Schizophrenia Overview and Treatment

Psychopharmacology

• Psychopharmacology is the study of the effects of drugs on the mind and behavior.
• It particularly focuses on psychotherapeutic medications used to treat mental illnesses.

Prehistoric Approaches to Treating Mental Illness

• Prehistoric cultures believed abnormal behavior was caused by evil spirits.
• Treatments involved removing these spirits through methods such as beating, trephining (drilling holes in the skull), and bleeding.

Later Approaches: Isolation and Constraint

• Later approaches involved isolating and restraining individuals perceived as mentally ill.
• Examples included hanging individuals by ropes, placing individuals in cages or confined spaces.

Later Approaches: Sensory Based Sensory Deprivation

• Sensory deprivation involved isolating individuals from sensory stimuli.
• Methods included the use of sensory deprivation apparatus, sensory shock.

Historical Medical Interventions

• Insulin shock therapy, electroconvulsive therapy, convulsant drugs were used to treat mental illness in the past.
• These therapies were often drastic, aimed at shocking the brain into normalcy and causing seizures.

Medical Interventions: Pre-Frontal Lobotomies

• Pre-frontal lobotomies were surgical procedures performed to sever connections in the prefrontal cortex.
• They were popular therapies, but now considered unethical and inhumane.

A New Style Intervention: Psychotherapy

• Psychotherapy is an interactive experience with a trained professional to understand and change behaviors, thoughts, relationships, and emotions.
• Major forms include psychoanalysis, humanistic, cognitive, and behavioral therapy.

Schizophrenia: Description and Symptoms

• Schizophrenia affects around 1% of the population.
• It is diagnosed by loss of contact with reality.
• Multiple behaviors, outcomes, and etiologies associated.

Schizophrenia: Symptoms

• Positive symptoms are behaviors that are present but should not be there.
  • This includes disorganized thoughts and delusions, disturbed perceptions (hallucinations, disorganized speech), and unusual movements
• Negative symptoms are behaviors that should be present but are absent.
  • Examples are social withdrawal, anhedonia (loss of pleasure), alogia (loss of speech), and amotivational (loss of motivation).
• Social or occupational dysfunction, self care, and cognitive impairments are also important manifestations of the disorder.

Schizophrenia: Treatment Options

• Treatment options for schizophrenia were initially scarce and ineffective.
• Psychoanalysis and psychosurgery proved ineffective.
• The chlorpromazine revolution marked a significant advancement.

The Chlorpromazine Revolution

• The introduction of chlorpromazine marked a significant turning point in the treatment of psychiatric disorders.
• It led to deinstitutionalization due to improved treatment.
• It has positive effects in improving the lives of patients with schizophrenia.

Chlorpromazine Side Effects

• Notable side effects of chlorpromazine include motion side effects mediated by basal ganglia (tardive dyskinesia) and parkinson-like symptoms (the Thorazine shuffle).
• Acute dystonia and akathisia are also possible side effects.

Antipsychotics (Major Tranquilizers)

• First-generation (typical) antipsychotics target dopamine receptors and can produce movement disorders.
• Second-generation (atypical) antipsychotics have broader mechanisms and effects and are more likely to be less toxic
• Concerns about treatment noncompliance persist.

The Mood Disorders

• Major depressive disorder is characterized by depressed mood lasting at least two weeks, diminished interest in activities, and other symptoms.
• Bipolar disorder involves alternating periods of mania and depression.
• Dysthymic disorder is a less severe and shorter-duration form of depressive disorder.

Major Depression

• Major depression is a mental condition characterized by feelings of severe despondency and dejection.
• It encompasses feelings of inadequacy, guilt, and lack of energy, appetite, and sleep.
• Biological, psychological, and social factors contribute to the development and progression of depression.

Causes of Major Depression

• Causes of major depression are multifaceted and include biological, psychological, and social-cultural factors.
• Factors like genetic predispositions, changes in brain chemistry, and negative past experiences play a role.

Psychotherapeutic Medications for Major Depression

• Antidepressants are a direct consequence of the chlorpromazine revolution
• Most effective treatment is a combination of medication and therapy.
• Different types of antidepressants are available (MAOIs, tricyclics, SSRIs, SNRIs, etc).

Three Major Classes of Antidepressants

• MAO inhibitors (MAOIs) prevent the deactivation of neurotransmitters.
• Tricyclic antidepressants (TCAs) inhibit the reuptake of neurotransmitters.
• Selective serotonin reuptake inhibitors (SSRIs) target serotonin specifically.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) are designed to inhibit both serotonin reuptake.

Monamine Oxidase Inhibitors (MAOIs)

• MAOIs are potentially effective but have severe side effects, especially when combined with particular foods or other medications
• Considered the third-line treatment due to safety concerns.

Tricyclics: The Second Generation

• Tricyclics are antidepressants with a low therapeutic index.
• They are associated with side effects such as constipation, dry mouth, and blurred vision.
• The risks of fatal overdose, seizures, and cardiac arrhythmia have reduced their use.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• SSRIs are the most commonly used antidepressants, due to better tolerated side effects.
• SSRIs typically take 4-6 weeks of consistent use to see improvements.

Benefits and Side Effects of SSRIs

• Typical side effects of SSRIs are generally mild.
• Potential for serotonin syndrome, a life-threatening complication that can occur in combination with other serotonergic medications.

An Herbal Approach: St. John's Wort

• St. John's Wort is an herbal supplement, not a drug, used for mild to moderate depression.
• It may function as a serotonergic reuptake inhibitor, but its mechanism of action isn't fully understood.
• It is generally considered as effective as mild to moderate depression as tricyclics or SSRIs

Other Re-Available Antidepressants

• Other types of antidepressants include norepinephrine reuptake inhibitors (NRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRI's).

The Mood Disorders: Bipolar Disorder

• Bipolar disorder is characterized by wild mood swings between depression and mania.
• Depression involves feelings of despondency and dejection.
• Mania involves hyper-elevated mood, euphoric feelings, and grandiosity.

Treatment for Bipolar Disorder

• Lithium is an effective mood stabilizer for bipolar disorder.
• It may stabilize the rate of receptor activity, lowering or raising neuronal excitement
• It has a low therapeutic index and potentially toxic side effects.

Treatment Approaches to Major Depression

• Pharmacologic intervention includes medications designed to target biochemical imbalances in the brain
• Electroconvulsive therapy is an electrically induced seizure used for severe cases of depression.
• Psychotherapy, or talk therapy, is a method for treating depression through psychological means.

What Works Best? A Biopsychosocial Approach

• Bio-medical therapies for depression include drug therapies, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS).
• Psychological approaches include insight-oriented psychotherapy, psychoanalysis, humanistic, cognitive, and behavioral-oriented psychotherapy.
• Social/community approaches include family therapy, community treatment, and prevention programs.

Test your knowledge on schizophrenia, including its symptoms, demographics, and various treatment approaches. This quiz explores both positive and negative symptoms and historical perspectives in psychotherapy. Expand your understanding of this complex mental health disorder.