Schizophrenia

What is schizophrenia?

A chronic psychotic disorder characterized by delusions, hallucinations, disorganized thinking, and negative symptoms lasting ≥6 months with functional impairment.

What neurotransmitters are implicated in schizophrenia?

• Dopamine

• Serotonin

• Glutamate

What brain changes are associated with schizophrenia?

• Enlarged ventricles

• Reduced gray matter

• Cortical thinning

What medical conditions can mimic schizophrenia?

• Substance-induced psychosis

• Bipolar disorder

• Severe depression with psychosis

• Delirium

• Thyroid disorders

• Neurologic disease

What are positive symptoms of schizophrenia?

• Hallucinations

• Delusions

• Disorganized speech

• Disorganized or catatonic behavior

What are negative symptoms of schizophrenia?

• Flat affect

• Avolition

• Alogia

• Anhedonia

• Social withdrawal

What are cognitive symptoms of schizophrenia?

• Poor attention

• Impaired working memory

• Executive dysfunction

What types of hallucinations occur in schizophrenia?

• Auditory

• Visual

• Olfactory

• Tactile

What type of hallucination is most common in schizophrenia?

Auditory hallucinations

What types of delusions occur in schizophrenia?

• Persecutory

• Grandiose

• Referential

• Somatic

• Religious

What is disorganized speech?

• Loose associations

• Tangentiality

• Word salad

• Thought blocking

What is disorganized behavior?

• Unpredictable agitation

• Poor hygiene

• Inappropriate behavior

What is catatonia?

Psychomotor disturbance with immobility, mutism, posturing, or agitation.

What is the diagnostic duration requirement for schizophrenia?

Symptoms lasting ≥6 months with ≥1 month of active-phase symptoms.

What is required for schizophrenia diagnosis?

≥2 symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms) with functional decline.

What differentiates schizophrenia from schizophreniform disorder?

Schizophreniform lasts 1–6 months

What differentiates schizophrenia from brief psychotic disorder?

Brief psychotic disorder lasts <1 month.

What differentiates schizophrenia from schizoaffective disorder?

Schizoaffective has mood episodes plus ≥2 weeks of psychosis without mood symptoms.

What differentiates schizophrenia from bipolar disorder with psychosis?

Bipolar psychosis occurs only during mood episodes.

What differentiates schizophrenia from substance-induced psychosis?

Symptoms persist beyond intoxication/withdrawal and occur without substance use.

What risk factors are associated with schizophrenia?

• Family history

• Urban living

• Cannabis use

• Childhood trauma

• Obstetric complications

What medical workup may be needed for psychosis?

• CBC

• CMP

• TSH

• B12

• Folate

• Toxicology screen

• HIV

• Syphilis

• Brain imaging if indicated

What imaging findings may occur in schizophrenia?

• Enlarged ventricles

• Cortical atrophy

What is the first-line treatment for schizophrenia?

Antipsychotic medications

What antipsychotics treat schizophrenia?

• Risperidone

• Olanzapine

• Quetiapine

• Aripiprazole

• Haloperidol

What is clozapine used for?

Treatment-resistant schizophrenia and reduction of suicide risk.

What monitoring is required for clozapine?

• ANC levels

• CBC

• Metabolic panel

What side effects occur with antipsychotics?

• Weight gain

• Metabolic syndrome

• EPS

• QT prolongation

• Hyperprolactinemia

What are extrapyramidal symptoms (EPS)?

• Acute dystonia

• Akathisia

• Parkinsonism

• Tardive dyskinesia

What medications treat EPS?

• Benztropine

• Diphenhydramine

• Propranolol (for akathisia)

What non-pharmacologic treatments help schizophrenia?

• CBT

• Social skills training

• Family therapy

• Supported employment

What lifestyle modifications help schizophrenia?

• Avoiding substances

• Sleep hygiene

• Structured routines

What complications can occur from untreated schizophrenia?

• Homelessness

• Substance use

• Violence risk

• Suicide

• Functional decline

What is the prognosis of treated schizophrenia?

Improved functioning with medication adherence and psychosocial support.

What is the prognosis of untreated schizophrenia?

Chronic psychosis, disability, and increased mortality.

What is the classic triad of schizophrenia?

• Delusions

• Hallucinations

• Disorganized thought

What symptom cluster strongly suggests schizophrenia?

• Auditory hallucinations

• Delusions

• Disorganized speech

What negative symptom cluster strongly suggests schizophrenia?

• Flat affect

• Avolition

• Social withdrawal