Healthcare information by krishna jadhav

Healthcare information by krishna jadhav

Contact information, map and directions, contact form, opening hours, services, ratings, photos, videos and announcements from Healthcare information by krishna jadhav, Medical and health, Aurangabad.

10/10/2022

The theme or rather the slogan for 2022’s celebration of World Mental health Day is “Make mental health & well-being for all a global priority."

10/09/2022

जागतिक आत्महत्या प्रतिबंधक दिन 2022 | World Su***de Prevention Day 2022 | Creating Hope Through Action

जागतिक आत्महत्या प्रतिबंधक दिन 2022 | World Su***de Prevention Day 2022 10/09/2022

जागतिक आत्महत्या प्रतिबंधक दिन 2022 | World Su***de Prevention Day 2022

https://youtu.be/fJQYkxykhnw

जागतिक आत्महत्या प्रतिबंधक दिन 2022 | World Su***de Prevention Day 2022 Thank you for visiting my channel description.Hello, I am Krishna Jadhav, I am working as a Medical Social Worker in NGO it's based in Pune. my work aware t...

05/09/2022

नेहमी हात स्वच्छ धुवा, रोगाला टाळा.

05/09/2022

क्या आपको मधुमेह हैं?.. | आपको आंखे चेक करना जरूरी हैं|

Diabetes | Foods avoid in Diabetes | मधुमेह असणाऱ्या व्यक्तींनी हे पदार्थ टाळावेत | Unhealthy foods 30/08/2022

Diabetes | Foods avoid in Diabetes | मधुमेह असणाऱ्या व्यक्तींनी हे पदार्थ टाळावेत | Unhealthy foods

https://youtu.be/vvNGc2EHD68

Diabetes | Foods avoid in Diabetes | मधुमेह असणाऱ्या व्यक्तींनी हे पदार्थ टाळावेत | Unhealthy foods Thank you for visiting my channel description.Hello, I am Krishna Jadhav, I am working as a Medical Social Worker in NGO it's based in Pune. my work aware t...

How to use a glucometer to check blood sugar | how to use Accu-chek glucometer | ग्लुकोमेटर | LIVE 29/08/2022

How to use a glucometer to check blood sugar | how to use Accu-chek glucometer | ग्लुकोमेटर | LIVE

https://www.youtube.com/watch?v=GfCxP1xkH7A&t=5s

How to use a glucometer to check blood sugar | how to use Accu-chek glucometer | ग्लुकोमेटर | LIVE Thank you for visiting my channel description.Hello, I am Krishna Jadhav, I am working as a Medical Social Worker in NGO it's based in Pune. my work aware t...

Diabetes: How to use an Insulin Pen | इन्सुलिन पेन कसा वापरावा. By Mr. Krishna Jadhav (MSW) 29/08/2022

Diabetes: How to use an Insulin Pen | इन्सुलिन पेन कसा वापरावा. By Mr. Krishna Jadhav (MSW)

How to USe Cartridge Insulin Pen
https://www.youtube.com/watch?v=yH36PBxg984&t=8s

Diabetes: How to use an Insulin Pen | इन्सुलिन पेन कसा वापरावा. By Mr. Krishna Jadhav (MSW) #मधुमेह #इन्सुलिन ...

05/01/2022

'माणसाने माणसाशी मानसासम वागणे' ही लोकप्रिय प्रार्थना आपणास माहीत आहे. तरीही अनेकदा समाजात माणसाकडे मानसासारखं न पाहता समाज त्याला घटस्फोटित, मानसिक रुग्ण, वेडा, मतिमंद,अपंग असे लेबल लावून टाकतो आणि तसेच संबोधतो. असे लेबल लावले गेल्याने व्यक्ती नैराश्यात जाऊ शकते.

तुम्हाला असा कोणता त्रास होत असल्यास नक्की संपर्क साधा.

*मनोबल आत्महत्या प्रतिबंधक हेल्पलाईन - 74120 40300*

मनोबल हेल्पलाईनची ही समुपदेशन सेवा 24*7 मोफत उपलब्ध आहे.

15/11/2021
15/11/2021
15/11/2021
26/09/2021
वाढत्या आत्महत्या रोखायच्या असतील तर...! 10/09/2021

वाढत्या आत्महत्या रोखायच्या असतील तर...!

*
_10 सप्टेंबर : जागतिक आत्महत्या प्रतिबंध दिनानिमित्त डॉ.हमीद दाभोलकर यांच्या विशेष लेख

वाढत्या आत्महत्या रोखायच्या असतील तर...!*
-

भारतात दरवर्षी दोन लाखांपेक्षा अधिक लोक आत्महत्या करतात. त्यांमधील साधारण निम्म्या आत्महत्या या 15 ते 35 वयोगटातील म्हणजे तरुणाईतील असतात. आत्महत्या हा विषय थोडा काळ हळहळणे आणि नंतर विसरून जाणे यापेक्षा खूप गंभीर आहे. युवाल नोवा हरारी हा आजच्या जगाचा एक महत्त्वाचा भाष्यकार असे म्हणतो की, 'आजच्या जगासाठी युद्ध आणि दहशतवाद यांपेक्षा ‘आत्महत्या’ हा अधिक महत्त्वाचा प्रश्न आहे.'

*- डॉ. हमीद दाभोलकर*

*https://kartavyasadhana.in/view-article/if-we-want-to-prevent-su***des-writes-dr-hamid-dabholkar*

वाढत्या आत्महत्या रोखायच्या असतील तर...! आत्महत्या हा अनेक दशके आपल्या समाजात दुर्लक्षिलेला विषय राहिला आहे. सुशांत सिंग राजपूत, जि...

