Week 6 - Schizophrenia + Substance use disorders

Schizophrenia

A mental disorder characterized by distortions of thinking and perceptions. It may include hallucinations, delusions, and disorganized thinking.

Pathophysiology of schizophrenia

The pathophysiology of schizophrenia is not fully understood, but it is believed to involve a combination of genetic, neurobiological, and environmental factors.

One prominent theory suggests that abnormalities in the brain's neurotransmitter systems, particularly dopamine, play a significant role in the development of schizophrenia. Dopamine is a neurotransmitter that helps regulate emotions, movement, and cognition. In individuals with schizophrenia, there may be an overactivity of dopamine receptors in certain areas of the brain, leading to the manifestation of symptoms such as hallucinations and delusions.

Additionally, structural abnormalities in the brain, such as enlarged ventricles and decreased gray matter volume, have been observed in individuals with schizophrenia. These structural changes may be linked to disruptions in neurodevelopmental processes during critical periods of brain maturation.

Moreover, genetic factors are thought to contribute to the risk of developing schizophrenia. Studies have shown that individuals with a family history of schizophrenia are more likely to develop the disorder themselves, suggesting a genetic predisposition. However, the exact genes involved in schizophrenia are complex and not fully understood.

In conclusion, the pathophysiology of schizophrenia is a multifaceted process involving a combination of genetic, neurobiological, and environmental factors.

Negative symptoms of Schizophrenia

6 A’s

1. Anhedonia - lack of pleasure

2. Flat Affect - lack of explression

3. Apathy - lack of interest

4. Anergia - lack of energy

5. Alogia - lack of speech

6. Avolition - lack of motivation

Positive symptoms of Schizophrenia

Symptoms that are added to a pt with Schizophrenia.

• Delusions

• Hallucinations

• Disorganized speech

Schizophrenia and suicide

Those with schizophrenia are 2.8x more likely to commit suicide then those who do not. Also the highest incident of suicide is within 30 days of seeing the Dr.

Areas of the brain involved in schizophrenia

• Basal Ganglia

  • involved in movement, emotions and integrating seneory infomration

• Frontal Lobe

  • Critical problem solving, insight and other high-level reasoning.

• Limbic system

  • Involvoled in emtion

• Auditory system

  • An oerly active Wernicke’s area is thought to create auditory hallucinations.

• Occipital Lobe

  • Processes information about the visual world. Full blown visual hallicutions are rare, but disturbinaces in this area can make interpreting complex images or recogning emotions on others faces hard.

• Hippocampus

  • Mediates learning and memory.

Phases of Schziphrenia

Prodromal

• Decline in functioning that precedes 1st episode.

• Socially withdrawn, irritable

• Physical complaints

• New found interest in the religion/occult

Psychotic (acute phase)

• Positive symptoms

• Perceptual disturbances (eg. auditory hallucinations)

• Delusions

• Disordered thought

Residual (chronic)

• Occurs between episodes of psychosis

• Marked by negative symptoms

• Odd thinking and behaviour

Complications of Schizophrenia

• Lack of personal hygiene

• Anxiety disorder

• Aggressive behaviour

• Being victimized

• Social isolation

• Relationship difficulties

• Drug/ tabacco/ alcohol abuse

• Inability to preform work or studies

• self-injury

• depression

DSM-5 diagnosis

Criterion A:

• Two or more of the following, each present for a signifiant poritoin of time during 1-month period.

  • Delusions

  • Hallucinations

  • Disorganized speech

  • Grossly disorganised or catatonic behaviour

  • Negative symptoms (ie. avolition)

Treatment for Schisophrenia

1. Antiphychotics

   1. Broken in to Typical and Atypical

2. Psychotherapy

   1. With the assistance of medication

3. Neuro Rehab

Extrapyramidal symptoms

Drug-induced movement disorders can occur as side effects of antipsychotic medications.

They include:

• dystonia: involuntary movement disorders

• akathisia: psychomotor restlessness. An inability to remain still.

• parkinsonism: slowed movements, rigidity (stiffness) and tremors.

• tardive dyskinesia: symptoms include involuntary tongue protrusion, lip smacking, South puckering, facial grimacing, excessive blinking, and writhing movements.

  • Doesn’t go away with discontinuation of medication

Anticholinergic medications

Drugs that block the action of the neurotransmitter acetylcholine in the brain and body. They are commonly used to treat conditions like overactive bladder, COPD, and Parkinson's disease.

Typical Antipsychotic drugs

Relieve the positive symptoms on Schziophrenia but very potent and lead to many side effects. They wokr by blocking dopamine receptors in all aprt of the brain.

• Chlorpromazine

• Haloperido

• Pimozide

• Fluphenazine

• Trifluoperazine

Atypical Antipsychotic drugs

Dopamine and Serotonin Antagonist

• Blocks dopamine and serotonin receptors in the brain

  • Amisulpiride

  • Clozapine

  • Olanzapine

  • Sertindole

  • Zotepine

  • Quetiapine

Partial Dopamine Antagonist

• Only blocks a portion of the dopamine receptors and also blocks serotonin receptors.

Contradictions for Atypical (2nd generation) Antipsychotics

• Hypersensitivity

• CNS depression including alcohol

• Liver, renal or cardiac insufficiency

• SSRI (can lead to sudden EPS)

• Tegretol (anticonvulsant)

• Cigarette smoking

• Blood dyscrasias (blood disorder) in clients with Parkinson’s

Contradictions for Typical (1st generation) Antipsychotics

• CNS depression including alcohol

• Liver, renal or cardiac insufficiency

• SSRI (can lead to sudden EPS)

• Tegretol (anticonvulsant)

• Luvox (increases concentration of Haldol and clozaril)

• Cigarette smoking (reduces plasma levels)

• Blood dyscrasias (blood disorder)

• Parkinson’s disease

• Prolactin dependant cancer of the breast

Patient teaching for Antipsychotic drugs

• Sugar free fluids and sugar free candy to relieve dry mouth

• Avoid calorie-laden bevrages and candy because the contribute to weight gain

• Constipation can be relieved by increaing water and bulk forming foods and exercise.

  • Stool softeners are permissible but laxatives should be avoided

• Rise slowly from sitting or lying to present othrostatic hypotension

• Use sunscreen and clothing to pretect skin from photosensativity

CAGE Questionarrie

C - Cut

• Have you ever felt like you should cut down on your substance use?

A - Annoyed

• Have you ever felt annoyed by other people’s perceptions of your substance use?

G - Guilty

• Have you ever felt guilty about your substance use?

E - An eye opener

• Have you ever used your substance first thing in the morning as are “eye-opener”?

Risk FActors for Substance use

• Genetic predisposition

• Early use

• Lack of supervision

• Peer pressure

• Using highly addictive substances

• Low self-esteem

• Trauma

• Grief and loss

• mental health disorder

Personality Risk factors for SA

Impulsivity

Sensation seeking

Anxiety sensitity

Negative thinking

Complications of Substance Abuse and Addiction

• Cardiovascule disease and stroke

• Cancer

• Hepatitis B and C

• HIV/AIDS

• Lung disease

• Worsening mental health illness/symptoms

• Problems with employment

• Relationship problems

• Legal issues

Cluster B Personality disorders

• Antisocial Personality disorder

• Borderline Personality disorder

• Histrionic Personality disorder

• Narcissistic Personality disorder