Schizophrenia: Psychotic Disorder
Department of Pharmaceutics, MNR college of pharmacy, Hyderabad, India
- *Corresponding Author:
- Nagashree Kotturi
Department of Pharmaceutics, MNR college of pharmacy, Hyderabad, India
Received Date: 26/05/2015; Accepted Date: 03/06/2015; Published Date: 09/06/2015
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Schizophrenia is a severe brain disease, which makes the person difficult to communicate with others, respond emotionally and to make decisions. Psychosis is a major symptom of schizophrenia. Abnormalities in brain may lead to development of Schizophrenia, which includes symptoms like mood disorders to suicidal tendency. The disease can be diagnosed by observing the symptoms, thus the patients can be treated with antipsychotics.
Paranoia, delusions, galactorrhoea
Schizophrenia is a mental disorder, involves abnormal behavior of the individual. It is usually characterized by failure to recognize what is real. Symptoms [1-12] include confused or unclear thinking, false beliefs, hallucinations (auditory), paranoia.
Abnormality of Brain in Schizophrenia Patients: Patients with schizophrenia showed smaller brain volume especially in areas involved in concentration, memory, thinking and perception. The distinguishing feature was patients with schizophrenia had larger ventricles, cavities within the brain that are filled with the same fluid as in the spine which bathes the brain, both cushioning it and providing nutrients. Another feature includes schizophrenic patients had a reduction in the size of the left temporal lobe and the front part of the hippocampus, a ridge along each lateral ventricle of the brain, wider cortical sulci, spaces in the folding’s at the surface of the cortex. Frontal lobes and hippocampus plays a vital role in decision making, emotion and memory.
Causes of Schizophrenia
The main cause of schizophrenia [13-24] is still unclear, but it might be caused due to heredity (genetics), viral infections or due to immune disorders.
Due to heredity characters the person may develop disease, which may be triggered by environmental events like (stressful situations, or viral infections). Schizophrenia [25-40] is also reported due to physical or hormonal changes which may occur during puberty in teen and young adults.
It includes positive and negative symptoms. The symptoms of schizophrenia [41-59] are usually classified into one of two categories – positive or negative. Positive symptoms include behavioral changes or thoughts like hallucinations or delusions, and negative symptoms involve withdrawal or lack of function, the person may feel apathetic or emotionless. Cognitive symptoms relate to thinking process, characterized by illness and they often struggle with functioning and organizing their thoughts.
Types of Schizophrenia:
–Paranoid Schizophrenia: Paranoid schizophrenia is characterized with delusions orhallucinations
–Disorganized Schizophrenia: It is characterized by in appropriate emotion or disorganizedbehavior.
–Catatonic Schizophrenia: Characterized by repeating another’s speech and movements.
–Undifferentiated Schizophrenia: May involve Many and varied Symptoms.
Diagnosis of Schizophrenia
There are no specific diagnostic methods for Schizophrenia. Patients are diagnosed with schizophrenia by observing the symptoms which may include physical examination and certain medical and psychological tests. Lab test includes complete blood count and imaging studies like MRI or CT scan.
A doctor monitors mental status by observing appearance and asking about delusions, hallucinations, substance abuse, thoughts, moods, and suicide.
Prevention of Schizophrenia
There is no prefect way to prevent schizophrenia, however earlier diagnosis may help prevent serious complications like suicidal tendency. The earlier medication prevents relapse or worsening of symptoms.
Antipsychotics are used to treat schizophrenia [60-70], but they are also effective in other psychotic states including manic states such as hallucinations, paranoia and delusions which are characterized as typical and atypical
Typical are conventional neuroleptics and major tranquilizors. Atypical antipsychotics are novel 2nd generation drugs.
Classification of antipsychotic drugs:
• Typical antipsychotics or First generation antipsychotics
Phenothiazines: e.g. chlorpromazine, fluphenazine, thioridazine
Thioxanthines: e.g. chlorprotixen, thiothixene
Butyrophenones: e.g. haloperidol, droperidol
• Atypical antipsychotics or second generation antipsychotics
Benzamides: remoxipride (investigational)
Diphenylbutylpiperazines: e.g. pimozide
First generation antipsychotics act by competitive blocking of D2 dopamine receptors.They also block muscarinic acetylcholine receptors, α adrenoreceptors and antihistamine receptors. First generation antipsychotics are associated with movement disorders, especially for drugs that bind tightly to dopaminergic neuroreceptors.
