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Schizophrenia: Treatment

by Helen Farrell, MD
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    00:01 Some prognostic factors that tell us whether or not a patient with schizophrenia is going to do really well or not so well are things such as the onset of the illness, okay? If somebody is presenting with an illness a little bit older, they’re going to have a better prognosis than if they’re presenting at a very young, tender age.

    00:25 Also, having good social supports from family, friends, psychiatrists, primary care providers, prognosis.

    00:32 all of these things are going to lead towards a better prognosis.

    00:37 And when it comes to symptomatology, we know that having positive symptoms, so things like paranoia, hallucinations, delusions, thought disorder.

    00:48 These things actually all trend towards a better prognosis.

    00:51 You think of them as little bit easier to treat than somebody who has negative symptoms, that leads to a little bit of a worst prognosis.

    01:01 Somebody who has new symptoms is also going to have a better prognosis than somebody without mood symptoms.

    01:08 Mood disorder can be treated and therefore, if that’s targeted, a person can have a good outcome.

    01:17 And usually females tend to do a little bit better than males in terms of prognosis.

    01:24 And any patient who is diagnosed with schizophrenia will probably experience and hopefully experience remissions from their disorder.

    01:33 However, relapses are possible, but for those patients who have very few and far between relapses, they’re going to do much better in the long run than a patient who’s having very frequent relapses of their disorder.

    01:48 And another key variable is what the premorbid functioning was for a patient.

    01:53 So somebody, say, like Mr. B who was doing really well before their symptoms, in college, engaged with their family, having hobbies, et cetera, that person’s going to be more likely to do really well and have a good prognosis overall.

    02:08 Here’s an important question for you.

    02:11 Are patients with schizophrenia more likely to be violent? Actually, no.

    02:17 Individuals with schizophrenia are more likely to be victims of violence than perpetrators, a very important point to remember.

    02:28 So when you think about Mr. B, what is your prognosis for him, this young college student who has found himself diagnosed with schizophrenia.

    02:38 Well, he actually shows some really good prognostic factors and these are very important to emphasize to both him and his family.

    02:47 So some of the factors supporting a favourable outcome for him include being enrolled at college, this indicates he has a high intelligence and a good premorbid functioning.

    02:58 Beyond that, there’s the presence of his supportive family, which is very hopeful.

    03:03 And this appears to be Mr. B’s first episode of psychosis.

    03:08 And with the right treatment and compliance, he might not have may future episodes and can actually do very well despite his illness.

    03:18 Let’s talk about the behavioral therapy treatment in schizophrenia.

    03:23 This is aimed to improve a patient’s ability to do well and actually function within society.

    03:29 So therapy is aimed at developing social skills, self-sufficiency, and also an ability to act appropriately in public and this all the aim of behavorial therapy.

    03:42 There can be cognitive problems associated with schizophrenia.

    03:46 Can you think of what any of those are? Well, deficits and processing of complex information can occur.

    03:54 Maintaining a steady focus of attention, working memory can be impaired.

    04:01 Distinguishing between relative and irrelevant stimuli can also happen.

    04:07 And abstract thinking can also be disrupted.

    04:13 When it comes to social skills training, what limitations are there in training persons with schizophrenia? Well, there is a difficulty in generating information – There is a difficulty in generalizing information learned into real life setting for some patients.

    04:36 The best approach in terms of being a therapist and working with a patient who has schizophrenia is to be direct and straightforward.

    04:44 Take an active and assertive posture to provide structure.

    04:50 And when it comes to group therapy, note that it’s not very well tolerated in individuals with psychosis because of the overstimulation.

    04:59 Only very high functioning and stable persons can tolerate insight oriented groups.

    05:07 I want to review briefly the culture specific psychoses.

    05:11 These include disorders that occur in different parts of the world.

    05:17 Koro is occurring in the Asian culture.

    05:21 This is the belief that the penis is shrinking and that it may cause death.

    05:27 Another disorder is amok.

    05:28 This is in Malaysian and Southeast Asian cultures.

    05:33 It’s a sudden, unprovoked outburst of violence, often followed by suicide.

    05:39 There’s also something called brain fag which occurs in Africa.

    05:43 This is where patients complain of a headache, fatigue, visual disturbances and it’s often occurring in male students.

    05:53 Some other syndromes that are important to be aware of are as follows.

    05:57 Capgras syndrome.

    05:59 This is the delusion that imposters have replaced familiar people.

    06:05 Fregoli’s syndrome is a delusion that a persecutor is taking on a variety of faces like an actor.

    06:15 Lycanthropy is a delusion of being a werewolf.

    06:20 Heutoscopy is the false belief that one has a double.

    06:24 Cotard syndrome, this is the delusional belief that an individual has lost everything including their body organs.

    06:33 And Folie a deux is a shared psychotic disorder or shared delusion between more than one person.

    06:40 This summarizes schizophrenia and some other related psychotic disorders.

    06:46 Very important to know the history, background, epidemiology, the causes of schizophrenia, and the treatments.


    About the Lecture

    The lecture Schizophrenia: Treatment by Helen Farrell, MD is from the course Major Psychiatric Disorders. It contains the following chapters:

    • Prognostic Factors
    • Behavioral Therapy Treatment
    • Other Syndromes of Psychosis

    Included Quiz Questions

    1. Early onset.
    2. Female sex.
    3. Family support.
    4. Presence of hallucinations.
    5. Good premorbid functioning.
    1. Brain fag
    2. Amok
    3. Capgras
    4. Cotard
    5. Koro
    1. Fregoli’s syndrome
    2. Cotard syndrome
    3. Lycanthropy
    4. Folie a deux
    5. Capgras syndrome

    Author of lecture Schizophrenia: Treatment

     Helen Farrell, MD

    Helen Farrell, MD


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