Schizophrenia is a disease that affects thoughts, emotions, and actions. It was first described in the 19th century and given its current name in 1911. There are various biological, psychological, and social factors involved in its etiology. Genetics plays a major role, with risk increasing if a family member has schizophrenia. Symptoms include positive symptoms like delusions and hallucinations as well as negative symptoms such as apathy. It is diagnosed based on symptoms and differential diagnosis is needed to rule out other conditions. Outcomes vary but many experience impairment. Management involves antipsychotic medication, psychosocial support, and addressing any substance abuse or medical issues.
Schizophrenia is a metal disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness and social interaction. Here the etiology, epidemiology, types, signs and symptoms, pathophysiology, complications, diagnosis as well as management of schizophrenia is explained.
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Schizophrenia is a metal disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness and social interaction. Here the etiology, epidemiology, types, signs and symptoms, pathophysiology, complications, diagnosis as well as management of schizophrenia is explained.
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
Neuropsychiatric aspects of hiv infection and aidsRobin Victor
HIV & AIDS are closely related to psychiatry with the infection giving rise to many psychiatric problems and psychiatric illnesses leading to risk of acquiring HIV. Hence the approach to such a situation must be holistic with good coordination between medical specialists and psychiatrists, psychologists to bring maximum possible benefit to people with such a difficult illness
Hallucination definition, explanation. Difference between true perception and hallucinations. Mental images. Pseudo-hallucinations. Causes of hallucinations. Types of hallucinations.
A mental health disorder characterized by feelings of worry, anxiety or fear that are strong enough to interfere with one's daily activities.
this is a detailed medical study mentioning all the aspects of anxiety disorder ,
please comment
thank you
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
Neuropsychiatric aspects of hiv infection and aidsRobin Victor
HIV & AIDS are closely related to psychiatry with the infection giving rise to many psychiatric problems and psychiatric illnesses leading to risk of acquiring HIV. Hence the approach to such a situation must be holistic with good coordination between medical specialists and psychiatrists, psychologists to bring maximum possible benefit to people with such a difficult illness
Hallucination definition, explanation. Difference between true perception and hallucinations. Mental images. Pseudo-hallucinations. Causes of hallucinations. Types of hallucinations.
A mental health disorder characterized by feelings of worry, anxiety or fear that are strong enough to interfere with one's daily activities.
this is a detailed medical study mentioning all the aspects of anxiety disorder ,
please comment
thank you
Schizophrenia is a chronic psychiatric disorder. People with this disorder experience distortions of reality, often experiencing delusions or hallucinations.
The exact cause of schizophrenia isn't known, but a combination of genetics, environment and altered brain chemistry and structure may play a role.
Schizophrenia is characterised by thoughts or experiences that seem out of touch with reality, disorganised speech or behaviour and decreased participation in daily activities. Difficulty with concentration and memory may also be present.
Treatment is usually lifelong and often involves a combination of medications, psychotherapy and coordinated speciality care services.
Schizophrenia is one of the most debilitating mental illness which demands immediate attention by the family. There are certain types of schizophrenia based on its symptom presentation and its management mostly depends sxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling. People with schizophrenia require lifelong treatment.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Schizophrenia
History
It is a disease of thoughts, action and emotions.
In the year 1860, Morel used the term demence
precoce to describe a state of bizarre behavior and
abnormal mental functions.
Emil kraeplin 1899 used the term dementia precox
and differentiated it from manic depressive illness.
Bleuler 1911, coined the term schizophrenia and
he thought that it resulted from splitting of psychic
functions particularly affective and cognitive.
2
4. Schizophrenia
Etiology
Biological factors:
Genetics:
The risk of developing schizophrenia in the
general population is 1%.
The risk becomes 10% if one parent or a sibling in
the family is schizophrenic.
The risk is 40% if both parents are schizophrenic.
It is 10-15% for a dizygotic co twin of an affected
individual and 40% for a monozygotic co twin.
4
6. Schizophrenia
Etiology
Biological factors:
Neurochemistry:
Dopamine based on the effect of amphetamine
which releases dopamine causing psychosis and
classical antipsychotic drugs which block dopamine
receptors.
