Schizophrenia: The bio, the psycho, and the social

Armin Moradi

2021-06-23

This presentation
Before we begin
The Bio
The Bio
The Bio
The Bio
The Bio
The Psycho
And the Social
Summary
Cheers!

This presentation

Available at amoradi.org/public/schizo_tx.html

Before we begin

The Bio

meds

The Bio

any antipsychotic
tolerability
minimum 4-6 weeks

According to the guidelines, there is no difference between the antipsychotics, in terms of efficacy. There is no real difference between antipsychotic classes either. So, in an exam, you can literally pick any antipsychotic and you'd be right, be it from the first or second generation. That's partly why every center has a preferred antipsychotic, like saskatoon using haloperidol whereas here we use olanzapine in ER.

Tolerance and discontinuation is the name of the game. choose whichever antipsychotic has the best side effect profile, and don't be shy about switching when one is clearly not tolerated.

You should see some benefit after 2 weeks, and >20% symptom response in 4-6 weeks. If not, consider optimizing the dose or switching. Optimize means at least 6 weeks of mid-range therapeutic dose and make sure they are compliant and not using substances.

The Bio

first episode: for 18 months
relapse: 2-5 years

The Bio

TRS -> clozapine
CRS -> nuthin!

The Bio

wtf? 30-60%?

The Psycho

Family therapy
Supported employment
CBT
Cognitive remediation
Social skills training
Life skills training
Psychoeducation

This is a list of things you can do. Family therapy includes the family and supports them in dealing with the patient, it seems to be mostly for the family and their interaction with the pt. It does improve outcomes though. Supported employment programs also improve outcomes. CBT you'd use for persistent symptoms, helps them deal with those symptoms that don't go away with medication, needs them to be doing fairly well, though, otherwise you can imagine it won't go well. Cognitive remediation therapy can somewhat help with memory, attention, and problem solving, there is also some evidence that the improvements persist on follow up. Social skills are good for patients who have difficulty in social settings, making friends, partying it up! It's essentially a guide on how to party! Life skills are good for patients who have difficulty managing their day to day activities. Psychoeducation doesn't change outcomes, but practically can create a better therapeutic alliance and improve adherence, so it's good.

And the Social

ACT
ICM
Case management
Acute care setting

The guidelines mostly focused on case management. ACT is the highest level of case management, 1:10 staff:patient ratio, sometimes 24/7 staff on call. Then intensive case management, 1:20 staff:patient ratio, and then normal case management. The guidelines have exact numbers on how many percent of the population should these services cover, but I feel that's more relevant to people up above, not us lowly trainees. Not sure about exams, though. Early psychosis intervention programs also must be available on an urgent basis, and should accept all new diagnosis regardless of age. Makes sense since the median age of onset in males is 21 and females 27, so there is a fair proportion of people who are diagnosed at 35+. They should be eligible for EPI as well.

Supported housing was also mentioned briefly and should be available.

The equivalent would be a combination of case management, coast team, and EPI.

Summary

bio: antipsychotic, 4-6w, 18m, 2-5y, clozapine
psycho: family, employment, CBT, social/life skills
social: EPI, case management, supported housing

Schizophrenia: The bio, the psycho, and the social

Armin Moradi

2021-06-23

Table of Contents

This presentation

Before we begin

The Bio

The Bio

The Bio

The Bio

The Bio

The Psycho

And the Social

Summary

Cheers!