Hello friends....this is my 24th powerpoint..that I am uploading here in slideshare... This ppt consists of SCHIZOPHRENIA...its causes...and management strategies............ This time, for a change, I have also included 2 explicit videos, that explain the vividness of the disease................. Also ,home remedies for schizophrenia has been outlined, so that timely steps can be taken to prevent the disease progression n severity!! Hoping that onlookers would go through this precise work..and mail or comment me their feedbacks!! Thank you!! Vishnu.R.Nair(rxvichu), 5th year Pharm.D, National College of Pharmacy, Kerala, India. :) :)

1. PRESENTED BY:
VISHNU.R. NAIR,
5TH YEAR PHARM.D,
NATIONAL COLLEGE OF PHARMACY, KERALA.

2. 1. VIDEO PRESENTATION ON CATATONIC SCHIZOPHRENIA
2. VIDEO PRESENTATION ON SCHIZOPHRENIA(IN GENERAL)
3. DEFINITION
4. TYPES OF SCHIZOPHRENIA
5. ETIOLOGY OF SCHIZOPHRENIA
6. PATHOPHYSIOLOGY
7. CLINICAL MANIFESTATIONS
8. DIAGNOSIS
9. MANAGEMENT OF SCHIZOPHRENIA

5. “SCHIZOPHRENIA is a HETEROGENOUS SYNDROME, characterized by
DISORGANIZED and BIZARRE THOUGHTS, DELUSIONS, HALLUCINATIONS,
and impaired psychosocial functioning. . .”

6. 1. CATATONIC SCHIZOPHRENIA:
- Mainly MOTOR symptoms are observed
- Rigid immobility/ high purposeless movements
- Patient is either “silent & withdrawn” or “loud & shouting”
- To be precise, the victim fluctuates in between 2 mental extremities. . .
2. DISORGANIZED SCHIZOPHRENIA:
- Patient has disorganized speech and behavior
- FLAT EFFECTS are also observed
- Bizarre behaviors are observed. . .

7. 3. PARANOID SCHIZOPHRENIA:
- Most common type
- Patient is pre-occupied with PARANOID DELUSIONS
- AUDITORY HALLUCINATIONS are experienced in such patients. . .
4. RESIDUAL SCHIZOPHRENIA:
- No psychosis, hallucinations or delusions occur in this case
- Some NEGATIVE SYMPTOMS of schizophrenia remain, that include:
a. Flat effects
b. Social withdrawal
c. Loose associations. . .

8. 1. GENETIC CAUSES:
- 10% chances for victim, with FIRST DEGREE RELATIVE HISTORY of
SCHIZOPHRENIA
- If both parents have the disease: there are 40% chances
- In case of twins: 48% chances. . .
2. ENVIRONMENTAL CAUSES:
Includes:
a. Virus exposure during SECOND TRIMESTER OF PREGNANCY
b. Virus exposure during INFANCY
c. Low OXYGEN levels during birth

9. c. Drugs:
i. AMPHETAMINE
ii. LEVODOPA
iii. KETAMINE
iv. COCAINE
v. PHENCYCLIDINE(PCP)
vi. LSD(LYSERGIC ACID DIETHYLAMIDE). . .
3. ABNORMALITY IN BRAIN STRUCTURE. . .

10. Pathophysiology of Schizophrenia can be explained by 3 mechanisms:
1. DOPAMINE ALTERATIONS:
- Hyperstimulation of DA(2) receptors  causes increased activity of CAUDATE &
PUTAMEN  leads to HALLUCINATIONS and DELUSIONS.
- EXCITOTOXINS/ VIRUSES  block DA-2 receptors  cause hypoactivity of
FRONTO-TEMPORAL REGION  causes NEGATIVE SCHIZOPHRENIC
EFFECTS . . .
2. HIGH LEVELS OF 5-HT(SEROTONIN):
- Stimulation of 5-HT receptors  reduces DA levels in the striatum
- 5-HT receptors are found widely in the MESOCORTICAL AREAS
- Increased activation of 5-HT Blocks DA release  triggers SCHIZOPHRENIA.
. .

