Review Question - QID 107069

The dominant schizophrenic symptom in this male is disorganization of thought and speech. Therefore, the subtype is disorganized schizophrenia.

Schizophrenia is a chronic disorder marked by periods of psychosis and disturbed behavior with a decline in function lasting > 6 months. It requires 2 or more positive symptoms (delusions, hallucinations, disorganized speech, or disorganized/catatonic behavior) or negative symptoms (flat affect, social withdrawal, lack of motivations, speech or thought) for the diagnosis. There are five subtypes (see incorrect answers for explanations): paranoid, disorganized, catatonic, undifferentiated, and residual. The subtypes are defined by the most dominant symptoms such as in this case, disorganized thought process and speech, which would classify this as disorganized schizophrenia.

Schultz et al. discuss the typical presentation of schizophrenia which can be abrupt or insidious. Patients typically develop the symptoms gradually such as social withdrawal, flat affect, loss of interest in their careers or school, and unusual behavior - to name a few. Many people will see this behavior as a phase but once the psychosis begins, it is then that family members or close friends become worried.

Freedman review the specific medications used in the treatment of schizophrenia. There are the first generation antipsychotics such as chlorpromazine and haloperidol, that function by blocking dopamine 2 (D2) receptors. Side effects include Parkinson's disease related symptoms such as: dystonia, akathisia, bradykinesia, and tremor. Second generation medications have less side effects, block less of the D2 receptor, and have other mechanisms of actions besides dopamine antagonism. The medications include clozapine, olanzapine, quetipine, riperidone, aripiprazole, and ziprasidone.

Incorrect Answers:
Answer 1: Paranoid schizophrenia's dominant symptom is the hallucinations and delusions.
Answer 3: Catatonic schizophrenia's dominant symptoms is the disturbance in movement where they may have extreme increases or decreases in activity.
Answer 4: Undifferentiated schizophrenia does not have any dominant symptoms but has elements of all types and may actually fluctuate between them.
Answer 5: The residual subtype is when the patient, at the time of evaluation, no longer has extreme psychosis and the symptoms are lessened significantly including the hallucinations and delusions.