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31.03.2014

Signs and symptoms of schizophrenia in elderly, tinnitus induced medications - PDF Review

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Schizophrenia can be youth's greatest disabler; yet 10%-20% fully recover (if they stay on antipsychotic medication).
Schizophrenia usually starts between the late teens and the mid-30s, whereas onset prior to adolescence is rare (although cases with age at onset of 5 or 6 years have been reported). 30's are more often female, have less evidence of structural brain abnormalities or cognitive impairment, and display a better outcome. In genetically vulnerable individuals, certain illicit drugs, especially cannabis ("pot"), have been shown to trigger Schizophrenia. The life expectancy of individual with Schizophrenia is shorter than that of the general population for a variety of reasons.
Schizophrenia shortens lifespan by up to 15 years, primarily due to cardiovascular disease, and this excess mortality is getting worse.
The best outcomes are associated with early and persistent treatment with antipsychotic medication soon after the onset of Schizophrenia. Schizophrenia is the fourth leading cause of disability in the developed world (for ages 15-44), and Schizophrenia is observed worldwide. In 2002, the overall cost of Schizophrenia in America was estimated to be USD $62.7 billion. Alcoholism and drug abuse worsen the course of this illness, and are frequently associated with it. The first-degree biological relatives of individuals with Schizophrenia have a risk for Schizophrenia that is about 10 times greater than that of the general population.
Antipsychotic medication shortens the duration of psychosis in Schizophrenia, and prevents recurrences (but psychotic relapses can still occur under stress). No therapy is a substitute for antipsychotic medication, but a number of psychological and social therapies do increase the effectiveness of antipsychotic medication. Research on cognitive remediation therapy for schizophrenia has shown the treatment effect is small and disappears at follow-up assessment. There are many ineffective therapies that promise miracle-like recovery from Schizophrenia with vitamins or other treatment fads. During untreated Schizophrenia, individuals may also develop paranoid personality traits; thus lack the essential social skills of trust, forgiveness, and gratitude. The schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted.
The course of schizophrenic disorders can be either continuous, or episodic with progressive or stable deficit, or there can be one or more episodes with complete or incomplete remission.
Paranoid Schizophrenia is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. A form of Schizophrenia in which affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable, and mannerisms common. Catatonic Schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. A depressive episode, which may be prolonged, arising in the aftermath of a schizophrenic illness. A chronic stage in the development of a schizophrenic illness in which there has been a clear progression from an early stage to a later stage characterized by long- term, though not necessarily irreversible, "negative" symptoms, e.g.
A disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance. Active-Phase Symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated).
There are 4 main problems that interfere with wisdom: irrationality, forgetfulness, distractibility and lack of interest (apathy). Most behaviors have an optimal level, and too much or too little of the behavior is maladaptive.
Ten to twenty percent of individuals with Schizophrenia totally recover from this disorder - provided that they stay indefinitely on their antipsychotic medication. The tragedy is that effective lifelong treatment for Schizophrenia now exists, but patients refuse to indefinitely stay on this antipsychotic medication.
If untreated, individuals with Schizophrenia may develop schizoid or paranoid traits which significantly interfere with their social functioning.
If untreated, the majority of individuals with Schizophrenia are unemployed and on some form of disability pension.
If untreated, most people with Schizophrenia develop neurologically-based "negative symptoms", and these symptoms cause a loss of conscientiousness.


