Schizophrenia is characterized by psychotic (loss of reality), hallucinations (perception disorders), delusions (false beliefs), incongruity of thought and action, affective flattening (limited emotional range), cognitive deficits (impairment of thinking and problem solving) and functional disorders in professional and social life. The cause is unknown, however, are strong evidence of a genetic component before. Symptoms usually begin in adolescence or early adulthood. For the diagnosis of the symptoms of oderer several episodes ? 6 months must continue. The treatment consists of drug therapy, psychotherapy and rehabilitation.

A psychosis include symptoms such as delusions, hallucinations, disorganized thinking and speech, as well as bizarre and inappropriate motor behavior, demonstrating a loss of contact with reality.

Schizophrenia is characterized by psychotic (loss of reality), hallucinations (perception disorders), delusions (false beliefs), incongruity of thought and action, affective flattening (limited emotional range), cognitive deficits (impairment of thinking and problem solving) and functional disorders in professional and social life. The cause is unknown, however, are strong evidence of a genetic component before. Symptoms usually begin in adolescence or early adulthood. For the diagnosis of the symptoms of oderer several episodes ? 6 months must continue. The treatment consists of drug therapy, psychotherapy and rehabilitation. A psychosis include symptoms such as delusions, hallucinations, disorganized thinking and speech, as well as bizarre and inappropriate motor behavior, demonstrating a loss of contact with reality. The prevalence of schizophrenia is about 1% worldwide. Men and women are about equally often affected; this ratio is relatively constant in all cultures. The proportion is higher perhaps because the disabilities result in lower socioeconomic groups in cities, by this disorder to unemployment and poverty. Similarly, a higher prevalence among people living alone may reflect the impact of the disease or its precursors on social functioning. The average age at onset is earlier early to mid-20s in women and in men; about 40% of men have their first episode before age 20. The disorder rarely begins in childhood, but it can in early adolescence or old age (then it is sometimes referred to as Paraphrenia) use. Etiology Although the exact cause is unknown, schizophrenia has a biological basis, evidenced by changes in the brain (eg. As enhanced brain ventricle, thinning of the cortex, the reduction of the anterior hippocampus and in other brain regions) changes in DeNB neurotransmitters, in particular, altered activity of dopamine and glutamate Some experts believe that schizophrenia occurs in people with an applied during the development of the nervous system vulnerability; Beginning, remission and recurrence of symptoms are the result of interactions between this vulnerability and environmental stressors (vulnerability-stress model). Development of the nervous system and vulnerability vulnerability may result from genetic predisposition Intrauterine, childbirth or postnatal complications viral CNS infections increases the risk by factors such as hunger or influenza in the mother in the second trimester of pregnancy, a birth weight <2500 g, Rh incompatibility during a second pregnancy and hypoxia. While most people with schizophrenia do not have a family history, but there is a connection with genetic factors. In humans, the 1st degree with schizophrenia have the risk of developing the disorder is about 10%, compared with a risk of 1% in the general population. The concordance rate in monozygotic twins is approximately 50%. Sensitive neurological and neuropsychiatric tests indicate that different eye movements, cognitive and attention deficits and faulty sensory gating occur more frequently in schizophrenic patients than in the general population. These markers (endophenotypes) also exist in the first degree relatives of people with schizophrenia, and they could use the genetic component of vulnerability darstellen.Umweltstressoren stressors can trigger the commencement or recurrence of symptoms in vulnerable people. The stressors may be (unemployment, poverty, travel away from home to study, ending a love relationship, the beginning of military service, for example.) Primarily biochemical (eg substance abuse, particularly marijuana.) Or social; However, these stressors are not the cause. It has not been proven that schizophrenia is caused by poor parenting. Protective factors that mitigate the effect of stress on the development or exacerbation of symptoms have good