For my detailed article on schizophrenia ask Whelehans staff for a free copy or log on to www.whelehans.ie.
Symptoms include hallucinations (seeing and hearing things), delusions (false ideas), disordered thoughts, and problems with mood, behaviour and motivation. It can cause a loss of touch with reality thus becoming unable to tell what is real and what is not. The cause is not clear. Symptoms can recur or persist long-term, but some people have just one episode of symptoms lasting a few weeks.
Positive and negative symptoms
The symptoms are classed as either positive or negative. Positive symptoms are abnormal mental functions while negative symptoms are a loss of normal mental functions.
Negative symptoms include loss of motivation (loss of interest in social activities and mixing with people, loss of concentration and inability to complete activities you previously had no problem completing), loss of a sense of pleasure, slow movements, lack of facial expression and low or flat mood. The person may neglect appearance and look unkempt. Negative symptoms of schizophrenia are similar to depression symptoms and can be misdiagnosed as depression
Positive symptoms are psychotic behaviours not seen in healthy people; they cause loss of touch with reality and include delusion, hallucinations, disordered thoughts and movement disorders
Incidence and prevalence
Schizophrenia occurs in about 1 in 100 people; this rate is the same for all ethnic groups. It occurs equally in men and women. It most often first develops between the ages of 15 to 25 in men and 25 to 35 in women. First diagnosis of schizophrenia is rare after the age of 45. The cause is not clear. It tends to run in families; 70% of the risk of schizophrenia is thought to be hereditary.
People living schizophrenia often do not realise they have a mental illness and may not think they need help because they believe their delusions or hallucinations are real. Antipsychotic drugs are broadly divided into two categories; older typical or newer atypical antipsychotics.
Older typical antipsychotics
Sometimes called first generation antipsychotics; first appeared in the 1950’s. Examples include chlorpromazine (Largactil®), trifluoperazine (Stelazine®), haloperidol (Serenace®), flupentixol (Depixol® Injection, Fluanxol® tablets), zuclopenthixol (Clopixol® Injection), and sulpiride (Dolmatil®). 30% of patients have a relapse during treatment with first-generation antipsychotic drugs compared with 80% without treatment.
Newer or atypical antipsychotics
Also known as second generation antipsychotics; first prescribed in the 1990’s. Examples are amisulpride (Solian®), aripiprazole (Abilify®), clozapine (Clozaril®), olanzapine (Zyprexa®), quetiapine (Seroquel®) and risperidone (Risperdal®). Atypical antipsychotics are often used first-line for newly diagnosed schizophrenia. This is because they demonstrate good balance between chance of success and the risk of side-effects.
Depot injections of an antipsychotic drug
Non-compliance can be a problem with schizophrenia. An American study showed that 74% of patients with schizophrenia discontinued medication within 18 months without consulting with their doctor leading to relapses. Non-compliance is similar for atypical and typical antipsychotics; therefore depot injections can be a solution where compliance is a problem. A depot injection is a long acting injection which is administered by a doctor or nurse and only needs to be administered typically every few weeks.
To be continued….next week I discuss treatment in more detail
Whelehans Pharmacy, 38 Pearse Street, Mullingar. Tel 04493 34591. Eamonn’s full comprehensive article is available in Whelehans on request. Ask staff for a free copy.