Schizophrenia Disease

DESCRIPTION

Major psychiatric disorder with prodrome, active and residual symptoms involving disturbances (lasting at least 6 months) in:

Appearance (deteriorated)
Speech (loosened association)
Behavior (stereotyped)
Perception (hallucinations)
Thinking (delusions)
System(s) affected: Nervous
Genetics: Genetic predisposition necessary for development
Incidence/Prevalence in USA: Lifetime (1%). Highest prevalence in lower socioeconomic classes.
Predominant age: Onset typically before age 45
Predominant sex: Male = Female; onset earlier in males (15-24) than females (25-34)

SIGNS AND SYMPTOMS

Withdrawal from reality
Delusions (fixed false unreal beliefs – paranoid: people persecuting or after you)
Reference (people or things have unusual significance)
Others can hear your thoughts, put thoughts into you or control you; grandiose or religious delusions
Hallucinations – usually auditory
Affect – flat or inappropriate emotion
Thought processes – loose associations (thoughts don't follow)
Much speech but convey little information
Extremes of gross overactivity to stupor with mutism

CAUSES

Unknown - not initiated or maintained by an organic factor. Probably a complex interaction between inherited and environmental factors.

RISK FACTORS

Biologic relative with schizophrenia (if first degree relative, risk is 8%)

LABORATORY

No test available to indicate schizophrenia
Laboratory tests needed to rule out organicity – may include CBC, blood chemistries, thyroid screen, urinalysis, vitamins (B12, folate, thiamine), blood and urine for drugs and alcohol
Others for: heavy metals – ceruloplasmin, urine porphobilinogen

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Psychological – Bender Gestalt, intelligence testing (WAIS-R), MMPI-2; neuropsychological testing
EEG – to rule out seizure disorder, brain damage, etc.

IMAGING

CT and MRI to rule out organicity

DIAGNOSTIC PROCEDURES

Lumbar puncture

APPROPRIATE HEALTH CARE

Usually hospitalize initially for organic workup and for treatment of psychotic symptoms
Outpatient if not dangerous to self or others, able to cooperate with treatment, and supportive family: community treatment and case management
Family intervention: psycho-education

GENERAL MEASURES

Ensure safety of patient and others - may act on delusional thinking

SURGICAL MEASURES

N/A

ACTIVITY

Establish safe hospital environment

DIET

No special diet

PATIENT EDUCATION

Education and support groups for patient and family available from National Alliance for the Mentally Ill (NAMI), 2101 Wilson Blvd., Suite 302, Arlington, VA 22201, (703) 524-7600
National Mental Health Association, National Mental Health Information Center, 1021 Prince St, Alexandria, VA 22314-2971; 800-969-6642
Smoking cessation: American Cancer Society; American Lung Association

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Side effects of neuroleptics, especially risk of tardive dyskinesia with chronic use
Self-inflicted trauma
Combative behavior toward others

EXPECTED COURSE AND PROGNOSIS

Chronic course – remission and exacerbations
Guarded prognosis, complete remission not common
The negative symptoms (consisting of decreased ambition, energy, emotional responsiveness, and social withdrawal) are often most difficult to treat

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: Unusual before puberty
Geriatric: Those who survive enter into a chronic phase
Others: Onset in 30's - more paranoid type

PREGNANCY

Use of haloperidol (most studies support its safety); complications of being on neuroleptics

OTHER NOTES

Schizophrenic patients occupy about half the beds in mental hospitals and 1/4 of all hospital beds; significant risk of comorbid substance abuse/dependence and suicide

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.