social support, good coping skills and antipsychotics. Symptoms and signs Schizophrenia is a chronic disease that may extend in phases, can vary with time and pattern of the phases. In patients with schizophrenia psychotic symptoms develop on average 12 to 24 months before the first consulting a doctor. Symptoms of schizophrenia typically impair the functionality and are often so pronounced that they burden the work, social relations and its own supply significantly. This often leads to unemployment, isolation, troubled relationships and a loss of quality of life. Phases changed schizophrenia in the premorbid phase, patients present u. U. show no symptoms, or they may impairments in social skills, mild cognitive disorganization or perceptual distortions, a reduced ability to feel joy (anhedonia), and other general coping deficits. Such features may be weak and only retrospectively be seen or noticed more in impairments in social, academic and occupational functioning. In the prodromal phase subclinical symptoms may occur; these are to withdrawal or isolation, irritability, mistrust, unusual thoughts, biases and disorganization [1]. Obviously schizophrenic symptoms (delusions and hallucinations) can suddenly use (within days or weeks) or slowly and gradually develop (over years). In the middle phase symptomatic periods can episodic (detectable with exacerbations and remissions) or continuously occur; functional deficits tend to deteriorate. In the late phase of the disease, the disease pattern can be established, and the degree of disability can be consolidated or even verbessern.Symptomkategorien in schizophrenia Generally the symptoms are categorized as positive: An excess of or distortion of normal functions Negatives: reduction or loss of normal functions and emotions Disorganized: disorganized thinking and behavior bizzarres Cognitive: deficits in information processing and problem solving patients may have only one or all categories symptoms. Positive symptoms can be further subdivided. Delusions hallucinations delusions are erroneous beliefs that are maintained despite clear contradictory evidence. There are several types of delusions: paranoid: Patients believe that they tortured, persecuted, threatened or would spying. Delusions: patients believe that passages from books, newspapers, song lyrics or other cues from the environment were addressed to them. Wahn sticking ideas of thought withdrawal or thought insertion: The patient believe that others could read their minds that their own thoughts transferred to others or that thoughts or impulses would imposed on them by external forces. Delusions in schizophrenia tend bizarre, d. H. (Believing z. B. that someone their internal organs without leaving a scar removed) clearly implausible and not from ordinary life experiences to be derived. Hallucinations are sensory perceptions that are not perceived by others. You can be audible, visual, olfactory, gustatory or tactile; However, the most frequent auditory hallucinations occur. Patients may hear voices that comment on their behavior that talk to each other or give critical and insulting comments. Delusions and hallucinations, patients can weigh heavily. Negative (deficit) symptoms include affective flattening: The expression of the patient acts immobile and without expression; Eye contact is avoided. Paucity of speech: The patient speaks little and gives concise answers, creating the impression of emptiness arises. Anhedonia: Lack of interest in activities, and in increasingly aimless activities. Social withdrawal: Lack of interest in relationships. Negative symptoms often lead to loss of motivation, lack of purpose and reduced determination. Symptoms of disorganization, which may be regarded as a kind of positive symptoms, are thought disorder Bizarre behavior Thinking is disjointed, with long-winded and not targeted speech, jumping from one topic to the next. The speech can be discreet muddled up completely incoherent and incomprehensible. Possible behavioral problems are childish silliness, agitation, improper appearance, poor hygiene or bizarre behavior. Catatonia is an extreme example of buzarrem behavior, which either include a rigid posture, which can not be by efforts outsider solve, or use in the haphazard and abrupt motor activity. Cognitive deficits include impairment in the following points: attention processing speed memory Abstract thinking problem solving understanding of social interactions The patient's thinking can inflexible, its reduced ability to solve problems, to understand the views of others and to learn from experience. The severity of cognitive impairment is a major