Topic Discussion By Alexandria Brown Schizophrenia Topic Discussion By Alexandria Brown

Overview What is Schizophrenia? Etiology Pathophysiology Clinical Presentation Diagnosing Schizophrenia Treatment Options Treatment Guidelines Monitoring Schizophrenia Complications of Schizophrenia

What Is SCHITZOPHRENIA? Schizophrenia is a mental illness that is a spectrum of symptoms and traits. Defined by Abnormalities concerning at least 2 of the following1: Hallucinations1,3 Delusions1,3 Disorganized Thought Processes or Speech1,3 Disorganized or Abnormal Motor/Movement Behaviors1,3 Negative Symptoms1,3

Schizophrenia is Complicated Commonly called a psychotic disorder that has multiple names and subcategories and spectrums Spectrums1,2 Schizotypal (personality) Disorder Schizoaffective Disorder Schizophreniform Disorder Subtypes of Delusion1,2,3 Paranoid/Persecutory Somatic Erotomaniac/ Jealous Grandiose Mixed Residual

ETIOLOGY The etiology of schizophrenia is not fully understood currently Researchers have concluded that there are some significant Risk Factors: Genetic Component1,5 Increased heritable risk for off-springs Environmental Component Season of Birth1,4 Traumatic Events1,4 Obstetrical Complications1,2,5,3

Pathophysiology Theorized but not fully known Theories include: GABA4,5 Dopamine4,5 Glutamate receptors reduced activity4,5

Clinical Presentation Depends on the type of Schizophrenia and the Individual Presents itself as: Hearing Voices or Visual Hallucinations1,5 Delusions1,5 Social Withdrawal1,5 Anxiety, Depression, OCD1,5 Lack of Awareness of Disease1,5 Substance Abuse5 Cognitive Symptoms5 Disorganized speech5

Diagnosis Often times it can go undiagnosed which usually leads to negative consequences Diagnosed through mental health services usually through psychiatry Follow Guidelines using the DSM-51 Diagnoses subtype and deciphers between spectrums of schizophrenia1 Determines if meets at least 2 of the criteria of abnormalities1

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Treatment Options Non-Pharmacological5,6 Pharmacological5,6 Psychotherapy Counseling Group Sessions Behavioral Health Skills and Employment Services ECT (Electroconvulsive Therapy) Pharmacological5,6 Long-Acting Injectable Anti-Psychotic Agents Treatment-Resistant Schizophrenia Antipsychotics Augmentation and Combination Therapy Depends on the Phase of Treatment6 Acute Phase Stabilization Phase Stable Phase

Pharmacological Treatment5,6,7 Treatment Guideline Type of Schizophrenia Pharmacological Treatment5,6,7 Schizophrenia First Generation: Phenothiazines Chlorpromazine 300-1000 mg/day Fluphenazine 5-20 mg/day Mesoridazine 150-400 mg/day Perphenazine 16-64 mg/day Thioridazine 300-800 mg/day Trifluoperazine 15-50 mg/day Butyrophenone Haloperidol 5-20 mg/day Others Loxapine 30-100 mg/day Molindone 30-100 mg/day Thiothixene 15-50 mg/day Second Generation Aripiprazole 10-30 mg/day Clozapine 150-600 mg/day Olanzapine 10-30 mg/day Quetiapine 300-800 mg/day Risperidone 2-8 mg/day Ziprasidone 120-200 mg/day Alternatives or for other Side Effects Benzodiazepines Lorazepam Schizoaffective Disorder Clozapine 150-600mg/day Risperidone 2-8 mg/day Olanzapine 10-30 mg/day Quetiapine 300-800 mg/day Ziprasidone 120-200 mg/day Aripiprazole 10-30 mg/day Schizophreniform Disorder Latuda

Monitoring Schizophrenia Lipid Levels Weight Gain Metabolism Cardiovascular Health Symptoms and Side Effects6,7 Suicide1 Psychotic Episodes6,7

Complications induced from Schizophrenia Obesity1,3,4 Drug Abuse1,3,4 Smoking/ Tobacco Use1,3,4 Anxiety Disorders1,3,4 Diabetes1,3,4 Metabolic Disorders1,3,4 Cardiovascular and Pulmonary Diseases1,3,4 Decreased Life Expectancy1,3,4

Sources Schizophrenia Spectrum and Other Psychotic Disorders. In: Diagnostic and Statistical Manual of Mental Disorders. DSM Library. American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596.dsm02 Cagliostro D. 5 Schizophrenia Subtypes. PsyCom.net - Mental Health Treatment Resource Since 1986. https://www.psycom.net/schizophrenia-5-subtypes. Accessed November 30, 2018. The National Institute of Mental Health. Schizophrenia. NIMH. https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. Accessed November 30, 2018. Fischer B, Buchanan R. Schizophrenia in adults: Epidemiology and pathogenesis - UpToDate. UpToDate. https://www-uptodate-com.ezproxy.rosalindfranklin.edu/contents/schizophrenia-in-adults-epidemiology-and- pathogenesis?search=schizophrenia&source=search_result&selectedTitle=3~150&usage_type=default&displa y_rank=3#H31673369. Accessed November 30, 2018. Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: Overview and Treatment Options. P T. 2014;39(9):638- 645. Lehman AF, Lieberman JA, Dixon LB, et al. Treatment of Patients With Schizophrenia. AMERICAN PSYCHIATRIC ASSOCIATION. 2010;(Second Edition):184. Psychosis and schizophrenia in adults: prevention and management | Guidance and guidelines | NICE. https://www.nice.org.uk/guidance/cg178/chapter/1-Recommendations#care-across-all-phases. Accessed December 7, 2018.