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Source: Crismon ML, Kattura RS, Buckley PF. Schizophrenia. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146064659.
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CONDITION/DISORDER SYNONYMS
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Chronic heterogeneous syndrome of disorganized and bizarre thoughts, delusions, hallucinations, inappropriate affect, cognitive deficits, and impaired psychosocial functioning.
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Psychosis may result from hyper- or hypoactivity of dopaminergic processes in specific brain regions.
Deficiency of glutamatergic activity produces symptoms similar to those of dopaminergic hyperactivity and possibly symptoms seen in schizophrenia.
Schizophrenic patients with abnormal brain scans have higher whole blood serotonin (5-hydroxytriptamine [5-HT]) concentrations that correlate with increased ventricular size.
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Lifetime prevalence ranges from 0.3% to 0.7%.
Worldwide prevalence is similar among most cultures.
Onset usually in late adolescence or early adulthood; rarely occurs before adolescence or after age of 40 years.
Prevalence equal in males and females, but illness onset tends to be earlier in males.
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CLINICAL PRESENTATION
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DIFFERENTIAL DIAGNOSIS
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Other psychoses (eg, delusional disorders, atypical psychoses)
Manic episodes.
Obsessive-compulsive disorder.
Psychotic depression.
Drug intoxication and abuse.
Thyroid, adrenal, and pituitary disorders.
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Alleviate target symptoms.
Avoid medication side effects.
Improve psychosocial functioning and productivity.
Achieve patient adherence with prescribed regimen.
Involve patient in treatment planning.
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TREATMENT: GENERAL APPROACH
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Prior to starting treatment, perform:
Mental status examination.
Physical and neurologic examination.
Family and social history.
Psychiatric diagnostic interview.
Laboratory workup:
First-line agents: second-generation antipsychotics (SGAs), except clozapine.
SGAs cause few extrapyramidal side effects and less effect on serum prolactin than first-generation antipsychotics (FGAs) but have increased risk for metabolic side effects, ...