The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative

symptoms, and cognitive symptoms.

Positive symptoms

Positive symptoms are psychotic behaviors not seen in healthy people. People with positive
symptoms often "lose touch" with reality. These symptoms can come and go. Sometimes they
are severe and at other times hardly noticeable, depending on whether the individual is receiving
treatment. They include the following:

Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear,
smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many
people with the disorder hear voices. The voices may talk to the person about his or her behavior,
order the person to do things, or warn the person of danger. Sometimes the voices talk to each
other. People with schizophrenia may hear voices for a long time before family and friends
notice the problem.

Other types of hallucinations include seeing people or objects that are not there, smelling odors
that no one else detects, and feeling things like invisible fingers touching their bodies when no
one is near.

Delusions are false beliefs that are not part of the person's culture and do not change. The person
believes delusions even after other people prove that the beliefs are not true or logical. People
with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can
control their behavior with magnetic waves. They may also believe that people on television are
directing special messages to them, or that radio stations are broadcasting their thoughts aloud to
others. Sometimes they believe they are someone else, such as a famous historical figure. They
may have paranoid delusions and believe that others are trying to harm them, such as by
cheating, harassing, poisoning, spying on, or plotting against them or the people they care about.
These beliefs are called "delusions of persecution."

Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder
is called "disorganized thinking." This is when a person has trouble organizing his or her
thoughts or connecting them logically. They may talk in a garbled way that is hard to understand.
Another form is called "thought blocking." This is when a person stops speaking abruptly in the
middle of a thought. When asked why he or she stopped talking, the person may say that it felt as
if the thought had been taken out of his or her head. Finally, a person with a thought disorder
might make up meaningless words, or "neologisms."

Movement disorders may appear as agitated body movements. A person with a movement
disorder may repeat certain motions over and over. In the other extreme, a person may become
catatonic. Catatonia is a state in which a person does not move and does not respond to others.
Catatonia is rare today, but it was more common when treatment for schizophrenia was not
available.2
"Voices" are the most common type of hallucination in schizophrenia.

Negative symptoms

Negative symptoms are associated with disruptions to normal emotions and behaviors. These
symptoms are harder to recognize as part of the disorder and can be mistaken for depression or
other conditions. These symptoms include the following:

 "Flat affect" (a person's face does not move or he or she talks in a dull or monotonous
voice)
 Lack of pleasure in everyday life
 Lack of ability to begin and sustain planned activities
 Speaking little, even when forced to interact.

People with negative symptoms need help with everyday tasks. They often neglect basic personal
hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are
symptoms caused by the schizophrenia.

Cognitive symptoms

Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to
recognize as part of the disorder. Often, they are detected only when other tests are performed.
Cognitive symptoms include the following:

 Poor "executive functioning" (the ability to understand information and use it to make
decisions)
 Trouble focusing or paying attention
 Problems with "working memory" (the ability to use information immediately after
learning it).

Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause
great emotional distress.

The pathophysiology of schizophrenia has long remained a mystery and still today, even with
various hypotheses, remains somewhat uncertain: there are too many variants; not enough
consistency in findings; and, despite research, a lack of documented proof.

The most well-known and respected hypothesis with regards to the pathophysiology of
schizophrenia began in the 1990s and consisted primarily of the notion there is a problem with
the dopamine levels in the brain of schizophrenics.
Dopamine is both a hormone and a neurotransmitter, which means that it activates five different
receptors in the brain, aptly named D1, D2, D3, D4, and D5. That said, it may not be the only
neurotransmitter involved in the pathophysiology of schizophrenia. Glutamate and Serotonin
have also been implicated. .
Contributing to this hypothesis is the fact that drugs administered to aid dopaminergic activity
bring on schizophrenic characteristics such as psychosis, in a patient, whereas drugs
administered to block them help reduce, or eliminate symptoms of schizophrenia altogether.

Additional studies affecting the pathophysiology of schizophrenia include suggestions that

maternal factors such as infection, malnutrician, location of birth, season of birth, and delivery,
may play a significant part in the formation and subsequent appearance of schizophrenia. Studies
have shown that the worldwide rate of births affected with schizophrenia is up to 8% higher
when occurring in spring or winter, though no explanation for this can be offered.

