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Schizophrenia is a heterogeneous syndrome characterized by perturbations of language, perception, thinking, social activity, affect, and volition.

Epidemiology

Epidemiologic surveys identify several risk factors for schizophrenia including

1.   Genetic susceptibility

2.   Early developmental insults

3.   Winter birth

4.   Increasing parental age.

5.   Genetic factors are involved in at least a subset of individuals who develop schizophrenia.

Pathophysiology

A number of structural and functional abnormalities have been identified in schizophrenia, including

(1) cortical atrophy and ventricular enlargement

(2) specific volume losses in the amygdala, hippocampus, right prefrontal cortex, fusiform gyrus, and thalamus

(3) progressive reduction in cortical volume over time

(4) reduced metabolism in the thalamus and prefrontal cortex

(5) abnormalities of the planum temporale

(6) changes in the size, orientation, and density of cells in the hippocampus and prefrontal cortex, and decreased numbers of cortical interneurons.

Clinical Manifestations

There are no pathognomonic features. The syndrome commonly begins in late adolescence, has an insidious onset, and, often, a poor outcome, progressing from social withdrawal and perceptual distortions to recurrent delusions and hallucinations.

 Patients may present with positive symptoms such as

1. Conceptual disorganization

2. Delusions

3. Hallucinations

4. Negative symptoms

5. Loss of function

6. Anhedonia

7. Decreased emotional expression

8. Impaired concentration

9. Diminished social engagement

The patient  must have at least two of these for a 1-month period and continuous signs for at least 6 months to meet formal diagnostic criteria.

As individuals age, positive psychotic symptoms tend to attenuate and some measure of social and occupational function may be regained.

Negative symptoms predominate in one-third of the schizophrenic population and are associated with a poor long-term outcome and a poor response to drug treatment. However, marked variability in the course and individual character of symptoms is typical.

CLASSIFICATION:

The four main subtypes of schizophrenia are

Catatonic: Catatonic-type describes patients whose clinical presentation is dominated by profound changes in motor activity, negativism, and echolalia or echopraxia.

Paranoid: Paranoid-type describes patients who have a prominent preoccupation with a specific delusional system and who otherwise do not qualify as having disorganized-type disease, in which disorganized speech and behavior are accompanied by a superficial or silly affect.

Disorganized:  schizophreniform disorder describes patients who meet the symptom requirements but not the duration requirements for schizophrenia, and schizoaffective disorder is used for those who manifest symptoms of schizophrenia and independent periods of mood disturbance.

Residual: In residual-type disease, negative symptomatology exists in the absence of delusions, hallucinations, or motor disturbance.

Many individuals have symptoms of more than one type.

The term Prognosis depends not on symptom severity but on the response to antipsychotic medication.

Schizophrenia-prone families are also at risk for other psychiatric disorders, including schizo affective disorder and schizo typal and schizoid personality disorders, the latter terms designating individuals who show a lifetime pattern of social and interpersonal deficits characterized by an inability to form close interpersonal relationships, eccentric behavior, and mild perceptual distortions.

Despite evidence for a genetic causation, the results of molecular genetic linkage studies in schizophrenia are inconclusive. Major gene effects appear unlikely.

Differential Diagnosis

The diagnosis is principally one of exclusion, requiring the absence of significant

·         Associated mood symptoms

·         Relevant medical condition

·         Substance abuse.

·         Drug reactions that cause hallucinations, paranoia, confusion, or bizarre behavior may be dose-related or idiosyncratic

·         Parkinsonian medications

·         Drug causes should be ruled out in any case of newly emergent psychosis.

THERAPEUTICS:

HYOSCYAMUS:

Remedy for acute mania with extreme excitation of sensorium and abnormal impulses

The patient imagines that he is pursued by some demon or that some one is trying to take his life and he runs away from an imaginary foe

He is talkative and constantly jumps from one subject to the other

COCAINE:

This remedy has the sensation as if foreign bodies were under skin and this is a hallucination

It has also hallucinations of hearing

STROMONIUM:

The remedy has most wild and terrifying mania

It has full of hallucinations he sees rats ,mice, snakes, and other animals approaching him and he retires in terror

He is loquacious and becomes religious and out bursts in violence with ideas of persecution

AURUM MET:

One of the great remedy for melancholia where there is an actual disgust for life

There is longing for death and tendency to suicide

This tendency is only mental and the patient rarely attempts it

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 NEOPLASM:-

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Neoplasms may be benign (not cancer), or malignant (cancer). Also called tumor