If untreated, some people with Schizophrenia find it difficult to live alone, to take care of their health, and maintain good hygiene practices.
Schizophrenia is associated with significant cognitive impairment, which is associated with poor functional recovery. Patients with schizophrenia have an increased prevalence of structural brain abnormalities.
Patients with schizophrenia have reduced life expectancy; the combination of illness and the effects of antipsychotic treatment place patients at risk of movement disorders, obesity, diabetes, hyperlipidemia, and sexual dysfunction. Pharmacotherapy with antipsychotic medications is an essential component of a treatment plan for most patients with schizophrenia. Psychosocial interventions work synergistically with medication to optimize treatment adherence and successful community living. Dosages should be maintained within the recommended range, and reasons for going outside the range should be clearly documented and justified. Regular and ongoing evaluations are equally necessary when patients respond to medications, when they fail to respond, and when they develop side effects. Research has not found clear and consistent differences between typical antipsychotic medications and atypical antipsychotic medications in regard to treatment response for positive symptoms, with the notable exception of clozapine for treatment-resistant patients. Engagement with the patient in the acute phase is facilitated by acknowledging his or her experiences, providing clear simple communication, and including family and supports where possible. Pharmacologic treatment should be initiated as soon as possible, and the risks and benefits of pharmacotherapy should always be explained. All these principles apply in emergency situations, but emergency medication strategies are available to contain the patient and maintain staff safety. Oral medications should be offered and, if accepted, can be as effective as IM medications. When necessary to preserve patient and staff safety, restraint measures should be taken by a trained team following an approved protocol. When appropriate, thepatientandcare- givers need to be engaged in the treatment process and provided with information and options. It may be possible to engage the patient in treatmentfrom the perspective of his or her concerns for secondary symptoms such as depression, anxiety, or insomnia, rather than from the perspective of the primary symptoms of psychosis.
Many patients experiencing a first episode of psychosis can be treated at home if safety and support issues are addressed. Low initial dosages of the medication should be used and titrated at not less than weekly intervals if the clinical situation is not emergent.
Titrate up to an initial target dosage (in 1 to 2 weeks in most cases) and monitor for side effects while awaiting an initial response. The goals of pharmacotherapy in this phase are to reduce the intensity and duration of active psychotic symptoms as fully as possible, to minimize side effects, and to promote adherence. The initial treatment response tends to be better in first-episode than in multiple-episode schizophrenia, but adherence tends to be poor. To maintain treatment adherence, it is crucial to have the patient participate in pharmacotherapy and to address individual barriers and resistance to ongoing therapy.
Assessments should take place at least every 3 months to achieve optimal dosages and choice of antipsychotic medications and to monitor for drug-induced side effects.
There are no predictive factors indicating which patients can safely and permanently discontinue antipsychotic medication.
Multiple-episode patients with a minimum of 5 years of stability, without relapse and with adequate functioning, should be observed before a slow withdrawal of antipsychotic medication over 6 to 24 months is considered. Recent research has shown that, for individuals with Schizophrenia, after stopping their antipsychotic medication 79% had a psychotic relapse by 12 months, 94% by 24 months, and 97% by 36 months.
Eighty percent of patients with first-episode psychosis are at risk for a second episode within the first 3 to 5 years, and recovery from a second episode is slower and often less complete. The 4 main pharmacologic strategies for initial nonresponders includeoptimization,substitution, augmentation, and combination.
A major depressive episode in the stable phase of schizophrenia is an indication for a trial of an antidepressant. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment. Often the negative symptoms steadily become more prominent during the course of Schizophrenia.
However, individuals with Schizophrenia often have a number of (non-diagnostic) neurological abnormalities.


Schizotypal, Schizoid, or Paranoid Personality Disorder may sometimes precede the onset of Schizophrenia. Usually it takes years before individuals can accept that they have Schizophrenia and need medication. Life-long treatment with antipsychotic medication is essential for recovery from Schizophrenia.
Most individuals with Schizophrenia qualify for government (or insurance) disability pensions. There are many dishonest recovery claims made about vitamins or treatments that "cure Schizophrenia". Over 35 years, those who had used cannabis more than 50 times at the beginning of the study had 3.7 times the normal rate of developing schizophrenia. Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition. Some schizophrenic symptoms, either "positive" or "negative", must still be present but they no longer dominate the clinical picture. Both cooperation and learning are made possible by the brain's emotional reward and punishment function. Unlike emotions, these 4 problems are not adaptive, but are symptoms of brain malfunctioning.
Stopping antipsychotic medication guarantees that people with Schizophrenia will relapse back into psychosis. The following shows which items on this scale would be rated as abnormal for Schizophrenia. These individuals may isolate themselves and stop participating in family and social functions.
These severely ill individuals stop pursuing goals, and become progressively more disorganized. This includes being provided with information on the risks and benefits of both taking and not taking medications. Medications selected for short-term control of agitated behaviour during the acute psychotic phase may not be optimal for efficacy and tolerability.
Thus, 3 years after stopping antipsychotic medication, only 3% of people with Schizophrenia didn't relapse. With each psychotic relapse, my patients would develop more permanent disability and eventually all of their antipsychotic medications would stop working.
Psychiatrists accept that Bipolar I Disorder requires indefinite treatment; yet many still don't accept that Schizophrenia requires indefinite treatment. The antipsychotic is gradually stopped, and another one is introduced with a short period where the 2 antipsychotics overlap. Thus evolution has hard-wired humans to feel anger when others harm them, and to feel guilt when they harm others.
After stopping antipsychotic medication, 97% of people with Schizophrenia suffer a relapse. Thus this research would suggest that legalizing cannabis could triple the incidence of schizophrenia in regular cannabis smokers. Thus human survival requires an optimal level of both fear and courage; too much or too little doesn't work.
If the brain decides that a cooperative or problem-solving effort should cease; you feel emotional detachment and stop caring. Self-control can break down and cause impulsivity when the brain's normal inhibitions fail. Malfunctioning of this self-control function is seen in Eating Disorders and Substance Use Disorders. In Schizophrenia and related disorders, there is malfunctioning of the brain's "detachment" function. This causes social withdrawal, intimacy avoidance, inability to feel pleasure, and restricted emotional expression.



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