Schizophrenia acute psychotic episode

Two studies have directly addressed the question of lithium s specificity for mania or affective psychosis, as it is sometimes called. In one of these studies a group of 78 patients admitted with an acute psychotic episode diagnosed as mania, schizophrenia or schizoaffective disorder were randomised to receive lithium or chlorpromazine. The authors hypothesised that patients diagnosed as manic would respond better to lithium and those diagnosed with schizophrenia would respond better to chlorpromazine. In contrast they found that there was no difference in the effects of the different drugs on people with different diagnostic labels and that the only discernible effect was the inferiority of lithium in severely disturbed patients (Braden et al. 1982). A similar study published in 1988 claimed to show that lithium had specificity for... 

Evidence indicates that the long-term outcome for a patient with schizophrenia is better when treatment of the acute episode is initiated rapidly. After a patient s first psychotic episode, treatment with the antipsychotic medication should be continued for at least 1 year after a full remission of psychotic symptoms. A trial period without medication may then be considered, except for patients with a history of serious suicide attempts or violent aggressive behavior... 

Although schizophrenia is the commonest and best known psychotic illness, it is not synonymous with psychosis but is just one of many causes of psychosis. Schizophrenia affects 1% of the population, and in the United States there are over 300,000 acute schizophrenic episodes annually. Between 25 and 50% of schizophrenia patients attempt suicide, and 10% eventually succeed, contributing to a mortality rate eight times as high as that of the general population. In the United States over 20% of all Social Security benefit days are used for the care of schizophrenic patients. The direct and indirect costs of schizophrenia in the United States alone are estimated to be in the tens of billions of dollars every year. 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

The key to distinguishing schizophrenia from a psychotic mood disorder is to obtain a history of the patient prior to the acute episode of psychosis. This includes both the past history from medical and psychiatric records and collateral history... 

Bipolar mania (ora only) - For the treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features. Schizophrenia - For the treatment of schizophrenia. 

Schizoaffective (SA) disorder is characterized by both psychotic and mood symptoms, with patients meeting the inclusion diagnostic criteria for acute schizophrenia and a major mood disorder. They should also have had a period during the episode of at least 2 weeks when psychotic symptoms predominate in the relative absence of mood symptoms. In addition, mood symptoms should be present for a substantial portion of an episode. This disorder can be further divided into SA-bipolar or SA-depressed subtypes. Although this disorder is not well understood, it has been considered as ... 

The hypoglutamatergic hypothesis of schizophrenia is attractive because it is consistent with the lack of changes in Da number in schizophrenia, and the increases in dopamine release in schizophrenia. They are also consistent with the ability of the noncompetitive NMDA antagonists PCP and ketamine to induce behaviors reminiscent of the positive symptoms of schizophrenia in normals and precipitate these episodes in patients. Ketamine was administered to schizophrenic patients acutely in a blinded, placebo-controlled trial (31). The drug caused a dose-related initiation of positive psychotic symptoms that were not blocked by haloperidol. The patients... 

Antipsychotic drugs commonly have been used empirically to manage manic and psychotic illness in bipolar disorder patients. Indeed, standard neuroleptics are a mainstay of the treatment of acute mania (only chlorpromazine is FDA-approved for this indication, although haloperidol has also been widely used) and for manic episodes that break through prophylactic treatment with LF or an anticonvulsant. However, the older antipsychotics are not used routinely for long-term prophylactic treatment in bipolar disorder because their effectiveness is untested, some may worsen depression, and the risk of tardive dyskinesia in these syndromes may be higher than in schizophrenia. 

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