Pharmcokinetics includes rapid oral absorption, undergoes extensive phase 1 metabolism and excreted in urine
Adverse drug reactions
• Due to blockade of dopamine D2 receptors –it may cause galactorrhoea,gynaecomastia or infertility in men.
• Increased triglycerides
• lowers seizure threshold
•prolongs QT interval, ventricular arrthymias and may lead to sudden death.
Second generation antipsychotics acts by blocking both serotonin and dopamine receptors. Has efficacy against negative symptoms.
Adverse drug reactions: Second generation antipsychotics have extrapyramidal symptoms when compared to first generation antipsychotics, but are associated with metabolic side effects like diabetes and weight gain.
Apart from antipsychotics, trans cranial magnetic stimulation (TMS) can used in treating schizophrenia, which involves electromagnetic induction of electric field in the brain. Deep TMS affect cells to depth of 6cm, whereas standard TMS affects neurons within 1.5-2 cm from the scalp, which acts by changing the excitability of the neurons, with fewer side effects. TMS decreases negative symptoms and auditory hallucinations in patients with schizophrenia.
Psychosocial Treatments: Individual and family treatments have been developed as therapies for treatment of schizophrenia [71-73]. Family interventions involves psych education with groups of families, which includes education about the illness, and options for reducing critical and emotionally over involved attitudes and behavior.
Studies demonstrated that family interventions reduce relapse rates and improve symptoms, quality of life in patients with schizophrenia.
Interventions in the Maintenance Phase involves identification of symptoms of relapse, teach self- management of symptoms
Stages of relapse
Stage 1: Overextension: in which patient feels overloaded and overwhelmed.
Stage 2: restricted consciousness: depression is coupled with withdrawal and anxiety.
Stage 3: disinhibition: Appearance of psychotic features like hallucinations and delusions in which patient can no longer control.
Stage 4: Psychotic disorganization: intensification of delusions and hallucinations in which patient loses control which involves inability to differentiate reality from psychosis and failure to recognize the environment.
Stage 5: psychotic resolution- Patient experiences psychosis, [74-76] but the symptoms are quiet
Managing Relapse: identification and management of symptoms decreases the severity of relapses, Prodromal phase arise before relapse-Time between the onset of symptoms and the requirement for treatment.
Causes of Relapse: Studies demonstrated, that people with schizophrenia without medication relapse at a rate of 60-70 % within the first year, interventions in the Health Promotion Phase, focus on prevention of relapse and symptom management.
Studies have demonstrated that the disease is less prevalent in women, when compared to men and they have fewer symptoms due to presence of estrogen. As the estrogen reduces the effect of dopamine in the central nervous system, it can be given in men, but it might not be an effective long term solution, as it leads to feminization of men.
- Kocazeybek B and Kalayci F. Assessment of Association between Schizophrenia and Chlamydiaceae UsingHill Criteria. J Psychiatry. 2015; 18:250.
- Zhang J et al. Interaction between MicroRNA-7 and its Target Genes in Schizophrenia Patients. J Psychiatry.2015;18:235.
- Ariela Gigi et al. Visual Impairment Affects the Perception of Reality: Visual Processing Deficits amongAdolescents with Schizophrenia. J Psychiatry. 2015;18:232.
- Chieffi S et al. Vulnerability to Distraction in Schizophrenia. J Psychiatry. 2015;18:228.
- Hukic DS et al. Genes Associated with Increased Fasting Glucose in Patients with Schizophrenia SpectrumDisorders. J Diabetes Metab. 2015;6: 512.
- Palego L et al. Sulfur Metabolism and Sulfur-Containing Amino Acids Derivatives – Part II: Autism SpectrumDisorders, Schizophrenia and Fibromyalgia. Biochem Pharmacol (Los Angel). 2015; 4:159.
