Schizophrenia : What should you know about it?
Bayan Abdullah, 4th year pharmacy student at Mu’tah University.
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The mental and psychiatric disorders aren’t less important than any health problem. It is tragically to know that more than 69% of schizophrenia patients don’t take a suitable care and 90% of them live in low to moderate revenue countries. So it is very necessary to raise up our awareness about it.
Schizophrenia is Greek word means “split mind” a complicated severe mental disease in which affects 1% worldwide or around 20 million of people. In fact, it is rare psychological condition comparably by anther mental disorders however it increases the incidence of mortality in patients by (2- 3) times more than health population due to ignoring anther diseases like infections and CVD. Schizophrenia acts as multifactor condition so it is a result of this connection between genatical, environmental and psychological factors. Scientists supposed that the predisposing factor of schizophrenia may developed early (in utero) level due to various medical complications like gestational diabetes, bleeding during pregnancy and others.
The most important time that can affect hugely the probability of being ill with schizophrenia in future is (2nd trimester) which includes basically fetal neurodevelopment feature. There are many theories to explain the pathophysiology of schizophrenia with deep details but in general most of them focus on excessive or reduction of neurotransmitters (dopamine, serotonin and glutamate), anther focus on impartment of (GABA, aspartate and glycine).
Unfortunately, there are many superstations about schizophrenia for example; the patient has 2 or more character at the same body or he is crazy and aggressive person. This is wrong thoughts that inspired from poor awareness about schizophrenia in many societies.
The most critical sign that distinguishes it from anther mental diseases is the disfiguration in thinking, emotions and behaviors with this hole between reality and what does he feel in order he has some types of hallucinations include unreal sounds or events in addition to delusions, disorganized speech and behavior and loss of connection between the internal feelings and his body language. These symptoms are more likely to be visible in early age in men (in their 20s) than women (in between 20s and 30s).
There are many types of schizophrenia:
– Paranoid schizophrenia
It is the most common type that involves hallucinations and delusions.
– Disorganized or Hebephrenic schizophrenia:
It developed early in age between 15-25 years old, patient with this type suffers from icy face that’s no emotions on.
– Catatonic schizophrenia:
The rarest type in which the patients` nature switches between two opposite condition like being talkative and silent.
– Cenesthopathic schizophrenia:
It includes strange body sensations.
– Unspecified schizophrenia:
General symptoms.
The diagnosis must be done by specialist doctors who are able to differentiate between schizophrenia and other conditions like bipolar disorder and have a good background to deal with them.
Regardless the complexity of this disease it is treatable. Both types of treatment (pharmacological and non-pharmacological) should be achieved together to relive symptoms, avoiding relapse and improve the relationship of patients with society as possible as we can.
Non-pharmacological treatment includes three kinds of therapy (personal, compliance and cognitive behavioral) in addition to stimulate the family support.
The pharmacological treatment depends basically on patients’ state and response. 1st line therapy is SGAs (second generation atypical antipsychotic drug that includes; Aripiprazole, Asenapine, Iloperidone, Olanzapine, Quetiapine and Ziprasidone) without Clozapine due to its risk in development agranulocytosis – it can be used in few conditions like resistant schizophrenia alone or sometimes in combination with chlorpromazine-. One of important programs in treatment of schizophrenia is six stage pharmaceutical algorithm which has achieved by TMAP: Texas Medication Algorithm Project.
The exact mechanism of action for all antipsychotic drugs is unknown but we classified them into: traditional and atypical. The atypical antipsychotic drugs are antagonist for both receptors (D2 and 5-HT2A) with different degrees.
As usual the nanomedicine is included in many fields due its great advantages – I wrote about them in previous article- so it’s very logic to introduce nanomedicine in psychology. One of good example about this is nanoemulsion of aripiprazole to increase the bioavailability and facility in order to across BBB. Aripiprazole was encapsulated in nanoemulsion (contains Tween 80, glycerol, lecithin and PKOEs) with droplets size less than 65nm, the encapsulating efficacy was increased. [For full details about this experiment see reference *.].
Ignoring any disease category due to its rarity should be stopped, its humanitarian responsibility not only medical one.
_____________________________________________ References: – https://www.who.int/news-room/fact-sheets/detail/schizophrenia – https://www.nhs.uk/conditions/schizophrenia/ – Patel, Krishna R et al. “Schizophrenia: overview and treatment options.” P & T : a peer-reviewed journal for formulary management vol. 39,9 (2014): 638-45. – Masoumi, Hamid Reza Fard et al. “Enhancement of encapsulation efficiency of nanoemulsion-containing aripiprazole for the treatment of schizophrenia using mixture experimental design.” International journal of nanomedicine vol. 10 6469-76. 13 Oct. 2015, doi:10.2147/IJN.S89364.” International journal of nanomedicine vol. 10 6469-76. 13 Oct. 2015, doi:10.2147/IJN.S89364. *