11. 3. GLUTAMINERGIC HYPOTHESIS:
- GLUTAMATE is the major EXCITATORY NEUROTRANSMITTER in the brain
- It helps to activate neurons and other brain cells
- Approx. 60% of neurons contain glutamate, and virtually almost all of them
contain some type of glutamate receptor
- Glutamate contributes to pre-natal and childhood brain development
- It plays a major role in LEARNING and MEMORY
- Glutamate is essential for “LONG TERM POTENTIATION”, a process by which
new knowledge and skills are RETAINED for FUTURE USE.
- The multiple areas of the brain involved in Schizophrenia are connected by a
circuit of brain cells, that rely on glutamate to communicate
- Research so far, suggests that either excess or deficiency of glutamate can trigger
schizophrenia, partly through its interactions with other neurotransmitters like
DOPAMINE and GABA(Gamma-amino butyric acid). . .

12. 1. Hallucinations
2. Delusions
3. Disorganized speech
4. Disorganized behaviour
5. Echopraxia
6. Negative effects:
i. Flat effects
ii. Social withdrawal
iii. Loose association
iv. Fixed stare
v. Lack of emotions and enthusiasm. . .

13. - According to the DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL
DISORDERS(DSM-IV)  To meet criteria for SCHIZOPHRENIA diagnosis 
patient should experience ATLEAST 2 of the following manifestations:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized behaviour(catatonic)
5. Negative symptoms
- ATLEAST 1 of the above symptoms should be DELUSIONS, HALLUCINATION/
DISORGANIZED SPEECH. . .

14. Includes:
1. GOALS OF THERAPY
2. PHARMACOTHERAPY
3. NON-PHARMACOTHERAPY. . .

15. 1. To limit symptoms to stable ones
2. To prevent morbidity and mortality
3. To avoid complications
4. To focus on maximum effective dose, with minimum ADRs
5. To improve HRQoL(Health Related Quality of Life). . .

16. A. FIRST GENERATION ANTIPSYCHOTICS:
I. GENERAL INTRODUCTION:
- Strong DA(2) receptor antagonists
- Also affect 5-HT, HISTAMINERGIC and MUSCARINIC receptors
- General ADRs observed include:
a. EXTRAPYRIMIDAL EFFECTS
b. TARDIVE DYSKINESIA
c. NEUROLEPTIC MALIGNANT SYNDROME(NMS)
- 7 drugs will be explained under this class.

17. 1. CHLORPROMAZINE(CPZ):
- Phenothiazine anti-psychotic
- DA-2 receptor blocker
- Available in different formulations
- Low potency
- Causes ADRs, like:
a. Sedation
b. Weight gain(other than those explained under GENERAL ADRs)
c. Aplastic anemia
- Interaction:
a. CPZ + chloramphenicol  high risk of APLASTIC ANEMIA
b. CPZ + BZDs  high risk of sedation, respiratory depression
- Dose : 100-500 mg/day . . .

18. 2. FLUPHENAZINE:
- High potency
- D1 & D2 antagonist
- Also blocks alpha-adrenergic receptors
- Doesn’t cause orthostasis
- Causes EPS, dystonia, etc
- Dose : 2-20 mg/day. . .

19. 3. PERPHENAZINE:
- DA and adrenergic receptor blocker
- Mid-potency
- Dose: 10 mg. . .
4. THIOTHIXENE:
- Blocks D2, muscarinic and alpha-adrenergic receptors
- Rarely used now. . .
5. TRIFLUOPERAZINE:
- D2 receptor antagonist
- Piperazine phenothiazine derivative. . .

20. 6. LOXAPINE(INHALED):
- D2 & 5-HT(2) receptor blocker
- Treats AGITATION caused by SCHIZOPHRENIA
- Dose: 10 mg/day. . .
7. HALOPERIDOL:
- High potency
- Doesn’t cause orthostasis
- Causes EPS, dystonia
- Interacts with drugs that prolong QTC interval
- Also known to cause HYPOGLYCEMIA with long-term usage
- Dose: 2-20 mg/day. . .

21. b. Second generation antipsychotics:
- D2 antagonists(except ARIPIPRAZOLE)
- Reduced risk of EPS/ TD
- High risks of weight gain and metabolic effects
- 10 drugs will be explained under this category. . .

22. 1. ASENAPINE:
- Used for ACUTE & MAINTENANCE treatment of SCHIZOPHRENIA
- Given via s.l route(since it has poor GI absorption)
- ADRs:
a. Weight gain
b. Sedation
- Blocks 5-HT, DA(all receptors), alpha-adrenergic receptors, and H-1 receptors
- Reduces psychosis
- Has low EPS risk compared to that of 1st generation antipsychotics. . .

