| Popis: |
Schizophrenia onset usually happens during early adulthood. The illness often includes positive symptoms (delusions, hallucinations), negative symptoms (social withdrawal, avolition), and a disorganized thought process. Currently there are no definitive tests or biomarkers for schizophrenia, so the medical workup should focus on excluding neurologic, metabolic, infectious, autoimmune, and other causes of psychosis. Brain imaging is not routinely performed. The most important goals of the emergency department evaluation are to assess for safety and to engage the patient in treatment. Framing the treatment plan around the patient’s own goals can facilitate engagement. Antipsychotic medication usually improves positive symptoms. Medication selection is based on the side-effect profile; olanzapine is not recommended for patients with a first episode of psychosis due to high rates of metabolic side effects. While not all patients will want to discuss the diagnosis, clinicians should be prepared for this conversation, especially if it will facilitate engagement. |