Another aspect of the pathophysiology of schizophrenia that has been explored in relative detail
is that of genetics, and their relation to the likelihood of immediate relatives being born with the
disease. Shockingly, it has been found that 10% of all immediate family members of an infected
person will be struck down with the disease. This is specifically in relation to parents, siblings,
and children. With regards to twins or other multiple births, the chances they will share the
disease is 50%. Genetic reports suggest that it is the X chromosome which determines whether or
not a person is infected with schizophrenia, specifically, chromosomes 1, 3, 5, and 11, however
further studies are needed in order to prove this theory.

Though there are many theories and hypotheses regarding the pathophysiology of schizophrenia,
there is, unfortunately, still no cure for the disease. The best a sufferer can hope for nowadays is
to benefit from available medication which keeps the disease under control or in remission for
the duration of time for which it is taken
Schizophrenia, also sometimes called split personality disorder, is a chronic, severe, debilitating
mental illness that affects about 1% of the population, corresponding to more than 2 million
people in the United States alone. Other statistics about schizophrenia include that it affects men
about one and a half times more commonly than women. It is one of the psychotic mental
disorders and is characterized by symptoms of thought, behavior, and social problems. The
thought problems associated with schizophrenia are described as psychosis, in that the person's
thinking is completely out of touch with reality at times. For example, the sufferer may hear
voices or see people that are in no way present or feel like bugs are crawling on their skin when
there are none. The individual with this disorder may also have disorganized speech,
disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased
behaviors or feelings, as well as delusions, which are ideas about themselves or others that have
no basis in reality (for example, experience the paranoia of thinking others are plotting against
them when they are not).

What are the different types of schizophrenia?

There are five types of schizophrenia, each based on the kind of symptoms the person has at the
time of assessment:

 Paranoid schizophrenia: The individual is preoccupied with one or more delusions or

many auditory hallucinations but does not have symptoms of disorganized schizophrenia.

 Disorganized schizophrenia: Prominent symptoms are disorganized speech and behavior,

as well as flat or inappropriate affect. The person does not have enough symptoms to be
characterized as catatonic schizophrenic.

 Catatonic schizophrenia: The person with this type of schizophrenia primarily has at least
two of the following symptoms: difficulty moving, resistance to moving, excessive
movement, abnormal movements, and/or repeating what others say or do.

 Undifferentiated schizophrenia: This is characterized by episodes of two or more of the

following symptoms: delusions, hallucinations, disorganized speech or behavior,
catatonic behavior or negative symptoms, but the individual does not qualify for a
diagnosis of paranoid, disorganized, or catatonic type of schizophrenia.

 Residual schizophrenia: While the full-blown characteristic positive symptoms of

schizophrenia (those that involve an excess of normal behavior, such as delusions,
paranoia, or heightened sensitivity) are absent, the sufferer has less severe forms of the
 disorder or has only negative symptoms (symptoms characterized by a decrease in
function, such as withdrawal, disinterest, and not speaking)

Symptoms of schizophrenia include the following:

Positive, more overtly psychotic symptoms

 Beliefs that have no basis in reality (delusions)

 Hearing, seeing, feeling, smelling, or tasting things that have no basis in reality
(hallucinations)

 Disorganized speech

 Disorganized behaviors

 Catatonic behaviors

Negative, potentially less overtly psychotic symptoms

 Inhibition of facial expressions

 Lack of speech

 Lack of motivation

How is schizophrenia diagnosed?

As is true with virtually any mental-health diagnosis, there is no one test that definitively
indicates that someone has schizophrenia. Therefore, health-care practitioners diagnose this
disorder by gathering comprehensive medical, family, and mental-health information. Patients
tend to benefit when the professional takes into account their client's entire life and background.
This includes but is not limited to the person's gender, sexual orientation, cultural, religious and
ethnic background, and socioeconomic status. The practitioner will also either perform a physical
examination or request that the individual's primary-care doctor perform one. The medical
examination will usually include lab tests to evaluate the person's general health and to explore
whether or not the individual has a medical condition that might produce psychological
symptoms.

