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Schizophrenia for USMLE Step 2 / COMLEX-USA Level 2

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Schizophrenia
  • Symptoms:
    • Positive Symptoms: Hallucinations (predominantly auditory), delusions, disorganized speech.
    • Negative Symptoms: Apathy, flat affect, anhedonia, social withdrawal.
    • Cognitive Symptoms: Impaired executive functions, attention, and memory.
schizophrenia diagnostic criteria
  • Management:
    • Pharmacological: First-line treatment includes atypical antipsychotics (e.g., risperidone, olanzapine).
    • Psychotherapy: Cognitive-behavioral therapy, supportive therapy.
    • Social Intervention: Community support, rehabilitation programs.
Schizophreniform Disorder
    • Duration: Symptoms similar to schizophrenia but last from 1 to 6 months.
    • Treatment: Similar to schizophrenia, often with the aim of preventing progression to schizophrenia.
Brief Psychotic Disorder
    • Characteristics: Sudden onset of psychotic symptoms that last less than a month, often triggered by extreme stress.
    • Management: Short-term antipsychotics and psychotherapy, focusing on stress management and resolution of the acute episode.
Schizoaffective Disorder
  • Diagnosis: Concurrent presence of schizophrenia symptoms and a mood disorder (depressive or bipolar type).
  • Treatment:
    • Antipsychotics: Core treatment for psychotic symptoms.
    • Mood Stabilizers or Antidepressants: Depending on the mood disorder component.
Delusional Disorder
    • Features: Non-bizarre delusions (e.g., being followed, poisoned) lasting at least 1 month.
    • Treatment: Challenging; antipsychotics can be used, often with limited effectiveness. Psychotherapy may help manage distress.
Shared Psychotic Disorder (Folie à Deux)
    • Concept: Psychotic symptoms, particularly delusions, shared between two closely associated individuals.
    • Management: Separation from the primary case often necessary, alongside individual therapy and possibly antipsychotics.
Treatment Considerations
    • Medication Adherence: Major challenge in long-term management, requiring regular monitoring and possibly the use of long-acting injectables.
    • Side Effects: Management of side effects like weight gain, metabolic syndrome, extrapyramidal symptoms, and tardive dyskinesia is critical for compliance.
    • Psychoeducation: Educating patients and families about the disorder and its management to enhance adherence and coping strategies.
See the following tutorial for details on Antipsychotics.
High-Yield Items for Step 2
1. Diagnosis and Differential: Ability to distinguish between various psychotic disorders based on duration, symptom type, and presence of mood symptoms. 2. Pharmacological Management: Knowledge of first-line and adjunctive treatments, including side effects and indications for use. 3. Psychotherapy and Supportive Treatments: Role of non-pharmacological interventions in managing chronic psychiatric conditions. 4. Legal and Ethical Issues: Handling issues like consent, involuntary treatment, and confidentiality in patients with severe mental illness.

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