- Werner FM and Covenas R . Clinical Efficacy of Antipsychotic Drugs in the Treatment of Schizophrenia. J CytolHistol. 2014;S4:013.
- Hussien ZN et al. Prevalence and Associate Factors of Suicidal Ideation and Attempt among People withSchizophrenia at Amanuel Mental Specialized Hospital Addis Ababa, Ethiopia. J Psychiatry. 2015;18:184.
- Singh M et al. Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning among Patients with Schizophrenia: ACross Sectional Comparative Study. J Psychiatry. 2015;18:211.
- Kaberi Bhattacharya. Cognitive Function in Schizophrenia: A Review. J Psychiatry. 2015; 18:1000187.
- Ikemoto K et al. Lectin-Positive Spherical Deposits (SPD) Detected in the Molecular Layer of HippocampalDentate Gyrus of Dementia, Downâ€™s Syndrome, and Schizophrenia. J Alzheimers Dis Parkinsonism.2014;4:169.
- Yavasci EO et al. Prediction of Depression in Schizophrenia: Can serum Levels of BDNF or EGF Help us?. J Psychiatry. 2014;17:1000156
- Yang C et al. A Review: Detecting Alterations of Brain Connectivity in Schizophrenia based on Structural MRI.J Psychiatry. 2014;17:159
- Jang CH et al. A Case of Clozapine-Resistant Schizophrenia Associated With a Large Arachnoid Cyst in theLeft Sylvian Fissure. J Psychiatry. 2014;17:176
- Saeed Ahmed et al. Nicotine Addiction in Schizophrenia, Availability of Better Treatment Options as are inGeneral Population International Journal of Emergency Mental Health and Human Resilience. 2014; 17:156-166.
- Langlois M et al. Thirty Days without a Bite: Wernickeâ€™s Encephalopathy in a Patient with ParanoidSchizophrenia. J Neurol Disord. 2014;2:182.
- Ryan M and Melzer T. Delusions in Schizophrenia: where are we and where Do we need to go?. Int J Sch Cog Psychol. 2014; 1:115.
- Quliti KWA . A Case Study of Partial Seizure with Secondary Generalization Induced by Clozapine in Patientwith Treatment Resistant Schizophrenia. Brain Disord Ther. 2014; 3:145.
- Millier A et al. Reasons for Aripiprazole Discontinuation in Schizophrenia â€“ A Retrospective. J NeurolNeurophysiol. 2014; 5:226.
- Meszaros ZS et al. Smoking Severity and Functional MRI Results In Schizophrenia: A Case-Series. J Addict ResTher. 2014; 5:189.
- Werner FM. Brain Centers Involved in Schizophrenia. J Cytol Histol. 2014; 5:e101.
- Yann auxemery. Munchhausen Syndrome by Proxy with Psychiatric Features. J Child Adolesc Behav. 2014;2:151.
- Prior SL et al. Metabolic Alterations Associated With Antipsychotic Useâ€“A Descriptive Study and Comparison between Haloperidol and Olanzapine in Schizophrenic and Bipolar Patients. JPharmacovigilance. 2014; 2:143.
- Yılmaz ED et al. Correlation between Anxiety and Personality in Caregivers for Patients with Schizophrenia. J Psychiatry. 2014; 17:130.
- Park AL. Exploring the Economic Implications of a Group-Based Lifestyle Intervention for Middle-Aged Adultswith Chronic Schizophrenia and Co-Morbid Type 2 Diabetes. J Diabetes Metab. 2014; 5:366
- Ahmadian S and Zaeifi D. D3 as a Possible Marker Based on D1- D4 Dopamine Receptors Expression inParanoid Schizophrenia Patients. J Mol Biomark Diagn. 2014; 5:171.
- Gharibzadeh S et al. Reactivation of NMDA Receptors by Synaptic Reentry Reinforcement, a Probable Causeof Auditory Hallucination in Schizophrenia. Brain DisordTher. 2014; 3:118
- RH Mataboge et al. Handedness in schizophrenia and schizoaffective disorder in an Afrikaner founderpopulation J Psychiatry 2014;17:475-482
- Rosedale MT et al. Transcranial Direct Current Stimulation to Enhance Cognition and Functioning inSchizophrenia. J Nov Physiother. 2014; 4:191.
