Danielle Craft (Buehler) ENG 1201 Yelena Mason November 24, 2013 A Psychotic Disorder I see pink elephants

dancing on the walls in my bedroom. Every night the elephants go to sleep and snake slithers across my toes, said the frantic patient to his psychiatrist. Although scene may seem funny, these similar hallucinations are a common side effect to the psychotic disorder of schizophrenia. Schizophrenia is a psychotic disorder that cannot be cured, its available medications for treatment causes many side effects, and new research has developed a theory explaining the cause of the disorder. Many psychotic disorders are not fully understood because psychotic disorder take place in the portion of the brain that affects behavior such as schizophrenia; therefore, the disease or disorder cannot be cured. Only the signs or symptoms can be treated in psychotic disorders because of the unknown origins. Schizophrenia is a disabling brain disorder that causes depression, manic depression, and anxiety (CDC). Individuals with schizophrenia may also have trouble with their speech because other individuals cannot understand their speech. Individuals with schizophrenia have trouble maintaining employment and carrying out simple jobs. Some of the reasons related to their problems with a continuous job are their beliefs that others are attempting to harm them. Some individuals, however, are able to live and maintain life because of their treatment (NIH, p.1). Delusions, hallucinations, withdrawal or regressive behaviors are

also signs used to identify schizophrenia that affect daily tasks. Schizophrenia is a chronic psychotic disorder and dopamine and serotonin are the major neurotransmitters (substances that provide communication between brain cells) represented in this disorder. Dopamine aids in the control of emotions, thoughts, and learning. Large problems in the ranges of dopamine result in the behavior problems associated with schizophrenia. The antipsychotic drugs are responsible for aiding in the regulation of dopamine (Ballington, p.183). According to Pharmacology for Technicians, the primary suggested use for antipsychotic drugs is for schizophrenia. Schizophrenia also causes problems in an individuals activities of daily living. A person has symptoms called the flat affect which causes the person to have limited facial expressions. The individual also lacks the ability to uphold planned activities and have enjoyment in activities. Other problems relate to an individuals personal hygiene and the individual appears to be lazy when attempting to be a part of social activities. This may be related to part of their withdrawal from society. Although the exact cause of schizophrenia is unknown, scientists believe that genetics are a great part of the schizophrenia disorder because it runs through families. Although genes play a role in the disease, scientists believe that the environment may add to it as well (NIH). Other aspects such as the appearance of the brain may be a cause of the disorder. Some individuals with schizophrenia have been observed to have less gray matter in the brain than healthy individuals and this may contribute to the different schizophrenia behaviors. Problems involved in schizophrenia also affect speech, the ability to act on new information, and their ability to comprehend new information (NIH). Mental disorders are treated by psychiatric drugs. These drugs are able to help individuals maintain a better life while suffering from the side effects of schizophrenia. These medications do not cure the patient of the disorder, but treat the symptoms of the disorders. Each person may
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not need the medications for a long length of time, but some individuals require the medications much longer than others. Antipsychotic drugs are used to treat psychotic disorders; however, some of the uses of these drugs cause severe side effects to the drugs. Side effects are seen in different individuals as well. The side effects vary based on the individuals weight, age, gender, physical illnesses, diet, genetics, liver and kidney function, and other medications the individual may be taking (NIH). Some problems, or negative side effects, from the older antipsychotic drug such as extrapyramidal symptoms are seen in patients with schizophrenia. The extrapyramidal symptoms are problems related to muscle control. The new antipsychotic drugs have now been made to improve effectiveness and decrease the negative side effects (Ballington, p.183). The drug prochlorperazine (Compazine) is an antipsychotic drug used to treat psychosis. Some side effects of antipsychotic drugs can cause damage to the person such as sedation that lasts for two weeks. Other side effects are known as anticholinergic side effects which are dryness of the mouth, eyes, and throat, blurred vision, or constipation. These side effects are considered mild and the patient generally is able to build a tolerance to these side effects. Cardiovascular side effects are postural hypotension, increased heart rate, fainting, or falling and are caused by psychotic drugs. Other psychotic drugs cause dermatologic problems such as excessive tanning or burning, gray skin appearance. The gray skin color is an accumulation of pigmented skin cells, but the new drugs have been able to limit the gray skin appearance. Endocrine side effects are seen in psychotic drugs. These effects are hyperglycemia, lack of menses, male breast enlargement, lactation in nonpregnant woman, sexual function. Diabetes, increased cholesterol levels, and weight gain are also possible side effects to the drugs. Hematologic problems are seen in bone marrow depression which generally cannot be reversed. Ophthalmologic problems are also seen in psychotic drug such as blindness. Withdrawal is also a

