schizophrenia
| Headline | |
|---|---|
| Etiology | Genetic link (50% concordance in identical twin; 15% in 1st degree relatives)? |
| Epidemiology | ~1% population prevalence. Age onset M (late teens) vs F (early twenties). Mortality from CVD, metabolic disease! |
| Clinical presentation | Ddx: always rule out organic causes if there is abrupt onset first presentation psychosis... acute transient psychosis, schizoaffective disorder (depression/mania in same disease course), personality disorder; organic causes of psychosis First Rank Symptoms: hallucinations (70% auditory), passivity phenomena, thought withdrawal/ insertion/broadcast, delusional perception → present most of the time for ≥1/12 Negative s/s: affective blunting, alogia, asociality, avolitionality, attention deficit |
| Pathogenesis | |
| Diagnostic investigations | |
| Management | Psychoeducation, therapeutic relationships • Better prognosis with ↑ age, 15% chance no further relapse after 1st episode psychosis • Avoid collaborating with delusions (“agree to disagree”) • Antipsychotics for positive s/s ➥➥ atypical = D2 blockers, EPSE - 1st line E.g. risperidone (↑ prolactin) ➥➥ typical = D2 blockers ⚠ EPSE ➥➥ metabolic syndrome • Clozapine only if treatment-resistant • Monitoring: FBC /wk → /2wk → /monthly; withdraw if leukopaenic • primary s/s are esp disabling! |
| Prevention |