Schizophrenia and Asymptomatic Antipsychotics Assignment 2022

Running head: SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
Schizophrenia and Asymptomatic Antipsychotics
Name of the Student
Name of the University
Author Note

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Abstract
Introduction
Schizophrenia is a complex chronic condition that affects the neuronal functions of the
individuals. It is mainly characterized by the presence of hallucinations and delusions and
often such behaviours are marked as psychotic symptoms that can cause loss of contacts from
the reality. Along with this presence of social withdrawal and cognitive impairment are also
observed. This section mainly tries to address the queries regarding the disease among the
older adult patients of oncology ward so that they can identify the symptoms of the disease
condition.
Discussion
As a part of the disease condition the patient may have enlargement of the third and
lateral ventricles and along with this, reduction of volume in regions like hippocampus,
anterior cingulate, superior temporal gyrus, parahippocampus, insula, amygdala, and inferior
and medial frontal gyri are also observed in MRI imaging. Structural abnormality in
hippocampus and white temporal lobe are associated with the work performance, working
memory. The dysfunction in the presynaptic dopamine secretion is associated with the
primary onset of psychosis in schizophrenia. Another crucial pathophysiological idea of
schizophrenia is associated with the antagonistic effect of the NMDA receptor. The use of
atypical antipsychotic drugs or Second-generation (atypical) antipsychotics (SGAs) is highly
recommended. Remoxipride drug can be used to treat this condition. It is specific D2
antagonist that helps to reduce the amount of dopamine by blocking the D2 receptors.
Conclusion

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The presence of hallucinations and delusions are the key feature of schizophrenia and it is
mainly associated with altered brain cell volume. For managing the condition, SGAs such as
Remoxipride can be prescribed.

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Introduction
Around the world, schizophrenia is one of the most painful mental health disorders
and it affects the thinking, feeling and behaviours of the individuals. However, it is also true
that, this disease is not common like other mental health problems. In case of Australia, it can
be stated that the almost 150,000 to 200,000 Australians are affected by this complex
condition in the country that is almost 1 out of 100 Australians are suffering from this
condition in the country. Among the patients of this disease, only 20 to 30 per cent of the
patients are facing the issues of brief period of schizophrenic attacks and for rest of the
patients, this disease is chronic condition (Charlson et al., 2018). This essay targets to educate
the family members of the patients suffering from schizophrenia.
What is Schizophrenia?
While defining schizophrenia disease it can be stated that it is a complex chronic
condition that affects the neuronal functions of the individuals. In this context, it can be
mentioned that that the disease is mainly associated with the alteration of thinking behaviours
of the individuals and along with this emotions of the individual is also altered due to this
disease conditions. Moreover, in some case, this disease also affects the perception of the
individual (Fatani et al., 2017).
Physiology of Schizophrenia
While discussing about schizophrenia, it can be stated that there are a few features of
this disease condition and they can be divided into three categories. The first category is
named as positive symptoms that comprise of hallucinations and delusions and often such
behaviours are marked as psychotic symptoms that can cause loss of contacts from the reality
(Aleman, 2014).

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The next category is negative symptoms that comprise of impaired motivation, social
withdrawal and lack of spontaneous speech of the individuals (Aleman, 2014).
The third category of the schizophrenic feature is associated with the cognitive
impairment or weakening of the cognitive power of the patients suffering from the
schizophrenia. Among all the three features of the disease, it can be stated that the positive
symptoms may be remit and relapse. On the other hand, the negative symptoms and cognitive
impairment are associated with long term chronic effects on the patients of schizophrenia.
The episode of psychosis generally takes place at the late adolescence period or in early
adulthood (Fatani et al., 2017). According to the study of Watkins and Andrews (2016), it is
reported that there are a few factors that can be marked as associative factors of the disease
and they are mainly substance abuse such as consumption of alcohol and tobacco, presence of
obsessive-compulsive disorder, depression, anxiety and panic. These symptoms can make the
disease condition more severe or worsen. Therefore, it is also observed that such behaviours
among the patients are also associated with the lack of mindfulness, non-adherence
behaviours, bad hygienic practices, poor social interactions and as a consequence of this the
condition becomes more critical for the health care professionals to treat the condition.
Pathophysiology of the Disease
While discussing about the pathophysiology of the
disease it can be stated that there various factors
that can contribute to the onset of the disease among
the individuals. Most of the researchers believe
that the onset of schizophrenia is a collaborative

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action of multiple factors such as neurophysiological factors, environmental factors,
impairment in the thalamus, temporal lobe, abnormalities in the neurotransmitters (Fatani et
al., 2017).
While discussing about the alteration in the brain structures, it can be stated that in
this condition, enlargement of the third and lateral ventricles are observed and along with this
slight reductions in overall grey matter volume and brain volume are also reported.
Moreover, in another study it is reported that in this condition, regional reductions in the
brain regions like hippocampus, anterior cingulate, superior temporal gyrus,
parahippocampus, insula, amygdala, and inferior and medial frontal gyri are reported (Grace,
2016). The study of Fatani et al. (2017), reported about the fact the reductions in the grey
matter volume and severity of the positive symptoms are correlated with each other. On the
other hand, hippocampal volume reduction is associated with the severity of the negative
symptoms and poor social interaction of the patients. In this context, it can be stated that the
structural abnormality in hippocampus and white temporal lobe are associated with the work
performance, working memory. While discussing about the role of neurotransmitters in the
onset of schizophrenia, it can be stated that among various theories, the association of
dopamine and glutamate with the onset of disease is well established and these two theories
are also well supported by various literature as well. According to the study of Howes et al.
(2017), it is stated that the increased level dopamine
transmission leads to onset of psychosis and after that
defective nature of the mesocortical dopamine will cause
over-activity of the mesolimbic system.
Fig.2- Reduced neuronal cells