contributor to beurteilen.Subtypen the total disability of schizophrenia Some experts divide schizophrenia in the deficit and the nichtdefizitären subtype, depending on the severity of the negative symptoms such as blunting of affect, lack of motivation and reduced purposefulness. Patients with subtype defizitärem show mainly negative symptoms can not be distinguished by other factors (eg., Depression, anxiety, poor stimulation environment side effects of psychotropic substances) explain. Patients with nichtdefizitärem subtype may have delusions, hallucinations and thought disorder, but they show no negative symptoms. The previously recognized subtypes of schizophrenia (paranoid, disorganized, catatonic, residual, undifferentiated) have not proved to be valid or reliable, and are no longer verwendet.Suizid About 5 to 6% of patients with schizophrenia commit suicide, and about 20% try ; many more have significant suicidal thoughts. Suicide is the most common cause of premature death in people with schizophrenia is what at least partially explains why the disorder, life expectancy reduced by an average of 10 years. The risk can be high especially among young people with schizophrenia and substance abuse. The risk is also increased in patients who have depressive symptoms or feelings of hopelessness, are unemployed, or who just had a psychotic episode or were discharged from the hospital. Patients with late onset and good premorbid functioning-ie precisely the patients with the best prognosis have the greatest risk of suicide. Since in these patients the ability to grief and mental pain is obtained, they can because they perceive the consequences of their disease realistic, rather an act of desperation neigen.Gewalt schizophrenia is a relatively moderate risk factor for violent behavior threats of violence and lighter aggressive breakthroughs. far more often than seriously dangerous behavior. Patients who operate substance abuse, paranoid and command hallucinations, and patients who do not take the prescribed drugs are seriously prone to violence more likely. Rarely attacked or killed a severely depressive, of lonely, paranoid patient someone he sees as the only cause of his troubles (eg. As an authority figure, a celebrity or partner) .Note symptoms first Tsuang MT, Van Os J, Tandon R, et al: Attenuated psychosis syndrome in DSM. 5 Schizophr Res 150 (1): 31-5, 2013. Diagnosis Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) combination of medical history, symptoms and signs, when the first episode of schizophrenia, the criteria met for the disease is detected and treated early, the result is better. There is no clear test for the detection of schizophrenia. Diagnosis is based on a comprehensive assessment of medical history, symptoms and signs. Often information from additional sources are important, such as family members, friends, teachers and colleagues. According to DSM-5 requires the diagnosis of the following: ? 2 characteristic symptoms (delusions, hallucinations, rutted speech, disorganized behavior, negative symptoms) made over a significant proportion of a 6-month period (the symptoms must have at least one of the first three include) prodromal or attenuated symptoms of impairment in social or occupational area or respect. its own supply, which are obviously over a 6-month period, with one month is included with active symptoms differential diagnosis Psychotic disorders due to physical illness or substance abuse must be excluded by history and examination incl. laboratory tests and neuroimaging (medical evaluation of a patient with mental symptoms). Some patients with schizophrenia have in imaging Although structural brain anomalies, but they are not specific enough to have diagnostic value. Other mental disorders associated with schizophrenia in relationship show similar symptoms are: Brief Psychotic Disorder Delusional disorder Schizoaffective disorder Schizophrenia disorder schizotypal personality disorder and mood disorders can cause a psychosis In addition, in some individuals. Certain personality disorders (in particular, schizotypal personality disorder) cause schizophrenia-like symptoms; but these are weaker in general and not psychotic. Prognosis The earlier treatment is started, the better the result. During the first 5 years after the onset of symptoms, the operability may deteriorate, and social and vocational skills can decrease the own supply is increasingly neglected. The negative symptoms can be stronger, cognitive ability may decrease. After that, the disability tends to remain stable. There are some indications that the severity of the disease later in life, v. a. in