Schizophrenia is a severe long-term psychiatric disease, associated with psychotic symptoms which means the patient is unable to differentiate between their thoughts and reality. Mainly thinking and perception becomes distorted and a blunted effect is also observed in schizophrenia patients.
The main symptoms and signs can be classified into Positive, Negative, and Cognitive aspects. Delusions or else false beliefs about reality and hallucinations or else experiences involving the apparent perception of some things that are not present can be defined as the main two positive symptoms. Lack of interest, inability to feel pleasure in normally pleasurable activities, and reduced ability to initiate and persist in purposeful activities are the main negative symptoms. Deficits in attention, information processing, and executive functions are observed as cognitive symptoms.
The commonest type of Schizophrenia is called, Paranoid Schizophrenia which involves delusional ideas which are paranoid or self-expansive and auditory hallucinations.
Etiology of Schizophrenia
- History of Schizophrenia in first-degree relatives
- Patients with birth complications
- Psychoactive substance misuse as cannabis
- Psychosocial stresses
Prognosis
Patients with no previous psychiatric history, shorter episodes of disease with a sudden onset at older age, and females with good social relationships and a good premorbid personality have a better prognosis of the disease.
Diagnostic Criteria
According to ICD 11 classification, Schizophrenia can be diagnosed if the below symptoms have persisted for at least one month.
The core symptoms are persistent delusions, persistent hallucinations, and disorganization in the form of thoughts and experiences of feelings, thoughts or behaviors are being influenced or controlled by external forces.
Management of Schizophrenia
The first step in managing an acute patient is deciding on the treatment setting.
If the patient is having
- Suicidal attempts
- Aggressive behaviors that threaten others
- Poor social support
- Acute severe illness
- Disturbed behavior
- Poor drug compliance
Then this patient requires hospital admission.
After being admitted to the ward, a supportive environment must be provided for the patient. After minimizing the harm, the next step of management is educating the patient and family. They must be educated that the disease is caused by a combination of biological and psychosocial factors, which causes alteration of chemicals in the brain which can be corrected by medications and sometimes electroconvulsive therapy. The relapses of the disease can be minimized through good compliance with drugs.
Pharmacological Management of Schizophrenia
The treatment of choice is commencing atypical antipsychotics such as Risperidone, Olanzapine, and Haloperidol. For patients with low compliance depot preparations can be given as IM Modecate or else called Fluphenazine decanoate. The main side effect associated with the use of antipsychotics is extrapyramidal side effects such as Tremors, Abnormal movements, Endocrine and Metabolic side effects, and anticholinergic side effects such as Dry mouth, Constipation, and Urinary retention. Patients must be advised to be cautious about side effects.
The drug of choice for a disease that is not responding to first-line drugs is Clozapine. Monitoring of Full Blood Count for reducing white blood cell count and Echocardiography for cardiomyopathy is essential during the administration of Clozapine due to side effects.
Non-Pharmacological Management
Patient and family education, cognitive behavioral therapy as cognitive restructuring, rehabilitation as training self-care skills, social skills, communication skills, vocational training, and leisure activities are important.
After discharging the patient must be followed up in a clinic initially monthly, then once in two weeks, and later once a month.
References
- ICD -11 , Classification of Mental and Behavioral Disorders- Diagnostic Criteria for Research
- Shorter Oxford Textbook of Psychiatry – 7th Edition – Paul Harrison, Philip Cowen, Tom Burns, Mina Fazel
- Handbook of Clinical Psychiatry – APractical Guide- Second Edition – Varuni De Silva, Raween Hanwella
