Summary of NICE Guidance for First-Episode Schizophrenia > A complete assessment is mandatory before starting treatment For people with first-episode psychosis offer: ●        oral antipsychotic medication with ●        psychological interventions (family intervention and individual CBT.) Advise people who want to try psychological interventions alone that these therapies are more effective when delivered with antipsychotic medication. If the person still wants to try psychological interventions alone: offer family intervention and CBT agree a time (1 month or less) to review treatment options, including introducing antipsychotic medication     continue to monitor symptoms, distress, impairment, and level of functioning (including education, training, and employment) regularly. It is also mandatory to assess and monitor the physical health of the patients before commencing antipsychotics and during treatment. Especially Weight, BMI Blood pressure and pulse Serum li

Causes of Poor Response to Treatment in Patients with Schizophrenia There can be several reasons for poor response to treatment in schizophrenia and may be related to illness, patient and their environment, treatment or clinician. Patients started on treatment at a relatively later stage in the course of their illness and/or patients having slow onset schizophrenia respond poorly to treatment. Likewise, disorganised/hebephrenic schizophrenia carries a poor prognosis. Poor compliance, subtherapeutic doses and (sometimes) plasma concentrations may also be reasons for inadequate response, just as comorbid substance or alcohol abuse is. Patients who use medications periodically, upon worsening, become less likely to respond to treatment.  Related to the Illness Slow onset schizophrenia  Hebephrenic subtype Predominantly negative symptoms Related to the Patients and their Environment Comorbid substance/alcohol use Poor compliance with treatment High-expressed emotions (positive

Verbigeration Verbigeration is the monotonous repetition of syllables and words,  like perseveration--in which a person repeats words in response to a stimulus. However, verbigeration occurs when a person repeats words without a stimulus.  It is an extreme form of loosening of associations.    We observe it in organic disorders.

Age Disorientation in Schizophrenia Age-disoriented patients are cognitively more impaired than their age-oriented counterparts. Whether the cognitive impairment is present to a greater degree premorbid among these patients, studies have not yet established this, but some data support this. Others have reported that rated school performance and grade-level do not distinguish age-disoriented from age-oriented subjects. Some have suggested that marked cognitive decline occurs following the first break.  Harvey et al. reported that age-related decline in mini-mental state examination scores is dramatically greater among age-disoriented schizophrenia patients than age-oriented subjects, consistent with more rapid deterioration. Examination of the specific PANSS items revealed that the age-disoriented group was consistently more delusional and more conceptually disorganized and showed increased stereotyped thinking, motor retardation, unusual thought content, disorientation, and poor attent

Criminal behavior, lack of guilt, and irritability are typical features of antisocial personality disorder. Evidence suggests that a low-activity variant of the MAO-A gene predisposes to adult antisocial behavior in men, especially in those who faced early adversity 1–4 . Catechol-O-methyltransferase enzyme metabolizes dopamine and other monoamines. Its gene, the COMT-gene, occurs in two forms: a high-activity form and a low-activity form. They associate these variants with differential abilities of the prefrontal cortex, especially working memory. People with low-activity form may have a more efficient prefrontal cortex, likely because of the greater dopamine level in the synaptic space 5,6 . We have associated serotonin transporter gene variants with neuroticism and a predisposition to depression. The variants may also influence individual response to SSRIs8. APOE4 gene is a risk factor for Alzheimer’s disease (compared to APOE2 and APOE3).

GB-PTV G ingko Biloba B enzodiazepines P ropranolol T etrabenazine V itamine E

What are the components and principles of management of schizophrenia ?  Answer: MENOMONIC -> CONFIATE CBT , c ognitive remediation, c lozapine, c risis resolution teams. O utreach teams  N eeds assessment  F amily intervention I ntegrated treatment for comorbid substance abuse A ntipsychotics T herapeutic realtionship  E arly intervention