Background: Schizophrenia is a psychotic illness that, in its active phase, includes delusions, hallucinations, and disruption of thinking, feeling, and many other mental functions, many cases run a chronic course, leaving residual psychiatric symptoms and impaired social functions, many cases run a chronic course, leaving residual psychiatric symptoms and impaired social functioning, in respect of relationships, study, and work.

The schizophrenic disorder are characterized in general by fundamental and characteristic distortion of thinking perception and affect that are inappropriate or blunted, clear consciousness and intellectual capacity are usually maintained although cognitive deficit many evolve in the course of time.

The world health organization (WHO) international classification of diseases (10th edition, ICD-10) describes schizophrenia as a severe psychotic illness is not attributable to organic brain disease, is not attributable to alcohol or drug-related intoxication, dependence or withdrawal, and is present prior to any symptoms suggestive of diagnosable mania or depression the disorder occurs with regular frequency nearly everywhere in the world with a lifetime prevalence of 1%, occurs in all culture with similar rates between males and females beginning mainly in younger age (16-25 years). The disorder affects about 21 million people worldwide.

Schizophrenia has a very long history, tracing back to the old testament (BC) where King Nebuchadnezzar was “driven from man and did eat grass like oxen his body wet with the dew of heaven till his hair grow like eagles” also back in 1400 BC “gluttonous filthy walks naked has lost his mind and moves about in uneasy manner . Since the various scientist have tried to describe the disease and by middle of 19th century European psychiatrist began describing about the disease as of unknown causes typically affecting young and often progress to chronic deterioration.

The disorders course with early onset, chronicity, disability and this contributes to its high burden in the community especially in developing countries and is characterized by many psychopathologies but most important include thought echo, thought insertion/withdraw, thought broadcasting delusions, hallucinations.

The course of the illness is further characterized by a high percentage of suicides and attempted suicides, decline in cognitive functions and frequent relapses. The results of numerous studies indicate that early treatment with antipsychotics leads to better long-term outcomes compared with control groups.

Schizophrenia is quite a disease with a high morbidity in developing countries, Muhimbili national hospital department of psychiatry, admits about 150 patients with different psychiatric disorders per month: 15 (10%) of these are readmissions due to replace in schizophrenia. A part from patients attending the clinic for follow up, approximately 15 patients with specific psychiatric problems are attended per day within the department.

Being a chronic disease schizophrenic patient are prone to replaces, according to data obtained in 2014 approximately 10% of people with schizophrenia are re-admitted due to replace at Muhimbili national hospital (MNH) psychiatric department each month.

Despite the presence of criteria allowing reliable diagnostic identification, schizophrenia remains a broad clinical syndrome with variable pattern of course, variable phenotypic expression and thus makes it poorly understood. The disorder also has complex etiology involving genetic contribution with environmental factors. Factors like childhood trauma, obstetric complications during birth, malformations in neural tube development have been associated with the onset of schizophrenic symptoms, the symptoms are also linked to certain neurotransmitter functioning like dopamine glutamate, serotonin in which increase in these neurotransmitter have been attributed to symptoms, also some drugs like levodopa cocaine amphetamines Khat, cathinone, methcathinone apomorphine phencyclidine bromocriptin.

Objectives of the study.
Broad objectives: To learn on the clinical diagnosis and management of schizophrenia.

Specific objectives:
To learn how to make a diagnosis of schizophrenia by the use of DSM IV-TR.
To learn and practice on short term and long term management of schizophrenia.
To learn and practice follow up to patient with schizophrenia.
To learn how to prevent and manage relapses.
To learn and practice management of side effects to the medications prescribed.

Descriptive of the study area: Bugando medical centre is a consultant referral teaching hospital for the lake and western zone of Tanzania. It is thus a referral centre for secondary and tertiary care for 7 region namely Mwanza, Kagera, Simiyu, Geita, Shinyanga, Mara, and Kigoma. The hospital serves a catchment population of more than 13 million people.

The hospital contain departments, one of them is the psychiatric department which provides inpatient and outpatient management for various psychiatric disorders whereby there are roughly about 50 beds at the inpatient unit and we have days for outpatient visit each week.

Activities participated: Over the entire period of my elective attachment I was involved in different activities and sessions run by the department. I was successful in attending major ward rounds in respective days whereby the cases of this particular study were identified, and I was involved in taking their details, learn their presentations, closely observe how they are managed and followed up in the ward and after discharge.

I was also able to learn other psychiatric conditions, how they present, assessment, diagnosis, management and follow up. I also learned and understood how to carry out some simple routine procedures in psychiatric ward like in administration of medicine of patients given that patients in psychiatry setting may be less compliant to needles and cannulation, also learning techniques on to safety handle violent patients, so as to prevent injury to the patient himself, other patient and hospital staff, also to prevent destruction of properties.

I was also able to attend psychiatric outpatient clinic on respective days of the week where I was able to learn the follow up care provided to patients after being discharged, I appreciated the importance of continuous cancelling to ensure that they keep taking the medications appropriately to avoid relapse.

I was also able to attend weekly sessions of occupational therapy where I learnt how to assist patient who seem to be having anhedonia to participate in therapy and its importance in fastening their recovery.

Over a period of 1 month, total of 39 patient were admitted, 28 being new admission and 11 being transmission among these patients admitted 12 were found to have the diagnosis of interest (schizophrenia) 5 females and 7 males, there were also other patients admitted previously before commencement of the study.