Schizophrenia is a chronic mental disorder that affects how a person thinks, feels, and behaves. It is characterized by distorted thoughts, hallucinations, delusions, and difficulty interpreting reality. The condition usually begins in late adolescence or early adulthood and requires long-term treatment. With proper therapy and support, many patients can lead stable and productive lives.
1. Causes and Risk Factors
The exact cause of schizophrenia is unknown, but a combination of biological, genetic, and environmental factors contribute to its development.
Biological Factors
- Dopamine and glutamate imbalance
- Brain structural abnormalities (enlarged ventricles)
- Neurodevelopmental issues
Genetic Factors
- Family history increases risk
- Inherited susceptibility genes
Environmental Factors
- Stressful life events
- Prenatal infections or malnutrition
- Substance abuse (especially cannabis in young people)
2. Symptoms of Schizophrenia
Symptoms are grouped into three main categories.
A. Positive Symptoms
- Delusions: False beliefs (e.g., being followed or controlled)
- Hallucinations: Hearing voices is most common
- Disorganized speech: Incoherent or irrelevant conversation
- Disorganized behavior: Agitation or unpredictable movements
B. Negative Symptoms
- Reduced emotional expression
- Lack of motivation
- Social withdrawal
- Poor hygiene or self-care
C. Cognitive Symptoms
- Difficulty concentrating
- Impaired memory
- Poor decision-making
3. Diagnosis
- Detailed clinical interview and psychiatric evaluation
- Symptoms must persist for at least 6 months
- Rule out substance abuse or medical conditions
- Brain imaging (MRI/CT) if needed to exclude structural causes
4. Treatment of Schizophrenia
Treatment involves a combination of medications, psychological support, and social rehabilitation.
1. Antipsychotic Medications (Main Therapy)
First-Generation Antipsychotics (Typical)
- Haloperidol
- Chlorpromazine
- Trifluoperazine
Side effects: Extrapyramidal symptoms (rigidity, tremor), tardive dyskinesia.
Second-Generation Antipsychotics (Atypical)
- Risperidone
- Olanzapine
- Quetiapine
- Aripiprazole
- Clozapine (used in treatment-resistant cases)
Side effects: Weight gain, metabolic syndrome, sedation.
2. Long-Acting Injectables (LAIs)
- Useful for patients with poor medication adherence
- Examples: Risperidone LAI, Paliperidone LAI, Haloperidol depot
3. Psychological Support
- Cognitive behavioral therapy (CBT)
- Family therapy
- Social skills training
4. Rehabilitation
- Vocational training
- Supportive housing
- Community mental health programs
5. Complications
- Suicidal behavior
- Substance abuse
- Social isolation
- Metabolic disorders due to medications
- Homelessness if untreated
6. Prevention and Early Management
- Recognize early warning signs (sleep problems, withdrawal, confusion)
- Avoid substance abuse
- Manage stress and maintain social support
7. Role of the Pharmacist
- Ensure correct and consistent medication use
- Monitor for side effects like weight gain, EPS, or sedation
- Provide drug–drug interaction checks
- Educate families on symptom recognition
- Support medication adherence and follow-up care
- Assist in selecting long-acting injectable options for non-adherent patients
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