Given the complexity of the disorders of schizophrenia, for optimal therapeutic results, physicians should consider some phases of the disorder symptoms of schizophrenia, namely prodromal phase, the active phase and the residual phase. The end result is a schizophrenic could reach back into operation in the field of employment, social and family.

Skizofrenla
Schizophrenia is a clinical syndrome with a variety of psychopathology, usually severe, prolonged and marked by the deviations of the thoughts, perceptions and emotions

Epidemioiogi
The prevalence of schizophrenia in the United States informed of various ranks from 1 to 1.5 percent, with incidence rate of 1 per 10,000 people per year. Gender prevalence of schizophrenia is the same, the difference in the onset and course of disease. The onset of men aged 15 to 25 years while women 25-35 years of age. The prognosis is worse in men than in women.
Some studies found that 80% of all schizophrenic patients suffer from physical illnesses and 50% of them undiagnosed. Suicide is a common cause of death among people with schizophrenia, 50% of schizophrenics had attempted suicide 1 time in his life and 10% managed to do it. Risk factors for suicide is the presence of depressive symptoms, age and high premorbid level of functioning.

Schizophrenia with comorbid alcohol abuse quinine about 30% to 50% 15% 25% Kanabis Sampalan and cocaine 5% -10%. Most research linking this as an indicator of poor prognosis due to reduced effectiveness of substance abuse and treatment adherence. It is usually found in people with schizophrenia are nicotine addiction, for example 3 times the general population (75% -90% vs 25% -30%). Patients with schizophrenia who smoke need higher doses of anti-psychotics because smoking increases the rate of drug metabolism but also reduce parkinsonism. Some reports say that schizophrenia is more common in people who are not married, but research can not prove that marriage protects against schizophrenia.

Etiology
Diathesis-stress model according to this theory of schizophrenia arising from psychosocial and environmental factors. This model holds that a person who has vulnerabilities (diatheses) when subjected to stressors are more prone to schizophrenia.

Biological factors
Complications at birth
Baby boy who suffered complications at birth tend to develop schizophrenia, perinatal hypoxia increases the susceptibility to schizophrenia.

Infection
Anatomical changes in the central nervous system, viral infections have been reported in people with schizophrenia. Studies suggest that exposure to viral infection in the second trimester of pregnancy will increase a person becomes schizophrenic.

Dopamine hypothesis
Dopamine is a neurotransmitter the first to contribute to the symptoms of schizophrenia. Almost all typical antipsychotic drugs or antipikal isolate dopamine D2 receptors, with blockage of signal transmission in the dopaminergic system of psychotic symptoms diredakan.1 ° On the basis of these observations suggest that the symptoms of schizophrenia, the symptoms are caused by overactivity ‘7 system dopaminergik.5

Serotonin Hypothesis
Gaddum, show Wooley in 1954, and observing the effects of lysergic acid diethylamide (LSD) is a substance that is mixed agonist / antagonist of 5-HT receptors. Obviously zatini cause severe psychotic state in normal man. Possible role of serotonin in schizophrenia re-surface, because penetitian atypical antipsychotic clozapine, which proved to have affinity for serotonin 5-HT than ~ D2.57 reseptordopamin

Brain Structure
Brain regions that receive much attention is the limbic system and basal ganglia. Pendent brain in schizophrenia be a little different from normal people, teilihat ventricle dilated, reducing the gray mass and an increase in some areas and decreased metabolic activity. Pemenksaaninikroskopis and brain tissue found little change in distnbusi brain cells that arise in the prenatal period by not getting the glial cells, usually occurs in brain trauma after lahir.81 °

Genetics
Scientists have long known that schizophrenia is derived, 1% of the general population, but 10% of people who have a first degree relationship as parents, older men and women with schizophrenia. People who have ties with two of those degrees uncles, aunts, grandparents and cousins say that more often than the general population. Identical twins from 40% to 65% as likely to suffer from schizophrenia, while dizygotic twins 12%. Child and both parents tend to schizophrenia 40%, single parents 12%.

Clinic
The progression of the disease of schizophrenia can be divided into 3 phases prodromal phase, ie the active phase and the residual phase. In the prodromal phase symptoms are nonspecific symptoms that could ever by week, month, or more than one year before the onset of psychosis becomes clear. Symptoms include Hendaye job function, social function, the function of the use of leisure time and self-care functions. Change this change will alter and make people anxious family and friends, going to say “this person does not like the old”. The prodromal phase, the longer the worse the prognosis. In the active phase of positive symptoms / psychosis are evident in the catatonic behavior, incoherence, suspicion, hallucinations accompanied by affective disorders. Almost all individuals from consideration in this phase, if symptoms are not treated for these symptoms may disappear spontaneously some time experiencing exacerbations or persists. The active phase will be followed by the residual phase in which symptoms similar to symptoms, but symptoms of the prodromal phase of positive / psychotic been reduced. Besides the symptoms of the symptoms that occur in three previous phases, pendente schizophrenia also experience a disruption of cognitive disorders speak spontaneously, such events, surveillance and executive (attention, concentration, social relationships)

