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Conservative use of drug therapy
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A psychological approach that emphasizes the present and future of the patient, rather than the past.
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Emphasis on nutrition and physical exercise
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Family participation, if appropriate
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Psychoeducation for patients and relatives
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Schizophrenia
Schizophrenia is a neurobiological disorder that results in disturbances in both the form and content of an individual’s thought process, perception, affect and social behavior. Schizophrenia has probably existed for thousands of years but was first described in 1896 as "dementia praecox." However, it was soon renamed as the severe disorganization of the mind as well as the variability in course and outcome of the disease because apparent. The literal translation of schizophrenia is "divided mind."
What behaviors are typical of schizophrenia?
The characteristic symptoms of schizophrenia can be conceptualized as either positive or negative.
Positive Symptoms: an apparent excess or distortion of
normal functioning in the following areas
- Perception – Hallucinations in any sensory modality. The most common are auditory. Presence of other sense hallucinations, especially visual, olfactory, or gustatory may indicate a medical or substance abuse causal agent.
- Inferential Thinking – Delusions. Some themes are persecution (others are ridiculing or tormenting the individual), religious, grandiose (super powers), somatic (e.g. internal organs are monitored), and referential (gestures and comments are directed toward the individual).
- Language – Disorganized speech patterns, e.g. incoherence, tangentiality, and loose associations.
- Behavioral Monitoring – grossly disorganized behavior that impairs hygiene, daily activities, and organization-appropriate social behavior.
Negative Symptoms: an apparent diminution or deficit in
normal functioning in the following areas
- Speech fluency and productivity: alogia (brief, laconic replies)
- Emotional range and intensity: affective flattening
- Initiation of goal-directed behavior: (avolition)
- Loss of interest or pleasure (anhedonia)
- Catatonia – bizarre motor abnormality characterized by immobility, mutism, resistance to being moved, assumption of unusual positions, echolalia (echoing of final words).
Depression, anxiety, eating and sleeping disturbances, and Nicotine dependence may be associated. An increased rate of suicide, 10%, is responsible for a lowered life expectancy.
Schizophrenia may be diagnosed when at least two of the general symptoms of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior or other negative symptoms are present for significant portions of time during a one-month period (or less if successfully treated), and continue for at least six months (to some degree). In some cases delusions are so bizarre or hallucinations so marked as to consist of a voice continuously commenting on the individual’s behavior or thoughts, or conversing with another voice, that a second symptom is not required for diagnosis. During this time period, there should also be a marked decrease in social/occupational functioning compared to before onset. The diagnosis of schizophrenia also depends on the exclusion of the other mental disorders, medical conditions, substance abuse, and certain developmental disorders.
Who develops schizophrenia?
The median onset age for the first schizophrenic episode is early to mid-20’s for men, and late 20’s for women. Women tend to have a wider range of onset age (26 to 45 compared to 18 to 25). The prevalence of schizophrenia is similar throughout the world, although more common in lower socio-economic and large urban centers. There is also a small increase in rates of schizophrenia for those individuals born in late spring and early winter months. Some aspect of the tendency to be schizophrenic seems to be genetically linked, however social-psychological, and biological-environmental may also be involved.
What treatments are available?
While behavior therapy has been shown to have some success in modifying some of the dysfunctional behaviors associated with schizophrenia, the most effective treatment continues to be with medications known as antipsychotics. The traditional antipsychotics include:
| Thioridazine (Mellaril) |
Trifluoperazine (Stelazine) |
Loxapine (Loxitane) |
| Fluphenazine (Permitil, Prolixin) |
Thiothixene (Navane) |
Molindone (Moban) |
| Perphenazine (Trilafon) |
Haloperidol (Haldol) |
Chlorpromazine (thorazine) |
The so-called new generation antipsychotics (claiming fewer neurological side-effects at clinically effective doses) include:
| Clozapine (Clozaril) |
Quetiapine (Seroquel) |
Quentiapine (Seroquel) |
| Amisulpiride |
Risperidone (Risperdal) |
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| Olanzapine (Zyprexa) |
Iloperidone |
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Consultations