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Schizophrenia for USMLE Step 3 / COMLEX-USA Level 3

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Schizophrenia
  • Symptoms:
    • Positive Symptoms: Hallucinations, delusions, disorganized speech.
    • Negative Symptoms: Apathy, flat affect, social withdrawal, lack of motivation.
    • Cognitive Symptoms: Impaired executive function, attention, and working memory.
schizophrenia diagnostic criteria
  • Management:
    • Pharmacological: Atypical antipsychotics (e.g., risperidone, olanzapine) are preferred due to fewer side effects.
    • Long-term Management: Monitoring for metabolic syndrome, ensuring adherence to treatment.
    • Psychosocial: Supported employment, cognitive-behavioral therapy, family therapy.
Schizophreniform Disorder
    • Duration: Symptoms last from 1 to 6 months.
    • Management: Similar to schizophrenia with a focus on short-term treatment and assessing for possible progression to schizophrenia.
Brief Psychotic Disorder
    • Characteristics: Sudden onset of symptoms, resolution within a month.
    • Management: Often stress-related; support and short-term antipsychotic treatment may be needed.
Schizoaffective Disorder
  • Diagnosis: Features of both schizophrenia and a mood disorder (depressive or bipolar).
  • Management:
    • Medication: Combination of antipsychotics and mood stabilizers or antidepressants.
    • Continuous Monitoring: For mood swings and psychotic symptoms.
Delusional Disorder
  • Features: Persistent delusions with relatively preserved psychosocial functioning.
  • Management:
    • Antipsychotics: Can be helpful, especially if symptoms are distressing.
    • Psychotherapy: Particularly important for insight and coping.
Shared Psychotic Disorder (Folie à Deux)
    • Concept: Delusional beliefs shared between two closely related individuals.
    • Management: Treatment of the primary case and separate treatment for the secondary person, often including psychotherapy and education.
Treatment Considerations
    • Medication Adherence: Challenges with compliance are common; consider long-acting injectable formulations.
    • Side Effects Management: Important to monitor and manage, particularly with long-term antipsychotic use (e.g., metabolic effects, extrapyramidal symptoms).
    • Legal and Ethical Issues: Competency, involuntary commitment, and treatment decisions, especially in acutely psychotic patients.
High-Yield Items for Step 3
1. Clinical Decision Making: Tailoring treatment plans based on individual patient needs, including choices between oral and injectable medications. 2. Crisis Management: Handling acute psychotic episodes, potential violence, or suicidal ideation. 3. Interprofessional Collaboration: Coordinating care with mental health specialists, social workers, and family members. 4. Long-Term Management: Monitoring chronic medication use, managing side effects, and providing psychosocial support.

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