Diagnosis:
Diagnostic guidelines PPDGJ-lll
There must be at least one of the following symptoms are very obvious (and usually two or more symptoms when the symptoms of the symptoms were less severe or less obvious):
- “Echo thoughts” = thoughts are repeated or echoed in his head (not hard) and the content of the tests of the mind, although the contents of the same, but the quality is different, or
- “The thought insertion or removal” = foreign content and foreign capital inflow in the mind (insertion) or the contents of his mind was carried out by something outside himself (withdrawal), and
- “Dissemination of Thought” content = pikiranya out for others or the public to know;
- “Delusion of control” = suspect he is controlled by some force from outside, or
- “Delusional passivitiy” = suspect him impotent and resigned to an external power, (about “his” = clearly refers kepergerakan body / limbs or thoughts, actions or special sensory);
= – “Delusional perceptions” sensory experience that is not normal, that is very typical of him, bersifatmistik bias or miracle;
Auditory hallucinations:
hallucinatory voices continually commented on the behavior of patients or
discuss each pasein patients (among many voices speaking), or
other types of hallucinatory voices coming and a body part.
Of course, the other suspects were established, which according to local cultures is considered unnatural and impossible, for example, beliefs about a particular religion or politics, or power and ability beyond normal humans (for example, able to control the weather, or communicate with aliens and other worlds)
Or at least two of the following symptoms should always be clear:
hallucinations that persist and the five senses, anything, when accompanied either by the assumption that the floating medium or form without clear affective content, or accompanied by excessive ideas (most of the ideas of value) in an agreement or if it happened every day for weeks, weeks or months continuously;
interrupted the flow of thoughts (break) or that have attachments (interpolation), that inconsistency berkibat or irrelevant speech, or neologisms;
catatonic behavior, such as noise excited state (nervousness), certain body positions (posture), or waxy flexibility, negativism, mutism, and stupor;
symptoms of “negative” as apathetic, barely spoke, and blunted emotional response or wrong, often resulting in withdrawal from social interaction and reduce social performance, but it should be clear that all this was caused by depression neuroleptika depression or medication;
The existence of specific symptoms mentioned above, has lasted over a period of one month or more (not applicable to every phase nonpsikotik (prodromal)
There must be a change in a consistent and significant in the overall quality (overall quality) and some aspects of personal behavior (personal conduct), manifest as loss of interest, life without meaning, does the attitude nothing very soluble (absorbed attitude ), and social isolation.
Forecast
Although complete remission or recovery in schizophrenia, most people have symptoms rest with varying severity. Overall, 25% of people complete recovery, 40% experienced a relapse and 35% experienced deterioration. So far there has been no method that can predict who will be healed not, but there are several factors that can influence such as age, a clear trigger, acute onset, a social history / pramorbid good work, symptoms of depression, marriage, history of mood disorders in the family, good support system and positive symptoms provide a good prognosis, while the young start, no trigger, the onset is unclear, the social history of the poor, is autistic, not married / widower, widow, a family history of schizophrenia, support systems for the poor, negative symptoms, history of prenatal trauma, not the 3-years remission, relapse, and history will often aggressive a poor prognosis.

Therapy / Tatalaksana
I. Psikofarmaka
Selection of drugs Basically, all anti-psychotic drugs have a primary effect (clinical effects) is equal to the equivalent dose, the large differences in side effects (side effects: sedation, autonomic, extrapyramidal). Consider the choice of antipsychotics dominant psychotic symptoms and side effects of medications. Replacement set to an equivalent dose. If certain antipsychotic medications do not provide a clinical response at doses that were optimal after an appropriate period of time can be replaced with other antipsychotic drugs (and should not the same group), the equivalent dose. If history of previous antipsychotic drugs have proved effective and well tolerated side effects, can be reelected to use now. If antipsychotic drugs most prominent negative symptoms than positive symptoms are atypical of the options on the contrary, when the most prominent positive symptoms, negative symptoms are the typical choice. Similarly patients with extrapyramidal side effects of our choice is the kind of atypical. Antipsychotic drugs circulating in the market can be grouped into two parts, namely, the first generation antipsychotics (APG I) and second generation antipsychotics (APG II). APG worked with D2 receptor blockade in mesolimbik, mesokortikal, and tuberoinfundibular nigostriatal so quickly to reduce positive symptoms, but side effects can long use include: extrapyramidal disorder, tardive dyskinesia, increased prolactin levels causing sexual dysfunction and weight gain and exacerbate negative symptoms and cognitive problems. I also APG anticholinergic effects like dry mouth blurred vision gangguaniniksi, defecation, and hypotension. APG can be divided into a high potential when using doses less than or equal to 10 mg of them is trifluoperazine, fluphenazine, haloperidol and pimozide. These medications are used to overcome the syndrome of psychosis with predominant symptoms of apathy, withdrawal, hipoaktif, suspicion, and hallucinations. Low-power, if the dose is 50 mg which is thiondazine chlorpromazine and used in patients with predominant symptoms of restless noisy, hyperactive and have trouble sleeping. APG II is often referred to as serotonin-dopamine antagonists (SDA) or atypical antipsychotics. Working through the interaction of serotonin and dopamine in the four lanes of dopamine in the brain that cause side effects and very effective low extrapyramidal overcome negative symptoms. The drugs are available for this group are clozapine, olanzapine, quetiapine and rispendon.