Serotonin based on the atypical antipsychotics
which block both dopamine and serotonin
receptors.
Glutamate based on the antagonism of glutamate
receptors by phencyclidine leading to psychosis.
6
8. Schizophrenia
Etiology
Psychological factors:
Psychological stress-high expressed emotions:
Families who have excessive critical comments and
hostility as well as emotional overinvlovement with the
patients are described as high expressed emotions
families. The chance of relapse for schizophrenic
patients living in those families is greater than in other
families.
Tim Crew and Mary Johnstone.
8
9. Schizophrenia
Etiology
Social
Cannabis: the use of cannabis in
adolescence increases the risk of
schizophrenia in adulthood.
Life events: schizophrenic patients may
exposed to more life events than normals.
PSYCHIATRY 4:10 History
9
10. Schizophrenia
epidemiology and risk factors
Age of onset: 15-35 years and it is 3-4
years earlier for males than females.
Sex: the incidence is the same for
both sexes but recent metanalysis
indicates more in men .
Socia class: more in lower
socioeconomic states ( drift
hypothesis)
10
11. Schizophrenia
epidemiology and risk factors
Immigration it is more common in
immigrants than native population
but this could be a gene environment
interaction.
It is more common in urban than rural
populations.
PSYCHIATRY 4:10 Epid
11
12. Schizophrenia
symptoms
DSM IV and ICD described some
types of schizophrenia as paranoid,
hebephrenic and catatonic types and
the symptoms are classified into
positive, acute or type I symptoms
and negative, chronic and type II
symptoms.
12
13. Schizophrenia
symptoms
Positive symptoms include: delusions which
could be bizarre, persecutory, control or
somatic. Hallucinations which are mostly
auditory of the second or third person,
commanding and running commentary.
Visual hallucination are less common.
Other thought disorders include loosening of
association and thought block
13
14. Schizophrenia
symptoms
Negative symptoms include:
Alogia
Affective flattening
Avolition-apathy
Anhedonia- asociality
Inattention
They are mostly a reflection of cognitive dysfunctions
due to prefrontal cortex atrophy.
Depression and extrapyramidal side effects of
antipsychotics could be misdiagnosed as negative
symptoms.
PSYCHIATRY 4:10
14
15. Schizophrenia
diagnosis
There have been many descriptions of
the condition and many criteria for the
diagnosis including Bleuler’s 4 A s and
Schneider’s first rank and second rank
symptoms and more recently DSM and
ICD.
The main symptoms required for the
diagnosis includes delusions,
hallucinations, disorganised thoughts and
behaviour.
15
16. Schizophrenia
cognition
Cognitive disorders are now considered
as the core symptoms of schizophrenia.
They impair individuals in areas of
vocation, social network and living
independently.
Typical antipsychotics cause cognitive
impairments and atypicals have no such
an effect.
Am J Psychiatry 166:6, June 2009
16
17. Schizophrenia
outcome and prognosis
Most of the studies done on the
schizophrenic patients revealed that a
proportion of the patients will remain ill
from the first episode and will never
recover. Another proportion will have
only one episode with some residual
effect and will be able to function
normally in areas of social and
occupational life.
17
18. Schizophrenia
outcome and prognosis
In the UK, a 5-year follow-up study of a first-admission
cohort of 49 schizophrenic patients found that in most
cases the illness followed one of four broad patterns:
• one episode only and no impairment (22%)
• several episodes with no or minimal impairment
(35%)
• repeated episodes with impairment after first
episode with subsequent exacerbation and no return
to normality (8%)
• impairment increasing with each of several episodes,
with increasingly severe residual symptoms and no
return to normality (35%
18
19. Schizophrenia
outcome and prognosis
The outcome is generally better for
females. The prognosis is better for both
sexes in developing than industrialized
countries.
Factors indicating poor prognosis include
male sex, family history of schizophrenia,
structural brain abnormalities, absence of
life events, early onset, cognitive deficit,
substance abuse and poor premorbid
functioning
19
20. Schizophrenia
outcome and prognosis
Good prognosis is predicted in good
premorbid social functioning, later
and sudden onset, presence of
depressive symptoms, good initial
response to medications and absence
of tension in the family.
