The diagnosis of schizophrenia is based on the following criteria:
- Two (or more) of the following symptoms must be present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these symptoms must include (i), (ii), or (iii):
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
- Impaired functioning in one or more major areas, such as work, interpersonal relations, or self-care, for a significant portion of the time since the onset of symptoms
- Symptoms persist for at least 6 months.
- Schizoaffective disorder, depressive disorder or bipolar disorder with psychotic features have been ruled out.
- The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
There are also special considerations for making the diagnosis of schizophrenia in individuals that have prior diagnoses of childhood developmental disorders such as autism spectrum disorders.
Treatment of Schizophrenia
The treatment of schizophrenia has three key aims: (a) symptomatic control, (b) maintenance of physical well-being, (c) minimization of disability. Antipsychotic medication is currently the most effective intervention for symptom control and relapse prevention. Psychological treatments can be used at any point to improve patients’ coping skills or cognitive function. Maintenance of physical well-being requires vigilance, advice about diet and healthy lifestyle choices and regular (at least annually) general medical examination and investigation. A recovery approach using behavioral and vocational interventions can assist patients in re-engaging with social roles thus reducing disability.
Antipsychotic medications, for first and second generation, work by reducing excess dopamine neurotransmission thought to underpin positive psychotic symptoms. Examples of commonly used antipsychotics are shown below:
|First generation antipsychotics (FGA)||Second generation antipsychotics (SGA)|
It is generally agreed that there is little difference in efficacy between antipsychotics. However, individual patients may respond better to some antipsychotics and not to others. Like in all other fields of medicine, there is no medication that is totally free of side-effects. First and second generation antipsychotics vary mostly with respect to side-effects. The most common side-effects of first generation antipsychotics are muscle rigidity and endocrine problems related to menstruation in women and sexual dysfunction in women and men. For second generation antipsychotics the most common side-effects are weight gain and abnormalities in blood sugar and lipids. Both types of medication may lead to drowsiness, increased heart rate and reduced blood pressure particularly at the beginning of treatment. In most cases it is possible to find acceptable solutions should these problems occur. Side-effects can be minimized by judicious treatment choice and dosing and regular monitoring.
Psychosocial interventions for Schizophrenia
There is a variety of psychosocial interventions ranging from basic support with housing and finances to more structured and targeted therapies. Those that have been proven to be effective include:
- Medication Management: This can be offered in a variety of formats to promote adherence.
- Cognitive Behavioral Therapy: Structured sessions to develop strategies for coping with distressing symptoms.
- Cognitive Remediation: Structured sessions involving mental exercises that help improve brain function.
- Psychoeducation: Psychoeducation consists of structured sessions that provide information about the symptoms of schizophrenia and help promote acceptance and problem solving; it can be offered in individual or group settings and usually involves both the patient and their family.
Mount Sinai’s Schizophrenia Services
The Mount Sinai Department of Psychiatry offers comprehensive, multidisciplinary treatment for schizophrenia and psychotic disorders through services such as the following:
- Outpatient Psychiatric Department Clinic: Our clinic provides a range of treatment options, including psychotherapy and medication management.
- Inpatient Psychiatric Service: Our inpatient care includes services such as individual psychopharmacology and individual and group psychotherapy for a range of mental illnesses.
- Psychiatric Emergency Room: Our dedicated psychiatric ER provides immediate evaluation and stabilization for patients in crisis.