Schizophrenia is a complex psychiatric disorder characterized by disorganized thoughts, delusions, hallucinations, inappropriate affect, and impaired social functioning. The exact causes are unknown but likely involve genetic, brain chemical, environmental, and family history factors. Brain imaging shows enlarged ventricles and decreased cortical size, particularly in the left temporal lobe. Symptoms include positive symptoms like hallucinations, negative symptoms like loss of interest, and mood symptoms. Treatment involves pharmacological therapy with antipsychotics and non-pharmacological approaches like therapy, social skills training, and vocational rehabilitation.

1. Schizophrenia

2. GROUP#06
GROUP MEMBERS:
FATIMALARAIB
KHADIJABIBI
SALMAIQBAL
SANA RAHAT
SANANAZ
SAMINANOOR
TEHMINA QAMAR
TABASSUMNAZ
ZAHIDABIBI
ZEBUNNISA

3. INTRODUCTION
Schizophrenia is one of the most complex and
challenging of psychiatric disorder. It represents a
heterogeneous syndrome of disorganized and
bizarre thoughts, delusions, hallucination,
inappropriate affects and impaired psychosocial
functioning.
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4. Conti…

6. ETIOLOGY
• Etiology of schizophrenia is unknown but
research have demonstrated various
abnormalities in brain structure and function.
• The exact cause of schizophrenia is most likely to
be multifactorial.
• These factors include:
1. Genetics
2. Brain chemical imbalance
3. Environmental factors
4. Family history

7. PATHOPHYSIOLOGY
Computed axial tomography (CAT) scans and
magnetic resonance imaging (MRI) studies
shows increased ventricular size, particularly in
the third lateral ventricles.

8. contd
Changes appears to be consistent with brain asymmetry, the ventricular
enlargement being most pronounced in the left temporal horn, Change in
hippocampal volume also occur, this results in impairment in
neuropsychological testing, these pts might not response to first
generation anti-psychotics

9. contd
• Decreased cortical size being most obvious
in left temporal lobe.

10. CAUSES

11. POSITIVE
SYMPTOMS
• Auditory hallucination
• Illusions
• Disorganized speech and behavior
NEGATIVE
SYMPTOMS
• Emotional range
• Loss of interest
• Poverty of speech
MOOD
SYMPTOMS
• Depression
• Anxiety
• Cheerful or sad
CLINICAL PRESENTATION OF
SCHIZOPHERINA

14. NON PHARMACOLOGICAL TREATMENT
OF SCHIZOPHERINA
PERSONAL THERAPH
FAMILY TREATMENT STRESS REDUCTION

15. SOCIAL SKILL
TRAINING
COGNITIVE
REMEDIATION
VOCATIONAL
REHABILITATION

16. Pharmacological
Therapy

17. ASSESSMENT
PRIOR TO
TREATMENT
Thorough mental
status examination,
Physical and
neurologic
examination
Complete family and
social history
Laboratory work-up
must be performed
to confirm the
diagnosis
Exclude general
medical or
substance-induced
causes of psychosis,
such as acute or
chronic drug
ingestion.
Laboratory tests,
Biologic markers, and
commonly available
brain imaging
techniques do not
assist in diagnosis or
selection of
medication. .

18. Laboratory
Test
Complete blood count
Electrolytes
Hepatic function
Renal function
Electrocardiogram
Fasting serum glucose
Serum lipids
Thyroid function
Urine drug screen.

19. ANTIPSYCHOTIC MEDICATIONS

21. FIRST GENERATION
ANTIPSYCHOTICS
Also called typical anti psychotics.
More likely to produce extrapyramidal side effects.
Not considered first-line treatment.
All FGA’s are equal in efficacy when used in equipotent doses.

22. MECHANISM OF ACTION
First-generation are D2 antagonists, they lower
dopaminergic neurotransmission in the four dopamine
pathways. In addition, they can also block other receptors
such as histamine-1, muscarinic-1 and alpha-1.

23. INDICATIONS
FGA’s
USES
Dementia
Tourette
Disorder
Acute Mania
Childhood
Schizophrenia
Severe
Agitation:
Delusional
Disorder:
Schizophrenia

24. ADVERSE DRUG REACTIONS
Urinary
retention
Dry mouth
Constipation
Torsades de
pointes
Ventricular
arrhythmia

25. EXAMPLES OF DRUGS
CHLORPROMAZINE
• Low potency
• EPS less common
• More anti-
cholinergic activity
• More sedative
• 100-800 mg/day
HALOPERIDOL
• High potency
• EPS more common
• Less anti-
cholinergic activity
• Less sedative
• 2-20 mg/day

26. SECOND GENERATION
ANTIPSYCHOTICS
Also called atypical anti psychotics .
First choice in treatment of schizophrenia.
More effective then FGA’s.
Much less likely to produce extrapyramidal side effects.
Enhanced efficacy.