In asking questions about mental-health symptoms, mental-health professionals are often

exploring if the individual suffers from hallucinations or delusions, depression and/or manic
symptoms, anxiety, substance abuse, as well as some personality disorders (for example,
schizotypal personality disorder) and developmental disorders (for example, autism spectrum
disorders). Since some of the symptoms of schizophrenia can also occur in other mental
illnesses, the mental-health screening is to determine if the individual suffers from
schizoaffective disorder or other psychotic disorder, bipolar disorder, an anxiety disorder, or a
substance abuse or personality disorder. Any disorder that is associated with bizarre behavior,
mood, or thinking, like borderline personality disorder or another psychotic disorder, as well as
dissociative identity disorder (DID), formally known as multiple personality disorder (MPD)
may be particularly challenging to distinguish from schizophrenia. In order to assess the person's
current emotional state, health-care providers perform a mental-status examination as well.

In addition to providing treatment that is appropriate to the diagnosis, determining the presence
of mental illnesses that may co-occur (be comorbid) with schizophrenia is important in
improving the life of individuals with schizophrenia. For example, people with schizophrenia are
at increased risk of having a depressive or anxiety disorder and of committing suicide.
MENIERE'S DISEASE
Meniere's disease is a disorder of
the inner ear that causes spontaneous
episodes of vertigo — a sensation of a
spinning motion — along with fluctuating
hearing loss, ringing in the ear (tinnitus),
and sometimes a feeling of fullness or
pressure in your ear. In most cases,
Meniere's disease affects only one ear.
People in their 40s and 50s are more likely
than people in other age groups to develop
Meniere's disease, but it can occur in
anyone, even children.
Meniere's disease can cause severe
dizziness, a roaring sound in your ears
called tinnitus, hearing loss that comes and goes and the feeling of ear pressure or
pain. It usually affects just one ear. It is a common cause of hearing loss.
Scientists don't yet know the cause. They think that it has to do with the fluid
levels or the mixing of fluids in the canals of your inner ear. Symptoms occur suddenly
and can happen as often as every day or as seldom as once a year. An attack can be a
combination of severe dizziness or vertigo, tinnitus and hearing loss lasting several
hours.
Although Meniere's disease is considered a chronic condition, there are various
treatment strategies that can help relieve symptoms and minimize the disease's long-
term impact on your life.
The Cause of Meniere’s Disease (Risk Factors)
The cause of Meniere's disease isn't well understood. It appears to be the result
of the abnormal volume or composition of fluid in the inner ear.
The inner ear is a cluster of connected passages and cavities called a labyrinth.
The outside of the inner ear is made of bone (bony labyrinth). Inside is a soft structure
of membrane (membranous labyrinth) that's a slightly smaller, similarly shaped version
of the bony labyrinth. The membranous labyrinth contains a fluid (endolymph) and is
lined with hair-like sensors that respond to movement of the fluid.
In order for all of the sensors in the inner ear to function properly, the fluid needs to
retain a certain volume, pressure and chemical composition. Factors that alter the
properties of inner ear fluid may help cause Meniere's disease. Scientists have
proposed a number of potential causes or triggers, including:
•

Improper fluid drainage, perhaps because of a blockage or anatomic abnormality

•

Abnormal immune response

•

Allergies
•

Viral infection
•

Genetic predisposition
•

Head trauma
Because no single cause has been identified, it's likely that Meniere's disease is caused
by a combination of factors.

