SCHIZOPHRENIA-Contd...
Schizophrenia by its nature composed of a group of disorders, involving disruption of thoughts and disintegration of personality.
Behavioral alterations thought, affect and perception are some of the symptoms.
Disturbances in thoughts are characterized as follows:-
1.Hallucinations
2.Delusions
3.Flat affect
4.Catatonic behavior(Muscular rigidity with a stupor state)
5.Incoherent association.
Schizophrenia occur in 1 % of the population starts the onset of the symptoms usually at 15 and 45 years of age.
Etiology
1.Genetic
2.Neurophysiologic theories such as dopamine over activities at its D-2 receptors
3.Psychosocial theories.
Many of the symptoms described by the Swiss psychiatrist Eugen Bleuler(1857-1939) are nonspecific as these symptoms are also present in non-schezophrenic. He described the 4-A's as follows:-
1.Association defects
2.Affect
3.Ambivalence
4.Autism
But the specific symptoms exclusively indicating the presence of schizophrenia are:-
1. Hallucinations especially auditory involve abnormal sensory perceptions without external cause.
2. Delusions with wrong belief and doubt without logical causes. Bizarre and seemingly realistic scenes uncover in front of the eyes. The patients may often complain that they are watched by others, they are the center of talks in society, and they are unjustifiably controlled by others.
Diagnosis:-
The patient must be brought to the diagnostic room only if any three of the following symptoms persist at least for one week continuously in order to confirm the person is a patient.
1. Delusions-Complains bizarre scenes, panic, doubts on others with obsession or withdrawal
2.Hallucinations.-Sensory perceptions
3.Incoherence
4.Catatonic look
5.Grossly inappropriate affect.
6.If he suffered from lack of self-care
7. Continuous signs of abnormalities are present at least for six months.
8.Autism
Classifications of Schizophrenia:-
1. Disorganized -or hebephrenic schizophrenia is characterized by marked incoherence and unresponsiveness of the patient
2. Catatonic-schizophrenia is characterized by rigidity, immobility, posture, silence, and other psychomotor effects.
3.Paranoid-Characters of delusions of grandeur or persecution with obsession and aggressiveness. The patient in this class is extremely violent.
4. Undifferentiated-This type of schizophrenia is characterized by prominent delusions, hallucinations, and disorganized behavior. Altogether this class contains an overall picture of mixed behavior. Some times it may escape from diagnosis by the presence only one symptom.
5. Residual-This designates a patient who not currently psychotic but has a history of one prior episode of prominent psychotic symptoms.
Residual symptoms such as withdrawal, vague association, illogical thinking, the inappropriate effect may impair daily living skills.
ANTI-PSYCHOTIC DRUGS
TRADITIONAL DRUGS:-
Phenothiazines:-
1.Chlorpromazine
2.Fluphenazine
3.Trifluoperazine
4.Thioridazine
5.Perphenazine
The distinctive side effects of thioridazine are 1.Primary retinopathy;2.Arrhythmias;3.Conduction block.
Butyrophenones:-
1.Haloperidol
2.Droperidol
Side effects of these drugs are mainlyExtrapyramidal effects;
Dibenzoxazepines:-
Loxapine
Thioxanthenes:-
Thiothixexne
Therapeutical Uses of Traditional Drugs:-
Traditional neuroleptics can be used therapeutically as follows:-
1.Agitated states, such as schizophrenia
2.Emesis-By blocking the Dopamine receptor at the vomiting center(Chemo Receptor Trigger Zone).However, thioridazine should not be used for this purpose.
3. Tourette's syndrome (a characteristic neurological disorder onset from the childhood characterized by stereotyped behavior with abnormal vocal sounds like tics)-Haloperidol is the drug of choice
4.Interactive hiccups-Chlorpromazine
5. Antipruritic therapy-Promethazine is used because of its antihistaminic effects.
Toxicology of Neuroleptics:-
1.Sedation
2.Extrapyramidal effects
3.Anticholinergic effects(Dry mouth, blurred vision, constipation, urinary retention, and further refer to cholinergic antagonists)
4.Alpha-adrenergic effects (Contraindicated to prostatic enlargement, hypotension, and further refer to Adrenergic Agonists)
High potency drugs such as haloperidol and fluphenazine produce severe extrapyramidal effects.
Low potency drugs such as thioridazine and chlorpromazine produce highest anticholinergic effects
5. Endocrine defects can cause galactorrhea, amenorrhea, and infertility due to blockade of dopamine release from the pituitary.
Extrapyramidal Effects:-
In general, the dopamine pathways blockade can cause prominent extrapyramidal effects as follows:-
1.Akathesia-Motor restlessness
2.Parkinson's disease-Bradykinesia
3. Dystonia-slow, prolonged muscle spasms of tongue, neck, and face)
4. Neuroleptic Malignant syndrome-This is also caused by prolonged treatments with neuroleptics. It is characterized by rigidity, altered mental status, cardiac arrhythmias, hypertension, and life-threatening hyperpyrexia. The disorder is best treated with Dantrolene a skeletal muscle relaxant.
5.Tardive dyskinesia-rhythmical involuntary movements of the tongue, lips or jaw.
The patient may demonstrate the puckering of the mouth or chewing movements.
Tardive dyskinesia is a common side effect with prolonged treatments with traditional antipsychotic drugs such as 6 months to 1-year use.
Withdrawing the treatment may cause a partial reversal of the condition but however, in many cases tardive dyskinesia is proved as irreversible.