10/09/2021
01/09/2021

कुटुंबातील पहिल्या अपत्यासाठी गरोदर महिला व स्तनदा मातांना प्रधानमंत्री मातृ वंदना योजनेंतर्गत मिळणार आर्थिक सहाय्य

*tJananiViksitDharini

Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

01/09/2021
Krishna Jadhav - YouTube 25/08/2021

Krishna Jadhav - YouTube

https://youtube.com/c/Krishnajadhavpatil

Krishna Jadhav - YouTube This my youtube channel

25/08/2021

एमएसडब्ल्यू (MSW) शिक्षण आणि करिअर



जसे कि आपल्याला माहित आहे,आजचे युग हे शिक्षणाचे युग आहे. आजच्या घडीला उच्च शिक्षण हे खुप महत्वाचे आहे. आजच्या पिढीला पुस्तकी ज्ञानाबरोबरच समाजाशी जोडणाऱ्या शिक्षणाची सुद्धा गरज आहे. अशीच समाजासाठी काम करण्याची आपली इच्छा असेल तर एमएसडब्ल्यू (MSW) कोर्स करून पूर्ण होऊ शकते.

एमएसडब्ल्यू म्हणजेच मास्टर ऑफ सोशल वर्क. ज्यांना खरंच वाटतंय कि,आपण समाजशास्त्रात आपलं नाव कमवावं तर त्यांना हे शिक्षण घेऊन पूर्ण करता येऊ शकते. या कोर्समध्ये समाजातील सर्वसमावेशक घटकांचा अभ्यास समाविष्ट आहे. एमएसडब्ल्यू (MSW) हा दोन वर्षाचा पूर्ण वेळ कोर्स असून यात ४ सेमिस्टर असतात. कोणत्याही शाखेतील पदवीधारक या कोर्स ला प्रवेश घेऊ शकतो. यासाठी प्रत्येक महाविद्यालयाची स्वतंत्र प्रवेश परीक्षा असते. एमएसडब्ल्यू (MSW) पूर्ण झाल्यानंतर विद्यार्थी हे हॉस्पिटल्स, मानसिक आरोग्य केंद्र, समुपदेशन, कंपन्या, महिला व बालकल्याण विभाग, समाजकल्याण, जनसंपर्क, एनजीओ, कम्युनिटी डेव्हलपमेंट, UNESCO, UNICEF, WHO, शिक्षण क्षेत्र, स्पेशल स्कुल, पुनर्वसन केंद्र, तुरुंग, ड्रग्स ऍडिक्शन, रिसर्च अशा क्षेत्रात चांगले काम करु शकतात.

हा कोर्स पूर्ण केल्यानंतर विद्यार्थ्याला खुपमोठ्या संधी उपलब्ध आहे. जसे की, सोशल वर्कर म्हणून आपण चांगले काम करू शकतो, जागतिक दर्जाच्या संस्थेत काम करू शकतो, वैयक्तिक समाधान मिळू शकते, समाजाचा अभ्यास करण्यासाठी. अशा प्रकारे आपण हे शिक्षण घेतल्यानंतर चांगले काम करू शकतो.



कृष्णा बी. जाधव (MSW)

कर्वे इन्स्टिट्यूट ऑफ सोशल सर्व्हिस, पुणे

संपर्क:9860432024

[email protected]

--
Regards,
Mr. Krishna B. Jadhav
Freelance Journalist, Psychiatric social worker
(B.A. Journalism and Mass Communication,
PG Certificate In Counselling Psychology,
MSW - In (Medical & Psychiatric Social Work)

25/08/2021

आपल्या मृत्यूनंतरही आपण एखाद्याला डोळसपणे मदत करू शकतो. त्याची कायम हरवलेली दृष्टी परत मिळवून देऊ शकतो.

राष्ट्रीय नेत्रदान पंधरवडा



Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

आरोग्यनिती 284🥗🧘🏽‍♂️🙂 23/08/2021

आरोग्यनिती 284🥗🧘🏽‍♂️🙂

*थायरॉईड*

*थायरॉईड होण्याची करणे:*
जर आपल्या शरीरात आयोडीनचे प्रमाण कमी झाले किंवा व्हायरल इन्फेक्शनची शक्यता असेल तर आपल्या थायरॉईड ग्रंथीला सूज येऊ शकते. या व्यतिरिक्त कमी थायरॉईड हार्मोन्स देखील कारणीभूत ठरू शकतात.
ताण किंवा ताण
हार्मोन्समधील बदलांमुळे थायरॉईड ग्रंथी देखील कमी होते.

*थायरॉईड विकाराने ग्रस्त असणाऱ्यानी आहारामध्ये*
अधिक तंतुमय पदार्थांचा समावेश करा.
चरबी आणि कर्बोदके खाणे कमी करा.ताजी फळे आणि हिरव्या भाज्या जास्तीत जास्त खा.
आयोडिनयुक्त मीठ, मासे, कवच असलेले मासे, अंडी, दही आणि गाईच्या दुधाचा समावेश करावा. त्यामुळे आयोडिनची योग्य पातळी राखली जाईल. गॉइटरसारखी गंभीर समस्या उद्भवू नये म्हणून ज्यात थायरॉइड ग्रंथींचा आकार वाढतो. त्यामुळे सोयाबीन, सॉय उत्पादनं, ब्रोकोली, कॉलीफ्लॉवर, कोबी, ब्रुसेल्स स्प्राऊट्स, टíनप्स, पीच, शेंगदाणे, मुळा हे गॉइट्रोजेन्स असणारे पदार्थ खाणं टाळावं. हे पदार्थ शिजवल्याने त्यातले घटक निकामी होतात, कारण ते उष्णता संवेदनशील असतात. परंतु हे पदार्थ केव्हा तरी आणि शिजवलेल्या स्थितीत खाणंच योग्य.
नाचणी, बाजरी, दाट हिरव्या रंगाच्या पालेभाज्या सूपच्या आणि रसाच्या स्वरूपात खाव्यात. टोमॅटो, गाजर, आंबे, पपई, अननस, संत्री ही पिवळी-नािरगी फळं खावीत. बदाम, अक्रोडसारखा सुकामेवा, अळशी, तीळासारख्या तेलबिया, दूध आणि दुग्धजन्य पदार्थ जसं लो-फॅट दूध/गाईचं दूध, ताक, दही आदींच्या सेवनाने आपण निरोगी राहतो.

