adjunctive benzodiazepines or hypnotics acutely for the control of psychosis. Patients who do not respond to or develop side effects with one drug can be switched to other antipsychotics. Patients who fail two or more drugs should be considered candidates for clozapine which is FDA approved for treatment resistant schizophrenia but is very underutilized. LONG TERM TREATMENT LONG ACTING INJECTABLE Most patients will need maintenance antipsychotics like aripiprazole long acting, risperidone microspheres, paliperidone palmitate and antipsychotics and adjunctive psychosocial therapies. Often the dose of the antipsychotic can be olanzapine pamoate are very helpful reduced during the maintenance to ensure adherence but are phase. Only a small minority of patients with extremely underutilized in the US good prognosis schizophrenia can be managed compared to the rest of the world without long term medications. 50-70% of patients with schizophrenia Risk of relapse OFF do not take the medications medications is as prescribed. 38 Clozapine has ANTI-SUICIDAL greater than ON medications. effects in patients with schizophrenia. Psychosocial treatments found to be effective as adjuncts to medications include: V Cognitive Behavior Therapy (CBT) V Assertive Community Treatment (ACT) V Social skills training V Psychoeducation V Vocational rehabilitation and family intervention (decreasing emotional over-involvement, critical comments, and hostility towards patient) SIDE EFFECTS • Some antipsychotics like olanzapine, quetiapine and clozapine are particularly likely to cause weight gain and metabolic problems. of antipsychotics commonly include: E Parkinsonism (rigidity, tremor, restlessness ,or gait abnormalities) • Children and adolescents are most sensitive to these side effects. E Sedation E Nausea • Patients should have their weight, waist circumference, glucose and lipids monitored regularly. E Weight gain & metabolic abnormalities wwW.HNKA (increased lipids, glucose, cholesterol etc.) INMAMN • Agranulocytosis is a blood disorder which is a rare side effect of clozapine and should be monitored for especially early in treatment. • Tardive dyskinesia is a rare but serious side effect than can occur in a small minority of patients on atypical antipsychotics and should be monitored for annually. THIS INFOGRAPHIC WAS BROUGHT TO YOU BY GLOBAL MEDICAL EDUCATION For more information on schizophrenia from the world's leading experts visit: www.gmeded.com CME