Pathophysiology of Schizophrenia

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Schizophrenia is a chronic and severe mental disorder

Schizophrenia is characterised by psychosis (loss of contact with reality),hallucinations(false perceptions),delusions(false beliefs),disorganised speech and behaviour,restricted emotions,impaired reasoning and problem solving,occupational and social dysfunction.

Check for symptoms:

Positive: Excess or distortion of normal functions.Hallucinations,Delusions.

Negative: Diminution or loss of normal functions.

Disorganised: Thought disorders and Bizarre behaviour

Cognitive: Difficulty in information processing and problem solving

Causes:

  • Alterations in brain structure (enlarged cerebral ventricles,thinning of cortex,decreased size of hippocampus and other brain structures)
  • Changes in neurotransmitter levels dopamine and glutamate.
  • Stressors can trigger the emergence of symptoms. Stressors may be primarily biochemical(substance abuse eg:marijuana),social(becoming unemployed,leaving home for education, joining armed forces,breaking off a romantic relationship)

Prescription contains:

Phenothiazines: Chlorpromazine,Prochlorperazine,Trifluoperazine,Fluphenazine,Perphenazine

Thioxanthenes: Thiothixene,Chlorprothixene

Butyrophenones: Haloperidol,Droperidol

2 nd generation antipsychotics: Clozapine,Olanzapine,Risperidone, Paliperidone

Quetiapine.

Drug and Dose:

Chlorpromazine – 30-800 mg

Thioridazine:150-800mg

Trifluoperazine 2-40 mg

Fluphenazine: 0.5-40 mg

Thiothixene: 8-60mg

Haloperidol: 1-15mg

Counselling on side effects:

Thioridazine : pigmentary retinopathy at higher doses.

Thiothixene,Haloperidol:high incidence of akathisia (restlessness, state of agitation, distress)

All phenothiazines: extrapyramidal symptoms (loss or impairment of the power of voluntary movement)

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