The set of diseases that usually refers to the "schizophrenia" are different in nature and cover a wide range of cognitive disorders, cognitive, and behavioral.
Prevalence of this problem was 0.5% in the whole world with equal distribution between the proportion of males and females.
A doctor in the first place to find out how distinguish schizophrenia from other diseases, and what are the problems that emerged in the hospital and how I was treated.
Reasons:
Seems to be not identify any underlying cause behind schizophrenia. While the injury is attributable to any cause leads to a breakdown in communication evolutionary nervous when an infected person and the interaction of genetic factors and the nature of the multiple factors affecting the development of the brain.
** It is likely that the daily use of Indian hemp (cannabis) is a risk factor is also important.
** Pathogenicity Genetic likely to be related to the gene and are not subject to mendelian inheritance.
Incidence of schizophrenia caused by hereditary transmission of capacity and was about 80%.
Genetic risk factor in schizophrenia:
• General population 1%
• second degree of kinship 2.5%
• parents (father \ mother) 4%
• 8% of siblings
• of a son living with parents 12%
• son of parents living with 30-40%
• twin dual Alloaqah 8-19%
• twin mono Alloaqah 40-60%
Brain scanning and studies on the brain of the infected tissue showed the existence of expansion in the cerebral ventricles with a mobile engineer random and chaotic in the hippocampus, and this supports the evolutionary theory of neural pathogenicity.
Observed that the dopamine receptors in the terminal was in the case of cellular disorder (increased so that the internal components of the cell influence of inducers Khajah ....), but serotonin may also be a common mechanism of pathogenicity.
Clinical features of schizophrenia:
This disease may begin at any age but is rare before puberty and peak onset occurs in the early twenties.
Symptoms that are taken into account and diagnosed as symptoms of the condition his term the first row, has described the German Kurt Schneider, "Kurt Schneider", namely:
• auditory hallucination of the absent person called termed "third person" with or without voice comments on the behavior of an infected person.
• withdrawal and Gahqrh intellectual, and involve the deployment.
• the whispers and the illusion of an initial (illusion has no basis).
• recognize and just imaginary.
• physical inertness, and a sense that the feelings and thoughts controlled by others.
Most of these symptoms when the patient is diagnostic of schizophrenia, however, most of these symptoms occur in other mental disorders.
There are other symptoms of acute schizophrenia include:
behavioral disorders and other hallucinations
High School, Sousse (persecutory)
The dullness in the mood.
Schizophrenia is divided into a positive "type 1" and negative "type 2 "....
1. The positive characteristics of schizophrenia:
Initially sharp and clear whispers, as well as hallucinations, and abnormal brain structure, and there are biochemical disorders include transport Aldopamina, and good response to antipsychotics, and the result is better.
2. Schizophrenia negative characteristics:
Gradual slow start, and the relative absence of acute symptoms, the presence of morbidity and social withdrawal, lack of efficiency and excitement, and structural brain abnormalities Internal Medicine, and poor response to antipsychotics.
Chronic schizophrenia:
The advantage of being last for a long time, and negative symptoms, and cumin, and the lack of excitement, and social withdrawal and emotional emptiness.
Differential Diagnosis
It should be a distinction between schizophrenia and the following cases:
■ organic mental disorders (such as partial complex epilepsy)
■ mood disorders (affective) (such as mania)
■ psychiatric medicines (such as the psychological effect of amphetamine)
■ personality disorders (schizophrenia).
In older patients, no acute or chronic syndrome affecting the brain can manifest in a manner similar to schizophrenia.
Includes a diagnostic point of aid is that a change of consciousness and memory disorders do not occur in schizophrenia, whereas visual hallucinations are unusual.
And schizoaffective psychosis is a clinical demonstration in which the schizophrenic disorders and symptoms occur in the same context and revolve in the orbit of one.
Warning:
The warning of schizophrenia is variable, and review treatment plans in the studies note that:
15-25% of people with schizophrenia recover completely.
70% have a relapse cases may be negative symptoms ranging from mild to moderate.
10% is the percentage of patients who remain status of permanent disability.
