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Schizophrenia

Introduction

Schizophrenia is characterized by altered thinking process, emotions, drive, behaviour and withdrawal from reality. Symptoms vary from patient to patient and from time to time.

Risk Factors

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Signs and symptoms

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Diagnostic criteria

• Bizarre appearance
• Reduced motor activity
• Social withdrawal
• Flattened affect
• Delusions
• Hallucinations

Investigations

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Managemet

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  • Non-pharmacological

    • Family counselling and psycho-education
    • Cognitive Behavioural Therapy (CBT) for stabilised patients
    • Supportive group therapy for patients with schizophrenia
    • Rehabilitation may be enhanced by assertive community programs, work assessment, occupational therapy and bridging programmes prior return to the community

  • Pharmacological

    In acute attacks:

    Treat like under section of aggressive disruptive behaviour.

    For maintenance:

    • Haloperidol 3-4.5 mg (PO) 12hourly
    OR
    • Chlorpromazine 100–600 mg (PO) daily in divided doses 6
    OR
    • Olanzepine 5–10mg (PO). Maximum dose 25mg/day 6
    OR
    • Risperidone 1mg (PO) 12 hourly then increase by 1mg every 2–3 days to 2– 3mg 12 hourly. Maximum dose 16mg/day 7

    Note:

    • The above medicines should not be given in combination
    • The atypical antipsychotics have been shown to be comparatively more effective in treatment of negative symptoms

    For patients who have poor compliance

    • Fluphenazine deaconate 12.5–50 mg (IM) every 4 weeks.
    OR
    • Flupenthixol deaconate (IM) 20–40 mg every 4 weeks

    Adjunct Treatment

    Antiparkinsonian drugs should only be used if extrapyramidal side effects occur, or at higher doses of antipsychotics likely to cause extrapyramidal side effects. Any of the following can be used:
    • Benzhexol 5mg once to two times a day (PO) last dose before 1400 hours to avoid insomnia
    OR
    • Procyclidine 10mg two times a day last dose before 1400 hours

Prevention

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Updated on,

20 Novemba 2020, 18:02:05

References

    1. STG
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