Schizophrenia PDF

PhCare 4: Clinical Pharmacy and Pharmacotherapeutics 1 SCHIZOPHRENIA AMIN, SALMAN BANTAN, ARABEL NECESITO, LESLIE  Learning Objectives: At the end of the lesson the students should be able to: 1. Define Schizophrenia...

PhCare 4: Clinical Pharmacy and Pharmacotherapeutics 1 SCHIZOPHRENIA AMIN, SALMAN BANTAN, ARABEL NECESITO, LESLIE  Learning Objectives: At the end of the lesson the students should be able to: 1. Define Schizophrenia 2. Explain the pathophysiology of schizophrenia 3. Identify the clinical presentation 4. Analyze the pharmacological and non- pharmacological treatment.  Overview Schizophrenia is a chronic, severe, disabling & challenging brain disorder that makes it difficult to distinguish between what is real and unreal, think clearly, manage emotions, relate to others, and function normally.  Overview The term schizo comes from greek that means “split” and phrenia that refers to “mind”. So, schizophrenia essentially means “split of mind” The onset of illness is often during late adolescence or early adulthood.  Epidemiology Lifetime prevalence: 1% Equally prevalent in men and women Affect all groups equally Peak age onset: 15-25 years for male and 25-30 years for females Rare before 10 years and above 50 years One of the most heritable psychiatric disease  Pathophysiology Symptoms Phases 1. Positive symptoms 1. Prodromal Phase 2. Negative symptoms 2. Active Phase 3. Cognitive Symptoms 3. Residual Phase  Pathophysiology Neurotransmitter abnormalities are central to the pathophysiology of schizophrenia, with dopamine, serotonin and glutamate all playing roles. Glutamate: The primary excitatory neurotransmitter in the brain. Dysfunction in this system may explain negative and cognitive symptoms, potentially leading to dopamine dysregulation  Pathophysiology Serotonin: Plays a role in mood regulation and has been implicated in the pathophysiology of schizophrenia. Second-generation antipsychotics often target serotonin receptors (like 5-HT2A) in addition to dopamine receptors, which may help alleviate some negative symptoms and reduce the risk of EPS  Pathophysiology Dopamine: Excessive dopamine activity in certain brain pathways is linked to the development of psychotic symptoms Four key dopamine pathways in the brain: mesolimbic, mesocortical, nigrostriatal, and tuberoinfundibular Pathophysiology  Pathophysiology Dopamine Pathways: 1. Mesocortical Pathways - Originates in the brain stem and projects two areas of the cortex (Prefrontal cortex and cingulate cortex) 2. Mesolimbic pathway - also originated on the brain stem and projects to the limbic system like the hypothalamus 3. Nigrostriatal Pathway - Originate from the substantia nigra and is linked to the EPS cause by D2 receptors  Pathophysiology Dopamine Pathways: 4. Tuberoinfundibular Pathway - a neurohormonal pathway also originates in the brain stem and projects to the pituitary where it controls the release of various neuroendocrine hormones. NOTE: These pathways (Mesocortical and mesolimbic) are primarily involved in the pathophysiology of schizophrenia. These pathways (Nigrostriatal and tuberoinfundibular) are more related to the effects of antipsychotic medications and do not directly contribute to the pathophysiology of schizophrenia itself.  Etiology The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition. Increased risk Genetics - Schizophrenia tends to run in families, but no single gene is thought to be responsible. - It's more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes does not necessarily mean you'll develop schizophrenia.  Etiology Neurotransmitters - Neurotransmitters are chemicals that carry messages between brain cells. - It is thought people with schizophrenia may have different amounts of certain neurotransmitters in their brains. Pregnancy and birth complications - Research has shown people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as: a low birthweight, premature labor, a lack of oxygen (asphyxia) during birth. It may be that these things have a subtle effect on brain development.  Etiology What triggers schizophrenia: Stress: bereavement, losing your job or home, divorce, the end of a relationship physical, sexual or emotional abuse Sexual abuse, physical abuse, emotional abuse, bullying. These kinds of experiences, although stressful, do not cause schizophrenia. However, they can trigger its development in someone already vulnerable to it. Drug abuse: Studies have shown using drugs, particularly cannabis, cocaine, LSD or amphetamines, can increase the risk of developing schizophrenia, psychosis or a similar illness.  