*हायपरथायरॉईड साठी योगासने आणि प्राणायाम:-*
सेतूबंधासन,मार्जरासान,शिशु
आसन,शवासन,मंदगतीने केलेले सूर्य नमस्कार ,उज्जयी, भ्रमरी (भ्रमराप्रमाणे श्वसन), नाडी शोधन आणि शीतली आणि शीतकारी

*हायपोथायरॉईड साठी योगासने:-*
सर्वांगासन,अधोमुखासन,विपरीतकरणी,जानू शीर्षासन,मत्स्यासन,हलासन, मार्जरासान
वेगाने सूर्य नमस्कार

परंतु प्रत्येकाची प्रकृती, दिनचर्या व राहणीमान वेगळे असते त्यामुळे आहार तज्ञांचा सल्याने आहारात बदल करावे…

*Nutritionist & Dietitian*
*Naturopathist*
*Amit Bhorkar*

आरोग्यनिती 284🥗🧘🏽‍♂️🙂 WhatsApp Group Invite

21/08/2021

*कोरोना प्रतिबंधात्मक लसीकरण मोहिमेत आरोग्य विभागाची अतुलनीय कामगिरी*

*दिवसभरात सुमारे अकरा लाख नागरिकांचे लसीकरण*

मुंबई, दि.२१: कोरोना प्रतिबंधात्मक लसीकरण मोहिमेमध्ये महाराष्ट्राने आज पुन्हा एकदा दमदार कामगिरी करीत दिवसभरात १० लाख ९६ हजार नागरिकांना लस देण्याचा विक्रम आपल्या नावावर नोंदविला आहे. एकाच दिवशी सुमारे अकरा लाखाच्या आसपास नागरिकांना लसीकरण करून आरोग्य विभागाने केलेल्या अतुलनीय कामाची दखल मुख्यमंत्री उद्धव ठाकरे आणि आरोग्यमंत्री राजेश टोपे यांनी घेतली असून याबद्दल आरोग्य यंत्रणेनेचे कौतुक करीत अभिनंदन केले आहे.

दिवसाला १० लाखापेक्षा अधिक लसीकरण केले जाऊ शकते हे आज आरोग्य विभागाच्या अधिकारी आणि कर्मचाऱ्यांनी सिद्ध केले असून याहीपेक्षा अधिक लसीकरणाची क्षमता राज्याची असल्याचे आरोग्यमंत्री श्री. टोपे यांनी सांगितले. विभागाच्यावतीने त्यासाठी अधिक प्रयत्न करण्यात येतील असेही त्यांनी सांगितले.

कोरोना प्रतिबंधात्मक लसीकरण मोहिमेत आज सायंकाळी सातपर्यंत ५२०० लसीकरण केंद्रांच्या माध्यमातून १० लाख ९६ हजार ४९३ नागरिकांना लस देण्यात आली. रात्री उशिरापर्यंत आकडेवारीत वाढ होण्याची शक्यता, आरोग्य विभागाचे अपर मुख्य सचिव डॉ. प्रदीप व्यास यांनी वर्तविली आहे.

काही दिवसांपूर्वी राज्यातील आतापर्यत दिलेल्या डोसेसची संख्या ५ कोटींवर गेली असून देशभऱात उत्तरप्रदेश पाठोपाठ महाराष्ट्राने ही विक्रमी कामगिरी केली आहे.

आज सायंकाळी सात वाजेपर्यंत दिवसभरात १० लाख ९६ हजार ४९३ नागरिकांचे लसीकरण झाले. यापूर्वी ३ जुलै रोजी ८ लाख ११ हजार नागरिकांना लस देऊन राज्याने विक्रमी कामगिरी नोंदविली होती त्यानंतर स्वातंत्र्यादिनाच्या पूर्वसंध्येला ९ लाख ६४ हजार ४६० नागरिकांना लस देऊन राज्याने आधीचा विक्रम मोडला. आजच्या सर्वोच्च संख्येने झालेल्या लसीकरणानंतर एक नवा विक्रम महाराष्ट्राच्या नावावर नोंदविल्याचे डॉ. व्यास यांनी सांगितले.

21/08/2021

जिथे घराभोवती पाणी साचते तिथे हमखास डासांची फावते आपल्या अवतीभवती परिसर स्वच्छ ठेऊन डासांची उत्पत्ती होणार नाही याची काळजी घेऊया!

