Psychotic and Bipolar Disorders: Schizophrenia

Schizophrenia is the most common psychotic illness, typically appearing between the late teenage years and the mid-30s. The first episode of psychosis may be preceded by a prodromal period. Schizophrenia symptoms fall into six common symptom clusters: delusions and hallucinations, disorganization of speech, cognitive dysfunction, negative symptoms, affective symptoms, and motor system abnormalities. The diagnosis is based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, including exclusion of other possible medical or psychiatric etiologies of psychosis. The main goals during the initial evaluation of a patient with suspected schizophrenia are to rule out secondary etiologies of symptoms and to assess for significant comorbid conditions, balancing broad screening tests with the exclusion of specific disorders suggested by the presentation and history. After the initial evaluation, antipsychotic drug treatment should be initiated and consideration given to psychosocial treatments in conjunction with pharmacotherapy. Comanagement of the patient by a mental health subspecialist and a family physician is important to ensure appropriate screening, diagnosis, and management of common associated conditions.