Schizophrenia

 

Hallucinations (Auditory)
i. First-person: Hearing voices narrating their own actions (e.g., “I am moving”).
ii. Second-person: Voices addressing the person directly (e.g., “You are evil”).
iii. Third-person: Voices discussing the person’s actions (e.g., “He is getting up”).
iv. Thought Echo: Hearing one’s thoughts aloud.
v. Gedanken-laut-werden: Hearing thoughts at the moment of thinking them.

Thought Disorders
i. Thought Insertion: Belief that thoughts are placed in the mind by others.
ii. Thought Withdrawal: Belief that thoughts are being stolen.
iii. Thought Broadcasting: Thinking others can hear their thoughts.
iv. Thought Blocking: Abrupt interruption of thinking.

Other Features
i. Passivity Phenomena: Belief that external forces control bodily sensations or actions.
ii. Delusional Perception: Misinterpreting normal objects with irrational significance (e.g., “The green light means I am the king”).
iii. Negative Symptoms: Blunted affect, reduced speech, lack of motivation, and inability to derive pleasure.

Management

Medication Management
i. Antipsychotic Medications: As the mainstay for schizophrenia, with atypical antipsychotics (e.g., Risperidone, Olanzapine) being preferred for fewer extrapyramidal side effects. The guidelines emphasize starting antipsychotic medication at the lowest effective dose.
ii. Clozapine: Recommended for treatment-resistant cases after at least two failed trials of other antipsychotics.
iii. Monitoring: Regular monitoring of side effects and metabolic parameters (weight, blood glucose, lipids) is essential, especially with atypical antipsychotics due to the risk of metabolic syndrome.

Psychological Interventions
i. Cognitive Behavioural Therapy for Psychosis (CBT): An evidence-based intervention recommended as a part of routine care, aiming to reduce distress and improve functioning.
ii. Psychoeducation: For both the individual and their family, improving understanding of the illness and management strategies.

Family Interventions
The guidelines recommend involving family members in treatment through family therapy or support groups, as family involvement improves outcomes.

Physical Health Monitoring
Regular assessment of physical health, including cardiovascular risk factors, is critical as individuals with schizophrenia are at increased risk of metabolic syndrome and cardiovascular disease.

Relapse Prevention and Long-Term Care
i. Early Intervention Services: The guidelines emphasize a 3-5 year period of intensive care, focusing on reducing relapse rates and improving functional recovery.
ii. Supported Employment and Education Programs: Important for social integration and recovery.

Hospital Admission
Recommended for individuals with acute psychosis who are a danger to themselves or others or when outpatient management is insufficient.

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