#जागतिकडासदिन

Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

21/08/2021

महाआरोग्य संवाद ..आरोग्य शिक्षण साहित्य

Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

21/08/2021

This is the month, remembered to create awareness about a rare , progressive , muscles wasting disorder called muscular Dystrophy .
In this condition , the sufferer become so pathetic ,at times that they are bound to be crippled and bed ridden and even their respiratory system also give up!
But our Organization Indian Association of Muscular Dystrophy is dedicated since 1992 , working tirelessly to give relief to such warriors. It need support from all quarters . For details please visit our site .and any queries , contact number is as under:
9218088880 . 🙏🏻

Photos from Healthcare information by krishna jadhav's post 20/08/2021

Launch of 'Fit Maharashtra'-an innovative intersectoral collaboration between Department of Public Health and Department of Education and Sports, Government of Maharashtra at Arogya Bhavan, Mumbai on 18/08/2021

Dr. Sadhana Tayade (Director Health Services, Maharashtra), the chief guest for the program, encouraged both the departments to work towards a common goal of increasing physical activity and ensuring a good health status. Dr. Padmaja Jogewar (Joint Director-NCD) in her address spoke on the burden of NCDs and the need to be physically active for effective prevention from NCDs, followed by a speech from TSO-Mr Abhay Chavhan, who shared his real-life experiences of being physically active and staying healthy. Dr. Duryodhan Chavan (ADHS Headquarters) appreciated this intersectoral partnership and expressed hope of its success. Technical support unit (NCD) by Piramal Swasthya will add technical backing to this partnership.

To make the program practice-oriented, yoga teachers were invited to teach basic yoga exercises and meditation that help in reducing weight and can be practiced while sitting on a chair.

There was also an anti-spitting oath taken during this program, so as to raise awareness around the bad effects of to***co.



Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

20/08/2021

डेंग्यू, चिकनगुनियाचा डास दिवसा चावतो. त्यामुळे आपले घर व कामाच्या ठिकाणी डास वाढणार नाहीत याची काळजी घ्या!

#जागतिकडासदिन

Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

20/08/2021

आज 20 ऑगस्ट 2021. 8 वर्षांपुर्वी परिवर्तन आणि अंधश्रद्धा निर्मूलन समितीचे संस्थापक डॉ.नरेंद्र दाभोलकर यांचा 20 ऑगस्ट 2013 रोजी पुण्यात खून झाला.
अंधश्रद्धा आणि मानसिक आरोग्य यांचा जवळचा संबंध आहे, आणि मानसिक आरोग्य आणि व्यसनमुक्ती हे स्वतंत्र पणे काम करायचे विषय आहे हे लक्षात आल्याने अंधश्रद्धा निर्मूलन समिती च्या सोबतीने त्यांनी आणि शैलाताई दाभोलकर यांनी परिवर्तन ची सुरवात एक छोटे केंद्र सुरू करून साताऱ्यात केली. आज परिवर्तन चे काम महाराष्ट्र सहित आसाम आणि अरुणाचल प्रदेशातील अतिदुर्गम भागापर्यंत जाऊन पोहचले आहे. मनोबल आत्महत्या प्रतिबंधक हेल्पलाईन, मनोबल डे केअर सेंटर, मानसरंग, माईंड कॅफे, किमया केंद्र , सातारा ,पुणे आणि आसाम येथे व्यसनमुक्ती आणि समुपदेशन केंद्र , महाराष्ट्र भर आणि देशभर होणारे मानसिक आरोग्य जनजागृती कार्यक्रम, अनेक तज्ज्ञ समुपदेशक आणि डॉक्टर्स - या सगळ्या माध्यमातून डॉक्टरांनी लावलेले हे विवेकाचे रोपटे मोठे होत आहे. कोविड काळात आणि नंतर ही
महाराष्ट्रसोबत आज पंजाब, हरियाणा, दिल्ली आणि राजस्थान मध्येही परिवर्तन ने प्रशिक्षित केलेले शेकडो मानसमित्र आणि मैत्रिणी लोकांना भावनिक प्रथमोपचार देण्याचं आणि लोकांच्या मानसिक आरोग्य विषयक गैरसमज दूर करण्याचं काम करत आहेत.
परिवर्तनची मानसमैत्रीण मनस्विनी हिने काढलेले
डॉक्टरांनी उभे केलेल्या कामाचं अतिशय समर्पक आणि अर्थपूर्ण चित्र या पोस्ट सोबत शेअर करत आहे.

*'तुम्ही लावलेलं हे विवेकाचं रोपटं मोठं होतंय डॉक्टर'.*

काम करत राहूया. हे रोपटे हिरवेगार ठेवूया.

19/08/2021

मी जबाबदार

Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

17/08/2021

मी जबाबदार



Rajesh Tope Rajendra Patil-Yadravkar CMOMaharashtra Ministry of Health and Family Welfare, Government of India

Rich or poor, young or old. TB can happen to anyone. 17/08/2021

Rich or poor, young or old. TB can happen to anyone.

https://youtu.be/cxcYoGld5b4

Rich or poor, young or old. TB can happen to anyone. Rich or poor, young or old. TB can happen to anyone. Our best chance to is to fight it together and achieve by 2025....

17/08/2021

‘Make mental health counselling accessible’
Tuesday, 17 August 2021 | Dr Neerja Aggarwal
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Dr Neerja Aggarwal, a rehabilitation and adolescent psychologist, talks about how parents can help adolescent deal with this sensitive period of their life

How has the pandemic affected the mental health of adolescents?

Adolescence is a sensitive period of life, it is an age of transition when the body and brain go through critical development stages. This process lasts till they are in their 20s. In this phase our socio-emotional brain matures earlier than our rational brain. So, during the adolescence period, a child is emotionally vulnerable. During these times adolescents can be more aggressive, more anxious, more enthusiastic and more euphoric.

COVID-19 has added to their anxieties, which cannot find an outlet because of the restrictions and confinement it has imposed. They are uncertain about their education and career. It can increase their anxieties, they can experience signs of OCD, depression, eating disorders and self-harm.

How can we minimise this impact? What do you think can be done at the family, community, and Government levels?

This is the age when one should be actively involved in various activities — academic, games and extracurricular. We need to channelise their energy into constructive work. At home, parents or caregivers can help them in structuring their routine, involving them in family activities and discussions.

