Antipsychotic treatment is associated with an increased risk of metabolic abnormalities, including increased susceptibility to type 2 diabetes. One new systematic review and meta-analysis suggests that patients with schizophrenia may be at increased risk of developing type 2 diabetes, even before treatment with antipsychotics has been started.See Management: approach
The MRHA recommend that clinicians do not prescribe valproic acid derivatives (including valproate) to female children, female adolescents, women of childbearing potential, or pregnant women unless other treatments are ineffective or not tolerated. This is because children exposed to these agents in utero are at a high risk of serious developmental disorders (in up to 30%-40% of cases) and congenital malformations (in approximately 10% of cases).See Management: treatment algorithm
A double-blind, placebo-controlled, randomised study reported that raloxifene appears to reduce illness severity and increase the probability of a clinical response in women with refractory schizophrenia. Raloxifene appears to have fewer oestrogenic adverse effects than other types of oestrogen treatment for women with treatment-resistant schizophrenia.See Management: emerging treatments
An illness characterised by a co-occurrence of at least two of the following symptoms: hallucinations, delusions, disorganised speech, disorganised/catatonic behaviour, or negative symptoms occurring for a significant period of time during a 1-month period and associated with continuous problems over at least a 6-month period.
Characteristic features are positive symptoms (e.g., auditory hallucinations, thought disorder, delusions) and negative symptoms (e.g., demotivation, self-neglect, and reduced emotion). For a diagnosis, at least one of the following symptoms must be present: delusions, hallucinations, or disorganised speech.
Onset is usually in early adulthood and may be preceded by years of ill-differentiated symptoms, from behavioural changes and delusions to frank psychosis.
Initially, patients are usually referred by family members. As the illness progresses, patients tend to self-refer or are brought in by a case manager or law enforcement officer.
Antipsychotic therapy and psychosocial interventions are effective for most patients, but to varying degrees.
Suicidal tendency is one of the most dangerous complications. The lifetime risk of suicide is around 5%. The risk is highest at the onset of the illness.
Schizophrenia is an illness characterised by a co-occurrence of at least two of the following symptoms: delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, or negative symptoms (e.g., affective flattening, avolition, anhedonia, attention deficit, or impoverishment of speech and language) occurring for a significant period of time during a 1-month period (active phase) and associated with continuous problems over at least a 6-month period. At least one of the symptoms needs to be a positive symptom (i.e., delusions, hallucinations, disorganised speech).  The duration of the active phase might be shorter than 1 month if the deficits are successfully treated. For a diagnosis of schizophrenia, symptoms must not only occur concomitantly with substance use or a mood-disorder episode. Affective episodes may occur during the course of illness; however, their total duration must be less than the total duration of the active and continuous phase periods.
Professor of Clinical Psychiatry
Department of Psychiatry and Human Behavior
University of California, Irvine School of Medicine
AP received a fee for consulting from Boehringer Ingelheim and a fee for speaking from Dainippon Sumitomo Pharma America, the manufacturer of lurasidone/Latuda.
Associate Clinical Professor of Psychiatry
University of California
RGB declares that he has no competing interests.
Dr Adrian Preda and Dr Robert G. Bota would like to gratefully acknowledge Dr Manish Kumar, who assisted with research for this monograph. MK declares that he has no competing interests.
South London and Maudsley NHS Foundation Trust
DT declares that he has no competing interests.
Department of Psychiatry
University of New Mexico School of Medicine
JY declares that he has no competing interests.
Professor of Psychiatry
University of Missouri Kansas City
KS declares that he has no competing interests.
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