Treatment:
Is to get the best results through partnership between social drugs and treatment.
1 - antipsychotic drugs:
These medicines through its role Alhasr the two sets of receptors, dopamine D1 - D2
These drugs are most effective in the acute situation with positive symptoms, and less effective in controlling the chronic condition, or with negative symptoms.
Full control of positive symptoms may need to 3 months of treatment, and stop medication too soon can lead to relapse.
Both the anti-psychotic drugs, and adrenergic receptors, dopamine D1 and D2, they usually produce extrapyramidal side effects and this limits their use in permanent cure when many patients.
And can limit these drugs and receptors Aladrinalgih Almskarnah As a result, can lead to many undesirable effects:
Unwanted effects of antipsychotic drugs:
Common effects:
- Kinetic effects:
• Acute dystonia
• parkinsonism
• akinesia (motor restlessness)
• senile dyskinesia
- The effects on the autonomic nervous system (sympathetic and anticholinergic):
low blood pressure
failure of ejaculation
- Effects of anti-Mscaren:
• dry mouth
• urinary retention
• constipation
• blurred (blurred) vision
- Metabolic effects:
weight gain
- Rare effects:
o hypersensitivity
o jaundice stasis
o leukopenia
o sensitivity of the skin
- Other effects:
o the development of cyanosis eyes
o impact of milk (due to excess prolactin)
o interruption of menstruation (amenorrhea)
o arrhythmia
o seizures
Malignant syndrome of antipsychotic drugs:
Side effects are rare and dangerous of these drugs, and this syndrome occurs when 0.2% of patients treated with these medicines, especially those with strong influence of the effectiveness of anti-Dopaminergic such as haloperidol (Haloperidol)
Symptoms occur within days to several weeks of starting treatment, and rise above include calorie and stiffness of muscles and the autonomic nervous system disorder (speeds up the heart, blood pressure disorder, pallor) and changes in mental status and level of consciousness.
Surveys show an increase in the level of creatine kinase and white blood cell count and a disturbance of liver function.
Treatments include the immediate suspension of the drug and taking necessary action to revive the patient, such as reducing the heat.
Albroomokrebtin can be given, which improves efficiency Dopaminergic addition to dantrolene, which reduces muscle tension, but did not prove any way practical usefulness in the treatment
For pregnancy:
The data about the effects of defects of the fetus to antipsychotic drugs is still limited, should be compared to the damage caused as a result of no treatment, with the possible risk of these drugs on the development of the fetus.
The group Butyrophenones (such as haloperidol) may be more secure than the group (Phenothiazines)
Must be evaluated on the basis of intake doses to avoid side effects, and since the drugs Barconsonah (which are used in the case of increasing the dose) with the effects of distorted and should be avoided.
2 - Phenothiazines:
Phenothiazines are the first group of anti-psychotic used widely.
Chlorpromazine is a drug user when the need for stronger analgesia, in a dose (100 - 1000 mg) per day, while Altrevloberazin is used when not needed for analgesia. Alvlovinazin is also used as medicine long-term to prevent relapse, and that Khaknp Mdkhrh (25-100 mg, injected muscle, every 1-4 weeks).
3 - Albotarufinonat:
Albotarufinonat (Calhaloberidol 2-30 mg daily) is also a powerful anti-psychotic effect. Have been used in the treatment of severe cases of schizophrenia and mania.
Likely to cause dystonia and / or extrapyramidal side effects, but the impact of the housing is much less soothing Phenothiazines.
One-third of patients with acute HAV schizophrenia would show a good response to haloperidol, one third Vsabdon a partial response to it.
4 - Typical antipsychotics:
These drugs so that they are surrounding abnormal receptor D2 less than D1 receptors, causing extrapyramidal side effects and less senile dyskinesia.
Currently recommended to use the typical antipsychotics is first-line medicines for the treatment of newly diagnosed cases of schizophrenia and for patients treated with typical anti-psychotic drugs, but with the important side effects.
5 - Alkluzaben:
Alkluzaben used in patients with schizophrenia Almand and resistant to treatment and who did not respond to Two types of antipsychotic drugs, or at least the first-line drugs.
