Schizophrenia 2e

by Norman Sartorius, Mario Maj (Editor)

This series acknowledges the substantial gap that still exists in psychiatry between research evidence and clinical clinicians are sometimes incompletely aware of research findings, or regard them as biased, not convincing or not relevant to their practice. By using systematic reviews with accompanying commentaries this volume is able to assess the "evidence" and "experiences" to give a critical and objective account of the relevant issues, while focusing on key topics. This comprehensive book addresses schizophrenia through a systematic review of the available rearch evidence. This book "...was a pleasure to review. One can dip in and out of it at random to find an important aspect of schizophrenia summarised in a few paragraphs. The reviews are all well written, balanced and up-to-date. It is designed for an international readership, and come commentaries, such as those on continental concepts of schizophrenia, or experience of stigma in the less industrialised world, are rarely found together in one volume." — British Journal of Psychiatry , 2001

Genres: Psychology

516 pages, Paperback

First published September 15, 1999

Reviews

[Michał Hołda · Rating 5 out of 5]

This book has commentaries to each chapter.

And contains some of what I had written under other review and some new news. :

The Saint Louis of Feighner definition of schizophrenia results upon three criteria.

-The presence of chronic illness with at least 6 months of symptoms in the absence of a period of depressive or manic symptoms sufficient to quality for affective disorder.

-The presence of delusion or hallucination or verbal production that makes communication difficult because of the lack of a logical or understandable organization.

- And the last three of the following manifestations, being single; poor premorbid social adjustment or work history, family history of schizophrenia, absence of alcoholism or drug abuse within one year of oncet of psychosis, and onset of illness prior to 40.
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There are two up to date classifications of Schizophrenia.

International Classification of Diseases,Tenth Revision (ICD-10) Depends upon the presence of characteristic symptoms, minimum duration of these symptoms, and a differentiation from affective criteria or psychotic, organic or substance include disorders.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition—DSM-IV—is the official manual of the American Psychiatric Association. Depends upon the presence of characteristic, minimum duration of these symptoms, minimum duration of the disorder, the presence of social/occupation dysfunction, and a differential from mood, schizoaffective, or other psychotic disorders, general medical condition, substance-induce disorder and pervasive developmental disorder.
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The differential between schizophrenia and brief psychotic disorder and schizophreniform rest upon criterion of delusions:

--less than one month for brief psychotic disorder;

more then one month but lest then 6 months for schizophreniform disorder,

-and more then 6 months for schizophrenia.

The differential diagnoses between schizophrenia and delusional disorder rest on nature of delusions (in delusionbal disorder they are not bizarre) and the absence of other characteristic symptoms of schizophrenia such as hallucination, disorganized speech and behavior or prominent negative symptoms.

Acording to DSM IV The positive symptoms appear to excess or disortation of normal function. Wheres negative symptoms appear to reflect a dimution or loss in normal function.
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The schizophrenic patient does not experience hallucinations as normal his hallucinations is like an event on another stage, not in the word, but in front of it, that means not participating in the field of normal perception, the persons concern is at the mercy of this perception not only because this hallucinated voice is coming from everywhere, but also because his body scheme has change (the perceived voice reches the center of the person, while the activity of the ego is blocked, and it is really impossible to objectify it); Schizophrenia hallucination is like revelation, stirring up a whole being person.
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Before the launch of clozapine, it was generally taken for granted, and backed up by many competitive trails, that the average neuroleptics differ in terms of tolerability but not regarding their efficiency.. As a rule of thumb, high potency drugs were associated with a greater risk for extrapyramidal motor side effects, while low potency medication were said to have more autonomic adverse events

Effect of drugs during the acute treatment wiith antipsychotics:

Entrapyramidal
- acute dystortion
- acute dyskinesia
- acute akathisia
- acute parkinsonism
- trative dyskinesia
- trative dystontia (akathisia)
Anticholinergic
- dry mouth
- constiption
- blured vision
- urinary retention
- sexual disfunction
Opthtalmologic
- lenticular changes
- pigmentary retinopathy
Endocrine and metabolic:
- increesed prolaction
gynaecomastia,
galactorrhoea
- weight gain
- sexual disfunction
- lipid and glucose metabolism disfunction
Antiadrenergic
-orthostic hypotension
- ECG alterations
> tachycradia
> tachyarrhythmia
> depressed ST segments
> flattened U waves
> prologed QT intervals
- sexual disfunction
Haemotolgic
- eosinophilia
- leucocytosis
- leucopenia
- agrenulocytosis
Dermatologic
- photesensitivity
- seborrhoeic dermatities
Sexual
- diminished libido
- orgasmic disfunction
- efectile dysfunction incl. priapism
ejaculatory dysfunction
> reduced volume
> delayed ejaculation
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Olanzaran is a second-generation (atypical) anti psychotic medication. These medications are way better then previous generation, there is no longer constans stress and tension that made physical pain and tiredness.

