Withdrawal symptoms schizophrenia

The term psychotomimetic was coined to compare the effects of hallucinogens to the symptoms of schizophrenia and other psychotic conditions. However, the effects produced by hallucinogens and mental illness are qualitatively different. While drug-induced hallucinations tend to be more visual, auditory hallucinations are most common in schizophrenia. The hallucinogenic drugs discussed here may induce positive symptoms (e.g., hallucinations), but do not induce the negative symptoms (e.g., cognitive deficits, social withdrawal) of schizophrenia. 

Chemerinski E, Ho BC, Flaum M, Arndt S, Fleming F, Andreasen NC (2002) Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia. Compr Psychiatry 43 393-396... 

Cognitive decline, depression, anxiety, violent behavior, and weight loss are reported following chronic use of phencyclidine. Prolonged psychosis has been reported, which can mimic acute schizophrenia, and can persist for 4-6 weeks. Tolerance to the psychoactive effects can lead abusers to take increased doses. Psychological dependence has been noted, but no distinct withdrawal symptoms have been reported. 

It is indicated in the treatment of depressive episodes associated with bipolar disorder. A combination of an antipsychotic drug and an antidepressant may be useful in some cases, especially in depressed psychotic patients, or in cases of agitated major depression with psychotic features. The first combination antipsychotic/antidepressant (olanza-pine/fluoxetine Symbyax) was recently FDA approved in the United States for treatment of depressive episodes associated with bipolar disorder. However, antidepressants and stimulants are unlikely to reduce apathy and withdrawal in schizophrenia, and they may induce clinical worsening in some cases. Adjunctive addition of lithium or an antimanic anticonvulsant, such as carbamazepine, may add benefit in some psychotic patients with prominent affective, aggressive, or resistant symptoms. 

Neuroleptics or antipsychotics suppress the positive symptoms of schizophrenia such as combativeness, hallucinations and formal thought disorder. Some also alleviate the negative symptoms such as affective blunting, withdrawal and seclusiveness. Neuroleptics also produce a state of apathy and emotional indifference. Most neuroleptics block dopamine D2-receptors but some, like clozapine, also block dopamine D4-receptors or serotonin 5-hydroxytryptamine2A-receptors. 

The prefrontal cortex (PFQ and in particular the dorsal lateral part (DLPFQ appear to be particularly important in schizophrenia (Kerwin 1992). Lesions there are known to produce functional defects in humans reminiscent of many of the negative symptoms of schizophrenia, such as attention and cognitive defects and withdrawal. Despite this, no specific pathology is seen in the DLPFC in schizophrenics although there is some atrophy and neuronal loss which are normally old and could be congenital. That being so, it is necessary to explain why the symptoms become apparent only in adolescence. 

The typical antipsychotic drugs, which for 50 years have been the mainstay of treatment of schizophrenia, as well as of psychosis that occurs secondary to bipolar disorder and major depressive disorder, affect primarily the positive symptoms[10]. The behavioral symptoms, such as agitation or profound withdrawal, that accompany psychosis, respond to the antipsychotic drugs within a period of hours to days after the initiation of treatment. The cognitive aspects of psychosis, such as the delusions and hallucinations, however, tend to resolve more slowly. In fact, for many patients the hallucinations and delusions may persist but lose their emotional salience and intrusiveness. The positive symptoms tend to wax and wane over time, are exacerbated by stress, and generally become less prominent as the patient becomes older. 

Controlled clinical investigations with careful titration of doses in normal subjects demonstrate that ketamine produces negative symptoms, such as withdrawal and the subtle cognitive impairments associated with schizophrenia [25]. As is the case for schizophrenia, these symptoms occur without clouding of consciousness or frank dementia. Positive symptoms with auditory hallucinations and fully... 

Anxiety symptoms may be present in several major psychiatric illnesses (e.g., mood disorders, schizophrenia, organic mental syndromes, and substance withdrawal). 

There are two general classes of clinical characteristics of schizophrenia. First, there are the positive symptoms that include auditory hallucinations (voices) and delusions, often paranoid. Second, there are the negative symptoms these include disorganization, loss of will, inability to pay attention, social withdrawal, and flattening of affect. The relative roles of positive and negative symptoms for a particular victim vary over time. The positive symptoms may predominate for a period to be followed by one in which the negative symptoms are more prominent. About 10% of people with schizophrenia commit suicide. 

Negative Symptoms. Although the odd nature of positive symptoms draws the most attention, the negative symptoms are perhaps the most disabling. These hinder a schizophrenia patient s desire and ability to maintain relationships or hold employment. The negative symptoms include poor motivation (avolition), a bland expressionless face (flattened affect), minimal speech (alogia), and social withdrawal. 

This is a partial listing of substances that may mimic symptoms of schizophrenia. Psychosis may occur during intoxication, withdrawal, and occasionally as prolonged sequelae long after substance use has ceased. Rarely will substance ingestion produce all five criteria for schizophrenia as outlined in Table 4.1. 

Cluster A Personality Disorders (Schizotypal PD, Schizoid PD, Paranoid PD). These are the odd and eccentric personality disorders. They all share certain features in common with schizophrenia, but schizotypal PD in particular appears to be most closely related to schizophrenia. The schizophrenia-like symptoms of these personality disorders (e.g., magical thinking, paranoia, social withdrawal) are less severe and generally don t impair social or employment function as severely as schizophrenia. 

Psychotic symptoms may also occur with the withdrawal of alcohol, sedatives, hypnotics, and anxiolytics The following symptoms may occur persecutory delusions, perceptual distortions, and vivid hallucinations in any modality, most classically visual and tactile hallucination of insects crawling under the skin (formication) Substance abuse history may be elicited from the history and confirmed by finding urinary metabolites Confirmation of schizophrenia can only be made if the psychotic symptoms persist for at least a month following drug withdrawal... 

Schizophrenia is a mental disorder that is characterized by positive symptoms such as delusions, hallucinations and disorganized speech/behavior and negative symptoms including apathy, withdrawal, lack of pleasure and impaired attention. Other... 

Negative symptoms commonly are considered a reduction in normal functions in schizophrenia, such as blunted affect, emotional withdrawal, poor rapport, passivity, and apathetic social withdrawal. Difficulty in abstract thinking, stereotyped thinking, and lack of spontaneity are associated with long periods of hospitalization and poor social functioning. 

In 1949 Cade published a paper describing his experience of treating 10 patients with mania with lithium. He announced dramatic effects and importantly claimed that the effects were specific to mania. This claim was made on the basis of a very brief description of the response of some patients with schizophrenia who were said to have shown no fundamental improvement although some of them became quiet and amenable (Cade 1949, p. 351). In addition, the delusions and hallucinations experienced by one of the patients diagnosed as manic failed to improve with lithium. All the patients with mania were said to have improved in terms of becoming quieter. Cade also noted the return of symptoms after lithium withdrawal. On the basis of these observations Cade concluded that the effect on patients with pure psychotic excitement - that is true manic attacks - is so specific that it leads to... 

Negative symptoms of schizophrenia is a term used to refer to symptoms such as apathy, social withdrawal and reduced emotional responsiveness associated with this diagnosis. 

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