Schizophrenia for the American Board of Internal Medicine (ABIM) Exam
Schizophrenia
- Symptoms:
- Positive Symptoms: Hallucinations (mostly auditory), delusions, and disorganized thinking.
- Negative Symptoms: Apathy, flat affect, anhedonia, and social withdrawal.
- Cognitive Symptoms: Impairments in attention, executive function, and working memory.
- Management:
- Pharmacological: Atypical antipsychotics (e.g., risperidone, olanzapine) are first-line due to efficacy and a more favorable side effect profile.
- Supportive Care: Psychoeducation, psychosocial interventions, and rehabilitation services.
Schizophreniform Disorder
- Duration: Symptomatic presentation similar to schizophrenia but lasting less than 6 months.
- Treatment: Similar pharmacological and supportive treatments as schizophrenia, with careful monitoring for possible progression to schizophrenia.
Brief Psychotic Disorder
- Characteristics: Acute onset of psychotic symptoms that last less than 1 month, often triggered by severe stress.
- Management: Short-term use of antipsychotics and supportive psychotherapy, with an emphasis on stress management.
Schizoaffective Disorder
- Diagnosis: Concurrent symptoms of schizophrenia and significant mood disturbances (depressive or manic).
- Treatment:
- Antipsychotics: Core treatment for psychotic symptoms.
- Mood Stabilizers/Antidepressants: Depending on the mood component, often used concurrently with antipsychotics.
Delusional Disorder
- Symptoms: Persistent delusions without other major psychotic symptoms, with relatively intact cognitive functions and affect.
- Management: Treatment is challenging; antipsychotics may be used, but therapeutic alliance and psychotherapy are crucial due to patients often not recognizing their illness.
Shared Psychotic Disorder (Folie à Deux)
- Description: Psychotic symptoms, particularly delusions, shared between two closely related individuals.
- Management: Addressing the primary case is crucial; both individuals may require separate treatment with antipsychotics and psychotherapy.
Important Considerations for Internists
- Comorbidity Management: Recognizing and managing comorbid conditions such as diabetes, cardiovascular disease, and substance abuse, which are more common in patients with schizophrenia.
- Metabolic Syndrome: Monitoring and managing weight gain, dyslipidemia, and hyperglycemia associated with antipsychotic use.
- Coordination of Care: Collaborating with psychiatrists, psychologists, social workers, and family members to provide comprehensive care.
- Long-Term Monitoring: Regular assessments to monitor the efficacy and side effects of treatment, and to adjust treatment plans as needed.
High-Yield Topics for ABIM