SCHIZOPHRENIA – TREATMENT & PROGNOSIS
SCHIZOPHRENIA – DIAGNOSIS, TREATMENT & PROGNOSIS
DIAGNOSIS:
DSM-5 criteria:
- Total duration of illness – Should be atleast 6 months.
- Within 6 months –
- 2 or more below mentioned symptoms should be present for at least 1 month.
- Or at least one of these must be either (1), (2) or (3)
Symptoms:
1. Delusions
2. Hallucinations
3. Disorganized speech (or formal thought disorder)
4. Disorganized. or catatonic behavior
5. Negative symptoms.
ICD-10 Criteria:
- Uses similar criterion for schizophrenia diagnosis.
- Total duration of symptoms – Should be more than 1 month
- (Note: DSM-5 total duration > 6 months).
TYPES:
According to ICD-10,
Paranoid schizophrenia –
- Most common type.
- Dominated by hallucinations and delusions.
- Late-onset & good prognosis.
- Usually preserved personality.
Catatonic schizophrenia –
- Dominated by catatonic (motor) symptoms.
- Best prognosis.
Hebephrenic (disorganized) schizophrenia –
- Dominated by prominent disorganization symptoms & negative symptoms.
- Early onset & bad prognosis.
- Severe deterioration of personality (patient is not able to maintain hygiene, social interaction is inappropriate, odd behaviors are present).
Undifferentiated schizophrenia –
- Not conforming to any of above subtypes or exhibiting features of more than one of them.
Residual schizophrenia –
- Characterized by progression from an early stage (with prominent delusions and hallucinations) –> Later stage (Reduced delusions & hallucinations & prominent negative symptoms).
Simple schizophrenia –
- Prominent negative symptom.
- No positive symptoms.
- Worst prognosis.
Post-schizophrenic depression –
- Depression episode starts after resolution of schizophrenic symptom
- Has increased risk of suicide.
TREATMENT:
- Antipsychotics/neuroleptics – Mainstay treatment.
- Typical antipsychotics or first-generation antipsychotics or dopamine receptor antagonists (DRAsJ –
- Chlorpromazine, thioridazine, haloperidol & fluphenazine.
- Atypical antipsychotics or second-generation antipsychotics or serotonin-dopamine antagonists –
- Clozapine (DOC in treatment resistance schizophrenia), Olanzapine & Risperidone.
PROGNOSIS:
Good prognostic factors:
- Acute or abrupt onset
- Late-onset (age > 35 years)
- Catatonic subtype and paranoid subtype
- Female sex
- Prominent positive symptoms
- Presence of affective symptoms (depression)
- Family history of mood disorder.
Bad prognostic factor:
- Insidious onset
- Early onset (age
- Simple, disorganized, undifferentiated subtype
- Male sex
- Prominent negative symptoms.
- Absence of affective symptoms.
- Family history of schizophrenia.
Exam Important
- Paranoid schizophrenia has late-onset & good prognosis.
- Catatonic schizophrenia has best prognosis.
- Hebephrenic (disorganized) schizophrenia has early onset & bad prognosis.
- Antipsychotics/neuroleptics are mainstay treatment for schizophrenia includes Chlorpromazine, thioridazine etc.,
- Clozapine is DOC for treatment resistance schizophrenia.
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