Schizophrenia is a chronic brain disorder that affects less than one percent of the U.S. population. People with schizophrenia may seem like they have lost touch with reality. Schizophrenia interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others.

 

 

Epidemiology

 

● the exact prevalence of schizophrenia is difficult to measure, but estimates range from 0.25% to 0.64% of U.S

● Schizophrenia spectrum disorders (SD) affects over 21 million people worldwide

● It has been estimated that approximately seven individuals per 1000 will develop SD during their lifetime

 

 

Risk Factors

 

• Genetic factors; Schizophrenia isn’t caused by just one genetic variation. Many different genes increase the risk of developing schizophrenia, but that no single gene causes the disorder by itself.

• Environmental factors; A number of genetic and environmental factors contribute to developing schizophrenia.

• Brain neurotransmitters: Dopamine receptors hyperactivity and deficiency of glutamatergic activity contribute to the development of schizophrenic symptoms.

 

 

 

Diagnosis

 

• While there is no single physical or lab test that can diagnosis schizophrenia, a health care provider who evaluates the symptoms over 6 months can help ensure a correct diagnosis.

• DSM-5 specifies the following criteria

• Continuous symptoms that persist for at least 6 months with at least one month of active phase symptoms (Criteria A). These symptoms include delusion, hallucinations, disorganized speech, negative symptoms, and disorganized behaviors.

              Criteria B: Significantly impaired psychological functioning.

 

 

 

Signs and Symptoms

 

• The exact nature of the symptoms varies greatly from patient to patient. It comprises Positive and Negative Symptoms.

• Positive symptoms include hallucinations (these may include auditory, visual, or visceral), delusions, thought disorders, and behavior disturbances.

Negative symptoms include social withdrawal, alogia (poverty of speech), apathy, and lack of drive and interest

 

 

 

 

Treatment Options for Schizophrenia

 

There is no cure for schizophrenia, but it can be treated and managed in several ways.

 

• Antipsychotic medications can help treat acute symptoms and maintain remission from the illness.

• Psychotherapy, such as cognitive-behavioral therapy and assertive community treatment, and supportive therapy

                                    

Self-management strategies and education

 

First Generation Antipsychotics (FGAs) or (Typical Antipsychotics)

 

•          Are D2 receptor antagonists

•          Are associated with a higher risk of extrapyramidal side effects (EPSE)

 

 

2nd Generation Antipsychotics (SGAs) or Atypical Antipsychotics)

 

•          Are 5HT2A / D2 antagonists

•          Are associated with lower risks of EPSE

•          associated with a higher risk of metabolic side effects, including weight gain, hyperlipidemia, and diabetes mellitus.

 

There is no evidence that SGAs are significantly more effective than FGAs in the treatment of cognitive and negative symptoms of schizophrenia.

 

 

Selection of antipsychotics based on

1.         The need to avoid certain side effects

2.         Concurrent medical or psychiatric disorders

3.         Patient history of response

 

 

Initial Therapy

 

i.          The goals during the first 7 days are decreased agitation, hostility, anxiety, and aggression, and normalization of sleep and eating. The treatment-naïve individuals with first break schizophrenia, start the treatment with Aripiprazole or Risperidone, or Ziprasidone.

ii.         For 1st episode psychosis, the dose range should be one-half of that chronically ill patients.

iii.        Titrate over the past few days to an average effective dose.

 

 

 

Stabilization Therapy

 

•          During 2nd or 3rd week, the goal of treatment is to improve socialization, self-care, and mood

•          If the patient begins to show an adequate response at a particular response, then continue at the dosage as long as symptoms continue to improve.

 

 

 

Maintenance Therapy

•          Avoidance of relapses is the goal of maintenance therapy.

•          Continue medication for at least 12 months after remission of the first psychiatric episode.

•          Lifetime pharmacotherapy at the lowest effective dose is necessary for most schizophrenic patients.

•          Antipsychotics 9espically FGAs and clozapine) should be tapered slowly before discontinuation to avoid cholinergic rebound

 

 

 

 

References

1. A. Orrico-Sánchez, M. López-Lacort, C. Muñoz-Quiles. Epidemiology of schizophrenia and its management over an 8-years period using real-world data in Spain. BMC Psychiatry. [Online] April 5, 2020. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02538-8.

2. What Is Schizophrenia? American Psychiatry Association. [Online] https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia.

3. Schizophrenia. National Institute of Mental Health. [Online] May 2020. https://www.nimh.nih.gov/health/topics/schizophrenia#part_2277.

4. Joseph T. Dipiro, Cecily V. Dipiro. Schizophrenia. [book auth.] Joseph T. Dipiro. Pharmacotherapy Handbook. s.l. : Mc Graw Hill Education.

 

 

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