Schizophrenia for the American Board of Psychiatry & Neurology (ABPN) Exam

• Diagnostic Criteria:
• Persistent presence of two or more core symptoms: hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, negative symptoms.
• Significant social or occupational dysfunction.
• Duration of symptoms for at least 6 months.

• Treatment:
• First-line Pharmacotherapy: Atypical antipsychotics (e.g., risperidone, olanzapine).
• Psychosocial Interventions: Cognitive behavioral therapy, supported employment, skills training.
• Management of Treatment-Resistant Cases: Clozapine for refractory schizophrenia.

• Characteristics:
• Symptoms identical to schizophrenia but duration of an episode is at least 1 month but less than 6 months.
• Treatment:
• Similar to schizophrenia, with an emphasis on early intervention and assessment for possible transition to schizophrenia.

• Features:
• Sudden onset of psychosis lasting more than 1 day and resolving by 1 month.
• Often occurs in response to extreme stress.
• Management:
• Short-term antipsychotics and psychotherapy focusing on stress management.

• Diagnosis:
• Concomitant presence of a mood disorder (major depressive or bipolar disorder) and psychotic symptoms.
• Psychotic symptoms must also occur outside the episodes of mood disturbance.
• Treatment:
• Combines treatment strategies for both schizophrenia and mood disorders, including mood stabilizers or antidepressants along with antipsychotics.

• Features:
• The presence of one or more delusions for at least 1 month.
• Functioning is not markedly impaired, and behavior is not obviously bizarre or odd outside of delusions.
• Treatment:
• Antipsychotics are selectively used based on symptom severity; psychotherapy is often beneficial.

• Description:
• Delusions shared between two closely associated individuals.
• Treatment involves separation of the pair and individual treatment with antipsychotics and psychotherapy.

• Long-term Management: Includes monitoring for side effects of antipsychotics, such as metabolic syndrome, EPS (extrapyramidal symptoms), and tardive dyskinesia. See the following tutorial for details on Antipsychotics.
• Adherence Issues: Address through patient education, use of long-acting injectables, and involvement of family in treatment planning.

• Exclusion of Organic Causes: Ruling out substance-induced psychotic disorders and general medical conditions.
• Distinction from Mood Disorders: Differentiating primary psychotic disorders from mood disorders with psychotic features based on the timing and context of symptoms.

• Involuntary Treatment: Understanding the legal criteria and ethical considerations for involuntary hospitalization and treatment.
• Capacity and Consent: Evaluating decision-making capacity in patients with severe psychiatric disorders.

1. Diagnosis and Differential Diagnosis: Mastery of diagnostic criteria and ability to distinguish among various psychotic disorders. 2. Pharmacological Treatments: Detailed knowledge of antipsychotic drug classes, mechanisms, side effects, and indications. 3. Management of Acute and Chronic Phases: Strategies for managing acute psychotic episodes and maintaining stability in the long term. 4. Psychotherapy and Rehabilitation: Role of psychosocial interventions in improving outcomes in psychotic disorders.