23. 2. CLOZAPINE:
- Most effective
- Blocks ADRENERGIC , CHOLINERGIC, HISTAMINERGIC, DA-4 and
SEROTONERGIC receptors
- Given for REFRACTORY SCHIZOPHRENIA
- Also indicated for SUICIDAL BEHAVIOUR and HOSTILITY associated with
SCHIZOPHRENIA
- ADRs:
a. Anticholinergic effects
b. Sedation
c. Cardiomyopathy
- Undergo WBC count monitoring every week for 1st 6 months(since it causes
AGRANULOCYTOSIS)
- Dose: 50-500 mg/day . . .

24. 3. ILOPERIDONE:
- Used for ACUTE treatment of SCHIZOPHRENIA
- Blocks D-2, 5-HT(2) receptors
- ADRs:
a. Weight gain
b. Anticholinergic effects
c. Tachycardia. . .
4. LURASIDONE:
- Blocks D-2, 5-HT(2A) receptors
- Given for age 13-17 years and above. . .

25. 5. OLANZAPINE:
- Blocks 5-HT, all DA receptors, muscarinic , alpha-adrenergic and H-1 receptors
- ADRs:
a. Weight gain
b. Sedation
c. Akathisia
d. Anticholinergic effects
- Used for adults
- Dose: 10-20 mg. . .

26. 6. PALIPERIDONE:
- Active metabolite of RISPERIDONE
- Used for ACUTE & MAINTENANCE therapy for SCHIZOPHRENIA
- Used in adolescents
- Blocks D2, 5-HT(2A), alpha-adrenergic, and H-1 receptors
- Given i.m. . .

27. 7. QUETIAPINE:
- Same ADRs as that of others explained before
- Blocks dopaminergic and serotonergic receptors
- Used in adults
- Dose: 250-500 mg/day. . .
8. RISPERIDONE:
- Blocks D2 and 5-HT(2) receptors
- Used in ADULTS & ADOLESCENTS
- ADRs:
a. Weight gain
b. Hyperprolactinemia
c. Akathisia. . .

28. 9. ZIPRASIDONE:
- Blocks D2, 5-HT(2), H-1 and alpha-adrenergic receptors
- Used to treat AGITATION with schizophrenia
- Low risk of HYPERLIPIDEMIA, WEIGHT GAIN and HYPERGLYCEMIA,
compared to other drugs in this class. . .
10. CARIPRAZINE:
- Blocks D2, 5-HT(1A) receptors. . .

29. C. SEROTONIN-DOPAMINE ACTIVITY MODULATORS(SDAM):
- Partially AGONIZE 5-HT(1A) and D2 receptors
- ANTAGONIZE 5-HT(2A), alpha-adrenergic receptors
- Drugs include:
1. BREXPIPRAZOLE:
- Adjust dose in RENAL/HEPATIC IMPAIRMENT
- Dose: 4 mg/day(max. dose)
- ADRs:
a. Weight gain
b. Akathisia. . .

30. 2. ARIPIPRAZOLE:
- Used to treat schizophrenia in ADOLESCENTS
- Given as :
a. ORAL: For acute and maintenance therapy
b. INTRAMUSCULAR: To treat acute exacerbation
- ADRs:
a. Nausea
b. Vomiting
c. Tremor
d. Constipation
- Dose: 10-15 mg/day. . .

31. 1. Cognitive therapy
2. Vocational rehabilitation
3. Assertive community treatment
4. Family intervention(support & care)
5. Smoking cessation
6. Transcranial magnetic stimulation(TMS)
7. Home remedies for SCHIZOPHRENIA:
a. Intake of GINGKO BILOBA(potentiates effects of antipsychotics, and also
protects from neural damages)
b. Intake of FISH OILS(Neuroprotective)
c. Intake of pumpkin seeds(Contains OMEGA-3- FATTY ACIDS)

32. d. Increase intake of VITAMIN ‘A’, ‘C’ & ‘E’
e. Increase intake of antioxidants like amla, carrots, spinach, lemons, etc. . .
f. Engage in 30 minutes of regular PHYSICAL EXERCISE daily, which help
alleviate stress and depression
g. Chamomile tea(nerve soothener)
h. Basil leaves (antioxidant)
i. Green cardamom(neuroprotective)
j. Increase intake of blueberries and strawberries. . .

33. THANK YOU !!!!
@RXVICHU-ALWZ4UH!!
  