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23.3 Schizophrenia

Table of Contents

It is characterized by altered thinking process, emotions, drive, behaviour and withdrawal from reality. Symptoms vary from patient to patient and from time to time.

Diagnostic Criteria

  • Bizarre appearance
  • Reduced motor activity
  • Social withdrawal
  • Flattened affect
  • Delusions
  • Hallucinations

Non-Pharmacological Treatment

  • Family counselling and psycho-education
  • Cognitive Behavioural Therapy (CBT) for stabilised patients
  • Supportive group therapy for patients with schizophrenia
  • Rehabilitation may be enhanced by assertive community programs, work assessment, occupational therapy and bridging programmes prior return to the community

Pharmacological Treatment In acute attacks:

Treat like under section: on aggressive disruptive behaviour.

For maintenance:

B: Haloperidol 3-4.5 mg (PO) 12hourly

OR

A: Chlorpromazine 100–600 mg (PO) daily in divided doses 6

OR

S: Olanzepine 5–10mg (PO). Maximum dose 25mg/day 6

OR

S: Risperidone 1mg (PO) 12 hourly then increase by 1mg every 2–3 days to 2– 3mg 12 hourly. Maximum dose 16mg/day 7

Note:
The above medicines should not be given in combination
The atypical antipsychotics have been shown to be comparatively more effective in treatment of negative symptoms

For patients who have poor compliance

D: Fluphenazine deaconate 12.5–50 mg (IM) every 4 weeks.

OR

S: Flupenthixol deaconate (IM) 20–40 mg every 4 weeks

Adjunct Treatment

Antiparkinsonian drugs should only be used if extrapyramidal side effects occur, or at higher doses of antipsychotics likely to cause extrapyramidal side effects. Any of the following can be used:

C: Benzhexol 5mg once to two times a day (PO) last dose before 1400 hours to avoid insomnia

OR

S: Procyclidine 10mg two times a day last dose before 1400 hours

Referral

Refer to the next level in the following situations:

  • First psychotic episode
  • High suicidal risk or risk of harm to others
  • Children and adolescents
  • The elderly
  • Pregnant and lactating women
  • No response to treatment
  • Intolerance to medicine treatment
  • Concurrent medical or other psychiatric illness

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