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In the last post, we saw how:
- Genetics plays a role in the cause of schizophrenia so environmental factors influence these genetics when present.
- Other than pharmacological treatments there are other forms of treatment available like CBT, Yoga and supplement use.
- Tardive dyskinesia affects younger people more than older people but should be watched in those who have extrapyramidal symptoms.
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People diagnosed with schizophrenia are sitting ducks in the Mental Health industry. They are being treated for a non-existent disease. Someone referred to schizophrenia as biological psychiatry’s Golden Goose. Self-healing is never an option. pic.twitter.com/J6u032M1PG
— Writer - Tracey Higgins (@TraceyHiggins92) October 28, 2022
Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for three consecutive months. This month will be dedicated to Schizophrenia. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Bipolar affective disorder. We are done looking at research work done in Nigeria on schizophrenia.
In this post, we are looking at a Twitter Post. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
Cause(Genetic)
Dopamine Hypothesis
The easiest way to put is that dopamine stimulation is the cause of schizophrenia. There are two observed findings that brought about this theory. The first is the fact that Dopamine Receptor Antagonists work. These drugs act against dopamine stimulation. The other fact is that there are psychotomimetic drugs like amphetamine and cocaine that make the patient behave similarly to schizophrenics.
The problem with the theory is that we are not sure if there is too much dopamine for some reason or there are too many receptors to dopamine responding or it is a combination is these two factors.
The specific dopamine tract in the brain is not stated but those from the mesocortical and mesolimbic tracts are usually named. Some have also postulated that in severely affected patients there is an increase in dopamine.
Imagining studies have indicated that there was an increase in the number of receptors in the caudate nucleus of those who have not had their receptors modified by these drugs.
Self Healing
According to NCBI, the percentage of those who have mental health problems is higher in the prison population. Violence among those with psychiatric disorders is very common. The prisoners who are violent in the prison are usually those who have, mental disorders. They do not obey the prison laws and are more common to involve themselves in these issues.
Those who have schizophrenia are about 4 to 7 folds more likely to commit assault and kill. They are also more lily to be aggressive in the way they speak and the way they act. Some studies have linked violence to schizophrenia but others have found no correlation. Some studies say that there may be a little increase in violent behaviour among those who abuse substances.
There needs to be more effort put into understanding the additional factors that can bring about violent behaviour in schizophrenia. If anything can be done about this additional factor then managing it will be fruitful. If it were to be possible to outline this risk, more would be done to watch those that have been found to have the ability to be violent. If these factors are deduced however there is the chance that the patient may be stigmatized.
There have been efforts to try a genetic link between aggression and schizophrenics
Among multiple risk factors, comorbid substance abuse has repeatedly been found to be associated with aggressive behaviour. Patients with schizophrenia without comorbid substance abuse have only a slightly increased risk of violent crime compared with the general population, suggesting that substance abuse plays a mediating role. Whether aggressive behaviour in schizophrenia can solely be attributed to comorbid substance abuse or whether a specific underlying gene results in both aggression and comorbid substance abuse in schizophrenia requires further study. Nonetheless, treating comorbid substance abuse is necessary for managing violent behaviour in patients with schizophrenia.
With the increasing perception that patients undergoing psychiatric treatment are dangerous, precariously identifying risk factors can exacerbate this notion.
Among the external factor that has been tested for their effect on schizophrenia. The chances for those who do not abuse substances are less compared to those who do. More studies need to be done on those who have comorbid substance abuse and its relationship with any gender expression. In any case, the patient should be treated for comorbid substance abuse. Labelling the patient violent can also lead to victimization
Treatment
**Other Side Effects **
Some other side effects seen in these drugs are sleepiness and hypotension. This is usually seen in less effective DRA for example perphenazine. The patient is worse affected when the drug is just started treatment. So those who are given these drugs can take weeks before they reach the best concentration for treatment. Most patients can form a tolerance to sleep and hypertension even though the sleep will remain. Some patients may be drowsy during the day and it may affect the patient's ability to function in society.
The DRA and SDA affect the endocrine system causing increased levels of prolactin and it causes galactorrhea. Long use of these drugs can affect gonadal function affecting the gonadotropin-releasing hormone. This then causes a reduction in sex drive and sexual desire.
Questions
- What did you learn about Schizophrenia?
Conclusion
- The dopamine hypothesis explains why dopaminergic antagonists work very well to manage symptoms of schizophrenia.
- Violence in schizophrenics is very common, the patient in the post will be better managed in a hospital.
- Sedation and hypotension are important side effects of DRA and SDA
References
- Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
- Page demarcations made with Inkscape.org
- NCBI