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In terms of global prevalence, (lifetime) it is between 14 and 55 people for every 10 000. For one year it is between 33 and 34 people for every 10 000. In South Africa we have a prevalence of 100 diagnoses for every 10 000 people.
DSM-5 criteria for schizophrenia
Schizophrenia models are grouped into three categories:
- Developmental
- Drug-induced
- Genetic.
Positive symptoms include delusions, hallucinations and thought disorders. Negative symptoms are anhedonia, avolition, social withdrawal, poverty of thought, and cognitive dysfunction.
The following are determinants of good outcomes in patients:
- Longer symptom duration
- Later age of onset
- Higher total PANNS score
- Greater positive symptoms
- Fewer negative symptoms
- Higher general psychopathology scores
- Lower scores on HamD
- Positive employment status
- Independent living.
METABOLIC MANAGEMENT
The overall incidence of metabolic problems is three times greater in people with schizophrenia. It is critical to manage the metabolic problems, cardiovascular risk, dyslipidaemias, hypertension, diabetes, weight gain, iron deficiencies and
vitamin deficiencies.
PRODROMAL SYMPTOMS
Patients show marked social isolation or withdrawal, impairment in role functioning, markedly peculiar behaviour and impairment in personal hygiene and grooming.
They come across as blunted or inappropriate and can be digressive, vague, using elaborate or circumstantial speech, or poverty of speech, or poverty of content of speech. They have odd beliefs or ‘magical’ thinking or unusual perceptual experiences. There is a marked lack of initiative, interests, or energy.
TREATMENT
Patients need early intervention to prevent any further relapses (as we would treat patients with myocardial infarctions). Ensure compliance to treatment.
THE ROLE OF THE DOCTOR
The role of the doctor is to manage the schizophrenia, compliance to the treatment plan, the use of long-acting injectables. The first six months after a psychotic episode is crucial, make sure to manage this well. Doctors must also manage the metabolic consequences of the disorder and the treatment as well as substance use and suicide risk.
