Schizophrenia can affect people throughout their lives, but it is most likely to occur in early adulthood (between the ages of 16 and 25 years). The prevalence of schizophrenia is about 1 percent around the globe. The patterns of vulnerability are different between males and females. Male shows a single peak of susceptibility to developing schizophrenia during 18 and 25 years. On the other hand, females show two peaks of susceptibility, one between the ages of 25 and 30 years and then again around the age of 40.
Causes of Schizophrenia
Neurochemical
abnormalities: According to studies, the neurotransmitter systems involved in
schizophrenia are dopamine, glutamate, acetylcholine, serotonin,
norepinephrine, and neuromodulators as neurotensin.
Genetics: The rate of
occurrence is higher in first-degree relatives; it is more likely to happen if
the family already has an individual with schizophrenia. Moreover, studies
showed that the rate of schizophrenia is higher in monozygotic twins as
compared to dizygotic twins.
Brain structure: It is noted that people affected with schizophrenia possess brain structures different from the normal brain, like enlargement of ventricles, the smaller size of medial temporal structures (hippocampus and amygdala), and decreased volume of white and grey matter.
Environmental factors: It is also believed that schizophrenia is more common in lower socioeconomic groups and urban areas. Exposure to viral infection in early life creates susceptibility to schizophrenia. Maternal exposure to the influenza virus during the second trimester of pregnancy is more likely to give birth to a child at increased risk for schizophrenia. Childhood trauma also has a link with schizophrenia.
Family factors: Poor parenting could also be the cause of schizophrenia. Other family factors that trigger the problem are negative-affective parenting style, criticisms, emotionally overinvolved attitudes, and behaviors.
Symptoms of schizophrenia
There are four various
types of symptoms of schizophrenia, i.e. negative, positive, cognitive, and
mood symptoms.
Positive symptoms: In
positive symptoms, abnormal behavior is added up and is followed by a break
from reality, organized thought processes, and content. The positive symptoms
involve hallucinations, delusions, loose associations, and disorganized
behavior. These symptoms lead to the need for hospitalization.
Negative symptoms: Negative symptoms include the abolition of some behaviors, i.e. poor hygiene, ambivalence, social isolation, amotivation, anhedonia, lack of speech, flat affect, apathy, and poverty of thought content.
Cognitive symptoms: Cognitive symptoms are the third type manifested by impairment in cognition and functional impairment. It includes problems in the registration of things in memory, trouble with recalling, disturbed executive functioning, loss of abstract thinking, and inability to focus on a particular task.
Mood symptoms: These symptoms are related to the mood of the patient. Some patients show depression, insomnia, agitation, mood liability, irritability, and anxiety.
The drugs of treatment
for schizophrenia usually deal with the positive and negative symptoms and are
divided into two categories:
Typical antipsychotic
medication. These neuroleptics were introduced in the 1950s, and they are
more effective for positive symptoms of schizophrenia but worsen the negative
symptoms because of their side effects.
Mode of action. Typical
neuroleptics act as an antagonist on the D2 receptor of Dopamine and reduce Dopamine.
Name of drugs. Following
drugs is fall in the category of typical neuroleptics:
- Chlorpromazine
- Haloperidol
- Fluphenazine
- Thioridazine
- Trifluoperazine
Side effects.These
all are sedative and cause extrapyramidal symptoms (EPS) involving acute
dystonia, tardive dyskinesia, and akathisia. Acute dystonia is
described as involuntary muscle tightening of the body; these acute dystonic
reactions are terrifying and lead to poor compliance. Tardive
dyskinesia is a major chronic extrapyramidal symptom characterized by a
disturbance in facial movements or expression. Akathisia is
characterized by the presence of restlessness, anxiety, agitation, or insomnia.
These drugs also cause Parkinsonism (Bradykinesia, cogwheel
rigidity, and stiffness) that contribute to other illness symptoms such as
vocal intonation, affective responses, reduced facial expression, and
gestures). These drugs also impair the patient’s ability to think and function
independently (negative impact on cognition). Other side effects of typical
neuroleptics are flushing, dizziness, and hypotension. It increases the
prolactin level and also causes a sexual disturbance.
Usually, antiparkinson or
anticholinergic medicines are prescribed along with typical neuroleptics to
treat EPS and Parkinsonism.
Atypical antipsychotic
medication. The atypical neuroleptics were introduced in the 1990s, and they
were more effective for the negative symptoms.
Mode of action. These
drugs act as an antagonist on the receptors of serotonin and some receptors of
histamine.
Benefits of atypical
antipsychotics. These drugs minimize the EPS and are better for cognition
and mood. They have efficacy for positive symptoms as well as more efficient
for negative symptoms.
Name of drugs. Following drugs is fall in the category of atypical neuroleptics.
- Clozapine
- Olanzapine
- Symbyax
- Risperidone
- Quetiapine
- Ziprasidone
- Aripiprazole
Side effects. Atypical neuroleptics cause metabolic syndrome (destroy lipids, cause hypertension, diabetes, and cholesterol). The use of these drugs can also lead to dementia. Clozapine cause agranulocytosis (decrease in white blood cells), epilepsy, and cardiac problems. Risperidone also increases the prolactin level and is related to EPS. Other side effects are restlessness, dizziness, sedation, constipation, dry mouth, nausea, rash, headache, and anxiety.
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