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  Schizophrenia

Schizophrenia comes from the Greek word, schizo “to split” or “to divide”and phren “mind”. It is commonly translated as “shattered mind” but it is not similar to a condition known as multiple personality disorder, dissociative identity disorder or “split personality”.

Schizophrenia
Schizophrenia


Schizophrenia may also be described in terms of "positive" and "negative" symptoms. Positive symptoms include: delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. Negative symptoms are so named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation. Some models of schizophrenia include formal thought disorder and planning difficulties in a third group, a "disorganization syndrome." Furthermore, neurocognitive deficits may be present. These may take the form of reduced or impaired psychological functions such as memory, attention, problem-solving, executive function or social cognition. There is no objective definitive biological test for schizophrenia. Recent studies suggest that important contributing factors for this disorder are the following: genetics, neurobiology and social environment. Therefore, diagnosis is mainly based on the clinical psychiatric history (as reported and experienced by the patient) and observable signs or objective data by a clinical psychiatrist, clinical psychologist or other competent clinician.

Schizophrenic patients are most likely be diagnosed with other disorders. The lifetime prevalence of substance abuse is 40%. Comorbidity with clinical depresssion, anxiety disorders, social problems and decreased life expectancy is also present. Increased physical health problems and high suicidal rate makes a schizophrenic patients live 10-12 years less that their healthy counterparts. Onset of schizophrenia typically occurs in late adolescence or early adulthood, with males tending to show symptoms earlier than females. The most commonly used criteria for diagnosing schizophrenia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems

To be diagnosed as having schizophrenia, a person must display:
• A) Characteristic symptoms: Two or more of the following, each present for a significant portion of time during a one-month period (or less, if successfully treated)
o delusions
o hallucinations
o disorganized speech
o grossly disorganized behavior or catatonic behavior
o negative symptoms, i.e., affective flattening , alogia or avolition Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing with each other.
• B) Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset.
• C) Duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if successfully treated) that meet Criterion A. Additional criteria (D, E and F) are also given that exclude a diagnosis of schizophrenia if symptoms of mood disorder or pervasive developmental disorder are present. Additionally a diagnosis of schizophrenia is excluded if the symptoms are the direct result of a substance (e.g., abuse of a drug, medication) or a general medical condition.

Subtypes
The DSM now contains five sub-classifications of schizophrenia:

• catatonic type (where marked absences or peculiarities of movement are present),
• disorganized type (where thought disorder and flat affect are present together),
• paranoid type (where delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening is absent),
• residual type (where positive symptoms are present at a low intensity only) and
• undifferentiated type (psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types has not been met). NB: Some older classifications still use "Hebephrenic schizophrenia" instead of "Disorganized schizophrenia".

Medication The first line pharmacological therapy for schizophrenia is usually the use of antipsychotic medication . Antipsychotic drugs are only providing symptomatic relief from the positive symptoms of psychosis. The newer atypical antipsychotic medications (such as clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and amisulpride) are usually preferred over older typical antipsychotic medications (such as chlorpromazine and haloperidol) due to their favorable side-effect profile. Compared to the typical antipsychotics, the atypicals are associated with a lower incident rate of extrapyramidal side effects (EPS) and tardive dyskinesia (TD). It is still unclear whether newer drugs reduce the chances of developing the rare but potentially life-threatening neuroleptic malignant syndrome (NMS). While the atypical antipsychotics are associated with less EPS and TD than the conventional antipsychotics, some of the agents in this class (especially olanzapine and clozapine) appear to be associated with metabolic side effects such as weight gain, hyperglycemia and hypertriglyceridemia that must be considered when choosing appropriate pharmacotherapy.

Therapy and community support Psychotherapy or other forms of talk therapy may be offered, with cognitive behavioral therapy being the most frequently used. This may focus on the direct reduction of the symptoms, or on related aspects, such as issues of self-esteem, social functioning, and insight. Cognitive behavioral therapy (CBT) can be an effective treatment for the psychotic symptoms of schizophrenia as shown by recent reviews.

Electroconvulsive therapy (also known as ECT or 'electroshock therapy') may be used in countries where it is legal. It is not considered a first line treatment but may be prescribed in cases where other treatments have failed. Psychosurgery has now become a rare procedure and is not a recommended treatment for schizophrenia. Other support services may also be available, such as drop-in centers, visits from members of a 'community mental health team' or assertive community treatment team, and patient-led support groups. Prognosis for any particular individual affected by schizophrenia is particularly hard to judge as treatment and access to treatment is continually changing, as new methods become available and medical recommendations change.

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