- Mesbah et al. Morphometric characteristics of craniofacial features in patients with schizophrenia JPsychiatry 2014;17:514-519
- Taiwo Olamide Oduguwa et al. A comparative study of self stigma between HIV/AIDS and schizophreniapatients J Psychiatry 2014;17:525-531
- Jan L and Chalany J. Clozapine for Treating Pharmaco resistant Schizophrenia among Elders. J Clin Diagn Res.2014; 2:101.
- Sakai M et al. An Attempt of Nonhuman Primate Modeling of Schizophrenia with Neonatal Challenges of Epidermal Growth Factor. J Addict Res Ther. 2014; 5:170.
- Hood S and Hudaib AR. A Patient with a Pancreatic Endocrine Tumor develops Chronic Schizophrenia: Reportof a Case. J Clin Case Rep. 2013; 4:328.
- Zhang J et al. A FDG-PET and fMRI Study on Glucose Metabolism and Hemodynamic Response during VisualAttentional Performance in Schizophrenia. OMICS J Radiology. 2013; 2:149.
- J Burns. Dispelling a myth: developing world poverty, inequality, violence and social fragmentation are notgood for outcome in schizophrenia Afr J Psychiatry 2009;12:200-205
- L Mosotho et al. Schizophrenia among Sesotho speakers in South Africa Afr J Psychiatry 2011;14:50-55
- JL Roos. Genetics of schizophrenia:communicating scientific findings in the clinical setting Afr J Psychiatry2011;14:105-111
- RJ Maydell et al. Clinical characteristics and premorbid variables in childhood onset schizophrenia: adescriptive study of twelve cases from a schizophrenia founder population Afr J Psychiatry 2009;12:144-148
- ABR Janse Van Rensburg et al. Diagnosis and treatment of schizophrenia in a general hospital based acutepsychiatric ward Afr J Psychiatry 2010;13:204-210
- L Asmal et al. Family therapy for schizophrenia: cultural challenges and implementation barriers in the SouthAfrican context Afr J Psychiatry 2011;14:367-371
- BA Issa. Delusional disorder-somatic type (or body dysmorphic disorder) and schizophrenia: a case report AfrJ Psychiatry 2010;13:61-63
- S Grover et al. Lilliputian hallucinations in Schizophrenia: a case report Afr J Psychiatry 2012;15:311-313
- I Smit et al. Neurological soft signs as an endophenotype in an African schizophrenia population –a pilot studyAfr J Psychiatry 2012;15:124-127
- A Ogunwale et al. Matricide and schizophrenia in the 21st century: a review and illustrative cases Afr J Psychiatry 2012;15:55-57
- O Esan. Prevalence of schizophrenia: recent developments Afr J Psychiatry 2013;16:93
- AO Adelufosi et al. Pattern of attendance and predictors of default among Nigerian outpatients withschizophrenia Afr J Psychiatry 2013;16:283-287
- L Koen et al.Antipsychotic prescription patterns in Xhosa patients with schizophrenia or schizoaffectivedisorder Afr J Psychiatry 2008;11:287-290
- F Seedat et al. Prevalence and clinical characteristics of obsessive-compulsive disorder and obsessive compulsive symptoms in Afrikaner schizophrenia and schizoaffective disorder patients Afr J Psychiatry 2007;10:219-224
- JK Burns et al. Cannabis use predicts shorter duration of untreated psychosis. S Afr Psychiatry Rev 2006;9:99-103
- S Jones et al. Management of treatment resistant schizophrenia S Afr Psychiatry Rev 2006;9:17-23
- Martin C Scholtz et al. Early non-psychotic deviant behaviour as an endophenotypic marker in bipolardisorder, schizo-affective disorder and schizophrenia S Afr Psychiatry Rev 2005;8:153-159
- Renata Ronelle du Preez and William Charles Griffith, Mark Page Major depressive disorder as a co-morbid diagnosis in schizophrenia versus the diagnosis of schizoaffective disorder –depressed type S Afr PsychiatryRev 2005;8:134-139
- Sean Exner Baumann. The schizophrenias as disorders of self consciousness S Afr Psychiatry Rev 2005;8:95-99
- Khan M and Kabadi UM. Metabolic Challenges in Schizophrenia. J Psychol Psychother. 2013; 3:115.
