EMMANUELKURUVILLA

SCHIZOPHRENIA
Schizophrenia is a mental disorder that makes it difficult to

tell the difference between real and unreal experiences, to think logically, to have normal emotional responses, and to behave normally in social situations. Schizophrenia is a complex illness.Genetic factors appear to play a role. People who have family members with schizophrenia may be more likely to get the illness themselves. Damage to the brain during pregnancy or birth. Schizophrenia is often associated with violence in the media - but this is the exception rather than the rule. Many people with schizophrenia live a stable life, work, and maintain relationships.

PATHOPHYSIOLOGY
Neuroimaging studies have demonstrated anatomical

abnormalities, such as enlargement of the ventricles and decreased brain volume in medial temporal areas, in patients with schizophrenia.These findings are of greater research interest than clinical use. The hippocampus is a small, cortical, supposedly seahorse-shaped part of the brain, curled within the medial border of the temporal lobe. The hippocampus is functionally part of the limbic system, where emotions are processed. The hippocampus is where we form declarative or episodic memories (memories of facts or events). The hippocampus is affected in Alzheimer disease, the preeminent disease of memory problems.

 The hippocampus is also one of the many parts of

the brain affected in schizophrenia. Disturbances in declarative memory are common in schizophrenia, although not as marked as in Alzheimer disease. Changes in the hippocampus, such as volume loss, change in perfusion, and change in contour, observed in brains from patients with schizophrenia (including nonmedicated patients) and relatives may be related to the cognitive problems of schizophreniaThe average age at the beginning of the study was 12 years

EPIDEMIOLOGY
Mortality/Morbidity People with schizophrenia have a 10% lifetime risk of suicide. Mortality is also increased because of medical illnesses, due to a combination of unhealthy lifestyles, side effects of medication, and decreased health care. Race
Sex

Age

Types of Schizophrenia
Paranoid
Hebephrenic Catatonic

Residual
Schizoaffective Undifferentiated

UNDEFFRENTIATED TYPE
Undifferentiated schizophrenia" is used as a label for

cases of schizophrenia that don't match any of the established types of schizophrenia. Undifferentiated type schizophrenia differs from "residual schizophrenia," which refers to chronic conditions after an acute schizophrenia episode.

PARANOID SCHIZOPHRENIA
Paranoid schizophrenia is one of several types of

schizophrenia, a chronic mental illness in which a person loses touch with reality (psychosis). The classic features of paranoid schizophrenia are having delusions and hearing things that aren't real. You may not have as many problems with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many complications, including suicidal behavior.

SCHIZOAFFECTIVE SCHIZOPHRENIA
Schizoaffective disorder is characterized by significant

mood symptoms, psychosis, and other symptoms of schizophrenia. It is differentiated from schizophrenia by occurrence of 1 episodes of depressive or manic symptoms. Schizoaffective disorder is considered when a psychotic patient also demonstrates mood symptoms. The diagnosis requires that significant mood symptoms (depressive or manic) be present for a substantial portion of the total duration of illness, concurrent with symptoms of schizophrenia. Differentiating schizoaffective disorder from schizophrenia and mood disorders may require longitudinal assessment of symptoms and symptom progression. The prognosis is somewhat better than that for schizophrenia but worse than that for mood disorders

HEBEPHRENIC SCHIZOPHRENIA
a form of schizophrenia characterized by severe

disintegration of personality including erratic speech and childish mannerisms and bizarre behavior; usually becomes evident during puberty; the most common diagnostic category in mental institutions

CATATONIC SCHIZOPHRENIA
Catatonic schizophrenia is one of several types of

schizophrenia, a chronic mental illness in which a person loses touch with reality (psychosis). Catatonic schizophrenia includes episodes of behavior at extreme opposite ends of the spectrum. You may seem like you're in coma-like daze unable to speak, move or respond or you may talk and behave in a bizarre, hyperactive way. Catatonic episodes may last for a month or longer without treatment.

RESIDUAL SCHIZOPHRENIA
Residual schizophrenia is diagnosed when a person

has a history of prominentschizophrenic symptoms, but none of his/her current symptoms dominate the clinical presentation. In other words, s/he may still be experiencing delusions,hearing voices, or showing some signs of disorganized speech or other positive symptoms typical of schizophrenia, but the intensity has decreased significantly. The symptoms are no longer as severe as they were when s/he was acutely ill, but indicators of the disorder are still evident.