27. MECHANISM OF ACTION

28. USES
• Negative symptoms
• Cognition

29. ADR’s

30. RISPERIDONE ZIPRASIDONE
Low incidence of EPS Enhanced efficacy
4-6 mg daily 40-160 me /day
Low possible dose should be used Less potential to produce weight gain
EXAMPLE OF DRUGS

31. Initial Treatment in an Acute
Psychotic Episode
ACUTE PHASE
Acute psychotic symptoms -delusions, hallucination, disorganized
thinking, behavioral disturbance.
The goals of acute phase treatment are,
• To ensure patient safety,
• To perform a comprehensive physical and psychiatric assessment.
• To provide prompt treatment of psychotic symptoms, and To
establish a therapeutic alliance with the patient and the patient's
family.
• Acute phase treatment may involve psychiatric hospitalization if
patient safety or compliance cannot be ensured in a less
restrictive setting

34. Emergent Pharmacotherapy In The Acute
Phase
• Although oral administration is optimal to minimize patient
distress, intramuscular agents may be necessary to reduce acute
agitation and psychosis in patients who are unable or unwilling
to comply with oral medication.
• Commonly used agents include:
1. Olanzapine 10-20mg IM or Ziprasidone 10-20mg IM.
2. Haloperidol 2-20mg IM (consider with benztropine 1-2mg IM to
reduce risk of EPS or acute dystonic reaction).
3. lorazepam, IM 2 mg, as needed in combination with the
maintenance antipsychotic may actually be more effective in
controlling agitation than using additional doses of the
antipsychotic.
If the patient is willing to take oral medication, but adherence is in
question, use of orally disintegrating tablets (risperidone ;
olanzapine ) or liquid (risperidone, aripiprazole) is recommended.

35. Use Of ECT In Acute Phase
• ECT (electroconvulsive therapy) in combination with
antipsychotic medications may be considered for
patients with schizophrenia or schizoaffective disorder
with severe psychotic symptoms that have not
responded to treatment with antipsychotic agents.
• The greatest therapeutic benefits appear to occur when
ECT is administered concomitantly with antipsychotic
medications.
• A trial of clozapine will generally be indicated before
acute treatment with ECT.
• ECT may also be beneficial if comorbid depressive
symptoms are resistant to treat or if features such as
suicidal ideation and behaviors.

36. STABILIZATION THERAPY
• Improvement is usually a slow but steady process over 6 to
12 weeks
or longer.
• Improvement in formal thought disorder should follow and
may take an additional6 to 8 weeks to respond.
• In a more chronically ill patient, symptoms may continue
to improve for 3 to6 months.
• An optimum dose of the chosen drug should be estimated
in the initial treatment plan.

37. • An optimum dose of the chosen drug should
be estimated in the initial treatment plan.
•
• the patient should remain at this
dosage as long symptoms
continue to improve. In general,
adequate time on a therapeutic
antipsychotic dose is the most
important factor.

38. Maintenance drug
therapy prevents
relapse, The average
relapse rate after 1
year is 18% to32%
with active drug.
MAINTENANE
TREATMENT

39. • After treatment of
the first psychotic
episode in a
schizophrenic
patient , medication
should be
continued for at
least 12 months
after remission.

40. • Continuous or lifetime
pharmacotherapy is
necessary in the majority
of patients to prevent
relapse.
• Antipsychotics should be
tapered slowly before
discontinuation.

41. LONG ACTING
ANTIPSYCHOTICS

42. Recommended for patients who are unreliable in taking oral medication on daily basis.
Not usually used as first line therapy
Patient’s motivation for treatment is a major factor influencing outcome
Conversion from oral therapy to a long acting injectable is most successful in patient s who have been stabilized on oral
therapy
Conversion of medication should start with stabilization on an oral dosage from of the same agent, or at least a short trial (
3- 7 days).
Dose adjustments are recommended to be made no more often than once every 4 weeks
For patients not exposed to the oral drug, an oral test dose of the medication is recommended before administering the
first IM dose of the long acting antipsychotics

43. “lack of improvement in positive symptoms, but
can be defined by poor improvement in
negative symptoms, or even by medication
intolerance”
Between 10% to 30% of patients receive
minimal symptomatic improvement after FGA
mono therapy trials
An additional group of patients 30% to 60%
has partial but inadequate improvement in
symptoms or unacceptable sideeffects
associated with antipsychotic use
MANAGEMENT OF TREATMENT RESISTANT SCHIZOPHRENIA

44. Acute overdose with antipsychotics rarely results in
serious symptomatology.
Dystonias and pseudoparkinsonism symptoms also
occur.
Mild intoxication manifests as sedation,
hypotension,and miosis, whereas with severe
intoxication, agitation and deliriummay typically
progress to motor retardation, seizures, cardiac
arrhythmias, respiratory arrest, and coma.
TOXICITY WITH
OVERDOSE

45. Supportive measures, gastric lavage, andactivated
charcoal are recommended.
Induction of emesis may be difficult because of
effects on the chemoreceptor trigger zone, and
dialysis is ineffective because of the degree of drug-
protein binding.
Phenytoin or sodium bicarbonate are useful in
the treatment of quinidine-like cardiac
conduction effects on the QRS or QTc intervals.

46. What withdrawal symptoms might I get?
• The main withdrawal symptoms associated with antipsychotics
are:
Restlessness, Anxiety Difficulty sleeping Agitation
nausea,
Uncontrollable
movements
Runny nose Tardive dyskinesia

47. How to Safely Stop Taking Antipsychotics
You will need to come off slowly and gradually by reducing your daily dose over
a perod of weeks or months.
Avoid stopping suddenly – if you come off too quickly you are much more likely
to have a relapse of your psychotic symptoms or to develop tardive psychosis.
Get support from people close to you. Ideally this will include support from
your GP or your psychiatrist as well as friends, family and peer support from
other people who've had similar experiences and can relate to what you're
going through

48. DRUG
DRUG
INTERACT
ION:
Anti psychotic + Tri cyclic
antidepressent(TCA) =
Slow mycoardial conduction
Anti psychotic + Selective serotinin
reuptake inhibitor (SSRI) = Akathisia
Anti psychotic + Metoclopramide =
Akathisia
Anti psychotic + Carbamazipine = Induce
colanzapine metabolism & lead to lower
serum concentration
Anti psychotic + erthromycin , cimitidine ,
gape fruit = Sedation