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Schizophrenia-Treatment


Schizophrenia-Treatment


Pharmacological treatment of schizophrenia includes antipsychotics/neuroleptics.

Both typical and atypical antipsychotics are used

Typical antipsychotics (1st gen):

  • Acts Via D2 Receptor Antagonism
  • Effective Against Positive Symptoms
  • Minimal Effect on Negative Symptoms
  • Causes More Extrapyramidal Side Effects

Atypical antipsychotics (1st gen):

  • Acts Via D2 & 5HT 2 Receptor Antagonism
  • Effective Against (+) and (-) Symptoms
  • Causes Less Extrapyramidal Side Effects
  • Causes Less other Side Effects

Schizophrenia-Prognosis


Schizophrenia-Prognosis


The prognostic factors of schizophrenia are:

Good Prognostic factors:

  • Acute / Abrupt Onset
  • Late Onset [Age > 35 Yrs.]
  • Catatonic & Paranoid
  • Female Sex
  • Prominent Positive Symptoms
  • Affective Symptoms [Depression]
  • Family History of Mood Disorder

Poor prognostic factors:

  • Insidious Onset
  • Early Onset [Age > 20 Yrs.]
  • Simple, Disorganized, Undifferentiated
  • Male Sex
  • Prominent Negative Symptoms
  • Absence of Affective Symptoms
  • Family History of Schizophrenia

Schizophrenia-Motor symptoms


Schizophrenia-Motor symptoms


The symptoms of schizophrenia are divided into:

  1. Positive
  2. Negative
  3. Disorganization
  4. Motor

Motor Symptoms:

  • Catatonia-Term given by Karl Kahl Baum
  • Stupor-Extreme hypoactivity or immobility and minimal response to stimuli
  • Excitement-Extreme Hyperactivity which is usually not goal directed
  • Posturing / Cataplexy-Spontaneous maintenance of posture for long periods of time
  • Waxy flexibility-Passive movements by examiner have plastic resistance
  • Automatic obedience-Excessive cooperation with examiner’s command despite unpleasant consequences
  • Echolalia-Mimicking examiner’s speech
  • Echopraxia-Mimicking examiner’s movements
  • Negativism-Refusal to accept examiner’s instructions or any attempts to move him
  • Grimacing-Maintenance of Odd facial expressions
  • Stereotypy-Spontaneous repetition of odd purposeless movements
  • Genehalten-Resistance to passive movements directly proportional to strength applied
  • Mannerisms-Spontaneous odd purposeful movements [Like Repeatedly saluting passerby]
  • Preservation-An induced movement which is senselessly repeated [Repeated tongue protruding]. Also sign of organic brain disorder or brain damage
  • Ambitendency-Inability to decide the desired motor movement

Schizophrenia-History


Schizophrenia-History


Schneiderian first rank symptoms-Given by Kurt Schneider to diagnose schizophrenia are:

  • Thought:
  1. Thought insertion
  2. Thought withdrawal
  3. Thought broadcast
  • Made:
  1. Made volition
  2. Made affect
  3. Made impulse
  • Auditory hallucination: Discussing/arguing, commenting, audible thoughts
  • Somatic passivity
  • Delusional perception

Etiopathogenesis of schizophrenia-Neuropathological factors


Etiopathogenesis of schizophrenia-Neuropathological factors


The etiopathogenesis of schizophrenia consists of following factors:

  • Genetic
  • Biochemical
  • Neuropathological

Neuropathological Factors:

  • Cerebral Ventricle s – ↓ Cerebral Grey Matter and ↑ Lateral and 3rd Ventricle
  • Limbic System – ↓ Hippocampus, ↓ Amygdala, ↓ Para hippocampal Gyrus
  • Abnormalities of Prefrontal Cortex, basal ganglia and cerebellum
  • Neuronal Loss in MEDIAL DORSAL Nucleus of Thalamus
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