Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact

Content Update

May 09, 2022

Lybalvi® Use in Patients with Bipolar I Disorder and Schizophrenia: Lybalvi® is a combination drug that contains olanzapine, a second-generation antipsychotic, and samidorphan, an opioid antagonist. It was U.S Food and Drug Administration approved in 2021 for the treatment of schizophrenia and for symptoms of psychosis associated with bipolar I disorder. Use of Lybalvi ® aims to increase medication adherence, treat and prevent metabolic comorbid conditions, and improve patient quality of life.



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

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

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

  3. Identify treatment goals for a patient with schizophrenia.

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

  5. Compare side effect profiles of individual antipsychotics.

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

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


Schizophrenia is a challenging disorder often requiring lifelong treatment. The disorder may have many pathophysiologic pathways that ultimately manifest with psychotic symptoms, including positive symptoms such as hallucinations and delusions, as well as disordered thinking. Commonly, these symptoms are accompanied by cognitive impairment (abnormalities in thinking, reasoning, attention, memory, and perception), impaired insight and judgment, and negative symptoms including loss of motivation (avolition), loss of emotional range (restricted affect), and a decrease in spontaneous speech (poverty of speech). Cognitive impairments and negative symptoms account for much of the poor social and functional outcomes. 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. Persons with schizophrenia have a higher mortality rate as compared with the general population, likely due to numerous factors such as physical comorbidities, insufficient health services, poor diet, lack of exercise, substance use (including tobacco), stigma about mental illness, and low socioeconomic status. However, earlier diagnosis, treatment, advances in research, and newer treatment developments have led to better outcomes with the potential for remission and recovery.


Approximately 0.7% of the world population suffers from schizophrenia, with symptoms typically presenting in late adolescence or early adulthood.1 Prevalence is equal in men and women, but symptoms appear earlier in men with first hospitalization typically occurring at 15 to 24 years compared to 25 to 34 years in women.

The etiology of schizophrenia remains unknown. A genetic basis is supported by the fact that first-degree relatives of patients with schizophrenia carry a 10% risk of developing the disorder, and when both parents ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.