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  1. 1. 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.
  2. 2. Diagnosis  Diagnosis requires 2 or more of the following symptoms  1.Delusions  2.Hallucinations-often auditory  3.Loose Associations  4.Disorganized behavior  5.Negative Symptoms-Flat affect, social withdrawal, lack of motivation, lack of speech or thought
  3. 3. Causes/Risk Factors  Mental health experts expressed confounding variables as to the cause of schizophrenia.  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.
  4. 4.  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 variables).
  5. 5. Genetic influence  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 schizophrenia include:  DISC1, Dysbindin, Neuregulin and G72 genes, but it has been estimated that up a dozen or more genes could be involved in schizophrenia risk.
  6. 6. Signs/Symptoms  This disease process is usually insidious in its onset, developing gradually over many years.  Individuals predisposed to this disease may have inciting triggers  Some examples may include: depression, anxiety, PTSD, sexual/physical abuse, and drugs.
  7. 7.  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.
  8. 8.  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.
  9. 9.  As a psychiatrist, it is your job to asses:  How long the symptoms have lasted  Functional decline  Developmental background  Substance abuse  Medical problems
  10. 10. Tx  Antipsychotic medicines are the most effective treatment for schizophrenia.  Examples include Haloperidol, Fluphenazine, Chlorpromazine.  Atypical antipsychotics are becoming more common, some of these include:  Clozapine, Olanzapine, Risperidone, and Aripiprazole(Abilify), are just a few to name.
  11. 11.  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.
  12. 12.  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 accordingly.
  13. 13. Prognosis  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.
  14. 14. Prevalence  An estimated 2.2 million are affected with schizophrenia in the United States  To give an idea of how unfortunately tremendous this number is:  Schizophrenia-over 2.2 million people  Multiple Sclerosis: 400,000 people  Insulin-dependent Diabetes: 350,000 people  Muscular Dystrophy: 35,000 people
  15. 15. Impact  Schizophrenia is a devastating disorder for most people who are afflicted, and very costly for families and society.  The overall U.S. cost of schizophrenia was estimated to be $62.7 billion, with $22.7 billion excess direct health care cost  ($7.0 billion outpatient, $5.0 billion drugs, $2.8 billion inpatient, $8.0 billion long-term care).
  16. 16.  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 justice resources.
  17. 17.  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.
  18. 18. Works Cited  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  Analysis Group, Inc.  The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press, 1996.  PubMed Health-Reviewed by: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.  Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 28  Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.  Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 404.