Questions and Answers
Patients with a longer duration of untreated psychosis (DUP) have a better long-term prognosis.
False
Physical examination for metabolic syndrome is a part of the assessment of treatment-resistant schizophrenia.
True
Early Intervention in Psychosis Service (EIS) teams were mandated in the UK in the 2010 NHS Plan.
False
There is convincing evidence that early intervention reduces the duration of untreated psychosis.
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Low-dose medication and cognitive behavioural approaches may decrease the conversion to psychosis.
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Omega-3 polyunsaturated fatty acids have shown no effect on reducing the risk of onset of psychosis.
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The treatment response becomes quicker and more frequent during subsequent psychotic episodes.
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Patients' views regarding treatment should be discussed during the assessment of treatment-resistant schizophrenia.
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Substance misuse among schizophrenia patients is associated with decreased risks of homelessness.
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Clozapine has shown some efficacy in reducing cannabis use among schizophrenia patients.
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Fazel et al. (2014a) found that 2.7% of male schizophrenia patients were convicted of a violent offence within 5 years of diagnosis.
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Patients with schizophrenia are more likely to be perpetrators of violence than victims.
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Clozapine and paliperidone extended release are beneficial for patients with persistent hostility and violence.
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Both male and female schizophrenia patients are less likely to be convicted of violent offenses within 5 years of diagnosis.
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There is comprehensive evidence supporting the efficacy of integrated outpatient programs for managing substance misuse and psychotic illness in schizophrenia patients.
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Comorbid depression and hopelessness are risk factors for suicide in schizophrenic patients.
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Patients with pronounced negative symptoms are more likely to make suicide attempts.
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Clozapine and antidepressants have been associated with reduced suicide rates in schizophrenia.
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Care Programme Approach (CPA) is only implemented in the UK for patients with schizophrenia.
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A key worker is assigned to maintain contact with patients and ensure the delivery of the treatment programme.
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Schizophrenia treatment does not require regular reviews.
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Depot injections are often used to help with medication adherence in schizophrenia patients.
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Patients with schizophrenia usually return to their premorbid level of functioning.
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CBT and other psychological interventions can be part of the integrated care package for schizophrenia management.
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Once stabilized after an acute episode, medication for schizophrenia should typically continue for at least 1-2 years.
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The severity and nature of residual symptoms of schizophrenia determine the extent and duration of ongoing care.
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The term schizophrenia should always be used carefully and sensitively due to its association with considerable stigma and misunderstanding.
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Discussion about schizophrenia should avoid any mention of its heritability to prevent unnecessary concern among patients and carers.
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The 'Recovery Approach' emphasizes the goal of eliminating the illness entirely.
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Psychiatrists should concern themselves more with whether a patient's thought is delusional than with its content and meaning for the patient.
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The family environment and substance misuse are psychosocial factors that can influence the outcome of schizophrenia treatment.
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After establishing heritability, it is not necessary to address increased risk concerns regarding schizophrenia in future generations.
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Parents should be reassured that their behavior is not a cause of schizophrenia in their children.
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The 'Recovery Movement' criticizes psychiatrists for being too optimistic about the prognosis in schizophrenia.
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Psychiatrists should adapt their approach to discussing schizophrenia according to the circumstances of each case.
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The involvement of the family in schizophrenia treatment decisions can be disregarded if it differs significantly from the clinical team's views.
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A test dose is necessary for both typical and atypical antipsychotic depot preparations.
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Olanzapine pamoate must be monitored for at least 3 hours post injection due to potential serious side effects.
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Maximum plasma concentrations of depot preparations are reached within a few days.
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About 2% of patients experience excessive sedation, confusion, or coma from olanzapine pamoate.
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Clozapine is rarely used for treatment-resistant schizophrenia due to its lack of effectiveness.
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Patients with chronic schizophrenia may require interventions for cognitive and social functioning.
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Support for family and carers has not been proven to be valuable in the management of treatment-resistant schizophrenia.
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One in three patients with schizophrenia is considered to have treatment-resistant schizophrenia.
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Patients with chronic schizophrenia do not need monitoring for comorbid conditions or substance misuse.
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Patients receiving depot antipsychotic treatment should continue to take oral antipsychotic medication without tapering the doses.
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Early intervention is important only for the first episode of schizophrenia.
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Cognitive behavioural therapy is one component of treatment for schizophrenia.
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Olanzapine is recommended as a first-line treatment for first episode psychosis due to its lower risk of metabolic syndrome.
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Antipsychotic medication is the mainstay of the treatment of schizophrenia.
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It is common for patients to be able to engage fruitfully in specific psychological therapies during the early stages of treatment.
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Metabolic syndrome in first-episode psychosis is present in about 50% of patients.
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Assertive outreach is a treatment component for vulnerable patients with schizophrenia.