women decreases. Spontaneous movement disorders may develop in patients with severe negative symptoms and cognitive functional limitations, even if no antipsychotics are used. Schizophrenia may be associated with other mental disorders. In severe comorbid OCD, the prognosis is very bad; together with symptoms of borderline personality disorder, the prognosis is better. About 80% of people with schizophrenia do at some point in their lives one or more episodes a major depression by. The forecast for the first year after diagnosis is closely related to the adherence compared with the prescribed psychoactive drugs. Overall, a third of patients achieve significant and sustained improvement; at one third, there is a slight improvement with recurrence and residual symptoms; one-third a serious and permanent impairment remains. Only about 15% of patients return completely back to their function level before the illness. Factors associated with a good prognosis include good premorbid functioning (eg. As good student, solid professional history) Delayed and / or sudden onset of the disease family history of other mental disorders as schizophrenia Mild cognitive impairment few negative symptoms Shorter duration the untreated psychosis factors associated with a poor prognosis, including Low age at onset poor premorbid functioning family history of schizophrenia Many negative symptoms of untreated psychosis Men Longer duration have poorer treatment outcomes than women; Women respond better to treatment with antipsychotics. Substance abuse is a significant problem in up to 50% of patients with schizophrenia. Individual examples suggest that the use of marijuana and other hallucinogens is very disadvantageous for patients with schizophrenia; therefore is strictly inadvisable. Comorbid substance abuse is a significant predictor of a poorer treatment outcome and can lack of adherence, repeated relapses, more frequent rehospitalization, diminishing functioning and loss of social support even lead to homelessness. Treatment antipsychotics rehabilitation, incl. Local emergency services Psychotherapy The time between the onset of psychotic symptoms and the first treatment correlated with how quickly and how well the initial therapy works. In early onset patients tend to speak more quickly and completely to treatment. Without constant use of antipsychotics after a first episode of another schizophrenic episode within the next 12 months occurs in 70-80% of patients. Continuous Antipsychotikagabe the 1-year recurrence rate can be reduced to about 30%. Drug treatment is continued for 1 to 2 years after a first episode. When patients were ill for longer, there's been for many years. General goals for schizophrenia treatment, reduce the severity of psychotic symptoms, avoid the recurrence of symptomatic episodes and associated Funktionseinschränkugnen Help function the patient at the highest possible level, the main components of treatment are antipsychotics, rehabilitation along with local emergency services and psychotherapy. Since it is in schizophrenia by a long-running and often recurrent disease, an important general goal is to teach the patient skills for self-management of their disease. When information about the disorder (psychoeducation) are made available to parents, which can reduce the recidivism rate. (See also the American Psychiatric Association's Practice Guideline for the Treatment of Patients With Schizophrenia, 2nd Edition.) The active ingredients are divided due to their affinity for specific neurotransmitter receptors and their effect in conventional antipsychotics and antipsychotics 2nd generation (SGA, atypical antipsychotics) , SGA may offer a number of advantages as a slightly better efficacy (although doubt newer evidence on the benefits of SGA as a class can) and a lower probability of the occurrence of involuntary movement disorders and associated adverse effects. However, the risk for metabolic syndrome (extreme abdominal fat, insulin resistance, dyslipidemia, and hypertension) is under SGA greater than under conventional antipsychotics. Several antipsychotics in both classes can lead to long QT syndrome and ultimately increase the risk of fatal arrhythmias; these drugs include thioridazine, haloperidol, olanzapine, risperidone and ziprasidone. Conventional antipsychotics The mechanism of action of conventional antipsychotics (s refer to the table. Conventional antipsychotics) is primarily based on a blockade of the dopamine-2 receptor (dopamine-2 blocker). Conventional antipsychotics can be classified as highly potent, medium and low potent potent. High potency antipsychotics have a