Dosage
In the administration should consider:
The appearance of the primary effects (clinical effects): 2-4ininggu
The side effects (side effects): 2-6 hours
Half life: 12-24 hours (giving 1-2 x / h)
Morning and afternoon dose may be different (a little early, a great night) not to interfere with the quality of life of patients.
Long acting antipsychotic drugs: fluphenazine decanoate 25 mg / cc deans or haloperidol 50 mg / cc, MI for 2-4ininggu. Useful for patients who do not / sulitininum drugs, and for maintenance therapy.

Face / Old Home grant recommended starting dose according to dose increase every 2-3 hours to achieve an effective dose (syndrome of psychosis disappeared), assessed each 2ininggu when participation increases until the optimal dose and 8 — 12ininggu maintained. (stabilization). The heritability of each 2ininggu (maintenance dose) and maintained 6 months to 2 years (interspersed 1-2/hari/minggu drug holiday) after tapering (2-dose 4ininggu derivatives) and then stops.
For patients with psychotic syndromes multiepisode attacks, maintenance therapy for at least 5 years (this can reduce the degree of recurrence of 2.5 to 5 times). In general, antipsychotic drugs should be continued for 3 months to 1 year after all symptoms disappeared completely psychotic. On completion of the symptoms can appear suddenly rebound cholinergic stomach upset, nausea, vomiting, diarrhea, dizziness and tremors. This situation can be overcome by giving agents such as sulfa anticholmnergic atropine injection of 0.25 mg IM, tablet trhexyphenidyl 3×2 mg / day.

II. Psychosocial Therapy
There are several methods that can be performed:
Individual psychotherapy
Supportive therapy
Social skills training
Occupational therapy
Cognitive and behavioral therapy (CBT)
Group Psychotherapy
Family Psychotherapy
Case Management
Assertive Community Treatment (ACT)
Other psychotic disorder
Disturbance scenario
Diagnostic Guidelines
The suspicion of suspicion is the only clinical feature or the most prominent symptom. The suspicion of suspicion (whether single or as a system of hypotheses) and must have at least 3 months duration and must be only staff (staff) and not the local culture

Depressive symptoms or a depressive episode that “any rule” may occur in intermittent, with the proviso that such a supposition, suspicion was established at the time that there is no affective disorder.

There must be evidence of the existence of brain disease

There should be auditonk hallucinations, and sometimes there are only temporary

He had no history of symptoms of schizophrenia (assumption of control, broadcasting thoughts, affects penumpulan, etc)

Acute and interference while Psikotlk
Diagnostic Guidelines
Using the sequence reflecting a diagnosis of an order of priority given to the main features of this disorder selected. This ranking is used:

An acute onset (within days or fewer symptoms 2ininggu term = psychotic symptoms obvious and annoying at least some aspects of daily life and work, not including periods of prodromal symptoms is often unclear) as a defining characteristic of whole group;

The existence of a distinctive syndrome (a “polymorphic” = diverse and changing rapidly, or “schizophrenia-like” = skizofrnik typical symptoms);

The existence of acute stress-related (not always available)

If you do not know how long the interruption

There were no changes in this group who meet the criteria for manic or depressive episode, although changes in symptoms of emotional and affective symptoms may be prominent and specific time

There is no organic cause, as kapitis trauma, delirium or dementia. Intoxication is not a result of using alcohol or drugs.

Disturbance Skizoafektif
Diagnostic Guidelines:
Skizoafektif disorder diagnosis is made only if gejal characteristic symptoms of schizophrenia and affective disorders are pending at the same time (simultaneously) or within a few days, one after another, in an episode of the same disease, and when, as a result of this episode does not meet kritena disease schizophrenia and manic or depressive episode

Can not be used for patients who show symptoms of schizophrenia and affective disorder, but in different episodes of the disease

If a schizophrenic patient showed depressive symptoms after experiencing a psychotic episode, a diagnosis coded F20.4 (post-schizophrenic depression). Some patients may experience recurrent episodes of manic and depressive skizoafektif type or a mixture of both. Another patient had an episode or two skizoafektif wedged between manic or depressive episode.

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