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llms.txtPsychiatry LLM catalogSitemap

Psych TopicsGeneral adult psychiatry — psychotic disorders

Psych · General adult psychiatry — psychotic disorders

Schizophrenia spectrum and other psychotic disorders

Also known as Schizophrenia · First-episode psychosis · Treatment-resistant schizophrenia · Schizoaffective disorder · Delusional disorder · Psychotic disorders · FEP · TRS

Exam-exhaustive fellowship reference on the schizophrenia spectrum — DSM-5-TR and ICD-11 definitions; symptom domains; epidemiology and risks; dopamine hypothesis; differentials; FEP work-up; antipsychotics with landmark trials; early intervention; LAIs; TRRIP and clozapine; psychosocial care; suicide and mortality; RANZCP/NICE/APA guidance. FRANZCP-primary, globally tagged.

high20 referencesUpdated 25 July 202619 min readVerification in progress

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Target exams

FRANZCPMRCPsychABPNMD-DNBNEET-SS

Red flags

  • New psychosis with fever, rigidity or fluctuating attention — exclude NMS, encephalitis and delirium before locking a primary psychiatric label
  • First-episode psychosis after age 40, or focal neurology, seizure or rapid cognitive decline — intensified organic work-up including neuroimaging and autoimmune consideration
  • Active suicidal intent or command hallucinations to harm — same-day senior review, means restriction, documented safety plan; do not discharge to an empty plan
  • Treatment resistance after two adequate antipsychotic trials — do not delay clozapine
  • Clozapine patient with fever, chest pain or tachycardia in the first month — stop and investigate myocarditis as an emergency
  • Clozapine patient with constipation, distension or vomiting — treat as potential life-threatening ileus
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Your progress

Saved on this device.

Practise this topic10 MCQs with explanations

Target exams

FRANZCPMRCPsychABPNMD-DNBNEET-SS

Red flags

  • New psychosis with fever, rigidity or fluctuating attention — exclude NMS, encephalitis and delirium before locking a primary psychiatric label
  • First-episode psychosis after age 40, or focal neurology, seizure or rapid cognitive decline — intensified organic work-up including neuroimaging and autoimmune consideration
  • Active suicidal intent or command hallucinations to harm — same-day senior review, means restriction, documented safety plan; do not discharge to an empty plan
  • Treatment resistance after two adequate antipsychotic trials — do not delay clozapine
  • Clozapine patient with fever, chest pain or tachycardia in the first month — stop and investigate myocarditis as an emergency
  • Clozapine patient with constipation, distension or vomiting — treat as potential life-threatening ileus
The one-line answer

Schizophrenia is an operational diagnosis with a formulation attached — catch it early, give two adequate antipsychotic trials and then clozapine, deliver psychosocial care as treatment rather than garnish, and monitor the body as hard as the mind. Suicide and cardiometabolic disease, not the voices, are what kill these patients.[4][13][16][17]

Meet the patient

A 21-year-old engineering student is brought in by his mother. Eight months ago he stopped going to tutorials. Four months ago he stopped washing. Last week he told her the lecture recordings are being edited to humiliate him, and that he can hear two men discussing his marks.[15][12]

He has smoked high-potency cannabis daily since 17. He is not agitated. He is polite, flat, and utterly certain.[15]

The registrar's instinct is to name the drug. The examiner's question is harder: "How long has he been unwell, and what has that cost him?" Eight months of untreated psychosis is the single most modifiable prognostic variable in the room.[15][12]

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References20ShowHide
  1. [1]Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia N Engl J Med, 2005.PMID 16172203
  2. [2]Jones PB, Barnes TR, Davies L, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1) Arch Gen Psychiatry, 2006.PMID 17015810
  3. [3]Kahn RS, Fleischhacker WW, Boter H, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial Lancet, 2008.PMID 18374841
  4. [4]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
  5. [5]Leucht S, Cipriani A, Spineli L, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis Lancet, 2013.PMID 23810019
  6. [6]Kane JM, Honigfeld G, Singer J, et al. Clozapine in treatment-resistant schizophrenics Psychopharmacol Bull, 1988.PMID 3290950
  7. [7]Howes OD, Kapur S The dopamine hypothesis of schizophrenia: version III--the final common pathway Schizophr Bull, 2009.PMID 19325164
  8. [8]Tiihonen J, Lönnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study) Lancet, 2009.PMID 19595447
  9. [9]Bertelsen M, Jeppesen P, Petersen L, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial Arch Gen Psychiatry, 2008.PMID 18606949
  10. [10]Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT) Arch Gen Psychiatry, 2003.PMID 12511175
  11. [11]Leucht S, Leucht C, Huhn M, et al. Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors Am J Psychiatry, 2017.PMID 28541090
  12. [12]Correll CU, Galling B, Pawar A, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression JAMA Psychiatry, 2018.PMID 29800949
  13. [13]Howes OD, McCutcheon R, Agid O, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology Am J Psychiatry, 2017.PMID 27919182
  14. [14]Petersen L, Nordentoft M, Jeppesen P, et al. Improving 1-year outcome in first-episode psychosis: OPUS trial Br J Psychiatry Suppl, 2005.PMID 16055817
  15. [15]Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review Arch Gen Psychiatry, 2005.PMID 16143729
  16. [16]Palmer BA, Pankratz VS, Bostwick JM The lifetime risk of suicide in schizophrenia: a reexamination Arch Gen Psychiatry, 2005.PMID 15753237
  17. [17]Saha S, Chant D, McGrath J A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry, 2007.PMID 17909124
  18. [18]Siskind D, Siskind V, Kisely S Clozapine Response Rates among People with Treatment-Resistant Schizophrenia: Data from a Systematic Review and Meta-Analysis Can J Psychiatry, 2017.PMID 28655284
  19. [19]Bighelli I, Rodolico A, García-Mieres H, et al. Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis Lancet Psychiatry, 2021.PMID 34653393
  20. [20]Davis JM, Chen N, Glick ID A meta-analysis of the efficacy of second-generation antipsychotics Arch Gen Psychiatry, 2003.PMID 12796218

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