Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms Psychotic symptoms Brief Psychotic Disorder such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating. Psychiatric Assessment, and alogia). Schizophrenia is associated with a decline in both cognitive and social functioning that often precedes the development of florid psychosis. The exact etiology of schizophrenia is unknown, although it is thought to be linked to an increase in dopaminergic activity. Treatment includes antipsychotics in conjunction with behavioral therapy.
Last updated: Nov 17, 2022
Schizophrenia is a chronic serious mental disorder characterized by loss of contact with reality and manifested by two main symptoms: hallucinations and delusions.
Genetic and environmental risk factors appear to act via a common pathway Common pathway Hemostasis of disrupting the function of 1 or more neurotransmitter components.
|Dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS pathways||Normal function||Role in schizophrenia||Effects/side effects of antipsychotics|
|Mesolimbic pathway||Role in motivation, emotions, reward||Overactivity results in positive symptoms||Improvement of positive symptoms|
|Mesocortical pathway||Cognition, executive function, emotions and affect||Underactivity results in negative symptoms||Worsening of negative symptoms|
|Nigrostriatal pathway Nigrostriatal pathway Basal Ganglia: Anatomy||Control of extrapyramidal system, purposeful motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology planning||No direct role in the etiology of schizophrenia||Extrapyramidal symptoms Extrapyramidal Symptoms Ataxia-telangiectasia|
|Tuberoinfundibular pathway||Inhibits prolactin Prolactin A lactogenic hormone secreted by the adenohypophysis. It is a polypeptide of approximately 23 kd. Besides its major action on lactation, in some species prolactin exerts effects on reproduction, maternal behavior, fat metabolism, immunomodulation and osmoregulation. Breasts: Anatomy release||No direct role in the etiology of schizophrenia||Hyperprolactinemia Hyperprolactinemia Hyperprolactinemia is defined as a condition of elevated levels of prolactin (PRL) hormone in the blood. The PRL hormone is secreted by the anterior pituitary gland and is responsible for breast development and lactation. The most common cause is PRL-secreting pituitary adenomas (prolactinomas). Hyperprolactinemia|
Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with schizophrenia also have physical abnormalities of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification tissue, which can be seen in neuroimaging Neuroimaging Non-invasive methods of visualizing the central nervous system, especially the brain, by various imaging modalities. Febrile Infant studies.
|Positive (psychotic phase)||
|Negative (residual phase)||
To recall the negative symptoms of schizophrenia, remember the 5 As:
Diagnosis is made by clinical observations based on the type of symptoms presented, their severity and duration, and how the patient’s life is affected by their presence.
Antipsychotic Antipsychotic Antipsychotics, also called neuroleptics, are used to treat psychotic disorders and alleviate agitation, mania, and aggression. Antipsychotics are notable for their use in treating schizophrenia and bipolar disorder and are divided into 1st-generation antipsychotics (FGAs) and atypical or 2nd-generation antipsychotics. First-Generation Antipsychotics medications form the centerpiece of treatment for schizophrenia, especially the positive symptoms. Only caroprazine has been shown to have significant effects on negative symptoms. The choice of a specific agent is mostly based on the adverse effect profile, required route of administration, and the patient’s previous response to the drug. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship who respond usually show the most rapid improvement in the 1st 2 weeks and will often continue to improve during the following weeks. While there is a wide variety of mechanisms of action, most antipsychotics block postsynaptic dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS receptors Receptors Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors.
1st-generation antipsychotics ( FGAs FGAs Antipsychotics, also called neuroleptics, are used to treat psychotic disorders and alleviate agitation, mania, and aggression. Antipsychotics are notable for their use in treating schizophrenia and bipolar disorder and are divided into 1st-generation antipsychotics (FGAs) and atypical or 2nd-generation antipsychotics. First-Generation Antipsychotics):
2nd-generation (atypical) antipsychotics ( SGAs SGAs Second-generation antipsychotics (SGA) are also called atypical antipsychotics. Medications in this class include aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lumateperone, lurasidone, olanzapine, paliperidone, pimavanserin, quetiapine, risperidone, and ziprasidone. Second-Generation Antipsychotics):
|Elevated prolactin Prolactin A lactogenic hormone secreted by the adenohypophysis. It is a polypeptide of approximately 23 kd. Besides its major action on lactation, in some species prolactin exerts effects on reproduction, maternal behavior, fat metabolism, immunomodulation and osmoregulation. Breasts: Anatomy||
|Neuroleptic malignant syndrome Neuroleptic malignant syndrome Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, and potentially life-threatening reaction to antipsychotic drugs. Neuroleptic malignant syndrome presents with ≥ 2 of the following cardinal symptoms: fever, altered mental status, muscle rigidity, and autonomic dysfunction. Neuroleptic Malignant Syndrome||
Nonpharmacological treatments are known to be partially effective in treating the negative and cognitive symptoms of the disorder and increase patient adherence to medications.
|Associated with better outcome||Associated with worse outcome|
|Late onset||Early onset|
|Good social support||Poor social support|
|Positive symptoms||Negative symptoms|
|Negative family history Family History Adult Health Maintenance||Positive family history Family History Adult Health Maintenance|
|Mood symptoms||No mood symptoms|
|Sudden onset||Gradual onset|
|Female gender Gender Gender Dysphoria||Male gender Gender Gender Dysphoria|
|Fewer relapses||Many relapses|
|Good premorbid condition (education, work)||Poor premorbid condition (no education, no work)|
The following conditions are differential diagnoses for schizophrenia:
|Differential diagnosis||Duration||Negative symptoms||Positive symptoms||Mood disorder|
|Schizophrenia||> 6 months (with at least 1 month of active phase symptoms)||Yes||Yes||Yes|
|Brief psychotic disorder Brief psychotic disorder Brief psychotic disorder is the presence of 1 or more psychotic symptoms lasting more than 1 day and less than 1 month. An episode is often stress-related with a sudden onset, and the patient fully returns to baseline functioning after an episode. Brief Psychotic Disorder||1 day to 1 month||No||Yes||Yes|
|Schizophreniform disorder||> 1 month, < 6 months||No||Yes||Yes, rare|
|Schizoaffective disorder Schizoaffective disorder Schizoaffective disorder is a mental disorder that is marked by 2 components: a psychotic component (hallucinations or delusions) and a mood component (mania or depression). Patients must therefore meet the diagnostic criteria for both major mood disorder and schizophrenia. Schizoaffective Disorder||Current mood episodes with active phase of schizophrenia plus at least 2 weeks of lifetime history of delusions or hallucinations without mood symptoms||Yes||Yes||Yes, predominantly|
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