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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Recognize the signs and symptoms of schizophrenia and be able to distinguish among positive, negative, and cognitive symptoms of the illness.

  2. Explain the pathophysiologic mechanisms that are thought to underlie schizophrenia.

  3. Identify the treatment goals for a patient with schizophrenia.

  4. Recommend appropriate antipsychotic medications based on patient-specific data.

  5. Compare the side effect profiles of individual antipsychotics.

  6. Educate patients and families about schizophrenia, treatments, and the importance of adherence to antipsychotic treatment.

  7. Describe the components of a monitoring plan to assess the effectiveness and safety of antipsychotic medications.

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KEY CONCEPTS

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  • Image not available. A diagnosis of schizophrenia is made clinically because there are no psychological assessments, brain imaging, or laboratory examinations that confirm the diagnosis.

  • Image not available. Patients presenting with odd behaviors, illogical thought processes, bizarre beliefs, and hallucinations should be assessed for schizophrenia.

  • Image not available. The goals of treatment are to reduce symptomatology, decrease psychotic relapses, and improve patient functioning and social outcomes.

  • Image not available. The cornerstone of treatment is antipsychotic medications. Because most patients with schizophrenia relapse when not medicated, long-term treatment is usually necessary.

  • Image not available. Psychosocial support is needed to help improve functional outcomes.

  • Image not available. Compared with the older antipsychotics (first-generation antipsychotics [FGAs], typical antipsychotics), the more recently developed second-generation antipsychotics (SGAs, atypical antipsychotics) are associated with a lower risk of motor side effects (tremor, stiffness, restlessness, and dyskinesia); may offer greater benefits for affective, negative, and cognitive symptoms; and may prolong the time to psychotic relapse.

  • Image not available. SGAs as a class are heterogeneous with regard to side effect profiles. Many SGAs carry an increased risk for weight gain and for the development of glucose and lipid abnormalities; therefore, careful monitoring is essential.

  • Image not available. Education of the patient and family regarding the benefits and risks of antipsychotic medications and the importance of adherence to their therapeutic regimens must be integrated into pharmacologic management.

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In most cases, schizophrenia is a devastating, chronically debilitating disorder. Conceptually, it may be thought of as a clinical syndrome, comprising several disease entities that manifest with psychotic symptoms, including hallucinations, delusions, and disordered thinking. Commonly, these more flagrant symptoms are accompanied by more insidious ones, including cognitive impairment (abnormalities in thinking, reasoning, attention, memory, and perception), impaired insight and judgment, loss of motivation (avolition), loss of emotional range (restricted affect), and a decrease in spontaneous speech (poverty of speech). The latter three symptoms are termed negative symptoms and collectively are frequently called the deficit syndrome. Cognitive impairments and negative symptoms account for much of the poor social and functional outcomes observed in schizophrenia. Schizophrenia is the fourth leading cause of disability among adults and is associated with substantially lower rates of employment, marriage, and independent living compared with population norms. However, earlier diagnosis and treatment, as well as advances in research and newer treatment developments, have led to better outcomes for people who have this complex and challenging illness.

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