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  • Image not available. The pathophysiology of schizophrenia may occur in one or more different neurotransmitter systems.
  • Image not available. The clinical presentation of schizophrenia is characterized by positive symptoms, negative symptoms, and impairment in cognitive functioning.
  • Image not available. Comprehensive care for individuals with schizophrenia must occur in the context of a multidisciplinary mental healthcare environment that offers psychotropic medication management and comprehensive psychosocial services.
  • Image not available. A thorough patient evaluation (e.g., history, mental status exam, physical exam, psychiatric diagnostic interview, and laboratory analysis) should occur to establish a diagnosis of schizophrenia and to identify potential co-occurring disorders, including substance abuse and general medical disorders.
  • Image not available. Given that it is challenging to differentiate among antipsychotics based upon efficacy, side-effect profiles become important in choosing an antipsychotic for an individual patient.
  • Image not available. Pharmacotherapy algorithms should emphasize monotherapies with antipsychotics of optimal efficacy: side-effect ratios and progress to medications with greater side-effect risks and then to combination regimens only in the most treatment-resistant patients.
  • Image not available. Adequate time on a given medication at a therapeutic dose is the most important variable in predicting medication response.
  • Image not available. Long-term, maintenance antipsychotic treatment is necessary for the vast majority of patients with schizophrenia in order to prevent relapse.
  • Image not available. Thorough patient and family psychoeducation should occur, including education about the illness, symptoms, prognosis, medication, psychosocial treatments, and methods to improve adaptive functioning.
  • Image not available. Pharmacotherapy decisions should be guided by systematic monitoring of patient symptoms, preferably with the use of brief symptom rating scales.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe the most common theories regarding the etiology of schizophrenia.
  • 2. Outline the neurotransmitters thought to be involved in schizophrenia.
  • 3. List the three categories of symptoms seen in schizophrenia and give examples of each.
  • 4. List the types of nonpharmacological therapies that should be offered to individuals with schizophrenia.
  • 5. Discuss the six major areas included in the initial evaluation of a patient suspected of having schizophrenia.
  • 6. Discuss the considerations for choosing initial drug therapy for a patient with schizophrenia.
  • 7. Recommend methods to improve treatment adherence in a patient with schizophrenia.
  • 8. Discuss treatment approaches for individuals with treatment resistant schizophrenia.
  • 9. Discuss the advantages of antipsychotic polypharmacy.
  • 10. Discuss the two major hypotheses regarding second-generation antipsychotic. mechanism of action, and give an example of a drug with each mechanistic approach.
  • 11. Compare the side-effect profiles of antipsychotics and apply this information to the selection of an appropriate antipsychotic regimen for an individual patient.
  • 12. Recommend a treatment plan for a patient with Parkinson’s symptoms secondary to a first-generation antipsychotic; secondary to a second-generation antipsychotic.
  • 13. Recommend treatment interventions for a patient with antipsychotic induced glucose intolerance.
  • 14. Evaluate a patient profile of a patient with schizophrenia and co-occurring general medical disorders for potential drug interactions.
  • 15. Outline a pharmacotherapeutic treatment plan for a patient with schizophrenia in acute exacerbation, including appropriate monitoring and follow-up.

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Schizophrenia is one of the most complex and challenging of psychiatric disorders. It represents a heterogeneous syndrome of ...

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