Schizophrenia and Depression (Reaction Post)

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I’m really not ok tonight. I’m so sick and tired of #Schizophrenia, it took so much from me. It’s not fair and it makes me so sad.

— 𝚊𝚕𝚝𝚎𝚛𝚎𝚍𝚜𝚌𝚑𝚒𝚣𝚘 👽 (@alteredschizo) October 18, 2022

In the last post, we saw how:

  • There are abnormalities that are seen in the cerebral cortex and especially regarding symmetry and ventricular size.
  • Smelling things that are not there can be seen as an early sign of schizophrenia.
  • Social skills training and family therapy are very useful forms of therapy.

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If you keep smelling something that is not really there, you may be experiencing the earliest symptoms of schizophrenia.

— Fact (@Fact) 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.


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Prefrontal cortex


There are gross anatomical abnormalities that are seen in the brains of those that have schizophrenia but these abnormalities have not been related to functional abnormalities. It has however been noted that people who have schizophrenia behave like those that have surgeries on the prefrontal lobes.


Thalamus


The thalamus has been noted to have a reduced volume in most studies that have been done assessing this metric. The part of the thalamus most affected is the subnuclei. The part of the thalamus that is also in communication with the prefrontal cortex also has this reduced volume. Supportive cells are also reduced in volume. The volume depiction is not due to the use of antipsychotics because these changes are seen in those that have not been placed on this medication.


Basal Ganglia plus cerebellum


There are similar movement abnormalities seen in this condition and those that have damaged both structures. Schizophrenia has been noted to affect the way the patient walks and their facial expression, particularly those who have been on treatment. The features are similar to tardive dyskinesia. In Parkinson's also there are movement disorders that are similar to what is seen in schizophrenia. Independent studies have been noted to show different parts of the basal ganglia that have reduced volume.


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Schizophrenia and Depression


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Source

According to Psycom, There is a link between depression and schizophrenia, and 25% of people who have schizophrenia can be diagnosed with depression because they meet the criteria for depression. Depression happens at every phase of schizophrenia. The patient may feel hopeless.

Major depression affects about 7% of the world's population and it is more common in women than in men.

Major depression happens at any age but the peak is at age 20 years. In major depression, the clinical features usually last more than 2 weeks and it is necessary for diagnosis.

The mood usually is low most days, there is reduced pleasure in previously pleasurable activities, and the patient may be weight loss or gain, changes in appetite and sleep issues. The patient is usually sluggish and tired on most days. The patients may feel guilty. The patient will not find it easy to concentrate. There are suicidal ideations or make attempts at the ideas.

These features usually affect the patient's ability to work and socialize and then there are substance abuse problems.

When a patient has schizophrenia and depression the problems with thinking and relating with others are worsened. Close to 6% of the people who have schizophrenia die because of suicide and one out of five of them is at risk of suicidal attempts.


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Treatment



Case Management


Managing schizophrenia involves a multidisciplinary approach the therapist, the psychiatrist, social worker are all involved in making the patient feel better. It is important to have a case manager coordinating the efforts of each person working on one patient. The case manager will work solely on the competence of the case manager. Because the case manager is usually overworked and ends up not doing a very good job


Assertive Community Treatment


This was first started in the 1970s in Wisconsin as a service delivery for those who had been with mental health problems over a long period. Each patient had a group of professionals caring for them at a time, a case manager, psychiatrist and others. Their job was to stay available for patients at any time they were needed.

They would give medication at home, check for the mental and physical well-being of the patient develop social skills on the spot and speak with the family of the affected patient. The staff-to-patient ratio was very high and could be as high as 1 staff to 12 patients. Its results were very good and reduced readmission.


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Questions


  • What did you learn about Schizophrenia?

Conclusion


  • There are abnormalities in the prefrontal cortex, thalamus, basal ganglia and cerebellum.

  • Depression can present in different ways that have depression schizophrenia or psychosis presenting.

  • Schizophrenia often requires multidisciplinary approach for management.

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References




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