Makindo Medical Notes

Related Subjects: |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Acute Psychosis |Delusions |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Postpartum/Postnatal Depression |Postpartum / Postnatal Psychosis |Eating disorders in Children

Gustatory (taste) and olfactory (smell) hallucinations can also be associated with temporal lobe epilepsy.

About

• Schizophrenia affects approximately 1% of the global population.
• It is believed to be a neurodevelopmental disorder, with both genetic and environmental factors contributing to its onset.
• Characterized by disturbances in thought, perception, and behavior, impacting daily functioning and quality of life.

Aetiology

• Structural brain abnormalities are observed, including smaller brain volume, enlarged sulci, and ventricles.
• Decreased volume is most notable in the temporal lobe, but other areas can also be affected.
• May be triggered or exacerbated by exposure to significant stress or trauma.

Positive Symptoms

• Hallucinations: Primarily auditory, often voices in the second or third person ("You" or "He/She"). Visual, tactile, olfactory, and gustatory hallucinations are less common but can occur.
• Delusions: Strongly held beliefs not rooted in reality, such as paranoid delusions (believing others are out to get them) and grandiose delusions (believing in special powers or missions).
• Disorganized Thinking: Speech may be incoherent or tangential, reflecting disorganized thought processes.
• Bizarre Behavior: Behavior that appears strange or out of place; may include unusual body movements, posture, or dress.

Negative Symptoms

• Emotional Withdrawal: Flat affect or reduced emotional expression, such as speaking in a monotone or showing limited facial expression.
• Social Withdrawal: Reduced interaction and connection with others, leading to isolation.
• Apathy and Anhedonia: Lack of motivation, energy, and reduced pleasure in daily activities.
• Poverty of Speech: Minimal verbal communication, often giving short or monosyllabic responses.

Management and Treatment

Medications

• Antipsychotics: Medications are usually the first line of treatment and are effective in managing symptoms. They include typical and atypical antipsychotics, with the latter often having fewer side effects.
• Clozapine: This antipsychotic is sometimes used for treatment-resistant schizophrenia. While effective, it requires regular monitoring due to potential side effects.
• Maintenance Therapy: Medications are often used long-term to prevent relapses, with adjustments made based on symptom severity.

Psychotherapy and Supportive Care

• Cognitive Behavioral Therapy (CBT): Aims to help patients understand and manage their symptoms, challenging irrational thoughts and behaviors. This therapy is particularly effective in reducing hallucinations and delusional beliefs.
• Supportive Counseling: Provides a safe space for patients to express their feelings and concerns, assisting with daily life challenges.
• Family Therapy: Family meetings offer education on schizophrenia, coping strategies, and practical problem-solving for caregivers and family members.
• Occupational and Vocational Support: Focuses on helping patients reintegrate into daily activities and improve social skills, enhancing self-sufficiency.

Hospitalization and Crisis Intervention

• In severe cases, hospitalization may be necessary to manage acute symptoms and prevent harm.
• Hospitalization provides a controlled environment for stabilizing symptoms, particularly during severe episodes or when there is a risk of self-harm.

Research and Emerging Therapies

• Electroconvulsive Therapy (ECT): Sometimes used for severe or resistant cases when medication and other therapies are not effective.
• Novel Medications: New antipsychotics and adjunctive therapies are under study, aimed at improving symptom management and reducing side effects.
• Deep Brain Stimulation (DBS): Although experimental, DBS is being explored as a potential treatment for severe schizophrenia symptoms.

Additional Resources

• For comprehensive management plans and guidelines: Managing the Acute Psychotic Episode
• American Psychiatric Association - Schizophrenia Resources