Schizophrenia Work up & Course

Epidemiology Work-Up:
Lifetime prevalence is 1% Rule out metabolic disorders, tox screen, CNS imaging
Onset before age 25 Course:
W=M May have prodromal symptoms up to a year before overt
One of the most common of the serious mental disorders psychotic symptoms appear
Etiology Exacerbations and remissions
Genetic, environmental, neurobiologic causes Positive symptoms become less severe over time
History of major disruption in life may precede deterioration Prognosis:
Symptoms 10-60% go into remission
Unkempt appearance 20-30% lead a somewhat normal life
Reduced motor activity 20-30% continue to experience moderate symptoms
Withdrawal from social interactions, personal care, poor 40-60% remain significantly impaired for entire life
relationships Concerns for homelessness and substance abuse
Speech Tx:
Neologisms, echolalia, verbigeration Antipsychotics and psychotherapy are mainstay of treatment
Flat affect Hospitalization for stabilization of medications, suicide/homicide risk,
Depressed mood severe symptoms, inability to care for self
Abnormal thought content Other medications uses as need for specific symptoms
No symptoms is diagnostic o Benzos, anti-parkinson drugs, propranolol, etc
Symptoms change over time Therapy:
History is essential in diagnosis Social Skills Training
Positive Negative Family Oriented Therapy
Delusions (paranoid, perceived threat) Affective flattening Case Management
Hallucinations (auditory) Avolition Assertive Community Treatment
Disorganized speech and behavior Alogia Group Therapy
Anhedonia CBT
Attention deficits Individual Psychotherapy
Social withdrawl Behavioral (music/art)
Types of Delusions Vocational therapy
Delusions of control
Delusions of grandiosity Other Psychotic Disorders
Delusions of guilt Schizophreniform disorder
Delusions of reference Lasts 1-6 months before full recovery
Persecutory delusions Schizoaffective disorder
Somatic delusions Sx of schizophrenia with depression or mania superimposed
Thought insertion, withdrawal or broadcasting Delusional Disorder
DSM-5 Criteria Later onset (35-50), nonbizarre delusions without
A. 2 or more of the following present for sig. amt of time during a hallucinations, disorganized thoughts, or negative sx
1-month period. At least one must be 1, 2 or 3. Less functional capacity loss, no changes in cognition
1. Delusions Shared Psychotic Disorder
2. Hallucinations Delusion develops in person with close relationship with
3. Disorganized speech someone already having delusions
4. Grossly disorganized/catatonic behavior Brief psychotic Disorder
5. Negative symptoms Psychotic symptoms less than 1 month before recovery
B. Marked decreased functioning in one or more (work, social,
interpersonal, self-care) for sig. amt. of time
C. Continuous signs of disturbance for at least 6 mos
D. Schizoaffective disorder & depressive/bipolar with psychotic
features have been ruled out
E. Disturbance not attributable to substance use or medical condition
F. If there is a hx of autism spectrum disorder or a communication
disorder of childhood onset, schizophrenia can only be diagnosed
if prominent delusions or hallucinations plus other required sx
above
Schizophrenia Subtypes
5 subtypes
Paranoid
Disorganized
Catatonic
Undifferentiated
Residual
*These are no longer used by the DSM-5 but appear in the ICD-10 codes