Second generation antipsychotics work by blocking the excitatory activity of dopamine and serotonin, chemicals (neurotransmitters) released by nerve cells (neurons) to transmit nerve signals. Dopamine and serotonin regulate many functions including pleasure sensation, mood, behavior, learning and memory, among others.

These medicine is way better then First-generation antipsychotics (FGAs), also known as neuroleptics, conventional or typical antipsychotics, have significant potential to cause extrapyramidal symptoms and tardive dyskinesia.J

Risperidone, the atypical antipsychotic drug studied by Honey et al. (18), was the first such drug, followed by olanzapine, quetiapine, ziprasidone, and iloperidone.

Olanzapine is similar to clozapine both in its chemical structure and it its pharmacological properties It has plasma half life of about 30 hours., the manufacturer recommended dosage between 5-20 mg.

Before registation olanzapine was compered to placebo and haroperidol in clinical trials, it was shown to be superior to placebo and at least equal to haloperiol with schizophrenia or schizoaffective disorder It was more effective in treating patterns in treading depressive and negative symptoms in schizophrenic patients.

And is as good as chloromazine in Treatment-resistant schizophrenia that is a lack of adequate response to anti psychotic medications resulting in incomplete functional and social recovery from the illness. Different definitions have been proposed for clinical practice and research work.

Now plasma half life of about 30 hours means that when patients takes 1 tablet of 5 mg a day, next 30 hours after the taking there is 2.5 mg of Olanzapine left in the body, now if you take it everyday, For months, year or years, or your whole adulthood, the medicine will accumulate in the body, and will prevent symptomps form happening, constantly. Therefore will prevend dopaine form overexitment and the only way to feel joy in life is to learn it all over again, could be faith, or appreciation of relationships, small things in life, to cherish.

That is why you should not stop taking medications on your own, it is enough for the doctor to check whether there is this drug in the blood plasma in the right amount. And in turn, what should not be done, i.e. diagnosing exaggeratedly, is used so that the patient starts treatment early and that the course of treatment is better.

Prof. Fleishhacker mentioned that the treatment of schizophrenia has changed since the introduction of non-seductive newer anti psychotics.

The treatment of negative symptomatology in schizophrenia still remains an important issue. So far there is little, if any, convincing evidence that the currently available anti psychotics affected the core negative symptom. There may be decrease of the symptoms during treatment, but in most cases this can also be explained in the context of the improvement of the condition of the patient.

According to the DSM IV, positive symptoms refer to an excess or disturbance of normal functioning. Where negative symptoms may reflect weakness or loss of normal functioning.

Narcoleptics were the first effective antypsychotic treatment: reducing positive symptoms at the acute psychotic episode, neuroleptic therapy enables patient to be discharged from hospital and, by preventing repales the psychological integration can be maintained. Soon neuroleptics were considered to be the cornerstone of the treatment of psychotic , disorders in general , and of schizophrenia more specifically.

With the introduction of neurloeptics , in the early 1950s, the number of institutionalized patients rapidly decreased. Unfortunately, several disable patients were often dumped in society without adequate provisions, unprepared to come with demands of social and professional integration.
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Schizophrenia is "the price that Homo sapiens pay for language." Symptoms represent " The language at the end of its tether.

We must abandon the view that schizophrenia and its carrier can be separated as one separates infection from its victim. That is, that it's subjective (self) of the subject can be treated as independent region. The second modification follows from the first: studding subjective calls for suitable meteorology, phenomenology in its continental seance.

Now I realized that it was only in the last year of my final exams (a-levels) that I was studying like an athlete for my final exams, and I wanted to rest. And my dad and the others expected me to work or study. - this disease is the price for being able to speak a language.

[Sergey Kochergan]

Kraepelin, Bleuler and all about