PSYCHIATRY 4:10
20
23. Schizophrenia
Management
The management of first episode schizophrenia
should include diagnosis and differential diagnosis.
Proper history, physical and neurological examination
is mandatory.
Investigations are needed to exclude other disorders
and they include:
Urine screening for drugs
Blood tests including full blood count, liver function
tests, thyroid function tests, urea and electrolytes
and calcium.
EEG and Neuroimaging including CT and MRI 23
24. Schizophrenia
Management
Antipsychotics: it is better to start with an atypical
antipsychotic if the patient is not already on
antipsychotics.
Benzodiazepines may be needed as adjuvants for a
short time to control agitation and insomnia.
Control drug and alcohol intake.
Family support in the form of psycho education and
groups . Try to identify high expressed emotions to
avoid future relapses.
24
25. Schizophrenia
Management
Encourage drug compliance.
Minimise the duration of untreated psychosis DUP.
Cognitive behaviour therapy to improve residual
psychopathology.
Try to avoid stigma of mental illness.
Hospitalisation
Risk assessment. Especially possibility of suicide and
homicide.
Psychiatry 4/11 25
26. Schizophrenia
Management
Pharmacological treatment of schizophrenia:
Chlorpromazine was introduced in 1952. it is one of a
group of antipsychotics called classical, typical,
dopamine blocking or first generation antipsychotics.
The other members include trifluperazine,
fluphenazine, thioridazine, haloperidone etc..
In the year 1990 another generation of antipsychotics
was introduced called nonclassical, second generation,
serotonin and dopamine blocking or atypical
antipsychotics. They include resperidone, olanzepine,
quetiapine, sertindole, zotepine, amisulpride,
ziprasidone and colzapine 26
27. Schizophrenia
Management
Antipsychotics have parenteral preparations for
patients who have low compliance.
Antipsycotics are absorbed in the jejunum and
metabolized in the liver. They also induce liver
enzymes and are protein bound. The antipsychotic
action of these drugs is thought to be postsynaptic
blockade of dopamine (D2)receptors in the mesolimbic
area of the brain. Modification of dopamine
transmission in the frontal cortex may be relevant too.
27
28. Schizophrenia
Management
They act on other receptors too leading to some side
effects and they include other dopamine receptor
subtypes, serotonin, muscarinic, adrenergic and
histaminergic receptors.
It is recommecded by NICE that a first onset of
schizophrenia be treated with oral atypical
antipsychotic. Parentral antipsychotics are left for
noncompliant patients. These drugs are used to treat
the acute episode and mentainence treatment
afterwards which could be for months or years.
28
29. Schizophrenia
Management
If the patient did not respond to atypical
antipsychotics or could not tolerate them he will be
switched to typical antipsychotics. Patients who did
respond or could not tolerate those drugs too will be
given clozapine under close monitering because of the
serious side effects.
29
30. Schizophrenia
Management
Atypical antipsychotics are thought to have a wider
antipsychotic effect because they on both serotonin
and dopamine receptors. They produce less side
effects therefore they are more tolerable by patients
and there will be shorter DUP duration of untreated
psychosis. However they much more expensive.
However the new side effect profile of those drugs
has changed a lot of those beliefs.
It is always preferable to discus the choice of the
treatment with the patients, family doctor and his
carers .
30
31. Schizophrenia
Management
Contraindications for typical antipsychotics include
bone marrow suppression and coma produced by CNS
depressants. Caution should be taken when given to
psychotic patients with cardiovascular, liver, renal and
neurological disorders as well as glaucoma.
Atypical drugs should be used with caution in
pregnancy and breast feeding mothers.
Clozapine is contraindicated in neutropenia,
agranylocytosis and myeloproliferative disorders.
31
32. Schizophrenia
Management
Unwanted effects
Typical antipsychotics
Extrapyramidal side effects include acute dystonia,
akathisia and parkinsinism. They could be controlled by
reducing the dose, changing the drug or adding an
anticholinergic drug like procyclidine or benzhexol
either orally or parenterally. Akithisia is controlled by
adding a beta blocker.
Tardive dyskinesia after prolonged use of
antipsychotics could be helped by changing to an
atypical antipsychotic or if no response clozapine.
