SCHIZOPHRENIA

• The word schizophrenia means splitting of the mind. Schizophrenia is characterized by disturbances in thought and verbal behaviour, perception, affect, motor behaviour and relationship to the external world. Clear consciousness and intellectual capacity are usually maintained, although certain cognitive deficit may evolve.
• The disturbance involves the most basic functions that give the normal person a feeling of individuality, uniqueness, and self-direction. Schizophrenia is a severe psychiatric disorder characterized by chronic or recurrent psychosis.
• Majority of individuals initially experience symptoms in their 20s. Males and Females are equally affected

Genetic factors

• About 8- 10% of first degree relatives of patients can present with Schizophrenia. One Schizophrenic parent – 10 %, Two Schizophrenic parents – 40 % chances.

Biochemical Theory

• Increased dopaminergic activity in the mesolimbic neuronal pathway and decreased dopaminergic activity in the prefrontal cortical pathway

Structural & Functional Changes in Brain

• Enlarged Third & Lateral Ventricles
• Decreased Volume of the limbic system, prefrontal cortex and Thalamus

Environmental Factors

• Stress & Psychosocial factors
• Frequent use of cannabis
• Advanced Paternal age at conception

• Include positive psychotic symptoms, negative psychotic symptoms, cognitive impairment, abnormal motor behavior and mood symptoms
• In thought and speech: Autistic thinking, Loosening of association, thought blocking, poverty of speech, mutism, delusion (unshakable false beliefs), Word salad, Echolalia, Flight of ideas, circumstantial speech, Tangential speech, Pressured speech
• In Perception: Hallucinations ( Perception without stimuli) – it can be in the form of auditory or visual mainly
• In affect: Apathy, emotional blunting, emotional shallowness, anhedonia (inability to experience pleasure) inappropriate emotional response
• In motor behavior : There can be either decease (decreased spontaneity, inertia, stupor) or an increase in psychomotor activity (excitement, aggressiveness, restlessness, agitation)
• Catatonia: abnormal movements and reactivity to the environment
• Positive symptoms of psychosis: Hallucinations, Illusions, Delusions (Bizzare, non-bizarre, Grandiosity, Ideas of Reference, Paranoia, Persecutory, Erotomania, Jealousy ), disorganized thought and speech Processes( Loose associations, word salad, Neologisms, Echolalia, Flight of ideas, Clang association, circumstantial speech, tangential speech, Thought blocking, Pressured speech)
• Negativesymptoms of psychosis: Flat affect, Avolition, Alogia, Anhedonia, Apathy

Differential Diagnosis

• Schizophreniform disorder: Duration of symptoms: 1-6 months, Negative symptoms
• Brief Psychotic disorder: hallucinations, Disorganised speech, catatonic behviour, usually develops after stressful life events
• Schizoaffective disorder: Psychotic symptoms with or without mood symptoms
• Mood disorder with psychotic features
• Delusional disorder

• Clinical diagnosis is done based on ICD11 or DSM 5 criteria
• Brain imaging: cortical atrophy, enlarged cerebral ventricles
• Urine Toxicology – to rule out substance use disorder

• The mainstay of Treatment is psychoeducation
• schizophrenia with positive symptoms is Vatonmada and with negative symptoms is Kaphonmada

Internal Medicines

• Swetasankhupuspi choorna + Sarpagandha churna + Gokshura churna
• Aswagandha + Swetasankhupuspi choorna + Yashti choorna
• Samana snehapana - Kalyanaka ghrita, Mahakalyanaka ghrita
• Manasamitra vataka if pithanubandha is present
• Somalata churna for correcting sleep disturbances

Procedures

• Sadyovirechana with Avipathy churna (in cases with increased psychomotor activity-PMA)
• Sirolepa to reduce the PMA
• Snehapana - Kalyanaka ghrita, Mahakalyanaka ghrita
• Virechana with Avipathy choorna / Gandharvahastadi eranda
• Yogavasthi – Doshahara kashayavasthi and Anuvasana vasthi with Kalyanaka ghrita /Mahakalyanaka ghrita
• Nasya – Anutaila, Ksheerabala 101
• Dhoopana – with haridradi yoga, Aparajita dhoopachurna ( effective in hallucinations and delusions)
• Repeated sodhana (yearly once or twice) with regular medication can improve the quality of life