- This medicine is a phenothiazine (Dai Daaziban Fino), where he owns a relatively large affinity for the receptors Dopaminergic D1-type pattern at the expense of D2, receptors and muscarinic Aladranerjeeh more than, as he caught the serotonin receptor 5-HT1 and 5-HT2.
- The survey showed that the cerebral functional Alkluzaben caught limbic selective receptors Dopaminergic receptors more than planned, which is likely to cause extrapyramidal side effects are far fewer.
- Back Alkluzaben exciting therapeutic effect on symptoms of positive and negative Mandh and resistant to treatment.
In any event, the Alkluzaben costly and cause severe scarcity Mahbbat in 1-2% of patients; so it is described only in the UK for patients registered at doctors and pharmacists registered service Klmasal to monitor patients.
- Be the initial dose by 25 mg per day, with a maintenance dose of 150-300 mg per day.
- The survey must be an enumeration of white blood cells a week for 18 weeks, then once every two weeks throughout the treatment period.
In addition to the effects of antipsychotic Alkluzaben it helps to reduce aggressive behavior and hostile and reduces the risk of suicide; with the possibility of its creation to a significant increase in weight with over-Games; There is also an increased risk of diabetes.
6 - risperidone:
It is derived from Abannzisoxasul bracketed with the common characteristics of the receptor Aldopamina pattern of D2 receptors and serotonin 5-HT2A.
Dose rate is between 6-10 mg per day.
Medicine does not cause sedation significantly and the total number of incidents and severity of extrapyramidal side effects is lower than if the use of conventional antipsychotics.
7 - Olanizaben:
Have affinity for the receptors of the type 5HT2_D1_D2_D4 and receptors, muscarinic, and studies have shown that its effects abroad hierarchy is less than the rest of medicine, and it seems that the obligation of doctors is clear that the drug due to side effects at least the weight and dose of the only daily (5 - 15 mg), however, the long-term use This medication carries the risk of obesity and diabetes.
And does not appear that any of the drugs (risperidone_ olanzapine) can be a qualitative treatment of schizophrenia, as is the case Almand of clozapine (clozapine)
Of schizophrenia, atypical drugs are also the following drugs:
(Amisulpride, Sulpiride, Zotepine, Ziprasidone and Quetiapine) seems to be the last (Quetiapine) is of a lower capacity to cause excessive secretion of prolactin.
Should monitor patients under treatment with drugs prior to the possibility of the development of diabetes they have, and may not involve more than one drug at the treatment of patients with schizophrenia.
Psychotherapy:
Include patient reassurance and support and strengthen the relationship between him and his doctor, and psychological treatment is contraindicated in patients or if the violent end of an exploratory (ie, knowledge of the patient and his condition).
In contrast, cognitive behavioral therapy for individuals may be useful in reducing the fantasies they have.
Social treatment:
Require the processing of social attention to the environment of the patient and the social function.
Can help educate the family, relatives, partners and the patient to give social and emotional stimuli appropriate to the patient's condition and emotions is appropriate that the excess can be a risk factor for Phoenix of the patient.
If the people who suffer from the disease are working, it is necessary to work in jobs protected.
Should be for groups of mental health care to follow up patients who do not adhere to treatment.
Assets associated with medical treatment:
The side effects are the motor that drives the most common reason patients with schizophrenia who take antipsychotic to go to the doctor and followed the patients deliberately harm themselves.
Usually appears booster acute indigestion in patients who recently started eating antipsychotics cause the so-called Balassar.
Extrapyramidal side effects are common and are similar to those in people with Parkinson's disease, these symptoms subside off the medication and the use of drugs Mscaren (eg, prostacyclin).
Concern of sitting:
A continuous movement, this is a common concern and affects the legs and looks like syndrome ((restless legs, but appears in the day.
Dopamine drugs can cause amenorrhea, Luther's milk, can be infected with the elderly and low pressure positive antipsychotics can cause delirium if they have the appearance of anti-Mscaren effects.
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