The island-features cerebral anoxia

Schizophrenia was known as dementia praecox by a

Psychologist called kraeplin in the 19th century. He described that it is

Associated with false beliefs or delusions, hearing or seeing unreal

Things or hallucinations, disorders of thinking, emotional blunting and

Running a progressive deteriorating course.

The modern diagnosis of schizophrenia relies on the work

Of a psychologist called schneider, who elucidated a number of first rank

Symptoms that should be present to diagnose schizophrenia in the absence

Of brain disease.

Schneider’s first rank symptoms

* auditory hallucinations – third person talking or


Arguing about the subject or a third person commentary on subjects

Actions.

* thought withdrawal or insertion or thought broadcast

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* somatic passivity (thoughts and actions are not his own)

* feeling of actions experienced as being under external

Control

* delusional perceptions (false beliefs)

Acute schizophrenia is characterized by the ‘positive’

Symptoms of delusions (false beliefs), hallucinations (seeing unreal

Things) and thought disorder.

Paranoid delusions are the most common symptoms. They may

Be persecutory (accusing), grandiose (thinking that you are the greatest),

Religious or hypochondrial and are occasionally bizarre.

Passivity phenomena are the most characteristic delusions.

The sufferer believes that impulses, actions, emotions or sensations that

He experiences are not his own, but are imposed on him by external forces.Cerebral anoxia

Hallucinations may be auditory and they are longer than in

Other psychoses.

Thought disorder occurs in about 20%. The patient’s speech

May appear odd; he may give seemingly irrelevant answers to direct

Questions, jump from one theme to another in conversation with no apparent

Cohesive link and occasionally use ordinary words in new ways (paraphrasia)

Or invent new words (neologisms). Sometimes, speech is totally

Incomprehensible: comprising a jumble of unrelated words (word salad).

Mood: the patient’s mood maybe abnormal. He may experience

Uncanny feeling that the world around him has changed in some way

(perplexity or delusional mood), or exhibit a flattening of emotional

Response (blunted effect).

Catatonic phenomena (e.G.Cerebral anoxia mutism, stupor, and adoption of

Strange postures or movements) are now seldom seen in developed countries.

The reason is unclear.

Chronic schizophrenia – in some patients, a more insidious

Defect state develops, management of which remains a major therapeutic

Problem. The negative symptoms of chronic schizophrenia include a lack of

Initiative and drive, poverty of speech, social withdrawal and blunting of

Emotional expression. Depression is also a common feature. Acute psychotic

Episodes can recur from time to time, precipitated by withdrawal of

Medication, or stressful life events.

Diseases, which can mimic schizophrenia – organic –

Epilepsy (temporal lobe in the brain), drug induced states (amphetamines,

cerebral anoxia

Cocaine, LSD, cannabis), alcoholic hallucinations, cerebral tumor,

Encephalitis head injury, sulcal widening, reduced (brain substance),

Temporal lobe volumes.

Functional — affective psychosis, schizoaffective disorder

(another type of schizophrenia), atypical psychosis and other paranoid

States, personality disorders.

Possible causes of schizophrenia – seasons of birth — late

Winter births.

Schizophrenia patients have a neurodevelopment defect in

The brain (ventricular enlargement, cortical).

Risk factors – premobid abnormalities in personality,

Trying to gain higher educational achievements (in males or females at the

University entrance class), social adjustment and neurology.

Genetic factors – 40% of monozygotic twins might have

cerebral anoxia

Schizophrenia.

Early environmental hazards – obstetric complications

(fits and high blood pressure during pregnancy or pre-eclampsia), bleeding

Before child birth dates or antepartum haemorrhage and maternal influenza,

Long labour, asphyxia or less oxygen to the baby during child birth.

Chemical imbalances in the brain — dopamine over activity

In some cases ‘congenital’ schizophrenia – patients, mostly males, who

Have abnormal personality in childhood, present early, and exhibit

Negative symptoms, morphological brain damage and cognitive impairment.

The disorder is neurodevelopmental in origin, resulting from genetic

Predisposition, an early environmental hazard, or both.

Adult onset schizophrenics include most females whom have

cerebral anoxia

More affective symptoms, and often show a relapsing and remitting course.

Treatment – acute phase – treatment has a dual purpose.

Control of aggressive or agitated behaviour (sedative effect of the drug

And reduced within hours) and alleviation of psychotic state (within

Days).

Once the patient is stabilized, maintenance therapy is

Continued with an oral or depot formulation; the latter to establish

Compliance in patients who may be unreliable at taking oral drugs.

Maintenance treatment at the lowest possible dose should be continued for

At least one year after a first episode, even if recovery is complete and

Rapid. In recurrent episodes, maintenance therapy should probably be

Continued indefinitely.

Traditional drugs – chlorpromazine, tiroidazine,

cerebral anoxia

Trifuoperazine, (all can cause sedation, extra pyramidal effects and

Postural hypotension), and haloperidol (less sedation, but more extra

Pyramidal effects).

Depot preparations – flupenthixol decanoate, flupenthixol

Enanthate (may cause depression).

New drugs – sulpride, riseperidone, clozapine and pimozide.

Treatment of chronic schizophrenia is more problematical, due to long-term

Side effects (e.G. Akathisia or unable to sit still, tardive dyskinesia or

Abnormal movements). There are some drugs with less side effects, e.G.

Clozapine is better than chlorpromazine for reducing negative, positive

And with less extra pyramidal effects. Treatment of acute patients is

Undertaken in the hospital and chronic ones as out patients.Cerebral anoxia both under

Stimulation (long-hospital stay) and over stimulation (critical relatives)

Effect the mental state. Cognitive behavioral methods can reduce relapses

By developing insight.

Rehabilitation should include;

1. Behavioral techniques to encourage social skills

2. Occupational therapy to assist in the activities of

Daily living

3. Re-employment in industrial therapy units, day centres

Or sheltered workshops

4. Residential placement in supervised hostels, group

Homes or sheltered housing.

In developing countries like sri lanka, problems arise in

The rehabilitation process. The facilities available (e.G. Residential

Facilities or half houses), for this are negligible. This is the most

Important factor in the rehabilitation process.Cerebral anoxia

The cooperation of a multidisciplinary professional team, including a

Psychiatrist, psychologist, social workers and occupational therapists, is

Most effective in providing the best possible therapeutic environment for

Individual patients.