Last reviewed: November 2017
Last updated: December  2017

Important updates

Emerging evidence suggests that glucose homeostasis may already be altered at disease onset in schizophrenia

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

Original source of update

UK guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) on avoiding valproate in girls and women of childbearing potential

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

Original source of update

The selective mixed estrogen agonist/antagonist raloxifene shows promise as an adjunctive treatment for treatment-resistant schizophrenia in women

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.

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Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • auditory hallucinations
  • delusions
  • avolition
  • anhedonia
  • asocial behaviour
  • affective blunting
  • alogia
  • cognitive deficits
  • somatisation

Other diagnostic factors

  • bizarre or disorganised/catatonic behaviour
  • tangentiality and looseness of association (derailment)
  • circumstantiality
  • pressured speech
  • distractible speech
  • depression
  • suicidality
  • anxiety
  • elation
  • incongruent affect
  • verbigeration
  • perseveration
  • word salad
  • derealisation
  • non-auditory hallucinations
  • déjà-vu
  • stilted goal-directed behaviours
  • catatonic symptoms
  • 'soft' neurological deficits

Risk factors

  • family history of schizophrenia
  • increasing paternal age
  • obstetric complications
  • cannabis use
  • low IQ
  • motor dysfunction
  • psychological stress
  • childhood abuse
  • birth in late winter/early spring season
  • cooler climate
  • migrant status

Diagnostic investigations

Investigations to consider

  • CT/MRI head
  • serum HIV ELISA
  • serum rapid plasma reagin (RPR) test
  • FBC
  • urine drug screen
  • plasma drug level monitoring
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Adrian Preda

Professor of Clinical Psychiatry

Department of Psychiatry and Human Behavior

University of California, Irvine School of Medicine

Irvine

CA

Disclosures

AP received a fee for consulting from Boehringer Ingelheim and a fee for speaking from Dainippon Sumitomo Pharma America, the manufacturer of lurasidone/Latuda.

Robert G. Bota

Associate Clinical Professor of Psychiatry

University of California

Irvine

CA

Disclosures

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.

Peer reviewers VIEW ALL

Chief Pharmacist

South London and Maudsley NHS Foundation Trust

London

UK

Disclosures

DT declares that he has no competing interests.

Professor

Department of Psychiatry

University of New Mexico School of Medicine

Albuquerque

NM

Disclosures

JY declares that he has no competing interests.

Professor of Psychiatry

University of Missouri Kansas City

Kansas City

MO

Disclosures

KS declares that he has no competing interests.

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