Summary
Definition
History and exam
Key diagnostic factors
- auditory hallucinations
- delusions
- avolition
- anhedonia
- asocial behavior
- affective blunting
- alogia
- cognitive deficits
- somatization
Other diagnostic factors
- lack of insight (anosognosia)
- bizarre or disorganized behavior
- tangentiality and looseness of association (derailment)
- circumstantiality
- pressured speech
- distractible speech
- depression
- suicidality
- anxiety
- elation
- incongruent affect
- verbigeration
- perseveration
- word salad
- derealization
- nonauditory hallucinations
- déjà-vu
- stilted goal-directed behaviors
- catatonic symptoms
- "soft" neurologic deficits
Risk factors
- family history of schizophrenia
- increasing paternal age
- obstetric complications
- cannabis use
- low IQ
- motor dysfunction
- psychological stress
- childhood abuse
- migrant status
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- MRI/CT head
- serum HIV enzyme-linked immunosorbent assay
- serum rapid plasma reagin (RPR) test
- CBC including absolute neutrophil count (ANC)
- drug toxicology screen
- BUN and electrolytes
- liver function tests
- thyroid-stimulating hormone
- pregnancy test
- genetic testing
Treatment algorithm
at risk of developing psychosis
acute psychotic episode
chronic symptoms
treatment-resistant schizophrenia
Contributors
Expert advisers
Xiaoduo Fan, MD, MPH, MSc
Professor of Psychiatry
Director, UMass MIND
UMass Memorial Health/UMass Chan Medical School
Worcester
MA
Disclosures
XF has received research support from Otsuka, Roche, Intra-Cellular Therapies, Avanir, and Janssen. XF holds a patent on "combination treatment for neuropsychiatric disorders" (USPTO patent # 11,331,319).
Acknowledgements
Dr Xiaoduo Fan would like to gratefully acknowledge Dr Adrian Preda and Dr Robert G. Bota, previous contributors to this topic.
Disclosures
AP and RGB declare that they have no competing interests.
Peer reviewers
David Taylor, PhD
Chief Pharmacist
South London and Maudsley NHS Foundation Trust
London
UK
Declarações
DT declares that he has no competing interests.
Joel Yager, MD
Professor
Department of Psychiatry
University of New Mexico School of Medicine
Albuquerque
NM
Declarações
JY declares that he has no competing interests.
Kemal Sagduyu, MD
Professor of Psychiatry
University of Missouri Kansas City
Kansas City
MO
Declarações
KS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.Texto completo
American Psychiatric Association. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Washington, DC: American Psychiatric Association; 2021.Texto completo
Hasan A, Falkai P, Wobrock T, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry. 2012 Jul;13(5):318-78. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Schizoaffective disorder
- Schizophreniform disorder and brief psychotic disorder
- Substance-induced psychotic disorder
Mais Diagnósticos diferenciaisDiretrizes
- Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5-TR)
- Evidence-based guidelines for the pharmacological treatment of schizophrenia
Mais DiretrizesFolhetos informativos para os pacientes
Schizophrenia: what is it?
Schizophrenia: questions to ask your doctor
Mais Folhetos informativos para os pacientesConectar-se ou assinar para acessar todo o BMJ Best Practice
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