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Thread of how schizoaffective mood disorder (schizophrenia and bipolar) impacts me as a Black Trans man.

— ☀️ cal (he/they) 🏳️‍⚧️ (@Calvintbfh) October 22, 2022

In the last post, we saw how:

• 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

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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 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.

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Cause(Biochemical Factors)

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Serotonin

New theories believe that serotonin levels are related to positive and negative features seen in schizophrenia. The effect of serotonin receptor antagonists and the antipsychotics such as clozapine and second-generation drugs that have been very effective in managing symptoms are testaments of the fact that this drug is very effective. In schizophrenia there is Anhedonia (lack of pleasure in previously pleasurable events) is a feature which is a very well-known feature.

Some studies have documented neuronal degradation in norepinephrine reward tracts as the cause of schizophrenia but it has not been accepted.

Gamma-aminobutyric acid (GABA)
This inhibitory neurotransmitter has been named as a cause of schizophrenia because some patients who have schizophrenia have GABAergic neuronal loss in the hippocampus. Loss of these neurons can cause the hyperactivity seen in schizophrenia.

Neuropeptides
Those that have been particularly named are substances P and neurotensin.

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Schizophrenia and Bipolar Disorder

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People illustrations by Storyset

Some classify schizoaffective disorder as a type of schizophrenia while others see it as a condition on its own. In schizoaffective disorder, there are components of schizophrenia like hallucination and delusion while still having mood disorders, particularly those of bipolar affective disorder. The features of bipolar affective disorder seen are those of depression and mania.

The two known types of schizoaffective disorder present with schizophrenia. The Bipolar type has symptoms of Bipolar affective disorder: mania and depression while the other known as the depressive type has symptoms of depression alone.

Each person who has the condition will have a different series of episodes. These mental disorders always lead to poor function at home, school and at work and they get worse when they are left untreated.

Symptoms

Schizoaffective disorder clinical features are different in each individual the symptoms may vary from hallucination, and delusions to not deriving pleasure from previously pleasurable activities.

For a patient to be diagnosed they usually have to have one episode of a mood disorder (mania or depression) and 2 weeks where they had psychotic symptoms.

The signs and symptoms also depend on the specific type of schizoaffective disorder.

• Delusions: are beliefs that are false by every evidence but are held as true.
• Hallucinations: These things that are seen and heard that are not actually there. People and voices -are not there.
• Abnormal speech: These may range from difficult to hear to difficult to understand.
• Abnormal behaviour
• Feelings of sadness, loss of appetite, weight loss, insomnia. These are symptoms of depression.
• Inability to function at work, at school and difficult social life.
• They can also have issues taking care of themselves.

Seeking Care

Anyone who may have schizoaffective disorder should be explained so they can see a doctor. Forcing them to go to the hospital is not the right way to go. You should consider meeting a doctor on their behalf and explaining to them the symptoms.

If you seek to help them because they are at a point where they can not help themselves, it is important to call the emergency cell of your country. For Nigeria, it is 199.

Suicide
If a person starts talking about suicide, they must get help as soon as possible. If they have started making these statements, you need to be by their side as you make the call for the emergency. Another option is to go to the emergency department of a nearby hospital.

Causes
The causes are similar to the causes we have been discussing above the genetic causes and it is seen in close relatives of those who have schizophrenia or bipolar disorder. The symptoms are also seen when stressors present themselves.

Psychomimetic also have this effect on people causing very similar symptoms.

This condition can also lead to complications like anxiety, sleep disorders and the like.

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Treatment

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Health and well-being monitoring

The drugs used in schizophrenia, particularly SDAs affect insulin metabolism and for this reason, their Body Mass Index should be monitored, their glucose levels should be checked first thing in the morning and also the lipid profile of these patients should be looked at always.

These patients should be weighed and calculated against their height for the BMI after 6 months from when they start getting their drugs.

Clozapine Side Effects
Because of the side effects of this drug it is very hard to prescribe. Top on the list is agranulocytosis. The first year of use is the most deadly period of using this drug with 0.3% of the portion those affected. In the USA the risk is not as high because the patients are being monitored for this complication weekly for the first 6 months and bi-weekly for the next 6. If the patient does not have this complication in a year then they are monitored monthly.

This drug also presents with the risk of seizures. It is higher in this drug than in any other antipsychotic. When the dose is higher than 600mg the risk is around 5%. The best thing to be done is to reduce the dose and add anticonvulsants. Myocarditis is also another side effect that has been noted with this drug.

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Questions

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• What did you learn about Schizophrenia?

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Conclusion

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• There are Biochemical factors that are thought to be involved in causing schiophrenia, they include serotonin,GABA and Neuropeptides.
• Schizoaffective disorder presents with features of schizophrenia and mood disorders
• Monitor the patients clinical features and doing blood work ups are important and could be life saving.

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References

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• Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
• Page demarcations made with Inkscape.org
• Mayoclinic