Schizophrenia is a disabling and challenging psychiatric illness. The lifetime prevalence of schizophrenia is approximately 1%.1,2 This illness affects males and females equally and the onset occurs in the late teens to mid-thirties. The exact etiology of schizophrenia is unknown but research indicates that genetics and alteration of neurotransmitters, such as dopamine, has a significant role in the development of schizophrenia.3
One common misconception is that schizophrenia means "split personalities“ or "multiple personalities.“ Schizophrenia, in fact, is an illness that is associated with various types of symptoms and is not a "split personality“ disorder. Positive symptoms, negative symptoms, and cognitive symptoms are the different types of symptoms associated with schizophrenia.1,4,5 Positive symptoms are symptoms that are considered an "excess“ of normal functions or "added“ to normal functions.1 Delusion and hallucinations are common examples of positive symptoms. Negative symptoms are "loss“ of normal functions or qualities that "subtracted“ from an individual's personality.1 Examples of common negative symptoms include alogia, avolition, and anhedonia. Negative symptoms, at times, may be more difficult to assess compared to positive symptoms since negative symptoms are also associated with other psychiatric disorders. Finally, cognitive symptoms such as impaired attention or memory may be present.5 In addition to these symptoms, individuals with schizophrenia will likely present with social and occupational dysfunction.1 For example, patients may have difficulty with self-care, maintaining employment or maintaining interpersonal relationships.
Currently, there are no objective measures to confirm the diagnosis of schizophrenia. At present, the accepted method of diagnosing schizophrenia can be carried out by evaluating the patient's symptoms and assessing the patient to determine if he meets the criteria for schizophrenia. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) is a diagnostic reference which provides the criteria for schizophrenia diagnosis.1 Characteristic symptoms, social and occupational dysfunction, duration and ruling out other disorders are the key components of the DSM-IV criteria for schizophrenia.
The goal, when treating a patient with schizophrenia, is to develop a treatment plan that decreases symptoms, improves quality of life, and improves patient functioning while minimizing adverse effects.4,6 The current treatment options for schizophrenia include nonpharmacolgic therapy and pharmacologic therapy. Both nonpharmacologic and pharmacologic therapy are beneficial for the treatment of schizophrenia. Nonpharmacologic therapy such as psychosocial support groups and programs generally focus on enhancing patient functioning. The use of nonpharmacologic treatment is beneficial in combination with pharmacologic treatment.4 Antipsychotics are a mainstay for the treatment of schizophrenia. Currently the two classes of antipsychotics which are used for schizophrenia are the first-generation antipsychotics (FGAs) and the second-generation antipsychotics (SGAs). Table 56-1 provides a list of current antipsychotics. Antipsychotics are an effective class of agents that will help control the symptoms associated with schizophrenia. Both antipsychotic classes are quite effective for improving positive symptoms. ...