Tuesday, May 25, 2010


Schizophrenia / psychosis are illness due to brain pathology. Neuro- transmitter like Dopamine dis-regulation play major role in etiology. Genetic also plays important role in etiology. Neuro-structural changes can be seen on MRI studies. MRI brain should always be done as 1st line investigation to rule out brain pathology.

(1) Schizophrenia is long term illness that require medication for long duration may be life long. Patient should not hesitate continuing medication for long time as newer molecules are safer, prevent long term cognitive deterioration, prevent further episodes, and benefits of continuing medications are significantly more than risk or side effect of continuation of these medicines. (2) Newer drugs ( Olanzapine, Amisulpride, Quetiapine, Aripiprazol, Risperidone) are more effective in controlling negative symptoms as well as positive symptoms also. Patients should ask treating Psychiatrist about them as risk of tremors, Extrapyramidal symptoms, Tardive Dyskinesia, drowsiness is less common with these drugs. (3) Clozapin is more useful in resistant and poorly responding patients but white blood cell count required to be monitored considering risk of agranulocytosis. (4) More negative symptoms / cognitive problems are present in patient with long term illness. (5) Omega 3 fatty acids are useful in resistant cases but are costly. (6) Counseling & Depot injectable will help in better compliance (Once in month) which in term help patient in better response. (7) Mouth dissolving preparation of medicine are available which are color less/ odor less/ and test less so can be dissolved in food of un-cooperative patient or patient who is not ready to accept medication due to poor understanding about illness. (8) The role of dietary nutrients in Schizophrenia – newer studies have found that resistant cases of Schizophrenia respond well to high doses of minerals like Zinc, Copper, Magnesium ( Play role at NMDA receptors in brain), Iron ( Low level of serum Iron found in clinical research). Vitamin’s like - Niacinamide, Pyridoxine( B6), Riboflavin, B12, Folate. Study conducted in United Stats also suggest use of Omega-3 fatty acid, Free fatty acid/ Arachidonic acid can lead o significant improvement. These treatments are available in India also but routinely ignored by practicing psychiatrist. Dietary changes can help Schizophrenic patients in better outcome and should be advised. (9) Govt.of India has given disability benefits to these patients with Schizophrenia and can get pension/ Travel & Incom tax concession / also continuation of pension of there parents. Relative should ask treating Psychiatrist about Disability certificate. (10) Proper training & rehabilitation can help patient in regaining his lost cognitive , social, occupational, functioning and better treatment outcome on long run. ( 11)  rTMS, Transcranial Magnetic Stimulation is newer development in treatment of Schizophrenia ( approved by US FDA in 2008), now it is available in India in few centers like Pune. Cost of therapy is low and effects are seen in 10 days. rTMS is very safe and effective treatment for resistant cases, for patients not tolerating medications due to side effect. In schizophrenia rTMS is very useful in controlling Hallucinations and negative symptoms/ cognitive deterioration. Cost per rTMS is around 3450/- Rs ( around 73 US $ ) in Joshi Hospital Pune.


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