RECENT ADVANCES IN DIAGNOSIS AND TREATMENT OF SCHIZOPHRENIA

AND ALZHEIMER/DEMENTIA

1. Introduction

Definition of Neurological disease

Health hazards due to neurological disease

2. Schizophrenia as neurological disorder

Definition of schizophrenia

Cause of schizophrenia

Diagnosis of schizophrenia

Biochemical & molecular analysis of schizophrenia

Treatment of schizophrenia

Limitation of treatment & future prospects for treatment of schizophrenia

3. Alzheimer as neurological disorder

Definition of Alzheimer disease (AD)

Cause of Alzheimer disease

Diagnosis of Alzheimer disease

Biochemical & molecular analysis of Alzheimer disease

Treatment of Alzheimer disease

Limitation in treatment & future prospect of treatment of Alzheimer disease

CONTENTS

1. What are neurological diseases? 1-4

2. Health hazards due to neurological disease 5-6

3. Schizophrenia or neurological disease 7-8

4. Definitions 7-8

5. Cause of schizophrenia 7-8

6. Diagnosis and treatments 9-10

7. Alzheimer Disease 11

8. Neurological Disorder 11-12

9. Diagnosis 13-16

10. Biochemical and molecular analysis of Alzheimer Disease 17-18

11. Treatment 18

12. Cause by enzymes 19-21

13. ICC 22

14. Parapsychology 23

What are Neurological Disorders?

The study of biology with nervous system is called neurology (the average weight of brain is

about 1400g in men and 1250g in women)

The study of disease of nervous system is called neurological disorder.

There are two categories of neurological disorder

Neurological disorder

↓

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↓ ↓

Neurosis Psychosis

Neurosis:

A Mental and emotional disorder that affect any part of the personality is a compound by less

destroys

Mental and emotional disorder that affects only part of the personality

Neurosis is a referred to disorder of sense and motion caused by general affecting of the nervous

system.

There are different types of neurosis:

1. Obbesive compulsive disorder

2. Impulse disorder

3. Anxiety

4. Hysteria

5. Phobias

PHYCHOSIS:

Psychosis refers to an abnormal condition of mind and its generic by psychiatric.

A loss of contact with reality (ICD- 290-299)

1. Schizophrenia

2. Personality

3. Bipolar

4. Post traumatic

5. Dissociative disorder

HEALTH HAZARDS DUE TO NEUROLOGICAL DISEASE:

Numerous brain disorders have importance in public health not only because of their frequency

but also related to their personal social and economical burden. The best knowledge of their

distribution and population under risk would favor the development of preventive and

therapeutic programs as well as needing of service including human resources equipment and

drugs.

The studies about cerebral disorder are predominantly based on patient of specific hospital in or

out patients’ wards specialized centers mainly university hospital. Recording this selection bias

the satisfies and / or more server disorder because of the lack of ample health care coverage and

no responsibility of centralized charts or records in defined areas. Another problem is the

definition of the population under risk.

What are neurological diseases?

The study of the nervous system and the structural and functional change occurring in them the

disease are divided into:

1. Congenital defects in development those in which degeneration reveals itself only after a

period of time.

2. Those in which distractive influence act upon a brain that was initially normal. The potter

was mainly vascular inflammatory toxic traumatic mechanical or a neoplastic.

TREATMENT:

NSAID opiods, gabapentin anticonvulsents and topical agents have all brain used with

variable success. Acupuncture is not effective human nerve growth factor (NGF) which

stimulated regeneration of damaged nerve fibers is being studied esp. to minimize the

neuropathy that antiretroviral drug cause pathological condition of the nervous system

that assend from the lower part of the body to the upper part.

SCHIZOPHRENIA:

A thought disorder affecting about 0.4-1.2% of the population marked by delusions hallucination

and disorganized speech and behavior (the positive symptoms) and by flat social withdraw and

absence of validation ( the negative symptoms) schizophrenia involve dysfunction in one or

more area such as interpersonal rotation work or education and self care associated feature

include appropriate affect, anhedonia , dysphoric mood abnormal psychomotor activity cognitive

dysfunction confusion took of insight and depersonalization. Abnormal neurological finding may

show a broad range of dysfunction including slow reaction time. Poor co-ordination

abnormalities in eye tracking and impaired sensory getting. Some individual drink excessive

amount of water and develop abnormalities in urine specific gravity and electrolyte balance

because none of its clinical features are diagnostic.

