Schizotaxia

Overview

A genetic predisposition for schizophrenia.

Symptoms

* Increased risk of schizophrenia * Psychiatric symptoms * Neurobiologic abnormalities

Causes

Schizophrenia affects 1% to 2% of the population in the United States and is equally prevalent in both sexes. It may result from a combination of genetic, biological, cultural, and psychological factors. Some evidence supports a genetic predisposition. Close relatives of people with schizophrenia have a greater likelihood of developing schizophrenia; the closer the degree of biological relatedness, the higher the risk. The most widely accepted biochemical theory holds that schizophrenia results from excessive activity at dopaminergic synapses. Other neurotransmitter alterations, such as serotonin increases, may also contribute to schizophrenic symptoms. In addition, patients with schizophrenia have structural abnormalities of the frontal and temporolimbic systems. Computed tomography scans and magnetic resonance imaging studies show various structural brain abnormalities, including frontal lobe atrophy and increased lateral and third ventricles. Positron emission tomography scans substantiate frontal lobe hypometabolism. Numerous psychological and sociocultural causes, such as disturbed family and interpersonal patterns, also have been proposed. Schizophrenia is more common in lower socioeconomic groups, possibly due to downward social drift, lack of upward socioeconomic mobility, and high stress levels that may stem from poverty, social failure, illness, and inadequate social resources. Higher incidence is also linked to low birth weight and congenital deafness.

Diagnosis

* Concentration -- Home Testing * ADHD -- Home Testing * Mental Health: Home Testing: * Home Emotional Stress Tests

Treatment

In schizophrenia, treatment focuses on meeting the physical and psychosocial needs of the patient, based on his previous level of adjustment and his response to medical and nursing interventions. Treatment may combine drug therapy, long-term psychotherapy for the patient and his family, psychosocial rehabilitation, vocational counseling, and the use of community resources. The primary treatment for more than 30 years, antipsychotic drugs (also called neuroleptic drugs) appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of positive psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation. Newer antipsychotics are effective in relieving positive and negative symptoms of schizophrenia. Other psychiatric drugs, such as antidepressants and anxiolytics, may control associated signs and symptoms. Certain antipsychotic drugs are associated with numerous adverse reactions, some of which are irreversible. (See Reviewing adverse effects of antipsychotic drugs, page 443.) The newer antipsychotic drugs appear to be effective in treating the negative symptoms of schizophrenia (withdrawal, apathy, or blunted affect). Antipsychotic drugs are broken down into two major classes: dopamine receptor antagonists (haloperidol and thorazine) and dopamine-serotonin antagonists, also called atypical antipsychotics (risperidone and clozapine). The long-acting medications haloperidol and fluphenazine may be given I.M. every 3 to 4 weeks to improve compliance. Clozapine may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls more psychotic signs and symptoms without the usual adverse effects. However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures. Agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia, may also occur; therefore, patients on clozapine must be monitored closely with frequent complete blood counts. Risperidone and olanzapine, like clozapine, have reduced the incidence of adverse effects, including extrapyramidal symptoms and anticholinergic adverse effects. Routine blood monitoring is essential to detect the estimated 1% to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible. Clinicians disagree about the effectiveness of psychotherapy in treating schizophrenia. Some consider it a useful adjunct to drug therapy. Others suggest that psychosocial rehabilitation, education, and social skills training are more effective for chronic schizophrenia. In addition to improving understanding of the disorder, these methods teach the patient and his family coping strategies, effective communication techniques, and social skills. Because schizophrenia typically disrupts the family, family therapy may be helpful to reduce guilt and disappointment as well as improve acceptance of the patient and his bizarre behavior.