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In the last post, we saw how:

• It has been found that there is a relationship between infectious diseases, the seasons and schizophrenia, also it is known that misuse of substances.

• Informing the general public on the cause of schizophrenia with any means will help change the results in treatment.

• For those who have poor response to acute management there are therapy options for them.

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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 this study that talks about Beliefs About the Cause of Schizophrenia Among Caregivers in Midwestern Nigeria. 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.

Epidemiology (ISocioeconomic, cultural and population density )

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Population Density
Schizophrenia is more common in local populations of more than 1 million people. It becomes less common when the population is less than 500 thousand to 100 thousand and is relatively non-existent in places with 10 thousand people.

If two patient has one or two parents with a history of schizophrenia the fact that one lives in a settlement with a dense population increases the incidence of schizophrenia double fold. It makes the case that in urban settlements there may be some factors that cause stress and create this problem.

Socioeconomics and culture
Schizophrenia can start as early as 15 years and management might require a lifetime of care. This may need hospitalization, and there might be remission and this can cost a lot of money. In America, it cost more to manage schizophrenia than the sum of all cancers. Schizophrenia is seen in 15 to 45% of the homeless in America.

Admissions
Since the 50s the views of people as a whole have changed due to widespread knowledge of the mental illness. Because of this, the way people are treated has changed as medical management developed. The issue is that with the most effective medication, the probability that a patient will be admitted back to the hospital is 40 to 60 %. Schizophrenia makes up 50% of all admissions to mental health facilities and 15 % of those who are receiving treatment.

Limitations and Strengths

People illustrations by Storyset

There were some things the study was not able to address. The study was done by patients' caregivers who were receiving treatment outside the hospital, it begs the question of it there may be social desirability bias, those who conducted the study may have found it more socially desirable to have these features be seen in society when in fact they may not be present.

The other issue is the relationship between the cause of the condition and the stigma that might be seen. This specific limitation itself needs to be studied.

The study can not easily be used as a representation of Sub-Saharan Africa.

One good part of this study is that fact that is focused on schizophrenia instead of mental illness. The broader scope of mental illness might not have given a clear picture of how this condition is perceived.

Treatment

Managing Side effects of Medication
The side effects of these drugs usually come first before people start to see them working. Response to medication may take days or sometimes weeks. The side effects seen in less efficacious drugs may be sleepiness, postural hypotension and cholinergic blockade. The main side effect seen in very potent drugs is extrapyramidal side effects.

Extrapyramidal Side effects
Many ways are seen as effective treatments for extrapyramidal side effects. Some clinicians reduce the dose of dopamine receptor agonists or they may make use of antiparkinson drugs to counteract the extra-pyramidal side effects. The best forms of effective antiparkinson drugs are cholinergic antagonists.

The problem is that these drugs can cause side effects such as dry mouth, constipation, visual problems and also memory problems. Another problem is the fact that they only work partially. Some extrapyramidal side effects just remain even after including these drugs.

The central-acting β-blockers like propranolol are effective in treating akathisia.

It is usually best to simply prescribe antiparkinsons medication for patients that are on conventional antipsychotics especially if they are more likely to experience extra-pyramidal side effects. The patients are typically those with a drug history with extra-pyramidal side effects and those that were on very potent medication. Younger men are prone to having dystonia and for this reason, should be placed on antiparkinson drugs. New drugs should also be considered for them.

Some patients may be more reactive to anti-psychosis medication and will have extra-pyramidal side effects at therapeutic concentrations. Some of these patients may even be more affected by these side effects than the condition itself. Instead of placing these patients on Dopamine receptors agonists, it is better to place them on Serotonin Dopamine agonists. It is still possible that they will still have these side effects even on Serotonin Dopamine Receptor Agonists.

Questions

• What did you learn about Schizophrenia?

Conclusion

• Socioeconomic, cultural and population density play a big role in the demographics of schizophrenia.

• Some of the limitations in the study were social desirability, Stigma in schizophrenia and it may not demonstrate the condition of other Subsaharan countries.

• One of the most common side effects are the extrapyramidal side effects of antipsychotics.

References

• Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
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• NCBI