Schizophrenia remains a diagnosis of exclusion. It is important to include psychosis with known

organic cause such as temporal lobe epilepsy metabolic disturbance toxic substances or psycho

active drugs. The onset of schizophrenia typically occurs between the late teens and the mid 30s

onset prior to adolescent is rare gender differences suggest that women are more likely to have

later onset more prominent mood symptoms and a better prognosis hospital based studies show a

higher rate of schizophrenia in men where as community based studies suggest an equal sex

ratio.

ETIOLOGY:

The Cause of Schizophrenia is unknown

TREATMENT:

Medication used to control schizophrenia include antipsychotic drugs that act on dopamine

receptors in the brain such as chlorpromazine, flaphenazine, haloperidol and resperidone each of

these may be associated with significant side effects as a result drug treatment with any of them

requires careful monitoring supportive psychotherapy or cognitive behavioral therapy may be

helpful for the patient or family.

Generally in clinical practice only one therapeutic modality is used however it is believed that

since the disease is brought about by multiple information’s within a various such system a

multifaceted therapeutic.

The study is proposed to show how important is the magnitude of these disorder in different

regions as well as necessity of the researchers in the biological or epidemiological fields also it is

proposed to show how important is the magnitude of these disorders in different regions as well

as the necessity of researchers in biological and / or epidemiological fields also it is proposed to

personal minimal subsidies for the formation of health care. In this way it is proposed to show

the relevance of the brain disorder supervision and evolution health care program for these

patients all sources of data with possible and recognizable flaws.

MATERIAL AND METHODS:

The study is based on the data derived from hospital with links with the health care system

based on the SINTASE (Integrative system of statically treatment of strategies series of the

social security) it is based on the following data, coded by the international classification of

disease.

ALZHEIMER’S DISEASE:

Alzheimer Disease is the most common form of dementia of the old and its incidence increase

with age. Alzheimer disease is invidious progression and cause defects in memory cognitive

attention and motivation. Most AD suffers also have symptoms of Parkinson’s disease (PD) and

neurodegenerative of the substantia nigra.

NEUROPATHY OF ALZHIEMER DISEASE:

Patient with Alzhiemer disease have massive shrinkage of cortex and sub cortical structure two

characteristics lession are found particularly in the neocortex hippocampus and amygdala

neurotic plaques are extracellular deposits of β-amyloids peptide surrounded by degenerating

neuritis and glial cells activated by inflammatory process. Alzheimer disease in brain regions not

implicated in the disease and in the brain of normal old people. Neurofibrallery tangles are

cytoplasmic bundles of paired helical filaments (PHFs) made from an abnormal

hyperphosphorelated state of tau a protein normally associated with microtubules. The density of

tangles correlates with the severty of dementia death of glutamergic cells in the cortex and loss

of several transmitter system that protect to the cortex dominate the pathology.

FAMILIAL ALZHIEMER DISEASE:

Rare familial Alzheimer’s disease is infected to mutation in four genes and much idiopathic AD

might be accounted for by polymorphism of an apolipoprotein gene mutation of the gene for

amyloid precursor gene protein (located on chromosomes 21) which gene rise BA are linked to

early code for persimilins have mutation linked to early onset AD, and tau gene mutation are

seen in dementia with Parkinson disease. There are three common allele of apolipoprotien

(A.P.E) one of which polymorphism of the APOE gene could account for up to 90% of

idiopathic AD.

DIAGNOSIS:

The term denoting the disease or syndrome a person has or is belived to have the diagnosis form

the basis of patient care.

Antenatal diagnosis: parental diagnosis

CYTOLOGICAL DIAGNOSIS: identification of disease based on cells and tissues present in

body.

DIFFERENTIAL DIAGNOSIS: identification of a disease by comparison of illness

DUAL DIAGNOSIS: the presence of mental illness in a patient with a history of concurrent

substance abuse.

RADIOGRAPHIC DIAGNOSIS: identification of an illness by enterperation of radiographic

finding.

IN NEURAL AND MENTAL ILLNESS USE

1) Computerized tomography scanning

2) PET: position emission tomography used but it is most costly.