stronger affinity for dopamine receptor and a low affinity for alpha-adrenergic and muscarinic receptors. Low-potency antipsychotics have a lower affinity for dopamine receptors, and a relatively greater affinity for alpha-adrenergic and muscarinic receptors, and histamine receptors. Various drugs are available as tablets, in liquid form or as short- and long-acting I.M. injection solutions. A specific drug is selected primarily on the basis of: unwanted effect profile of administration Necessary The previous patient response to the drug Conventional antipsychotics drug daily dose (range) * Usual adult dose Comments Chlorpromazine † ‡, 30-800 mg 400 mg po available before bedtime Prototypical niederpotente substance Also as rectal suppository thioridazine ‡ 150-800 mg 400 mg p.o. before bedtime single drug with an absolute maximum (800 mg / day), because it was caused in higher doses retinitis pigmentosa and a significant anticholinergic effect has the warning QTc prolongation included in the package insert trifluoperazine †, ‡ 2-40 mg 10 mg po before bedtime - fluphenazine †, ‡ 0.5-40 mg 7.5 mg po (Not available dose equivalents) perphenazine †, ‡ 12-64 mg 16 mg at bedtime Also available as i.m.-depot formulations fluphenazine decanoate and fluphenazine enanthate p.o. before bed - loxapine 20-250 mg 60 mg p.o. before bedtime affinity for dopamine-2 and 5-hydroxytryptamine (serotonin) -2-receptors molindone 15-225 mg 60 mg p.o. bedtime may associated with weight loss thiothixene †, ‡ 8-60 mg 10 mg p.o. before bedtime High incidence of akathisia haloperidol †, ‡ 1-15 mg 8 mg p.o. before bedtime Prototypical highly potent substance haloperidol decanoate available as i.m. depot akathisia pimozide is often 1-10 mg 3 mg p.o. bedtime authorization only for Tourette Syndrome * Current dosing recommendations for conventional antipsychotics: beginning in the low range of the displayed values ??and gradually Dose escalation to a single dose; taking before bedtime is recommended. There is no evidence that a rapid increase in dose is more effective. † These drugs are available to treat acute in i.m. form. ‡ These drugs are available as a concentrate for oral administration. QTc = QT interval corrected respect. Heart rate. Clinical Calculator: QT interval correction (ECG) Some Antipschotika are available as long-term sustained release formulations (see table: depot antipsychotics). These preparations are useful to resolve lack of adherence. You can also help patients who can not reliably swallow every day their medication due to disorganization, indifference or denial of the disease. Depot antipsychotics drug dosage * maximum levels † Aripiprazole, long-acting, injectable 300-400 mg every month 5-7 days fluphenazine decanoate 12.5-50 mg every 2-4 weeks 1 day fluphenazine enanthate 12.5-50 mg every 1 -2 weeks 2 days Haloperidol decanoate 25-150 mg every 28 days (a range of 3-5 weeks is allowed) 7 day olanzapine pamoate ‡ 210-300 mg 300-405 mg every 2 weeks or every 4 weeks 7 days risperidone Mikrosphären§ 12.5 50 mg every 2 weeks 35 days * in the application with the Z-track method. † Time to peak levels after a single dose is given. ‡ olanzapine pamoate rare but significant sedation may cause, therefore, the patients for 3 h must be observed after the injection. §Wegen a 3-week delay between the first injection and the achievement of adequate blood levels, patients should continue taking oral antipsychotics three weeks after the first injection. It is recommended before starting therapy to assess the tolerability with oral risperidone. Conventional antipsychotics have different side effects such as sedation, cognitive dulling, dystonia and muscle stiffness, tremors, elevated prolactin levels, weight gain and lower limits for seizure disorders in patients with seizure disorders or those who have a risk for it (for the treatment of adverse effects s ??see Table. Treatment acute adverse effects of antipsychotics). Akathisia (restlessness) is particularly unpleasant and can lead to a lack of adherence. It can be treated with propranolol. Behandlung der akuten unerwünschten Wirkungen von Antipsychotika Symptome Therapie Bemerkungen Akute dystonische Reaktionen (z. B. okulogyre Krise, Tortikollis) Benztropin 2 mg i.v. or i.m. (kann einmal nach 20 min wiederholt werden) Diphenhydramin 50 mg i.v. or i.m. alle 20 min für 2 Dosen Benztropin 2 mg p.o. kann, zusammen mit einem Antipsychotikum gegeben, eine Dystonie verhindern. Larynx-Dystonie Lorazepam 4 mg i.v. über 10 min, dann 1–2 mg langsam i.v. Es kann eine Intubation erforderlich sein. Akinesie, schwere Parki

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