side effect; however, withdrawal is one of the signs to the disorder, but the antipsychotic drugs are able to cause more problems related to withdrawal. Antipsychotic drugs also cause neurologic side effects such as extrapyramidal side effects because of the irregular dopamine transmitters (Ballington, p.183-184). The newer antipsychotic drugs do not have as many negative side effects; however, they do have side effects such as weight gain, diabetes, and hyperglycemia (Ballington, p.185). Other side effects such as rigidity, tremors, and muscle spasms are related to typical antipsychotic medications (NIH). Unfortunately, the use of typical antipsychotic medication can cause tardive dyskinesia which causes the individuals to lose control of certain muscle movements. Psychosocial treatments are also available for individuals with stabilized medication for schizophrenia. These treatments help individuals manage daily tasks such as going to the grocery, provide support to allow the individuals to go to a job, and aid in promoting the individuals to socialize (NIH). Studies have also noted the difference in the changes of the brain of individuals with schizophrenia. Specific structural changes have taken place in the brain as a result of the disorder. These changes, however, are not a direct result or side effect from the antipsychotic drugs because there have been observances of patients with the same brain structural changes that have not taken the antipsychotic drugs (CDC). Although schizophrenia is a psychotic disorder, it has been linked to infectious diseases. Research linked to schizophrenia and the understanding of the infectious disease could help to diminish some of the disabilities that trail the psychiatric disorders (CDC, p.1) Studies have indicated that there may be another cause to the disorder of schizophrenia other than brain disturbances. These new studies have identified an infection of Toxoplasma gondii. Toxoplasma gondii is an organism that can produce the same symptoms as the symptoms seen in schizophrenia patients. The human antibodies against Toxoplasma gondii have been observed in
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individuals that have psychiatric disorders such as schizophrenia. Cats often carry Toxoplasma gondii and humans exposed to those cats can ingest the organism. It is also contracted in undercooked meat, but the response of the individual affected is based on the individuals immune response and genetics (CDC). Some of the medications for schizophrenia are able to restrain Toxoplasma gondii (Torrey, pg. 1). This connection of the drug to the organism also demonstrates the connection of schizophrenia to the organism of Toxoplasma gondii. Although Toxoplasma organisms have been seen in individuals with schizophrenia, it has also been observed to weaken and modify learning in mice. Mice have also shown changes in their behavior and memory after contracting an organism of Toxoplasma (CDC). Toxoplasma has also been known to cause other problems in humans such as still births because it crosses the placenta in the mother and affects the baby. Many bacteria, viruses, and organisms are stopped by the mothers immune system, but this organism is able to avoid the mothers immune system and cross the placenta. This is the reason pregnant women are warned to stay away from cats (especially their litter boxes) during pregnancy. The following table indicates the existence of Toxoplasma gondii in psychiatric patients. This was taken from the Centers for Disease and Control website to show some of the patients that have been noted for Toxoplasma gondii while suffering from the psychotic disorder of schizophrenia. Understanding the link between Toxoplasma gondii and schizophrenia could one day lead to research that could cure the psychotic disorder of schizophrenia.

Toxoplasma gondii and Schizophrenia E. Fuller Torrey* and Robert H. Yolken Author affiliations: *Stanley Medical Research Institute, Bethesda, Maryland, USA; Johns Hopkins University Medical Center, Baltimore, Maryland, USA Toxoplasmosis antibody studies of psychiatric patients Y Author and country Test used Patients Controls % Patients % Controls antibody positive antibody positive p valuechi square

1958 1961

Caglieris (20)Italy Cook & Derrick (21)Australia Yegerov et al. (22)Russia Avlavidov (23)Bulgaria Berengo et al. (24)Italy Roch & Varela (25)Mexico Garrido & Redondo (26)Spain Garcia (27)Cuba