3) MRI: magnetic resonance imaging

4) SPECT: single protein emission computerized tomography used and it is advanced

technique

5) EEG: electron encephalography used to absent of ray in your brain

RELAXATION TECHNIQUE: technique developed by Jacobson is the most commonly used

PHARMACOLOGICAL AGENTS: psychoactive drugs to reduce anxiety and depression help

to relieve headache analgesic are also used.

Yoga therapy is also used to reduce headache, depression, psychosis, neurosis, mental illness etc.

The steps of Yoga Therapy:

1. Krias or cleaning process

2. Asnas or postural pattern

3. Pranayams or breathing exercise

Approach is definitely more effective than a therapy against one causative factor. Various modes

of treatment tried in tension type headache include.

1) HYPNOTOIC SUGGESTION TECHNIQUE:

To induce relaxation and to overcome deeply buried unconscious Conflict.

2) BIOFEEDBACK TECHNIQUE:

Using electroencephalography (EEG) for general relaxation as well as relaxation of

specific muscle groups under tension

3) PSYCHOTHERAPEUTIC TECHNIQUE:

To make the Patient aware of pattern of maladjustment which are initiating the headache.

MOLECULAR AND BIOCHEMICAL MARKER:

Two pathways cleave amyloid precursor protein (APP). One of which lead to the

formation of BA is a normal secretary product found in human cerebrospinal fluid (CSF).

APP is over expressed in down syndromes and following brain isochemia and head injury

BA aggregates and is deposit to plaques where it is toxic leading to formation of

neurofibralliary tangles mutation of the APP gene in the production of BA and its

deposition in plaques presenilin mutation may not by altering the regulation of the APP

cleavage pathway

TAU AND ALZHIMEIR DISEASE:

Tau is protein needed for the assembly of microtubules Mutation of the tau gene are

linked to dementia in which neurofibrillary tangles are found extensively in the frontal

and temporal cortex but in which there are few plaques. Tau protein may disrupt

microtubules formation and increase aggregation of tau info PHFs. although tau in PHFs

is hyperphosphorelated that is not the result of mutation and the consequence of this

abnormal phosphorelation is unclear.

PHARMACOLOGICAL INTERVENTION IN ALZHIEMER DISEASE:

Acetyl cholinesterase (Ach) inhibitors which potentiate the effect of Ach released in the

cortex from cholinergic neurons can produce modust improvement in some patient anti

inflametry drugs can arrest cognitive declines. However, real progress will require novel

strategies for example the discovery of drugs to inhibit the enzyme that process APP.

TAU AND ALZHIEMER DISEASE

Trisomy 21 head injury ischemia mutation in APP and presenillin gene

↓ ↓ ↓ ↓

Over expression of APP

↓

Production of FBA

apoe E4 ← Aggregation of BA

↓

Neuritic plaques

↓ ↓

Trigrinoming complement cascade BA neurotoxicity

↓ ↓

Inflammatory response [Ca2 +]

↓ ↓

Activation of glial cells tau hyper phosphorelation

Disruption to cytoskelton ← mutation

in tau gene

↓

PHFs formation

PHF formation in tangles

↓

Dementia → Death of glutamate

neurons--------------------------------------------------------------------

→ Death of cholinergic neurons ↓

↓

Loss of nigrostationary pathway

↓

Parkinson’s disease

Β- Amyloid

Membrain

Extra cellular leumen of organells

Processing of amyloid precursor protein (APP) the β-amyloid domain of the molecules is

hatched.

SAPP: secrete amyloid precursor protein

INTERNATIONAL CODE FOR DISEASE

ICD- 013 (central nervous system disorder)

ICD-290-319 (mental disorder)

ICD- 950-957 (injury to nerves and spinal cord)

In relation to the utility of this system for epidemiologic purpose the study of

ABRSCO (16) Demonstrate that the data are not expression of the total of the

reality but can favor the inferences for the evolution poverty is the more

concentrated

SINTASE can help to understand the regional inequalities of the health status of

the population.

PARAPSYCHOLOGY

A branch of psychology that deals with alleged instance of extrasensory

perception e.x - telepathy, psychokinesis, clairivyonce and associated

phenomenon.

The phenomenon of brain is called parapsychology.