Schizophrenia

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SCHIZOPHRENIA Brain Morphology: Enlarged ventricles reduces brain volume Worse tissue loss ~ worse symptoms Cannot distinguish fantasy from reality Aysha Choudhury Safia Khan Ayomide Gdadmosi Ben Gubby Aysha Arshi

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Negative Symptoms Emotes less Rejects social gatherings Stops hobbies Neglects hygiene “When I was in a severe state as a student, I would talk to my friends once a week, if that.” More burden on others , responds less to medication than positive symptoms.

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Positive Symptoms Delusions (False beliefs) .. of Paranoia .. of Reference .. Somatic (bodily) .. of Grandeur

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Positive Symptoms Disorganised speech Skips subject -subject Unrecognisable terms Rambling monologues Sensory Hallucinations 10 x risk of homicide Abnormal (motor) behaviour Rigid limbs, bizarre posture for hours/days Non-responsive while awake ( catatonia )

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Diagnosis At least 2 present over 6 months:

Treatments:

Treatments Side Effects Antipsychotics Non-drug Typical examples: Chlorpromazine Trifluoperazine Haloperidol Atypical examples: Clozapine Olanzapine Risperidone

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Non-drug approaches Family therapy Understand Schizophrenia How to solve problems in the home Cognitive Behavioural Therapy Recognise hallucinations e.g. Learn to ignore demons telling them to harm others Art therapy Alleviates negative symptoms e.g. Depression

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Drug Trial Process e.g. Risperidone can cause Insomnia (SE) Consider : Contra-indications/ Interactions? e.g . Diazepam (sedating) treats insomnia Or.. If unsuccessful... How are antipsychotic drugs selected ; What factors need to be considered ? Stevens-Johnson Syndrome CONTRA-INDICATION Of CLOZAPINE

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Akathisia : ..difficult to sit still and stop moving Side Effects

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Side Effects Ease off after body becomes accustom to medication

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Commonly: Symptoms in women: Irregular periods Production of breast milk Excess facial hair ... in men: Loss of libido Decreased muscle mass Breast enlargement ( gynaecomastia ) Exception: 2nd gen – Aripiprazole (Partial AGONIST of receptors) Hyperprolactinaemia

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If elevated , they put the patient at risk of cardiovascular disease ... medication may need to be lowered/changed or discontinued . Monitoring Health Parameters Antipsychotic medication increases the risk of developing cardiovascular diseases such as hypertension, heart disease, type II Diabetes. Before treatment, take baseline measurements of: ...take readings again 3 MONTHS after starting or switching antipsychotics ... and annually thereafter.

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REFERENCES Pathology : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2416751/ Symptoms : http://www.nhs.uk/Conditions/Schizophrenia/Pages/Symptoms.aspx Diagnosis : http://www.mayoclinic.org/diseases-conditions/schizophrenia/basics/tests-diagnosis/con-20021077 Side effects : http://stahlonline.cambridge.org/essential_4th_chapter.jsf?page=chapter5_summary.- htm&name =Chapter%205&title=Summary - http://www.patient.co.uk/health/antipsychotic-medicines - http://www.hormone.org/questions-and-answers/2010/hyperprolactinemia Treatments : http://www.nhs.uk/Conditions/Schizophrenia/Pages/treatment.aspx Monitoring : http://www.leicspart.nhs.uk/

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