PATHOPHYSIOLOGY
Cause and pathogenesis
Some lysenkoism:
1. Disturbance of micro-circulation in cochlear : low-oxygen of membranous labyrinth
,disorder of metabolize ,the increase of osmotic pressure in endolymphatic fluid.
2. Disbalance between creat and absorb of endolymphatic fluid: the increase of calcium
in membranous labyrinth result in function abnormal of secrete cell ,and lead to the
increase of production of endolymphatic fluid or fibrosis of ductus endolymphaticus can
result in the reduce of absorb in endolymphatic fluid .Finally disorder both and leads to
membranous labyrinth hydrocele.
3. Immunoreaction and the abnormality Of immunity itself: The reaction of antigen and
antibody in inner ear can leads to expand of blood vessel and the increase of capability
of go thorough, or composite matter of and antigen antibody deposit in endolymphatic
sac ,and affects absorb. finally result in membranous labyrinth hydrocele.
4. Rupture of membranous labyrinth: Inflammation or trauma can result in membranous
labyrinth hydrocele and can leads to the rupture of membranous labyrinth , allowing the
endolymphatic fluid and perilymph fluid to mix , it will stimulate the sense nerves of the
acoustic and vestibular ,finally appear tinnitus ,deafness ,vertigo and so on.
5. Other lysenkoism : For example psychological factors can act as a trigger mechanism
for an attack, but this is not a primarily responsible for the development of the disease.
Pathophysiology
1. The early stages of membranous labyrinth hydrocele : vestibular membrane will be
pushed to scala vestibuli due to the increase of endolymph pressure.
2. The aggravation of membranous labyrinth hydrocele will make the swell of utricle and
semicircular canal.
3. Some cells in spiral organ will change
4. Endolymphatic sac will undergo fibrosis.
Clinical Manifestations
The primary signs and symptoms of Meniere's disease are:
•

Recurring episodes of vertigo. Vertigo is similar to the sensation you

experience if you spin around quickly several times and suddenly stop. You feel
as if the room is still spinning, and you lose your balance. Episodes of vertigo
occur without warning and usually last 20 minutes to two hours or more, up to 24
hours. Severe vertigo can cause nausea and vomiting.
•

Hearing loss. Hearing loss in Meniere's disease may fluctuate, particularly early
in the course of the disease. Eventually, most people experience some degree of
permanent hearing loss.
•

Tinnitus. Tinnitus is the perception of a ringing, buzzing, roaring, whistling or

hissing sound in your ear. With Meniere's disease, tinnitus is often low-pitched.
•

Aural fullness. Aural fullness is the feeling of fullness or pressure in the ear.
A typical episode might start with a feeling of fullness in your ear, increasing tinnitus
and decreasing hearing followed by severe vertigo, often accompanied by nausea and
vomiting. Such an episode might last two to three hours, after which signs and
symptoms improve. Episodes often occur in clusters, with long periods of mild or no
symptoms (remission) between.
Still, the severity, frequency and duration of each of these sensory perception
problems vary, especially early in the disease. For example, you could have frequent
episodes with severe vertigo and only mild disturbances in other sensations. Or you
may experience mild vertigo and hearing loss infrequently but have frequent tinnitus that
disturbs your sleep.
Medical Management
No cure exists for Meniere's disease, but a number of strategies may help you
manage some symptoms. Research shows that most people with Meniere's disease
respond to treatment, although long-term hearing loss is difficult to prevent.
A . Medications for vertigo
Your doctor may prescribe medications to be taken during an episode of vertigo
to lessen the severity of an attack:
•

Motion sickness medications, such as meclizine (Antivert) or diazepam

(Valium), may reduce the spinning sensation of vertigo and help control nausea
and vomiting.
•

Anti-nausea medications, such as promethazine, may control nausea and

vomiting during an episode of vertigo.
B . Long-term medication use
Your doctor may prescribe a medication to reduce fluid retention (diuretic), such
as the drug combination triamterene and hydrochlorothiazide (Dyazide,
Maxzide). Reducing the amount of fluid your body retains may help regulate the
fluid volume and pressure in your inner ear. For some people a diuretic helps
control the severity and frequency of Meniere's disease symptoms.
Because diuretic medications cause you to urinate more frequently, your system
may become depleted of certain minerals, such as potassium. If you take a diuretic,
supplement your diet each week with three or four extra servings of potassium-rich
foods, such as bananas, cantaloupe, oranges, spinach and sweet potatoes.
C . Noninvasive therapies and procedures
Some people with Meniere's may benefit from other noninvasive therapies and
procedures, such as:
•

Rehabilitation. If you experience problems with your balance between episodes

of vertigo, you may benefit from vestibular rehabilitation therapy. The goal of this
therapy, which may include exercises and activities that you perform during
therapy sessions and at home, is to help your body and brain regain the ability to
process balance information correctly.