SYMPTOMS
As the illness continues, psychotic symptoms develop: Appearance or mood that shows no emotion (flat affect) Bizarre movements that show less of a reaction to the

environment (catatonic behavior) False beliefs (delusions) Hearing, seeing, or feeling things that are not there (hallucinations) Problems with thinking often occur: Problems paying attention Thoughts "jump" between unrelated topics Symptoms can be different depending on the type of schizophrenia: ALOGIA(poverty speech)

 Paranoid types often feel anxious, are more often angry or

argumentative, and falsely believe that others are trying to harm them or their loved ones. Disorganized types have problems thinking and expressing their ideas clearly, often exhibit childlike behavior, and frequently show little emotion. Catatonic types may be in a constant state of unrest, or they may not move or be underactive. Their muscles and posture may be rigid. They may grimace or have other odd facial expressions, and they may be less responsive to others. Undifferentiated types may have symptoms of more than one other type of schizophrenia.
People with any type of schizophrenia may have difficulty keeping

friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.

DIAGNOSIS
A psychiatrist should perform an evaluation to make the

diagnosis. The diagnosis is made based on a thorough interview of the person and family members. No medical tests for schizophrenia exist. The following factors may suggest a schizophrenia diagnosis, but do not confirm it: Course of illness and how long symptoms have lasted Changes from level of function before illness Developmental background Genetic and family history Response to medication CT scans of the head and other imaging techniques may find some changes that occur with schizophrenia and may rule out other disorders.

Treatment of Schizophrenia

The acute psychotic schizophrenic patients will respond usually to antipsychotic medication. According to current consensus we use in the first line therapy the newer atypical antipsychotics, because their use is not complicated by appearance of extrapyramidal sideeffects, or these are much lower than with classical antipsychotics.
conventional antipsychotics (classical neuroleptics) atypical antipsychotics

chlorpromazine, chlorprotixene, clopenthixole, levopromazine, periciazine, thioridazine

droperidole, flupentixol, fluphenazine, fluspirilene, haloperidol, melperone, oxyprothepine, penfluridol, perphenazine, pimozide, prochlorperazine, trifluoperazine amisulpiride, clozapine, olanzapine, quetiapine, risperidone, sertindole, sulpiride

ATYPICAL DRUGS SIDE EFFECTS

Sleepiness (sedation) or dizziness
Weight gain and increased chance of diabetes and

high cholesterol Less common side effects include: Feelings of restlessness or "jitters" Problems of movement and gait Muscle contractions or spasms Tremor

SUPPORT PROGRAMS AND THERAPIES

Supportive and problem-focused forms of therapy may be

helpful for many people. Behavioral techniques, such as social skills training, can be used during therapy or at home to improve function socially and at work. Family treatments that combine support and education about schizophrenia (psychoeducation) appear to help families cope and reduce the odds of symptoms returning. Programs that emphasize outreach and community support services can help people who lack family and social support. Important skills for a person with schizophrenia include:

 Learning to take medications correctly and how to

manage side effects Learning to watch for early signs of a relapse and knowing how to react when they occur Coping with symptoms that are present even while taking medications. A therapist can help persons with schizophrenia test the reality of thoughts and perceptions. Learning life skills, such as job training, money management, use of public transportation, relationship building, and practical communication

COMPLICATIONS
People with schizophrenia have a high risk of

developing a substance abuse problem. Use of alcohol or other drugs increases the risk of relapse, and should be treated by a professional. Physical illness is common among people with schizophrenia due to an inactive lifestyle and side effects from medication. Physical illness may not be detected because of poor access to medical care and difficulties talking to health care providers. Not taking medication will often cause symptoms to return

REFERENCE
Schizophrenia, NICE Clinical Guideline (March 2009); Core

interventions in the treatment and management of schizophrenia in primary and secondary care Schizophrenia, Clinical Knowledge Summaries (October 2009) No authors listed; Cognitive behavioural therapy for schizophrenia. Drug Ther Bull. 2010 Jan;48(1):6-9. [abstract] Jones C, Cormac I, Silveira da Mota Neto JI, et al; Cognitive behaviour therapy for schizophrenia. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD000524. [abstract] Rummel C, Kissling W, Leucht S; Antidepressants for the negative symptoms of schizophrenia. Cochrane Database Syst Rev. 2006 Jul 19;3:CD005581. [abstract] Rathbone J, Zhang L, Zhang M, et al; Chinese herbal medicine for schizophrenia: cochrane systematic review of randomised trials. Br J Psychiatry. 2007 May;190:379-84. [abstract]