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1. Many people recover from schizophrenia
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Cochrane Database Syst Rev. Cases involving children as young as five years have been reported, but these are rare. In men, the symptoms tend to present between 18 and 25 years of age. In women, the onset of symptoms has two peaks, the first between 25 years of age and the mids, and the second after 40 years of age.
Clinical Practice Guidelines for Management of Schizophrenia
Patients may have symptoms during a prodromal phase before they become psychotic. These symptoms include social withdrawal, loss of interest in work or school, deterioration of hygiene, angry outbursts, and behavior that is out of character. The patient will eventually exhibit active-phase symptoms of the disorder.
Criteria for schizophrenia include signs and symptoms of at least six months' duration, including at least one month of active-phase positive and negative symptoms Table 1. Negative symptoms include a decrease in the range and intensity of expressed emotions i. Two or more of the following, each present for a significant portion of time during a 1-month period or less if successfully treated.
[Full text] Nonadherence with antipsychotic medication in schizophrenia: challenge | PROM
At least one of these must be 1 , 2 , or 3 :. Disorganized speech e. Grossly disorganized or catatonic behavior. Negative symptoms i. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning.
Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms or less if successfully treated that meet Criterion A i.
During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form e. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either: 1 no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2 if mood episodes have occurred during active-phase symptoms, they 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 physiological effects of a substance e. 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 of schizophrenia, are also present for at least 1 month or less if successfully treated.
Reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Other organic and psychiatric diagnoses can present with symptoms of psychosis Table 2. Ideally, patients should be observed in a controlled setting for an extended time.
go to link This allows for differentiation between psychiatric disorders; however, this is not always feasible. In most situations, physicians must rely on a history provided by family members. Brief psychotic disorder. Delusions, hallucinations, and disorganized speech or behavior lasting for at least one day but less than one month. Prominent obsessions, compulsions, and preoccupations with appearance or body odor, hoarding, or body-focused repetitive behaviors.
Deficits in social interaction with repetitive and restricted behaviors and other cognitive and communication deficits. Mood episode concurrent with active-phase symptoms; mood symptoms present for a substantial portion of the disturbance; delusions present for two weeks without prominent mood symptoms. Nonbizarre delusions, absence of hallucinations, disorganized speech or behavior, negative symptoms.
Substance abuse. Abnormal leukocyte count, positive results on human immunodeficiency virus or rapid plasma reagin test. Elevated iron and indirect bilirubin levels, low vitamin B 12 levels, macrocytic anemia. Anemia, elevated antinuclear antibody titers, pleural effusion detected on chest radiography, proteinuria. Lesions detected on computed tomography or magnetic resonance imaging of the brain. Ataxia, dysarthria, hepatomegaly, hyperreflexia, jaundice, Kayser-Fleischer rings in the cornea. Basal ganglia lesions detected on magnetic resonance imaging, Coombs-negative hemolytic anemia, elevated liver enzyme levels.
Information from reference 1. Patients diagnosed with psychosis, schizophrenia, or both should be urgently referred for psychiatric evaluation. Antipsychotic agents are the first-line treatment for patients with schizophrenia. There are two general types of antipsychotic drugs: first-generation typical and second-generation atypical agents.
Table 3 lists commonly used antipsychotic drugs, their adverse effects, typical dosages, and price. Drowsiness, dry mouth, elevated prolactin levels, extrapyramidal symptoms, glucose intolerance, postural hypotension, weight gain. Drowsiness, dry mouth, extrapyramidal symptoms, galactorrhea, hypotension, tachycardia.
More effective for treating positive symptoms, 13 but has a high risk of extrapyramidal symptoms Aripiprazole Abilify. Anxiety, constipation, dizziness, headache, insomnia, metabolic changes, nausea, vomiting.
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