- Andreica-Săndică B. The Necessity of Family Type Interventions During First - Episode Psychosis inSchizophrenia. J Trauma Treat. 2012; 2:e111.
- Yamagishi S et al. Spine Homeostasis as a Novel Therapeutic Target for Schizophrenia. Clin PharmacolBiopharm.2012; S1:001.
- Ikemoto K. Why D-neuron? Direction from Psychiatric Research. J Neurol Neurophysiol. 2012; S11-002.
- Sandy PT and Mgutshini T. Integrating Religiosity into Motivational Interviewing and Nicotine ReplacementTherapy for a Patient with Schizophrenia and Nicotine Addiction: Lessons from a Mental Health Service. JAddict Res Ther. 2012; 3:127.
- Mas-ExpÃ³sito L et al. Physical Health and Schizophrenia in Clinical Practice Guidelines and ConsensusStatements. J Addict Res Ther. 2012; S8:001.
- Ikemoto K. D-Neuron: Is it Ligand-Producing Neuron of Taar1? From Schizophrenia Research. J CommunityMed Health Educ. 2013;3:221.
- Shankar GS and Yuan C. Effects of 5HT2c Blockade of Dibenzodiazepines on Thyroid Levels in Patients withSchizophrenia or Schizoaffective Disorder. Autacoids. 2013; 2:102.
- Jacob A et al. Abnormal Brain Circuitry and Neurophysiology Demonstrated by Molecular Imaging Modalitiesin Schizophrenia. J Alzheimers Dis Parkinsonism. 2013; 3: 114.
- Ikemoto K. Are D-Neurons and Trace Amine-Associated Receptor, Type 1 Involved in Mesolimbic DopamineHyperactivity of Schizophrenia? Medchem. 2012; 2:111.
- Grover et al. Relapse of Tourette Syndrome with Clozapine in a Patient of Paranoid Schizophrenia. J ClinicCase Reports. 2012; 2:e112.
- Tsui MCM. Review of the Effects of Yoga on People with Schizophrenia. J Yoga Phys Therapy. 2012; S1:001.
- Hima Bindu A et al. Genetic and Degenerative Neurological Disorders â€“ an Emphasis on Alzheimerâ€™s,the Mystery. J Genet Syndr Gene Ther. 2011; 2:109
- Luo JJ and Dun NJ. New Research Advances in Obesity: Relevant to Neurologic Disorders. Brain Disord Ther.2012; 1:e103.
- Karkhane Yousefi M et al. A Review of Vareniclineâ€™s Efficacy and Tolerability in Smoking CessationStudies in Subjects with Schizophrenia. J Addict Res Ther. 2011; S4:001.
- Linda P et al. Comparative Proteome Analysis of Thalamus and Cortex from Rats Subchronically Treated withKynurenine and Probenecid. J Proteomics Bioinform. 2008;1: 090-097
- Stone MH. Marijuana and Psychosis: The Effects of Adolescent Abuse of Marijuana and other Drugs in aGroup of Forensic Psychiatric Patients. J Child Adolesc Behav. 2015; 3:188
- Maner F et al. The Coexistence of Arachnoid Cyst with First Episode Psychosis: Four Cases. J Neurol Disord.2014; 2:186.
- Chaurasia RN and Mishra V. Hashimotoâ€™s Encephalopathy Presenting as Acute Psychosis. Int J Neurorehabilitation. 2014;1:131.
- Mufaddel A. Epilepsy and its Management in Relation to Psychiatry. Int J Neurorehabilitation. 2014; 1:121.
- Stevens AWMM et al. The Effect of Sleep Disturbance during Pregnancy and Perinatal Period on PostpartumPsychopathology in Women with Bipolar Disorder. J Womenâ€™s Health Care. 2014; 3:196.
- Jennifer Piel. Case of Migraine Psychosis with Traumatic Brain Injury. J Psychiatry. 2014; 17:113.