Before I got promotion into the 5th semester the only notion that I had about schizophrenia was from the climax of a movie in which the protagonist after losing her spouse had a strong feeling that she the late lady love of her is waiting for him on the other side of cliff and he tried a number of times to jump from cliff and reach her lost love but his kith and kens were actual hindrances in his path and the doctor after formal auscultation as the MBBS do termed that person schizophrenic.
Now when I am in third Prof of my degree program I got the real opportunity to study the psychiatric disease in detail not for sake of knowledge neither for getting good grades just for winning a prize of 1000 rupees because I am in a real recession.
What is schizophrenia?
The mental illness which person is unable to
Tell the difference between reality and fantasy
Think rationally
Behave normally in social events
Have strong emotional feelings about something that just can’t be done
Symptomatology:
Now we come towards the symptoms of schizophrenia which are actually of two types
1-Postive symptoms
2-Negative symptoms
Positive symptoms:
These are the signs which are advisory in nature and the patient gets good piece of advice from this vicious disease and they include
Delusions of grandeur
Paranoia
Thought disorder, having wild trains of thinking
Distorted sentences
illogical conclusions
Feeling that thoughts and feelings are injected by some outside agency
Hallucinations which may be
Auditory as hearing the voices like the trees are talking to patient or the paintings
Visual in which the patient visualizes in mind of some unreasonable phenomenon about to occur like the attack of Martians on earth etc
Negative symptoms:
Withdrawal from social events
Smoothness of emotional reactions
Other symptoms may include cognitive impairment, depression anxiety which may predispose suicidal tendencies.
Historical Viewpoint:
The development of the disease named schizophrenia is not much old because its name was coined by EUGENE BLEULAR in 1911 and afterwards the work has been done on it. According to ancient writings of Romans Chinese Egyptian and Greek people it is learned that people suffering from psychiatric illnesses were thought as done by some evil force or was a curse of gods on the ones suffering so there has not any substantial prove from history about this neurological ailment.
Occurrence:
1% of world’s populace suffers from this disorder and it normally occurs in people having ages in between 17 to 35 years and it affects men one and half times more than women and occurs to males in early ages than to women whom it affects in late 20’s.
Half of the patient visiting a medical facility for psychiatric advice belongs to schizophrenia.
Etiology and Pathogenesis:
The spreading pattern of schizophrenia is quite weird and it involves a number of factors like
1-Genetic factors:
The disease shows a strong but incomplete hereditary tendency. In homozygote twins the tendency is about 50% pointing towards the effect of environment.
Genetic linkage studies have shown have identified a number of vulnerable genes but it is quite clear that no single gene is actually responsible for schizophrenia.
Neureglin 1 gene hypothesis:
This gene had a role in synaptic development , plasticity and the expression of NMDA receptors and when this gene was knocked out from mouse then the mouse developed schizophrenic symptoms like that of humans.
Drug abuse:
The abusive use of drugs like cocaine, amphetamine and alcohol result in psychosis and development of schizophrenia.
Environmental Influences:
The influence of surroundings can surely be harsh enough to cause schizophrenia, like the maternal infections or other transient catastrophes during prenatal life like hypoxia of fetus which may cause cortical atrophy and the post mortem study of schizophrenic patients show that the cerebral cortex is damaged. So this is not a gradual neurodegenerative disease but occurs abruptly due to malformations or aberrations of brain development during the intra uterine life.
Neurochemical Theories:
There are a number of theories proposed by neurologists regarding the spread of schizophrenia due to some chemical of the nervous system some of them are given as above
Dopamine Theory:
It was proposed by CARLSON who was awarded Nobel Prize in the year 2000 for his splendid work regarding schizophrenia. The points of evidence he gave were
1-Amphetamine which indirectly increases the concentration of dopamine causes symptoms similar to schizophrenia in both animal and human models.
2-dopamine receptor agonists (apomorphine and bromrcriptine) potentate the symptoms of schizophrenia due to their dopamimetic role at dopamine receptors.
3-Dopsmine antagonists (reserpine) relieve the symptoms of schizophrenia by lowering the amounts of dopamine at the dopaminergic neurons.
So as this theory claims the dopamine has a significant role in the schizophrenia .i.e.
Large amount of dopamine leads to intense schizophrenia
A low amount of dopamine relieves schizophrenia.
Glutamate theory:
According to this theory the NMDA receptor antagonists phencyclidine, ketamine which lower the amount of glutamate at these receptors potentiate the symptoms of schizophrenia and the study of poet mortem brains of schizophrenics have shown low levels of glutamate neurotransmitter.
Thus low amount of glutamate intense schizophrenia
High amounts of glutamate no schizophrenia.
Diagnosis:
Their is not any exact test present on the whole of this planet which can diagnose v. the only way to diagnose it is via getting complete medical history of patient
Getting mental health information
Gender
Sexual orientation
Religious cultural ethnic backgrounds
Socioeconomic condition
General physical examination
Then the psychiatrist may ask the patient of any delusions, hallucinations or any other odd or eccentric mental feeling the patient is encountering now a days.
Medication:
The allopathic medicine used to treat schizophrenia is called anti psychotic medicine.
They are classified as under
1-First generation or typical Antipsychotics
Chlorpromazine
Haloperidol
Fluphenazine
Flupentixol
Clopentixol
2-Second generation or typical Antipsychotics
Clozapine
Risperidone
Sertindole
Aripiprazole
Zotepine
Mechanism of action of Antipsychotic drugs:
All antisychotics are
Dopaminergic antagonists at D-2 receptors
They may also block
Monoamine receptors esp. 5-HT2
Clozapine also blocks D-4 receptors
Imaging studies have shown that therapeutic effect requires 80% receptor occupancy at D2 receptor.
Unwanted effects:
They include
Extra pyramidal motor disturbances
Tardive dyskinesia
Abnormal prolactin secretion
Sedation
Anticholinergic effects may cause low GIT motility, xerostomia etc
Antiserotonergic effects may cause weight gaining
Antiadrenergic effects may cause orthostatic hypotension
Psychosocial treatment of schizophrenia:
These includes the moral support provided by family and friends to the patient and enhances his problem solving skills and make him feel good and make him less critical of his situation and increase the social hang outs with him. It includes meeting him daily and arranges community sittings and other things which don’t make him alone or give him solitude.
Prognosis with schizophrenia:
Patients with schizophrenia have twice the rate of death than normal people, almost half of the schizophrenics will suffer from a substances use disorder like alcohol or cannabis abuse. Schizophrenics could have better life if the family and friends become more supportive than critical.
Muslim schizophrenics:
It is save in the annals of history that TARIK BEN ZIAD the conqueror of Spain ordered his troops to burn down the fleet when they entered the shores of Spain since he had a strong belief of his victory due to robust faith in the Allah and he did so and proved that if a Muslim has a schizophrenic faith in Allah anything could be achieved.
By
Waleed Javaid
BPD01091020
Doctor Of Pharmacy
The University Of Lahore