0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

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TABLE 16.5. Signs and Symptoms of Schizophrenia

PHASE SIGNS/SYMPTOMS TREATMENT

Prodromal Phase Social isolation, new interest in religion/philosophy, Experimental studies designed to train

restlessness, difficulty concentrating patients on appropriate social behavior

Positive symptoms Delusions, hallucinations, strange behaviors, Antipsychotics, outpatient therapy, inpatient

incoherent thought process, grossly disorganized treatment if new onset, suicidal, or severe

or catatonic behavior psychosis

Negative symptoms Flat affect, decreased fluency, and productivity of Atypical antipsychotics, group therapy,

thought and speech, social withdrawal, decrease inpatient if new onset, suicidal, or severe

in goal-directed behavior symptoms

Residual phase Occurs between episodes of psychosis, patient Outpatient and group therapy

retains flat affect and continues to hear voices

DIAGNOSIS

Clinical diagnosis; check labs, head CT, and cerebrospinal fluid if indicated

TREATMENT

A patient who presents with brief psychotic disorder has a high risk of suicide.

Any patient with new-onset psychosis needs to be evaluated by a psychiatrist

and/or admitted after organic causes are ruled out.

A 24-year-old man is brought to the ED by his mother for hearing voices “telling

me that the day of doom is coming.” He is also becoming increasingly paranoid

and believes that others are “out to get me because I speak the truth.” He is

diagnosed with new-onset schizophrenia. What are the risk factors for schizophrenia?

Multiple factors are associated with this disease. Those with family history

(first-degree relatives of patients with schizophrenia have 10 times the

risk of developing schizophrenia), brain abnormalities, low socioeconomic

class, and those born in winter months living in northern climates have an increased

risk of disease.

Schizophrenia

SYMPTOMS/EXAM

See Table 16.5.

DIFFERENTIAL

■ Same as for acute psychosis if new onset schizophrenia

■ Schizoaffective disorder:Psychosis occurs exclusively during an episode

of mania or depression.