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Integrated, multidisciplinary working involves solely primary care.
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Risperidone, amisulpride, and aripiprazole are suggested antipsychotic drugs for first episode psychosis.
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Physical examinations and routine investigations should be carried out to provide baseline data for metabolic syndrome monitoring.
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Successful management of schizophrenia always requires strict hospitalization for the first episode.
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A thorough assessment often requires multiple interviews due to the patient's withdrawn or suspicious nature.
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The development of crisis teams has conclusively proven to reduce hospital admissions.
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The importance of medication, including its limitations and side effects, should always be clearly communicated to the patient and their carers.
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An updated knowledge of novel service delivery methods is considered irrelevant to the management of schizophrenia.
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Clinical guidelines for the management of schizophrenia are optional and not critical for making management decisions.
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The first step in managing schizophrenia is forming a good relationship with the patient.
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Hospital admission for the first episode of schizophrenia never involves the use of the Mental Health Act.
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Study Notes
Use of Antipsychotic Depot Preparations
- Depot preparations are useful for patients who do not take their drugs reliably
- A small test dose is given initially to check for side effects, except for atypical antipsychotic preparations
- Maintenance dose is established by observation and follow-up
- Depot preparations have long half-lives, taking several weeks to reach maximum plasma concentrations
- Dose increases and decreases should be made gradually, and oral antipsychotic medication tapered carefully
Treatment-Resistant Schizophrenia
- About one in three patients with schizophrenia have treatment-resistant schizophrenia
- Management is challenging due to the illness and lack of evidence-based treatment options
- Clozapine is often used, but requires regular blood monitoring and has risks of agranulocytosis and other side effects
Specific Issues in Management
- Living accommodation and circumstances
- Occupational activities
- Activities of everyday living
- Cognitive remediation, social skills training, and related therapies
- Monitoring and management of comorbid conditions and substance misuse
- Optimization of medication efficacy and tolerability
- Support for family and carers
Discussing Schizophrenia with Patients and Carers
- The term "schizophrenia" should be used carefully and sensitively
- Patients and carers should have opportunities to ask questions and express views
- Involving the family in treatment decisions is important
- Discussing the nature of the illness, aetiology, and prognosis is necessary
- The "Recovery Approach" emphasizes the patient's aspirations and living life fully with the illness
Assessment of Treatment-Resistant Schizophrenia
- Review diagnosis, comorbidities, and treatment history
- Rate current symptoms and severity
- Physical examination and investigations
- Discuss patient views on treatment
- Check treatment adherence and consider blood tests and further investigations
Early Intervention and Other Aspects of Management
- Early treatment may improve long-term prognosis
- "Early Intervention in Psychosis Service" teams aim to identify and treat patients early
- The effectiveness of early intervention is debated
- Substance misuse is common in schizophrenia patients and associated with worse outcomes
- Comorbid substance misuse should be addressed in an integrated way
The Violent Patient
- Violence is common in schizophrenia, especially with comorbid substance misuse
- Medication, especially clozapine, may reduce the risk of violence
- Patients with schizophrenia are more likely to be victims of violence than perpetrators
- Careful follow-up and community supervision may reduce victimization
Management of Violence and Suicide Risk
- Suicide risk is high in schizophrenia, especially in the early stages
- Risk factors include comorbid depression, hopelessness, and recent hospitalization
- Lowering suicide risk involves managing risk factors and treating depressive symptoms
- Clozapine and antidepressants may reduce suicide risk
Management of Schizophrenia in Children and Adolescents
- Little evidence guides management in this population
- The same principles apply as for adults, but with greater caution regarding medication### Initiation of Treatment
- Establishing a good relationship with the patient is crucial for successful management of schizophrenia
- Plans should be realistic and acceptable to the patient and their carers
- Importance of medication, its limitations, and side effects should be carefully explained
- Discussions should be informed by up-to-date knowledge of evidence-based treatment
Management of Schizophrenia
- Key elements of management include:
- Establishing a good relationship with the patient
- Making realistic plans
- Explaining medication and its limitations
- Considering novel modes of service delivery
- Keeping up-to-date with current clinical guidelines is essential for informed management decisions
The Acute Illness
- Admission to hospital is usually necessary for:
- First episode of schizophrenia
- Severe relapses
- Hospital admission provides:
- Thorough assessment
- Safe environment
- Relief to the family
- Home treatment is possible for less severe episodes with adequate resources
- Crisis teams aim to treat and support acutely ill patients at home
- Evidence for crisis teams reducing admissions is relatively weak
- Eliciting symptoms from a withdrawn or suspicious patient can be difficult and may require multiple interviews
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Description
This quiz covers the use of antipsychotic depot preparations in patients who do not take their drugs reliably. It discusses the administration of a test dose and the establishment of a maintenance dose.