Dye test Dye testC.F. Skin testC.F. Skin testC.F. Dye test Dye test C.F. Skin test

Inpatients with schizophrenia Inpatients with schizophrenia Inpatients with schizophrenia Psychiatric inpatients, not specified Inpatients with schizophrenia Schizophrenia, hospital status not specified Inpatients with schizophrenia Psychiatric inpatients

Normal subjects General population

21 (13/61) 36 (19/53) 1:1611 (6/53) 1:4 19 (7/37)32 (12/37) 26 (5/19)21 (3/14) 14 (76/560) 86% (836/973) 44 (17/39) 60 (60/100)

15 (12/81) 24 (182/760)13 (99/760) 4 (1/25)28 (7/25) 3 (1/35)9 (3/34) 4% (49/1200) 30% (4,411/14,689) 29 (147/500) 30 (30/100)

0.376 0.0530.840

1962 1962 1966 1966 1968 1979 Since 1999 1999 2001 2001 2002 2003

Hospital employees Female surgical patients General population General population General population Normal persons

0.1240.784 0.0170.339 <0.0001 <0.0001 0.072 <0.0001

Qiuying et al. (28)China Gu et al. (29)China Yolken et al. (30)Germany Boronow et al. (31)United States Leweke et al. (32)Germany Torrey & Yolken (unpub. data)Ireland

EIA EIA

Inpatients with schizophrenia First-episode schizophrenia

Normal persons from same 14 (22/152) region for routine physicals Normal controls matched for age, sex, birthplace Normal controls matched for age, sex, SES Normal controls matched for age Normal controls matched for age, sex, SES Hospital employees 33 (45/135) 42 (16/38) 12 (28/229) 36 (13/36)

10 (41/396) 9 (4/43) 11 (3/27) 7 (7/100) 14 (10/73)

0.181 0.002 0.007 0.147 <0.007

EIA: IgG or First-episode IgM schizophrenia EIA EIA Outpatients with schizophrenia First-episode schizophrenia, never treated Inpatients with schizophrenia

2003

EIA

60 (31/52)

45 (9/20)

0.299

C.F., complement fixation; EIA, enzyme immunoassay; Ig, immunoglobulin; SES, socioeconomic status.

Schizophrenia is a debilitating psychotic disorder that affects the daily activities of individuals because of the many symptoms involved in the disease. Medications are available, but there are many side effects involved that also affect the daily tasks of the individuals. There is no cure for schizophrenia, but the new discoveries and research related to the psychotic disorder could one day allow schizophrenia patients to live without the symptoms of the disorder or the side effects from the medications.

Works Cited Balllington, Don A.; Laughlin Mary M. Pharmacology for Technicians, Fifth Edition.St. Paul, MN Paradigm Publishing, Inc. 2013. (Pharmacy drug materials)

Centers for Disease Control and Prevention: 27 October 2013. <http://wwwnc.cdc.gov/eid/article/4/1/98-0118_article.htm> Table. <http://wwwnc.cdc.gov/eid/article/9/11/03-0143-t1.htm> Moritz, Steffen; Andreou, Christina; Klingberg, Stefan; Thoering, Teresa; Peters, Maarten J.V. Neuropharmacology. Sep 2013, Vol. 72, p179-186.

National Institute of Mental Health.27 October 2013.

<http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml>

National Institute of Mental Health. 09 November 2013. <http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml>

Schizophrenia Health Center. 03 November 2013. http://www.webmd.com/schizophrenia/guide/mental-health-schizophrenia

Stiles-Shields, Colleen; Bogue, Cynthia; Grange, Daniel Le; Yohanna, Daniel. An Examination of Adults on Antipsychotic Medication at Risk for Metabolic Syndrome. Wiley Subscription Services, Inc.2013.

Torrey, E.Fuller; Yolken , Robert H. Toxoplasma gondii and Schizophrenia. Emerging Infectious Diseases Journal. Web. November 2003. (03 November 2013). Centers for Disease Control and Prevention: November 2013.Table http://wwwnc.cdc.gov/eid/article/9/11/03-0143-t1.htm Zelman; Tompary; Raymond; Holdaway; Mulvihill. Human Diseases: A systematic Approach, 7th Edition.New Jersey.Pearson Education, Inc. 2010.