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However, recent studies showed that the dysfunction in the presynaptic dopamine secretion is
associated with the primary onset of psychosis in schizophrenia. Another crucial
pathophysiological idea of schizophrenia is associated with the antagonistic effect of the
NMDA receptor such as ketamine and phencyclidine (PCP). The normal actions of the
NMDA receptor are exerted through the actions of glutamate and aspartate bindings. In
various studies, it can be stated that NMDA antagonists can induce psychotic symptoms,
cognitive deficits and defects in MMN that mimic the symptoms of schizophrenia. From this
study it was observed that abnormalities in glutamate neurotransmission are associated with
the reduced function or density of NMDA receptors (Fatani et al., 2017). Therefore, it was
reported that excess glutamate in the body can be marked as a major driving forces for the
onset of schizophrenia. Another crucial aspect of the schizophrenia pathophysiology is
associated with the lack of gliosis that is proliferation of the glial cells in response to the
damage in the nervous system of the body. According to the study of Watkins and Andrews
(2016), it is stated that in case of schizophrenia glial cell destruction in the brain region is
very common.
Medications for the Disease
While discussing about the treatment process of schizophrenia, it can be stated that for
treating the condition, pharmacological and non-pharmacological therapy can be
recommended. However, initially pharmacological treatment is recommended for helping the
patient to come back to the normal functioning in life such as normal sleeping practice. Along
with this, for treating the acute stage of disease condition, maintenance therapy is
recommended and in various studies, it was reported that the application of this therapy is
capable of avoiding the relapse of the disease condition. In this regard, it can be indicated that
the drug therapy should be continued for minimum one year period. In case of the medicinal

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therapy, the use of atypical antipsychotic drugs or Second-generation (atypical)
antipsychotics (SGAs) is highly recommended over the first generation antipsychotic drugs.
However, among the SGAs the use of clozapine should be avoided initially as it has various
side effects such as blurred vision, weight gain, sleeping problems, dizziness, shaking or
tremors and dry mouth (Jibson, 2016). However, the exact mechanism of action of the
atypical antipsychotic drugs is not well known still it is assumed by various researchers that
the action of these drugs is mainly et well known still it is assumed by various researchers
that the action of these drugs is mainly exerted by the mechanism of dopamine antagonists or
D2-antagonists and 5-HT2A antagonists. The issue of positive symptoms in the schizophrenia
is relieved by the action of D2-antagonism. On the other hand, HT2A antagonism is
associated with the enhancement of negative symptoms and cognitive behaviours and that
medication helps to release of dopamine into the prefrontal cortex (Jibson, 2016).
Pharmacology of the Medications
As a part of the atypical antipsychotic drug treatment, the use of Remoxipride drug
can be recommended by the physicians. It is specific D2 receptor blockers and unlike other
medicines this medicine does not block any other receptors such as noradrenergic,
cholinergic and histaminergic receptors. The chemical formula of this component is
C16H23BrN2O3 (Drugbank, 2020). The mechanism of action of this drug is associated with the
suppression of dopamine release. As it is believed that the over activity of neurotransmitter
dopamine in the mesolimbic pathway is associated with the positive symptoms and dopamine
function in the mesocortical pathway is associated with the negative symptoms of the disease.
Hence, lowering the level of dopamine can reduce the symptoms of schizophrenia in the
patients. Therefore, it should be noted that exposure to multiple psychotic at same time
should be avoided in order to prevent adverse drug reactions (Drugbank, 2020).

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Conclusion
Hence, it can be concluded that schizophrenia is one of the most common
neuropsychiatric disorder; however, in Australia, the prevalence of disease is not so serious.
In case of schizophrenia there are three sets of features and they are positive symptoms,
negative symptoms and cognitive difficulties. As a part of this, cases of hallucinations,
delusions, impaired motivation, social withdrawals are reported. The disease is characterized
by the alteration in the brain volume and different regions of the brain are affected by this
disease. In order to manage the disease condition, SGAs are recommended primarily. For
example, the use of Remoxipride can be used.

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References
Aleman, A. (2014). Neurocognitive basis of schizophrenia: information processing
abnormalities and clues for treatment. Advances in Neuroscience, 2014.
Charlson, F. J., Ferrari, A. J., Santomauro, D. F., Diminic, S., Stockings, E., Scott, J. G., ... &
Whiteford, H. A. (2018). Global epidemiology and burden of schizophrenia: findings
from the global burden of disease study 2016. Schizophrenia bulletin, 44(6), 1195-1203.
Drugbank (2020). Remoxipride. Drugbank. Retrieved from-
https://www.drugbank.ca/drugs/DB00409 [Accessed on 28th March 2020]
Fatani, B. Z., Aldawod, R., Alhawaj, A., Alsadah, S., Slais, F. R., Alyaseen, E. N., ... &
Qassaim, Y. A. (2017). Schizophrenia: etiology, pathophysiology and management-a
review. The Egyptian Journal of Hospital Medicine, 69(6), 2640-2646.
Grace, A. A. (2016). Dysregulation of the dopamine system in the pathophysiology of
schizophrenia and depression. Nature Reviews Neuroscience, 17(8), 524.
Howes, O. D., McCutcheon, R., Owen, M. J., & Murray, R. M. (2017). The role of genes,
stress, and dopamine in the development of schizophrenia. Biological psychiatry, 81(1),
9-20.
Jibson, M. D. (2016). Second-generation antipsychotic medications: Pharmacology,
administration, and side effects. UpToDate. Waltham, MA (accessed 12 January 2017).
Watkins, C. C., & Andrews, S. R. (2016). Clinical studies of neuroinflammatory mechanisms
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