So What is it?
Schizophrenia is defined as a chronic mental
disorder with periods of psychosis, disturbed
behavior and thought, and decline in
functioning that lasts >6months.
Simply put, individuals affected lack the
ability to tell the difference between what is
real and what is not real. They tend to not
have normal emotional responses and act
abnormally in social situations.
Diagnosis requires 2 or more of the following
5.Negative Symptoms-Flat affect, social
withdrawal, lack of motivation, lack of speech
Mental health experts expressed
confounding variables as to the cause of
It has been implicated to be multifactorial,
which means environmental, social, genetic,
can all be possible factors involved.
Marijuana use in teens has been implicated
as a risk factor for schizophrenia, though
this claim is still controversial.
In the past 15 years, longitudinal cohort studies
have showed strong support for an association
between marijuana use as an adolescent and a
greater risk for developing a psychotic disorder
such as schizophrenia.
These studies surveyed for self-reported
marijuana use before psychosis onset and
controlled for a variety of potential
confounding factors (e.g, other drug use and
demographic, social, and psychological
The genes, in combination with suspected
environmental factors - are believed to be the
factors that result in schizophrenia. These genes
that seem to cause increased risk of
DISC1, Dysbindin, Neuregulin and G72 genes,
but it has been estimated that up a dozen or
more genes could be involved in schizophrenia
This disease process is usually insidious in
its onset, developing gradually over many
Individuals predisposed to this disease may
have inciting triggers
Some examples may include: depression,
anxiety, PTSD, sexual/physical abuse, and
Classic early symptoms include trouble
concentrating, Insomnia, irritability.
These symptoms are usually compounded
with bizarre behaviors, auditory
hallucinations, isolation, delusions of
grandiosity, and loose associations.
The issue is that there are really no medical
tests to absolutely diagnose schizophrenia
which is why brain scans such as CT/MRI,
and blood tests, are usually ordered to rule
out any organic cause.
As a psychiatrist, it is your job to asses:
How long the symptoms have lasted
Antipsychotic medicines are the most
effective treatment for schizophrenia.
Examples include Haloperidol,
Atypical antipsychotics are becoming more
common, some of these include:
Clozapine, Olanzapine, Risperidone, and
Aripiprazole(Abilify), are just a few to
All antipsychotic medications have the same
goal, which is to somehow re-establish the
chemical imbalances in the brain that are
causing these intense varied symptoms.
Changing the chemical imbalances will not
cure the disease, but the goal is to control
the symptoms to allow individuals to live
relatively normal lives.
Some of the antipsychotics have very
dangerous side effects
Some very sever and often irreversible
effects include: Tardive Dyskinesia or
Leukopenia(low white count)
The prescribing physician must be
extremely wary of this and monitor patients
The prognosis for schizophrenia is hard to predict. Most of the
time, symptoms improve with medication, but many people may
have some trouble functioning. They are at risk of repeated
episodes, especially during the early stages of the illness.
People with schizophrenia may need housing, job training, and
other community support programs. People with the most severe
forms of this disease may not be able to live alone. They may need
to live in group homes or other long-term, structured residences.
Symptoms are very likely to return when medication is stopped,
which is why the planned regimen by the physician is extremely
important to abide by and family members of the patients affected
must be advised make sure patient stays on course.
An estimated 2.2 million are affected with schizophrenia
in the United States
To give an idea of how unfortunately tremendous this
Schizophrenia-over 2.2 million people
Multiple Sclerosis: 400,000 people
Insulin-dependent Diabetes: 350,000 people
Muscular Dystrophy: 35,000 people
Schizophrenia is a devastating disorder for most people
who are afflicted, and very costly for families and
The overall U.S. cost of schizophrenia was estimated to
be $62.7 billion, with $22.7 billion excess direct health
($7.0 billion outpatient, $5.0 billion drugs, $2.8 billion
inpatient, $8.0 billion long-term care).
Schizophrenia has long been considered the most
chronic, debilitating and costly mental illness, which as
stated before consumes a total of about $63 billion a
year for direct treatment, societal and family costs.
Richard Wyatt, M.D., chief of
neuropsychiatry, National Institutes of Mental
Health, has said that nearly 30 percent ($19 billion) of
schizophrenia's cost involves direct treatment and the
rest is absorbed by other factors -- lost time from work
for patients and care givers, social services and criminal
Schizophrenia Ranks among the top 10 causes of disability
in developed countries worldwide
The reason why it is so pressing for us to be aware of the
signs and symptoms of this disease is, according to
researchers at Yale Medical school, the earlier that
schizophrenia is diagnosed and treated, the better the
outcome of the person and the better the recovery.
Which means excess healthcare costs can be directed
elsewhere, healthier social living, less stress on families, and
most importantly better outcomes for the patients.
First Aid for the USMLE
Jeffrey S.Futterleib, MD- Yale School of medicine
Eric Kuom, MD-Yale School of Medicine
Jaysson Brooks, MD-Johns Hopkins
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