Other Mental Health

Question 1

A young male patient is reported to be more withdrawn from his peers than usual and has dropped out of college and quit his job within the last five months. The parent is concerned that the patient may have schizophrenia because a maternal uncle has the disease. What will the primary care provider do next?

Provide reassurance that classic symptoms of schizophrenia are not present

Refer the patient for inpatient psychiatric treatment

Consider treatment with antipsychotic medications

Ask about the patient’s speech and thinking patterns

Answer 1

In order to diagnose schizophrenia, one or more of the positive signs of delusions, hallucinations, or disorganized speech must be present.

Question 2

Schizophrenia

Answer 2

Schizophrenia is a chronic, severe, and disabling brain disorder. Schizophrenia interrupts a person’s capacity to accurately perceive reality, to communicate and relate to others, and to complete the usual activities of daily living, especially during acute phases of the illness.

Question 3

Onset of Schizophrenia

Answer 3

Typically between 16 - 30 years old

Unusual for someone older than 45 to be diagnosed

Question 4

Schizophrenia Causes

Answer 4

Unknown, but genetic and environment influences play role - suspected that environment is the key with a genetic pre-disposition

Question 5

Schizophrenia Initial Presentation

Answer 5

“Prodromal Period” occurs before the psychotic presentation
Changes in grades, habits, sleep, mood, reduced attention / drive / motivation

Difficult to discern from normal teenage changes

Question 6

Schizophrenia Symptoms

Answer 6

Positive Symptoms (added to usual human experience such as  hallucinations)
Negative Symptoms (decrease or loss of normal function such as withdrawal, no joy)
Cognitive Symptoms (Focus loss, impaired verbal skills, loss of problem solving)

Question 7

Diagnosis of Schizophrenia

Answer 7

No single test. Rule out organic causes

-CB, thyroid, renal, hepatic, infection, tox, alcohol, CT

Question 8

Diagnosis by Symptom

Answer 8

Generally, positive symptoms must occur for a month and there must be 6 months of interruption of normal life

The more negative symptoms, the more serious the disorder

Question 9

Treatment of Schizophrenia

Answer 9

In the first episode there is an increased responsiveness to medication adverse effect, so start with low doses

Question 10

First and Second Gen Antipsychotics

Answer 10

All carry a black box warning on use in elderly cause increase mortality in treatment of dementia psychosis

EPS and TD are concerns, may be less common in second gen (but second gen is very expensive and not any more effective)

Question 11

First Gen Antipsychotics Tips

Answer 11

Consider also prescribing antiparkinson meds to reduce EPS dystonia

EPS also responds well to IM benadryl and IM benzotropine

Question 12

Tardive Dyskinesia

Answer 12

Movement disorder that can become irreversible

Atypical antipsychotics may carry a low risk

Question 13

Neuroleptic Malignant Syndrome

Answer 13

The hallmark symptoms of this hypodopaminergic state include an elevated core body temperature and a modest to severe muscle rigidity. Two or more of the following symptoms are also required for diagnosis: diaphoresis, tachycardia, elevated or labile blood pressure, dysphagia, incontinence, tremor, changes in level of consciousness, mutism, leukocytosis, laboratory evidence of muscle injuries, and hepatic enzyme elevations.