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Q & A: Schizophrenia

Posted by: Dr. Tina Morse PsyD, MFT

Topic: Mind

BrainEnviron

What have you come to understand are the neurobiological bases for schizophrenia, and what are the therapeutic benefits and unwanted side effects of antipsychotic medications?

Schizophrenia is a brain disease that is thought to stem from genetic variables or abnormalities in structure, neurochemistry, function, and environmental factors. Although there have been a number of theories that attempt to explain the exact causation, The Dopamine Model is the predominant theory that has been used for the last couple of decades. This model represents that excessive dopamine is thought to lead to a disorganization of thought and perception, failures in screening stimuli, and behavioral agitation. Newer research reflects that glutamate toxicity leads to the potential poisoning of cells by activating free radicals that eventually kill them (Preston and Johnson, 2010).

Neuroanatomical abnormalities in the brain are thought to include: an enlargement of lateral ventricles, problems in the prefrontal cortex, posterior brain and the mesolimbic system. Additionally, structural abnormalities within the medial temporal area including the amygdala, cerebellum, hypothalamus and the hippocampus are thought to contribute to the development of schizophrenia. A marked lower density and decreased gray matter (or shrunken area in the brain) is thought to lead to disordered thinking, dialog and behavior, as neurotransmitters that support communication among complementary nerves, tissues and organs are stifled. Amphetamines increase dopamine activity and can contribute to the development of paranoid psychosis and exacerbate psychotic symptoms. Individuals suffering from a transitory psychosis who have a hereditary history of schizophrenia are at risk for developing the disorder within a year (Preston, O’Neal & Talaga, 2010).

According to Preston, O’Neal and Talaga (2010), characterological symptoms of schizophrenia include: alienation or social isolation, marked feelings of inadequacy, and poorly developed social skills. Positive symptoms include: agitation, hallucinations, delusions and bizarre behavior.

Traditional, first-generation antipsychotic medications include neuroleptics and phenothiazines. They can be effective in treating schizophrenia and other psychotic disorders with delusion-related symptoms. In targeting the mesolimbic system, they inhibit acetylcholine receptors. This can lead to negative side effects that include: dry membranes within the eyes and the mouth, dizziness, distorted vision, drowsiness, rashes on the skin, sun sensitivity, rapid heartbeat, and menstrual problems among women. Antipsychotic medications have a tendency to promote problems in metabolic function and can cause considerable weight gain.

According to Preston, O’Neal & Talaga, (2010) “…the potency of an antipsychotic (until the atypicals) correlates with their ability to bind to and block the postsynaptic dopamine (D2) receptors in the mesolimbic system.” It is important to consider a patient’s motor state when prescribing: agitated patients do well with a more sedating medication like Seroquel, while withdrawn patients do better with a less-sedating drug like Abilify. Negative symptoms like: apathy, anhedonia, blunted affect, feelings of emptiness, lack of thought, non-motivated states can be effectively treated with a variety of medications that include: Zyprexa (olanzepine) and Geodon’s (Ziprasidone). However, the drug of choice for a first-episode patient with positive symptoms, and/or a combination of both positive and negative symptoms is Risperdal (Risperidone). Second-generation antipsychotics treat psychosis and schizophrenia in relation to a mood disorder.

References

Preston, J.H., O’Neal, J.H., and Talaga, M.C. (2010) Child and Adolescent Clinical Psychopharmacology Made Simple, second edition. New York: New Harbinger Publications.

Preston, J.H., Johnson, J., M.D. (2010) Clinical Psychopharmacology Made Ridiculously Simple, Edition 7. New York: New Harbinger Publications.

Preston, J. D., O’Neal, J. H., and Talaga, M. C. (2010). Handbook of clinical psychopharmacology for therapists. New York. New Harbinger publications.


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