If we can make them aware and involve them in mental health counselling, it will help them understand various issues related to the pandemic, finances and mental health better. Besides, we need to make mental health counselling accessible to adolescents through various online mediums so that they can share their issues and seek help as and when required.

It is also important to create awareness about the National Mental Health Programme that was launched in 2014 so that people affected by mental illness and their families can get benefits of the programme that ensures socio-economic inclusion of persons affected by mental illness by providing accessible, affordable and quality health and social care.

The pandemic has increased the technology usage, which was of concern before COVID-19 too. What is your advice to parents and caregivers?

Yes, it is true that during the pandemic, technology is the only medium for their education, entertainment, and social interaction. So, we cannot control and block technological usage completely. We can help them in structuring their routine, making room for other activities, such as playing board games with the family.

To limit the use, parents can set some rules. But then parents, too, should adhere to the rules.

At this age, there is a delay in the release of the circadian hormone melatonin which delays their sleep. Exposure to screen at bedtime can further affect their sleep pattern. So, parents need to communicate it to them in a subtle way.

Parenting an adolescent has become even more challenging during the pandemic. How should parents keep calm?

Patience is the key. So parents need to practise everything they are going to preach to their adolescents themselves. While dealing with an adolescent or young adult, you should be friendly, include them in decisions so that they feel involved. Convey your point to them in a non-confrontational manner without comparing them with anyone or criticising them or their friends.

17/08/2021

कुछ दुर्लभ मामलों में बच्चों में मल्टी सिस्टम इन्फलेमेटरी सिंड्रोम देखा जा रहा है, जानें क्या हैं इसके लक्षण।

17/08/2021

महामारी में बच्चों के मानसिक देखभाल की ओर ध्यान की अधिक आवश्यकता है, उनके साथ अधिक से अधिक समय बिताएं और इन बातों का ध्यान रखें।

15/08/2021

Let's make our country free from Mental health Stigma....

Photos from Healthcare information by krishna jadhav's post 12/08/2021

Shri Mansukh Mandaviya launches Awareness Campaign for , , and .

https://pib.gov.in/PressReleseDetail.aspx?PRID=1745157

10/08/2021

Schizhophrenia

Author: Frances R Frankenburg, MD; Chief Editor: Glen L Xiong, MD more...
SECTIONS
Practice Essentials
Schizophrenia is a brain disorder that affects how people think, feel, and perceive. The hallmark symptom of schizophrenia is psychosis, such as experiencing auditory hallucinations (voices) and delusions (fixed false beliefs).

Signs and symptoms
The symptoms of schizophrenia may be divided into the following 4 domains:

Positive symptoms - Psychotic symptoms, such as hallucinations, which are usually auditory; delusions; and disorganized speech and behavior

Negative symptoms - Decrease in emotional range, poverty of speech, and loss of interests and drive; the person with schizophrenia has tremendous inertia

Cognitive symptoms - Neurocognitive deficits (eg, deficits in working memory and attention and in executive functions, such as the ability to organize and abstract); patients also find it difficult to understand nuances and subtleties of interpersonal cues and relationships

Mood symptoms - Patients often seem cheerful or sad in a way that is difficult to understand; they often are depressed

See Clinical Presentation for more detail.

Diagnosis
Schizophrenia is not associated with any characteristic laboratory results.

Diagnostic criteria

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), to meet the criteria for diagnosis of schizophrenia, the patient must have experienced at least 2 of the following symptoms [1] :

Delusions

Hallucinations

Disorganized speech

Disorganized or catatonic behavior

Negative symptoms

At least 1 of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.

Continuous signs of the disturbance must persist for at least 6 months, during which the patient must experience at least 1 month of active symptoms (or less if successfully treated), with social or occupational deterioration problems occurring over a significant amount of time. These problems must not be attributable to another condition.

The American Psychiatric Association (APA) removed schizophrenia subtypes from the DSM-5 because they did not appear to be helpful for providing better-targeted treatment or predicting treatment response.

See Workup for more detail.

Management
Antipsychotic medications diminish the positive symptoms of schizophrenia and prevent relapses.

There is no clear antipsychotic drug of choice for schizophrenia. Clozapine is the most effective medication but is not recommended as first-line therapy.

Psychosocial treatment is essential. The best-studied psychosocial treatments are social skills training, cognitive-behavioral therapy, cognitive remediation, and social cognition training.

Psychosocial treatments are currently oriented according to the recovery model. According to this model, the goals of treatment for a person with schizophrenia are as follows:

To have few or stable symptoms

Not to be hospitalized

To manage his or her own funds and medications

To be either working or in school at least half-time

See Treatment and Medication for more detail.

Background
Schizophrenia is a brain disorder that probably comprises multiple etiologies. The hallmark symptom of schizophrenia is psychosis, such as experiencing auditory hallucinations (voices) and delusions (fixed false beliefs). Impaired cognition or a disturbance in information processing is an underappreciated symptom that interferes with day-to-day life. People with schizophrenia have lower rates of employment, marriage, and independent living compared with other people.

Schizophrenia is a clinical diagnosis. It must be differentiated from other psychiatric and medical illnesses, as well as from disorders such as heavy metal toxicity, adverse effects of drugs, and vitamin deficiencies. (See DDx and Workup.)

Treatment of schizophrenia requires an integration of medical, psychological, and psychosocial inputs. The bulk of care occurs in an outpatient setting and is best carried out by a multidisciplinary team. Psychosocial rehabilitation is an essential part of treatment.

Antipsychotic medications, also known as neuroleptic medications or major tranquilizers, diminish the positive symptoms of schizophrenia and prevent relapses. Unfortunately, they are also associated with a number of adverse effects. (See Treatment and Medication.)

