Hypofrontality in Schizophrenia Hypofrontality, or reduced activity in the brain's frontal lobes, is a well-established feature of schizophrenia. The frontal lobes are responsible for various executive functions, such as planning, decision-making, working memory, and inhibitory control, which are often impaired in individuals with schizophrenia. Proposed mechanisms Several studies using neuroimaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have shown reduced activation or metabolism in the frontal lobes of individuals with schizophrenia compared to healthy controls. This hypofrontality has been linked to the negative symptoms and cognitive impairments commonly observed in schizophrenia. reduced blood flow reduced dopaminergic activation reduced metabolism However, it is important to note that hypofrontality's exact nature and causes in schizophrenia are not yet fully understood and require further research. Additio...

ICD-11Criteria for Schizophrenia or Other Primary Psychotic Disorders (BlockL1‑6A2) Schizophrenia and other primary psychotic disorders are characterised by significant impairments in reality testing and alterations in behaviour manifest in positive symptoms such as persistent delusions, persistent hallucinations, disorganised thinking (typically manifest as disorganised speech), grossly disorganised behaviour, and experiences of passivity and control, negative symptoms such as blunted or flat affect and avolition, and psychomotor disturbances. The symptoms occur with sufficient frequency and intensity to deviate from expected cultural or subcultural norms. These symptoms do not arise as a feature of another mental and behavioural disorder (e.g., a mood disorder, delirium, or a disorder due to substance use). The categories in this grouping should not be used to classify the expression of ideas, beliefs, or behaviours that are culturally sanctioned. Coded Elsewhere:    Substan...

ICD-11 Criteria for Schizophrenia (6A20 ) Schizophrenia is characterised by disturbances in multiple mental modalities, including thinking (e.g., delusions, disorganisation in the form of thought), perception (e.g., hallucinations), self-experience (e.g., the experience that one's feelings, impulses, thoughts, or behaviour are under the control of an external force), cognition (e.g., impaired attention, verbal memory, and social cognition), volition (e.g., loss of motivation), affect (e.g., blunted emotional expression), and behaviour (e.g., behaviour that appears bizarre or purposeless, unpredictable or inappropriate emotional responses that interfere with the organisation of behaviour). Psychomotor disturbances, including catatonia, may be present. Persistent delusions, persistent hallucinations, thought disorder, and experiences of influence, passivity, or control are considered core symptoms. Symptoms must have persisted for at least one month in order for a diagnosis of schi...

Causes of Increased Mortality in Schizophrenia The mortality rate is elevated in patients with schizophrenia. The following are the common natural and unnatural causes of increased mortality in patients with schizophrenia.  Unnatural Causes  Approximately 60% of the increased mortality is because of unnatural causes, especially suicide and accidents. Natural Causes  Nearly 40% of the increased risk is because of natural causes, such as: Cardiovascular disease Smoking Sedentary lifestyle Obesity Medication side effects

Typical Versus Atypical Antipsychotics By definition, typical antipsychotics are those which produce extrapyramidal side effects, while atypical antipsychotics do not. However, at the doses used today, most atypical antipsychotics do not produce extrapyramidal side effects. Whether typical and atypical antipsychotics differ in efficacy in a long-held debate. Except for clozapine, there are no significant differences in the efficacy of typical and atypical antipsychotics.  Two large pragmatic studies, CATIE  in the United States, and CutLASS  in the United Kingdom, in 2005 and 2006, respectively, produced similar conclusions. Another meta-analysis, in 2009 showed that risperidone, olanzapine, and amisulpride were more effective compared to typical antipsychotics.  Overall, typical antipsychotics are more likely to produce extrapyramidal side effects, while atypical ones are more likely to produce metabolic side effects, including weight gain, hyperlipemia, and diabete...

Assessment and Management of The Risk of Violence in Schizophrenia Scenario A 21-year-old lady with the diagnosis of schizophrenia informs you she will kill her neighbour tomorrow as she has ruined her life. She tells not to disclose this to anyone. How will you assess the homicidal risk in this patient? What treatment and follow up recommendations will you make in this case? Clinical Assessment  Listen to the patient and develop a therapeutic relationship.  begin the assessment and enquire about her demographics.  Enquire about the issue that she brought up—she will kill her neighbour.  Elaborate on how she thinks her neighbour has ruined her life.  Explore her thoughts a nd whether the patient may have persecutory delusions Assess how much resentment she feels? Follow up with inquiry about her mood, esp. about irritability and depression How she plans to commit the act Has she threatened the person? Whether she has done so in the past If so, ...