Mental health session 9: Schizophrenia

Session 9: Schizophrenia

 

About one percent of the population suffers from this disease

Strong genetic link

More common in men

  • s/s positive: delusions, hallucinations, disorganized, speech
  • s/s negative: not connecting socially, decreased expression

 

Schizophreniform disorder

  • Less intense than schizophrenia
  • 2 or more s/s for more than a month
  • This is the diagnosis before full blown schizophrenia

Schizophrenia

  • 2 or more s/s for more than 6 months
  • Phases
    • Premorbid phase
      • Shy, withdrawn, a- or anti social behaviour
      • Prodromal phase
    • Acute phase
      • Decline in functioning
      • Increase in thoughts and behaviour that are overwhelming
    • Stabilization phase
      • Decrease in symptoms
      • Increase socialization
      • Needs medication
    • Maintenance phase
      • Try to get back to previous level of functioning
      • Medications may decrease in this phase
      • Family support and community is crucial

 

Hallucinations

  • Auditory is most common,
  • Visual, tactile, olfactory, gustatory (taste)

 

Positive hallucination are added effects, and negative hallucinations are things that they stop doing like social activities and coping mechanisms

 

Neurocognitive impairment

  • Reduction of normal cognitive level
  • Memory attention, and thinking,
  • This could be independent of other cognitive functions.

 

Alterations in behaviour and catalonia

  • Negativism – the person does not react to stimulus even when painful
  • Immobile
  • Mutisim
  • excessive motor activity without purpose

 

Risk factors of schizophrenia

  • Stresses in prenatal period – lack of food to starvation, influenza and other infections
  • Strong genetic connection

 

Risk factors for suicide

  • Male, not adherent to medications, impulsive, psychosis, and multiple hospitalizations

 

Pharmacology

  • First gen: (mostly treats positive s/s)  Haloperidol, Chlorpromazine, THiothixene, fluphenazine
  • EPS that are severe – dystonia, akathisia
    • This can lead to parkinson’s like permanent movements

 

  • Second gen: treat the negative s/s as well.
    • Clozapine – great drug, but at risk for agranulocytosis
    • Ziprasidone -done – take with meal to increase absorption.

 

Nicotine – interacts with CYP450 enzyme so that the medication may be need to be reduced if the person smokes les cigarettes per day. clozapine and zyprexa

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