Diagnostic criteria (DSM-5)
The specific DSM-5 criteria for schizophrenia are as follows [1] :

The presence of 2 (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated), with at least 1 of them being (1), (2), or (3): (1) delusions, (2) hallucinations, (3) disorganized speech, (4) grossly disorganized or catatonic behavior, and (5) negative symptoms

For a significant portion of the time since the onset of the disturbance, level of functioning in 1 or more major areas (eg, work, interpersonal relations, or self-care) is markedly below the level achieved before onset; when the onset is in childhood or adolescence, the expected level of interpersonal, academic or occupational functioning is not achieved

Continuous signs of the disturbance persist for a period of at least 6 months, which must include at least 1 month of symptoms (or less if successfully treated); prodromal symptoms often precede the active phase, and residual symptoms may follow it, characterized by mild or subthreshold forms of hallucinations or delusions

Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms or (2) any mood episodes that have occurred during active-phase symptoms have been present for a minority of the total duration of the active and residual periods of the illness

The disturbance is not attributable to the physiologic effects of a substance (eg, a drug of abuse or a medication) or another medical condition

If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms or schizophrenia are also present for at least 1 month (or less if successfully treated)

In addition to the 5 symptom domain areas identified in the first diagnostic criterion, assessment of cognition, depression, and mania symptom domains is vital for distinguishing between schizophrenia and other psychotic disorders.

Various course specifiers are used, though only if the disorder has been present for at least 1 year and if they do not contradict diagnostic course criteria. These specifiers include the following [1] :

First episode, currently in acute episode

First episode, currently in partial remission

First episode, currently in full remission

Multiple episodes, currently in acute episode

Multiple episodes, currently in partial remission

Multiple episodes, currently in full remission

Continuous

Unspecified

The presence or absence of catatonia is specified. Individuals meeting the criteria for catatonia receive an additional diagnosis of catatonia associated with schizophrenia to indicate the presence of the comorbidity.

Finally, the current severity of the disorder is specified by evaluating the primary symptoms of psychosis and rating their severity on a 5-point scale ranging from 0 (not present) to 4 (present and severe).

Schizophrenia subtypes were removed from DSM-5 because they did not appear to help with providing better-targeted treatment or predicting treatment response.

Pathophysiology
Anatomic, neurotransmitter, and immune system abnormalities have been implicated in the pathophysiology of schizophrenia.

Anatomic abnormalities
Neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. For example, the ventricles are somewhat larger, there is decreased brain volume in medial temporal areas, and changes are seen in the hippocampus. [2, 3, 4]

Interest has also focused on the various connections within the brain rather than on localization in a single part of the brain. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. [5] A meta-analysis of studies using diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white-matter tracts are reduced in schizophrenia. [6]

In the Edinburgh High-Risk Study, brain imaging showed reductions in whole-brain volume and in left and right prefrontal and temporal lobe volumes in 17 of 146 people who were at high genetic risk for schizophrenia. The changes in prefrontal lobes were associated with increasing severity of psychotic symptoms. [7]

In a meta-analysis of 27 longitudinal MRI studies comparing schizophrenic patients with control subjects, schizophrenia was associated with structural brain abnormalities that progressed over time. The abnormalities identified included loss of whole-brain volume in both gray and white matter and increases in lateral ventricular volume. [8]

These findings are of interest more for research purposes than for clinical application.

Neurotransmitter system abnormalities
Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first clearly effective antipsychotic drugs, chlorpromazine and reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms.

Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. (Negative and positive symptoms are defined elsewhere; see Presentation.) Moreover, the newer antipsychotic drugs block both dopamine D2 and serotonin (5-hydroxytryptamine [5-HT]) receptors.

Clozapine, perhaps the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.

Much research focuses on the N -methyl-D-aspartate (NMDA) subclass of glutamate receptors because NMDA antagonists, such as phencyclidine and ketamine, can lead to psychotic symptoms in healthy subjects. [9, 10] Some researchers consider schizophrenia, in large part, a hypoglutamatergic disorder.

Inflammation and immune function
Immune function is disturbed in schizophrenia. [11] Overactivation of the immune system (eg, from prenatal infection or postnatal stress) may result in overexpression of inflammatory cytokines and subsequent alteration of brain structure and function. For example, schizophrenic patients have elevated levels of proinflammatory cytokines that activate the kynurenine pathway, by which tryptophan is metabolized into kynurenic and quinolinic acids; these acids regulate NMDA receptor activity and may also be involved in dopamine regulation.

Insulin resistance and metabolic disturbances, which are common in the schizophrenic population, have also been linked to inflammation. Thus, inflammation might be related both to the psychopathology of schizophrenia and to metabolic disturbances seen in patients with schizophrenia. [12]

Etiology
The causes of schizophrenia are not known. Most likely, there are at least 2 sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. [13, 14, 15] Increased paternal age is associated with a greater risk of schizophrenia.

Genetic factors
The risk of schizophrenia is elevated in biologic relatives of persons with schizophrenia but not in adopted relatives. [16] The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins.

Genome-wide association studies have identified many candidate genes, but the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.

