Schizophrenia and Other Psychotic Disorders — Summary

Source Info

  • Type: Textbook chapter (Handbook of Clinical Psychiatry)
  • Author(s): Dr. Varuni de Silva, Dr. Raveen Hanwella
  • Date: Undated (current clinical practice)
  • Filed at: sources/textbooks/schizophrenia-raveen-hanwella-book.pdf

Key Takeaways

  1. Clinical Features: Categorized into positive (delusions, hallucinations), negative (apathy, anhedonia, asociality, avolition, affective flattening), and cognitive symptoms (attention, memory deficits).
  2. Diagnosis (ICD-10): Minimum 1 very clear symptom from groups a-d (thought phenomena, passivity, voices, bizarre delusions) or 2+ from groups e-h (persistent hallucinations, thought disorder, catatonia, negative symptoms) for 1 month or more.
  3. Subtypes: Paranoid (commonest), Catatonic (psychomotor disturbance), Hebephrenic (affective symptoms), and Undifferentiated.
  4. Prognosis: Indicators of poor prognosis include insidious onset, early onset, poor premorbid history, and prominent negative symptoms.
  5. Clozapine: Superior efficacy for treatment-resistant schizophrenia (failure of 2 drugs at 8 weeks). Requires strict FBC monitoring (weekly for 18 weeks) due to agranulocytosis risk.
  6. Sri Lanka Context: Typical antipsychotics and specific atypicals (Risperidone, Olanzapine, Clozapine) are available in government hospitals.
  7. Morbid Jealousy (Othello Syndrome): Characterized by delusional jealousy, high risk of violence, and association with alcohol/impotence.
  8. Acute and Transient Psychotic Disorders: Acute onset (<2 weeks), polymorphic symptoms, recovery within 2-3 months.

Wiki Pages Updated

Notable Details

  • ⚠️ EXAM DETAIL: ECT is first-line treatment for catatonic schizophrenia.
  • ⚠️ EXAM DETAIL: Depot antipsychotics should not be used in acute episodes as they cannot be titrated rapidly.
  • ⚠️ EXAM DETAIL: Morbid jealousy is associated with alcohol use and erectile impotence in males.
  • ⚠️ EXAM DETAIL: Indicators of poor prognosis include insidious onset and prominent negative symptoms.