Author: Renu Maurya

Schizophrenia-Epidemiology


Schizophrenia-Epidemiology


Prevalence of schizophrenia Incidence Rate 0.15-0.25 Per 1000
General population 1%
Non twin sibling of schizophrenic patient 8%
Dizygotic twin of schizophrenic patient 12%
Monozygotic twin of schizophrenic patient 47%
Child with 1 schizophrenic parent 12%
Child with both parents’ schizophrenic 40%
  • Usual Age of onset in Adolescence & Young Adulthood [If age > 45 then Late Onset]
  • Male= Female, However the onset is earlier in males
  • Prevalence more in LOWER SOCIO-ECONOMIC status
  • Body Type – Asthenic [Thin & Weak] > Athletic [Muscular] > Pyknic [Short – Fat]
  • Pyknic predisposed to manic depressive illness [Bipolar Ds]

Etiopathogenesis of schizophrenia-Genetic factors


Etiopathogenesis of schizophrenia-Genetic factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Genetic Factors:

  • Nine Linkage sites identified – 1q, 5q, 6p, 8p, 10p, 13q, 15q, 22q
  1. α- 7 nicotinic receptor
  2. DISC 1 [Disrupted in Schizophrenia]
  3. COMT [Catechol-o-methyl transferase]
  4. NRG 1 [Neuregulin 1]
  5. GRM 3 [Glutamate receptor metabotropic]
  6. RGS 4 [Regulator of G Signaling]
  7. DAOA [ D Amino Acid Oxidase Activator]

Etiopathogenesis of schizophrenia-Biochemical factors


Etiopathogenesis of schizophrenia-Biochemical factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Biochemical factors:

Dopamine Hypothesis – Excess of dopaminergic activity

Serotonin – Currently along with dopamine excess of serotonin is also considered

Other Neurotransmitter – GABA, NE, Ach, Nicotine, Glutamate

Schizophrenia-Disorganization symptoms


Schizophrenia-Disorganization symptoms


The symptoms of schizophrenia are divided into:

  • Positive
  • Negative
  • Disorganization
  • Motor

Disorganization symptoms:

  • Formal Thought disorder – Loss of organization of thought
  • Disorganized behavior – inappropriate behavior which breaks social norms
  • Inappropriate affect – Affect which is not in sync with the social situation

Schizophrenia-Diagnosis


Schizophrenia-Diagnosis


Diagnosis of Schizophrenia:

  1. Delusions

  2. Hallucinations

  3. Disorganized Speech [ Formal thought disorder]

  4. Disorganized or Catatonic behavior

  5. Negative Symptoms

DSM 5

2 or More of above for > 1months [with one from [1], [2] or [3]

Duration of Illness > 6 Months

ICD-10

2 or More of above for > 1months [with one from [1], [2] or [3]

Duration of Illness > 1 Months

Schizoaffective disorder


Schizoaffective disorder


Has both features of Schizophrenic and mood disorders

Schizoaffective disorder [Bipolar or manic type]

Schizoaffective disorder [Depressive type]

Management

Mood Stabilizers, Antipsychotics and Antidepressants

Other antipsychotics


Other antipsychotics


  • Long Acting Injectable [Depot] Antipsychotics used in patients with poor compliance
  • Available for
  1. Fluphenthixol
  2. Fluphenazine
  3. Haloperidol
  4. Pipotiazine
  5. Risperidone
  6. Zuclopenthixol
  7. Olanzapine
  8. Paliperidone
  9. Aripiprazole
  • Thioridazine can cause irreversible retinal pigmentation, QT Prolongation but Less EPM side effect
  • Chlorpromazine with corneal and lenticular deposits
  • Penfluridol is the longest acting antipsychotic
  • Ziprasidone can cause QT Prolongation [Cardiac arrythmias]
  • Aripiprazole is a partial agonist at D2 Receptors [All other antipsychotic are D2 Antagonists]

Delusional disorder


Delusional disorder


Delusional disorder:

  • Development of a single or a set of related delusion which are persistent
  • Hallucination, disorganization and negative symptoms are absent
  • Persecutory Type, Jealous Type, Erotomania Type, Grandiose Type
  • Somatic Type – Delusional parasitosis, Delusional dysmorphophobia, Delusion of Halitosis
  • Capgras Syndrome – Familiar person has been replaced by an imposter
  • Fregoli Syndrome – Familiar person are taking the guise of strangers
  • Syndrome of intermetamorphosis – People can change into other person
  • Syndrome of subjective doubles – Patient has many doubles who are living life of their own

Induced delusional disorder:

  • Characterized by spread of delusion from one person to another
  • Folie-e-deux – When two people are involved [Folie e trois, Folie e quatre]
  • The patient functions normally in domains which are unaffected by the delusion
  • Management – Antipsychotic Drugs

Clozapine


Clozapine


First Atypical antipsychotic and is Drug of Choice in RESISTANT Schizophrenia

Low D2 Affinity [Lack of Extrapyramidal S/E]and Strong D4 Affinity

Antagonist of 5HT2A, D1, D3 and Alpha-adrenergic receptor

Preferred Antipsychotic in patient who with EPM side effects including tardive dyskinesia

S/E – Sedation, Syncope, hypotension, tachycardia, Nausea & Vomiting, Weight Gain [Highest], constipation, sialorrhea [Hypersalivation], agranulocytosis, myocarditis, seizures [Dose Dependent]

WBC count monitored regularly [Stop if WBC < 3000/mm3 or Neutrophils <1500/mm3]

Should not be started if WBC Count < 3500/mm3.

Should not be started with Carbamazepine as both are bone marrow suppressants

Acute psychotic disorder


Acute psychotic disorder


Delusion, hallucination and disorganization symptoms like schizophrenia

Does not meet the duration criteria for diagnosis of schizophrenia

Preceded by STRESSOR [Stressful Life Event] and may be precipitated by Fever

ICD -10 [Acute & Transient Psychotic Ds]

DSM5

  • [ if Duration < 1 Month Brief Psychotic Disorder
  • Duration 1-6 Months – Schizophreniform Disorder]

Management

  • Antipsychotics and Benzodiazepines
Malcare WordPress Security