In 2021, Cheng et al investigated the extent of shared genetic architecture between schizophrenia and brain cortical surface area (SA) and thickness (TH) to identify shared genomic loci. Based on GWAS data from 139,053 participants, the researchers found that most genetic variants associated with cortical SA and TH are also linked to the risk of developing schizophrenia. Results were obtained using MiXeR, a statistical tool that quantifies polygenic overlap irrespective of genetic correlation. MiXeR estimated schizophrenia to be more polygenic than total SA and average TH (9,703 single-nucleotide variants, or SNVs, vs. 2101 and 1,363, respectively). Most of the SNVs associated with total SA (93.6%) may be associated with the development of schizophrenia, according to the study. [17]

In a 2014 study, researchers identified new genetic loci not previously known to be associated with schizophrenia. Of the 108 genetic loci linked to schizophrenia that were identified in the study, 83 had not previously been found. The investigators also determined that among 128 independent associations related to the 108 loci, enriched associations existed not only among genes expressed in the brain, but also among those expressed in tissues related to immunity, giving support to the theory linking the immune system to schizophrenia. [18, 19]

Some loci of particular interest include the following:

Catechol-O-methyltransferase (COMT) gene

RELN gene

Nitric oxide synthase 1 adaptor protein (NOS1AP) gene

Metabotropic glutamate receptor 3 (GRM3) gene

The COMT gene codes for the postsynaptic intracellular enzyme COMT, which is involved in the methylation and degradation of the catecholamine neurotransmitters dopamine, epinephrine, and norepinephrine. The several allelic variants of COMT affect its activity. The valine-valine variant degrades dopamine faster than the valine-methionine variant does; subjects with 2 copies of the methionine allele were less likely to develop psychotic symptoms with cannabis use than were other cannabis-using subjects without that variant. [20]

The RELN gene codes for the protein reelin, which plays a role in brain development and GABAergic activity. In an international study, a common variant in this gene increased the risk of schizophrenia, but only in women. [21]

The NOS1AP gene codes for the enzyme nitric oxide synthase, which is found in high concentration in inhibitory neurons in the brain. Nitric oxide acts as an intracellular messenger. Using a newly developed statistical technique, the posterior probability of linkage disequilibrium, researchers have identified a single-nucleotide polymorphism associated with higher levels of expression of this gene in postmortem brain samples from individuals with schizophrenia. [22]

The GRM3 gene is a protein-coding gene associated with bipolar affective disorder. In a 2014 study, researchers found a variant in the GRM3 gene that was associated with a two- to three-fold increase in the risk of developing schizophrenia or alcohol dependence and an approximately three-fold greater risk of developing bipolar disorder. In the study, researchers performed a genetic analysis of 4971 patients with schizophrenia, bipolar disorder, or alcoholism and of 1309 healthy controls. The GRM3 variant associated with schizophrenia, alcohol dependence, and bipolar disorder in the study, which is seen in about 1 of every 200 people, may be a nonspecific risk factor for mental disorders and a potential treatment target. [18, 23]

Other genetic changes involve the structure of the gene. For example, copy number variants are deletions and duplications of segments of DNA; they can involve genes or regulatory regions. These variants are usually inherited, but can arise spontaneously. Copy number variants such as the deletions found at 1q21.1, 15q13.3, and 22q11.2 increase the risk of developing schizophrenia. [24, 25] At most, however, these findings probably account for only a small part of the heritability of schizophrenia.

In addition, the effects of some of these copy number variants are not restricted to schizophrenia. Other copy number variant disorders include autism, intellectual disability, attention-deficit hyperactivity disorder, and epilepsy. [26]

In a study of 39,000 people referred to a diagnostic laboratory, about 1000 had a copy number variant at 1 of the following loci: 1q21.1, 15q11.2, 15q13.3, 16p11.2, 16p13.11, and 22q11.2. Clinically, these people had various neurologic or psychiatric disorders, including developmental delay, intellectual disability, and autism-related disorders. Subjects also had congenital anomalies. [27]

Many studies have also looked for abnormalities in neurodevelopmental genes. Disruptions in the DISC1, NRG1, DTNBP1, KCNH2, AKT1, and RGS4 genes have been associated with schizophrenia, albeit with significant variability between studies. [28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40] These findings also lend support to the hypothesis that schizophrenia is a disease in which multiple rare genetic variants lead to a common clinical outcome.

Some people with schizophrenia have no family history of the disorder. These cases may be the result of new mutations. De novo mutations in the exome (the part of the chromosome that codes for proteins) seem to be more common in patients with schizophrenia than would otherwise be expected. [41, 42] In a pair of exome sequencing studies, researchers identified de novo genetic mutations in patients with schizophrenia that cluster in specific proteins involved in brain function and overlap with mutations that have been identified in patients with autism, mental retardation and intellectual disability. [43, 44]

A genome-wide association study beginning with a Swedish sample of 5,000 cases and 6,000 controls compared the results with a previous genome-wide association study and findings of single-nucleotide polymorphisms (SNP) in independent examples. It found a clustering at 22 loci, 14 of which were new. Most of the SNPs were common and, collectively, could account for perhaps as much as one third of the variance in liability for schizophrenia. In other words, common genetic variation may be involved in schizophrenia. This is somewhat similar to the understanding of other complex trait diseases such as coronary artery disease. [45]

Schizophrenia and bipolar disorder are likely to have a large overlap in genetic risk factors, but only a small portion of this genetic risk has been identified. [46]

As can be seen, working out the details of these genetic factors is difficult. Interactions with the rest of the genome and with the environment will doubtless prove to be important. Nonetheless, a meta-analysis of twin studies estimated that genetic factors account for about four fifths of liability to schizophrenia. [47]

Perinatal factors
Women who are malnourished or who have certain viral illnesses during their pregnancy may be at greater risk of giving birth to children who later develop schizophrenia. [48] For example, children born to Dutch mothers who were malnourished during World War II have a high rate of schizophrenia.

