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Nigel is 19 years old. He started at a local University six

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sherine mostafa

on 17 September 2014

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Transcript of Nigel is 19 years old. He started at a local University six

Monitoring
Diagnosis
Diagnostic signs and symptoms
Tests and screening
1. complete blood count (CBC)
2. MRI imaging and CT scan
** ventricular enlargement, decreased brain size and brain asymmetry)
Pathophysiology
1st: Dopamine hypothesis:
Dopamine hyperactivity in the mesolimbic, mesocortical pathway.
(Antiparkinson's agents causes psychosis symptoms and D2 blockers showed improved symptoms)

2nd: Serotonin hypothesis (5-HT):
increased levels of serotonin neurotransmitters.
(schizophrenic patients have high levels of 5-HT and that correlates to the ventricular size enlargement)

3rd: Glutamate hypothesis:
decreased levels and activity of Glutamate.
(NMDA receptor antagonists causes psychosis symptoms)
Treatment
Desired outcome:
1. Alleviation of symptoms.
2. Avoidance of side effects.
3. Improvement of psychological function and productivity.
4. Patient compliance
Medications
Schizophrenia
Nigel is 19 years old. He started at a local University six months ago to do a course on Computer Science, but failed to attend lectures after the first few weeks. He began to suffer from periods where he would not get up in the morning, and didn't seem to care whether he went to University or not, and was unable to concentrate on any of his work. He became more and more withdrawn, and stopped going out with his friends. He neglected his personal hygiene, which was unusual for him as he had previously been careful about his appearance. He described strangers following him in the street and, one day after shouting that there were people installing hidden cameras in his bedroom to spy on him, he stormed out of the house. When he did not return that night, his mother and father went out to search for him and found him wandering the streets. With much persuasion they managed to get him to return home and next morning they contacted their doctor.
Case study
Objectives:
1. know the diagnostic signs of the disease and how to confirm the diagnosis.
2. Understand precisely the pathophysiology of the disease.
3. understand the treatment plan and all related treatment problems.
4. Explore the medications side effects, contraindications and drug interactions.

positive symptoms
Negative symptoms
hallucinations
delusions.
disorganized speech
social withdrawal
affective flattening
decreased speech fluency
**To diagnose schizophrenia at least 2 of theses symptoms should be persistent for 1 month.
Recently in 2o11, at the American psychiatric association meeting, prof. Sabine Bahn announced the invention of Veripsych., the first blood based diagnostic test to confirm the presence of schizophrenia.
It is not a genetic test but an automated test that uses single serum sample to detect 51 protein biomarkers.
FGAs
"Typical"
SGAs
"Atypical"
D2 receptor
D2 receptor
5HT receptors
Treatment plan
Initial therapy
Stabilization therapy
Maintenance Therapy
Goal
Dose
problem
Major problem

Relapse
Non adherence
other causes
side effects
??!
patient compliance
Long acting "Depot"
Side effects
Typical: DA receptors
Movement side effects
Dystonia
Akathesia
Parkinson's symptoms
Tardive diskenisia (IRREVERSIBLE)
Atypical
D2 receptors
Alpha receptors
5HT receptors
Muscarinic receptors.
Histaminic receptors
D2 receptors:
nigrostriatal pathway--> EPS
pituitary gland--> Hyperprolactinemia--> galactorrea and gyncomestia

Muscarinic --> constipation, dry eyes.
alpha--> postural hypotension
histaminic--> sedation
EPS
WBCs
Obesity related problems

Thank You =)
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