Clinical presentation The clinical presentation of schizophrenia can vary widely between individuals, and may be divided into the following 3 domains: Positive symptoms - Psychotic symptoms, such as hallucinations, which are usually auditory; delusions; and disorganized speech and behavior. Negative symptoms - A decrease in emotional range, poverty of speech, and loss of interests and drive  Clinical presentation Cognitive symptoms - Neurocognitive deficits (eg, deficits in working memory and attention and in executive functions, such as the ability to organize and abstract); patients also find it difficult to understand nuances and subtleties of interpersonal cues and relationships  Clinical presentation 5 TYPES OF HALLUCINATIONS 1. Auditory: hearing voices or sounds that are not there 2. Visual:seeing people, colors, shapes, or items that aren't real 3. Tactile: feeling sensations (bugs crawling on or under your skin) or as if you're being touched when you're not 4. Olfactory: Smelling something that has no physical source 5. Taste: Experiencing taste in your mouth when you have not eaten anything  Diagnosis Finding a diagnosis of schizophrenia may include: Physical exam: This may be done to rule out other problems that could cause similar symptoms and check for any related complications. Tests and screenings: These may include tests that help rule out conditions with similar symptoms and screening for alcohol and drug use. A healthcare professional also may request imaging studies, such as an MRI or a CT scan.  Diagnosis Blood Test: A routine blood test can help a doctor rule out conditions with similar symptoms, such as alcohol and drug abuse. Interactions between certain medications, such as corticosteroids and cardiovascular medications Mental health evaluation: A healthcare professional or mental health professional checks mental status by noting how a person looks and behaves, and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. This evaluation includes family and personal history.  Pharmacological Treatment First-Generation Antipsychotics (Typical Antipsychotics) These are older medications, including Haloperidol and Chlorpromazine, which primarily target dopamine receptors to reduce positive symptoms (e.g., hallucinations and delusions). Common side effects: Extrapyramidal symptoms (motor control issues like tremors), tardive dyskinesia (involuntary facial and body movements), and sedation.  Pharmacological Treatment Second-Generation Antipsychotics (Atypical Antipsychotics) Newer medications such as Risperidone, Olanzapine, and Clozapine, which affect both dopamine and serotonin receptors, helping to address both positive and negative symptoms (e.g., social withdrawal, lack of motivation). Common side effects: Weight gain, metabolic syndrome, and, less commonly, movement disorders.  Pharmacological Treatment Additional Pharmacological Interventions Mood Stabilizers and antidepressants may be added in cases with significant mood symptoms. Clozapine is especially useful in treatment-resistant schizophrenia but requires regular blood monitoring due to risk of agranulocytosis (a drop in white blood cells).  Non-Pharmacological Treatment Psychotherapy: Cognitive Behavioral Therapy (CBT): Helps individuals identify and manage symptoms, understand distorted thinking patterns, and reduce distress related to hallucinations or delusions. Cognitive Remediation Therapy (CRT): Focuses on improving cognitive functions like memory, attention, and problem-solving. Social Skills Training: Aims to improve social interactions, communication, and daily living skills, helping patients reintegrate into society and enhance their independence.  Non-Pharmacological Treatment Family Therapy: Supports the patient’s family members to better understand the illness, improve communication, and build a supportive environment for recovery. Psychoeducation: Provides patients and families with information about schizophrenia, treatment options, and self-care techniques, empowering them to take an active role in the management process.  Non-Pharmacological Treatment Community and Vocational Support: Community support services, including employment assistance and structured community programs, aid in maintaining a sense of purpose, routine, and stability.