Diagnosis and Management of Schizophrenia
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Transcript of Diagnosis and Management of Schizophrenia
Diagnosis and Management of Schizophrenia
Stephen R. Marder, M.D.Professor and Director, Section on Psychosis
Semel Institute for Neuroscience at UCLAVA Desert Pacific Mental Illness Research, Education,
and Clinical Center
Diagnosis and Management of Schizophrenia
• Process for diagnosing schizophrenia• Epidemiology• Genetics and environment• How to access severity• Capacity to Work• Current and future treatment
DSM-IV criteria for schizophrenia
A. Characteristic SymptomsB. Social/occupational dysfunctionC. Duration of 6 monthsD. Schizoaffective and mood disorder exclusionE. Substance/general medical exclusionF. Relationship to pervasive developmental
disorder
Diagnostic Process for Schizophrenia
• Physical and lab exams rule out psychotic disorder due to a medical condition and substance-induced psychosis
• Imaging (CT, MRI, PET) are seldom helpful in diagnosis
• The diagnosis is commonly made from history and the mental status exam
• There are currently no reliable biomarkers for diagnosis or severity
Characteristic Psychotic Symptoms in Schizophrenia
• Audible thoughts• Voices arguing or commenting• Thought withdrawal or insertions by outside
forces• Thought broadcasting• Impulses, volitional acts, or feelings imposed
by outside forces• Delusional perceptions
Symptom dimensions in schizophrenia
• Psychotic– Hallucinations– Suspiciousness– Delusions
• Negative– Impoverished speech– Lack of motivation– Asociality– Decreased Affect
• Neurocognitive – Impairments – Memory– Attention– Motor skills– Social cognition– Executive skills– Disorganized speech
Epidemiology of Schizophrenia• Lifetime prevalence of about 1%• No differences related to culture or race• Onset in men is usually earlier (15-24) than in
women (25-34)
Both Sexes%
Total Male %
Total Female%
TotalHIV/AIDS 13.0 HIV/AIDS 12.1 HIV AIDS 13.9Depressive disorders 8.6 Road traffic accidents 7.7 Depressive disorders 10.6Road traffic accidents 4.9 Depressive disorders 6.7 Tuberculosis 3.2Tuberculosis 3.9 Alcohol Use Disorders 5.1 Iron deficiency anemia 3.2Alcohol Use Disorders 3.0 Tuberculosis 4.5 Schizophrenia 2.8Self-inflicted Injuries 2.7 Violence 3.7 Obstructed labor 2.7Iron-deficiency anemia 2.6 Self-inflicted Injuries 3.0 Bipolar disorder 2.5Schizophrenia 2.6 Schizophrenia 2.5 Abortion 2.5Bipolar disorder 2.5 Bipolar disorder 2.4 Self-inflicted injuries 2.4Violence 2.3 Iron deficiency anemia 2.1 Maternal sepsis 2.1
Top 10 Causes of DALYS in Adults (15-44 years)
DALY=Sum of years of life lost due to premature mortality and years lost due to disability
WHO. The World Health Report 2001. Available at http://www.who.int/whr/2001/en/index.html
Course of Schizophrenia
Age (Years)
Good
Function
Psycho-pathology
Poor15 20 30 40 50 60 70
Premorbid Progression StableRelapsing
Sheitman BB, Lieberman JA. The natural history and pathophysiology of treatment-resistant schizophrenia.J Psychiatr Res. 1998(May-Aug);32(3-4):143-150
Severity in Schizophrenia
• People with schizophrenia have different levels of disability varying from no disability to complete dependence on institutional care
• The amount and type of disability is related to the symptoms of the individual’s illness and how responsive these symptoms are to treatment
Severity in Schizophrenia
• The severity of psychotic symptoms are related to– How distracting– Do they influence behavior – eg, command
hallucinations– Do they cause suffering– Do they impair social functioning – eg,
suspiciousness
Severity• The severity of negative symptoms are related to – Social isolation– Apathy– Lack of expressiveness
• The severity of cognitive impairments are related to – Poor concentration– Poor memory– Inability to make simple decisions– Inability to interpret social signals– Slower pace
Pharmacological Treatment of Acute Schizophrenia
• Antipsychotic medications are effective for decreasing the severity of psychotic symptoms
• Nearly all patients on antipsychotic medications will experience some burden from side effects
• Antipsychotics are relatively ineffective for negative symptoms and cognitive impairment
Long-term treatment of schizophrenia• Antipsychotic medications are effective for
preventing relapse in stabilized patients• Effective nonpharmacological treatments include
patient and family education, skills training, supported employment, cognitive behavior therapies, and psychotherapies
• For most individuals, antipsychotic medications control the symptoms while non-pharmacological treatments address the impairments in social, vocational, and educational functioning