32
33. Schizophrenia
Management
Unwanted effects
Anticholinergic side effects including constipation,
urinary hesitancy or retention, blurred vision,
precipitaton of glaucoma, failure of ejaculation and
cutaneous flushling.
Antiadrenergic effects as hypotension and inhibition
of ejaculation too.
Sedation due to D2, H1 and alpa receptor antagonism.
Cardiovascular effects as tachycardia, prolonged QT
interval, flat T wave, cardiac arrythmias and
myocarditis.
33
34. Schizophrenia
Management
Unwanted effects
Hyperprolactinemia due to hypothalamopituitary D2
receptor blockade in the form ammenorrhea,
galactorrhea, and breast enlargement in females.
Impotence and gynecomastia in males.
Other side effects include photosensivity, skin
pigmentation, allergic rash, corneal and lense deposits,
cholestatic jaundice, leucopenia and agranulocytosis,
and lowering seizure threshold.
34
35. Schizophrenia
Management
Unwanted effects
Neuroleptic malignant syndrome it is fatal in 20% of
the cases and is characterised by hyperthermia,
autonomic instability, alteration of consciousness and
elevated serum CPK.
They might also produce weight gain, hypothermia,
nausia and agitation and anxiety.
35
36. Schizophrenia
Management
Unwanted effects
Atypical antipsychotics were thought to have a very
safe profile of side effects, however they were found
to cause somnolence with metabolic syndrome in the
form of type 2 diabetes, obesity and dyslipidemia.
Amisulpride: insomnia and agitation.
Aripiprazole: nausia, vomiting, anxiety and
restlessness.
36
37. Schizophrenia
Management
Clozapine: sedation, fatigue, hypersalivation,
anticholinergic effects, weight gain, postural
hypotension, tachycardia and nausia. Agranulocytosis,
lowering seizure threshold and hyperglycemia.
Olanzepine: obesity, somnolence, dizziness,
anticholinergic effects and hyperglycemia.
37
38. Schizophrenia
Management
Quetiapine: postural hypotension, somnolence,
dizziness, constipation and dry mouth and prolonged
QT interval.
Resperidone: extrapyramidal side effects, insomnia,
anxiety, agitation, headache and weight gain.
Psychiatry 4/11
38
39. 39
Schizophrenia related disorders
• Schizophreniform psychosis or
acute schizophrenia like psychosis
This is a condition were the symptoms are similar to
schizophrenia but the duration of the symptoms is
more than one month and less than six months.
Patients return to their baseline level of functioning
once the disorder has resolved.
(60-80)% of patients progress to schizophrenia.
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Schizophrenia related disorders
• Schizophreniform psychosis or
acute schizophrenia like psychosis
• It has a rapid onset without a prodrome.
Hallucinations, delusions and negative
symptoms of alogia and avolition may be
present. Speech may be confused or
disorganized and behaviour may be
disorganized or catatonic.
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Schizophrenia related disorders
• Schizoaffective disorder
• They are a heterogenous group of disorders. Some
may have a mood disorder with prominent
schizophrenic symptoms, schizophrenia with
prominent affective symptoms and others have a
distinct clinical picture.
• Men with disorder are more likely to have antisocial
behaviour with flat or inappropriate affect.
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Schizophrenia related disorders
• Delusional disorder
• Occurs when a patient exhibit nonbizarre
delusions of at least one month’s duration
that cannot be attributed to other psychotic
disorders.
• Nonbizarre means that the delusions must be
about situations that can occur in real life,
such as being followed, infected, loved at a
distance and so on
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Delusional disorder
• It is much rarer than schizophrenia. Slightly more common in
females. Men are more likely to develop paranoid delusions
than women, who are more likely to develop delusions of
erotomania.
• There is some association with recent immigration and low
socioeconomic status.
• Types:
• persecutory type.
• jealous type.
• erotomanic type.
• somatic type. MHP : Parasitosis, Foul body odour or
Halithosis, and dysmorphophobia.
• grandiose type.
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Brief psychotic disorder
• Is an acute and transient psychotic syndrome.
It lasts from one day to one month and the
symptoms may resemble those of SZ. It may
develop in response to a severe psychosocial
stressor or group of stressors.