After the 1957 influenza A2 epidemics in Japan, England, and Scandinavia, rates of schizophrenia were higher among offspring of women who contracted influenza during their second trimester. Women in California who were pregnant between 1959 and 1966 were more likely to have a child who developed schizophrenia if they had influenza in the first trimester of their pregnancy. [49]

Obstetric complications may be associated with a higher incidence of schizophrenia. Children born in the winter months may be at greater risk for developing schizophrenia. [50]

A study of Finnish women supported an interaction between genetic and environmental influences on causation of schizophrenia. [51] In this study, a review of 9596 women in Helsinki who received hospital treatment during pregnancy for an upper urinary tract infection between 1947 and 1990 found no overall significant increase in the risk of schizophrenia among their offspring but a 5-fold higher risk among the offspring of women who also had a family history of psychosis. The authors estimated that among offspring of women with both prenatal pyelonephritis and a positive family history of psychotic disorders, 38-46% of schizophrenia cases resulted from the synergistic action of the 2 risk factors. [51]

Drug use
A new study suggests that heavy ma*****na use in teenagers aged 15–17 years may hasten the onset of psychosis in those at high risk for developing a psychotic disorder. In an analysis of 247 hospitalized patients who had experienced first-episode psychosis, the Allied Cohort on the Early course of Schizophrenia (ACES) II project found that the onset of psychosis in those who used cannabis from age 15 to 17 years occurred at a mean age of 21.07 years, compared with a mean age of 23.86 years in patients who did not use cannabis during those same teenage years. However, the researchers could not say whether ma*****na use may actually cause psychosis to develop early or whether people who have a predilection for earlier onset of psychosis also may be more likely, owing to various factors, to use ma*****na. [52]

Epidemiology
United States and international statistics
The lifetime prevalence of schizophrenia has generally been estimated to be approximately 1% worldwide. [53] However, a systematic review by Saha et al of 188 studies drawn from 46 countries found a lifetime risk of 4.0 per 1000 population; prevalence estimates from countries considered least developed were significantly lower than those from countries classed as emerging or developed. [54] Immigrants to developed countries show increased rates of schizophrenia, with the risk extending to the second generation. [13, 14, 15]

Age-, race-, and sex-related demographics
The onset of schizophrenia usually occurs between the late teens and the mid-30s. [1] For males, the peak age of onset for the first psychotic episode is in the early to middle 20s; for females, it is in the late 20s. The first 5–10 years of the illness can be stormy, but this initial period is usually followed by decades of relative stability (though a return to baseline is unusual). Positive symptoms are more likely to remit than are cognitive and negative symptoms (see Presentation).

Although some variation by race or ethnicity has been reported, no racial differences in the prevalence of schizophrenia have been positively identified. Some research indicates that schizophrenia is diagnosed more frequently in black people than in white people; this finding has been attributed to cultural bias of practitioners.

The prevalence of schizophrenia is about the same in men and women. The onset of schizophrenia is later in women than in men, and the clinical manifestations are less severe. This may be because of the antidopaminergic influence of estrogen.

Prognosis
The prognosis is guarded. Full recovery is unusual. Early onset of illness, family history of schizophrenia, structural brain abnormalities, and prominent cognitive symptoms are associated with a poor prognosis. The prognosis is better for people living in low-income and middle-income countries. [55]

Symptoms usually follow a waxing-and-waning course and their nature may change over time. Positive symptoms respond fairly well to antipsychotic medication, but the other symptoms are quite persistent.

Because of vocational difficulties, many patients with schizophrenia also have to cope with the burdens of poverty. These include limited access to medical care, which may lead to poor control of the disease; homelessness; and incarceration, typically for minor offenses.

People with schizophrenia have a 5% lifetime risk of su***de. [56] Other factors that contribute to increased mortality include lifestyle issues such as cigarette smoking, poor nutrition, and lack of exercise, and perhaps poorer medical care and complications of medications. A study from Britain shows that this “mortality gap” is increasing. [57]

Women with schizophrenia may have higher rates of breast cancer than women in the general population. In a meta-analysis of more than 125,000 women, this increased risk was significant in studies in which breast cancer occurred before the diagnosis of schizophrenia was excluded. However, the association between schizophrenia and breast cancer incidence was not significant in studies that did not specify the exclusion of breast cancer cases that occurred prior to the diagnosis of schizophrenia. Researchers suggest factors such as obesity, nulliparity, and potentially even increased prolactin levels may raise the risk for breast cancer. It is important to note that significant heterogeneity exists among the included studies, and it is possible that a future study will show a decreased breast cancer risk in women with schizophrenia compared with the general population. [58]

Patient Education
The nature of schizophrenia makes it a potentially difficult illness for patients to understand. Nevertheless, teaching the patient to understand the importance of medication compliance and of abstinence from alcohol and other drugs of abuse is important.

It is helpful to work with the patient so that both patient and family can learn to recognize early signs of a decompensation (eg, insomnia or increased irritability). A review of 44 studies showed that education of patients about the nature of their illness and treatment, when added to standard care, led to reductions in rehospitalization and symptoms. [59] Education may improve adherence to medication and may help the patient cope with the illness better in other ways.

Family members can be referred to the National Alliance on Mental Illness (NAMI) (or another appropriate support group, if one is available). These groups can provide education and support.

People with schizophrenia have also championed self-help recovery-based approaches to care, with an emphasis on developing the personal strengths and resilience needed to combat this illness.

Much psychosocial treatment that is discussed below has an educational component.

Because other illnesses are common in schizophrenia, education about the importance of a healthy lifestyle and regular health care is helpful. Counseling with respect to sexuality, pregnancy, and sexually transmitted diseases is important for these patients.

The following resources may also be helpful:

Mayo Clinic -Schizophrenia

National Institute of Mental Health -Schizophrenia

Medline Plus -Schizophrenia

For patient education resources, see the Schizophrenia Health Center, as well as Schizophrenia.

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