Schizophrenia
Brandon Grove, MD, and Heidi James, MD
Background
- Affects men earlier, more commonly, and more severely than women
- Symptoms include
- Positive symptoms
- Negative symptoms
- Cognitive deficits
- Mood symptoms
- Differential includes
- Mood disorders
- Drug use or organic causes of symptom
Clinical Findings
- Symptoms for ≥6 mo with a negative effect on functioning
- 2 of 5 of the following symptoms, including at least 1 of first 3, are present:
- Delusions
- Hallucinations
- Disorganized speech
- Catatonic behavior
- Negative symptoms
- Investigations
- Labs
- Complete blood count (CBC), metabolic panel, B12, folate levels
- Drug screen
- Screening for infections as needed
- Brain imaging as needed
Management
- Typical antipsychotics
- Watch for extrapyramidal side effects
- Atypicals antipsychotics
- Affects glucose and lipid metabolism
- Clozapine is most effective
- Follow CBC - risk of agranulocytosis
- Medications must be taken consistently
- Psychologists, social workers, and behavioral therapists are helpful
