Schizophrenia – American haldol injection dosage Family Physician

Schizophrenia is the most common psychotic disease, with a global prevalence of less than 1%. It affects all ethnicities and is slightly more common in haldol injection dosage men. Patients with schizophrenia commonly experience debilitating social and occupational impairments, but some are able to function well with proper treatment. Symptom onset is generally between late adolescence and the mid-30s. There are two categories of symptoms: positive and negative. Hallucinations, delusions, and disorganized speech are examples of positive symptoms, whereas decreased emotional expression and lack of motivation are negative haldol injection dosage symptoms. Antipsychotic medications can treat some symptoms of schizophrenia but are haldol injection dosage associated with multiple adverse effects, including extrapyramidal symptoms and metabolic changes. Patients receiving antipsychotic medications, especially second-generation (or atypical) antipsychotics, should be monitored regularly for metabolic changes and cardiovascular risk haldol injection dosage factors. Persons with schizophrenia who undergo psychosocial therapy in addition to haldol injection dosage medical therapy have better outcomes. Patients diagnosed with schizophrenia have a higher overall mortality rate haldol injection dosage than the general public, partly because of the increased suicide risk associated with schizophrenia.

Schizophrenia is a pervasive, chronic mental disorder with a global prevalence of 0.3% to 0.7%. 1 although there is no significant difference between sexes, a slight predominance is noted in men. 1 , 2 schizophrenia affects persons in all ethnicities. However, a recent study confirmed that in the united states, blacks are diagnosed with schizophrenia at a disproportionately higher rate haldol injection dosage compared with non-hispanic whites. 3 this finding could point to a racial or ethnic haldol injection dosage bias in the diagnosis of schizophrenia in black persons who haldol injection dosage present with psychosis. 3

B. For a significant portion of the time since the onset haldol injection dosage of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset haldol injection dosage (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)

C. Continuous signs of the disturbance persist for at least 6 haldol injection dosage months. This 6-month period must include at least 1 month of symptoms haldol injection dosage (or less if successfully treated) that meet criterion A (i.E., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only haldol injection dosage negative symptoms or by two or more symptoms listed in haldol injection dosage criterion A present in an attenuated form (e.G., odd beliefs, unusual perceptual experiences)

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features haldol injection dosage have been ruled out because either: (1) no major depressive or manic episodes have occurred concurrently with haldol injection dosage the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total haldol injection dosage duration of the active and residual periods of the illness

F. If there is a history of autism spectrum disorder or haldol injection dosage a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent haldol injection dosage delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated)

B. For a significant portion of the time since the onset haldol injection dosage of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset haldol injection dosage (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)

C. Continuous signs of the disturbance persist for at least 6 haldol injection dosage months. This 6-month period must include at least 1 month of symptoms haldol injection dosage (or less if successfully treated) that meet criterion A (i.E., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only haldol injection dosage negative symptoms or by two or more symptoms listed in haldol injection dosage criterion A present in an attenuated form (e.G., odd beliefs, unusual perceptual experiences)

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features haldol injection dosage have been ruled out because either: (1) no major depressive or manic episodes have occurred concurrently with haldol injection dosage the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total haldol injection dosage duration of the active and residual periods of the illness

F. If there is a history of autism spectrum disorder or haldol injection dosage a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent haldol injection dosage delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated)

Patients diagnosed with psychosis, schizophrenia, or both should be urgently referred for psychiatric evaluation. 8 not all patients with acute psychosis require hospitalization, but it should be considered for those who may pose haldol injection dosage a danger to themselves or others. 4 the most effective treatment for schizophrenia is a multidisciplinary haldol injection dosage approach including medication, psychological treatment, and social support. 5 , 9 – 11 the goal of treatment is remission, which is defined as a period of six months with haldol injection dosage no symptoms or mild symptoms that do not interfere with haldol injection dosage a person’s behaviors. 12 ANTIPSYCHOTICS

Antipsychotic agents are the first-line treatment for patients with schizophrenia. There are two general types of antipsychotic drugs: first-generation (typical) and second-generation (atypical) agents. Table 3 lists commonly used antipsychotic drugs, their adverse effects, typical dosages, and price. 11 , 13 – 21 multiple guidelines recommend starting antipsychotic medications as soon as haldol injection dosage possible after psychotic symptoms are recognized and/or the patient is diagnosed with schizophrenia. 8 , 10 , 11 , 13 , 21 , 22 the national institute for health and care excellence suggests haldol injection dosage urgent referral to mental health services when a person presents haldol injection dosage with psychotic symptoms, and recommends that primary care physicians initiate antipsychotic medications only haldol injection dosage in consultation with a psychiatrist ( table 4). 8 initial medication choice should be individualized, taking into account financial considerations, adverse effect profiles, dosing regimens, and patient preferences.

Antipsychotic medications are more effective than placebo in reducing overall haldol injection dosage symptoms of schizophrenia and preventing relapse. 13 – 15 patients with schizophrenia who are receiving antipsychotic drugs report haldol injection dosage a better quality of life, but have a higher incidence of weight gain, sedation, and movement disorders. 15 as such, all patients who report symptom relief while receiving medication should haldol injection dosage be offered maintenance therapy with antipsychotics. 11 A patient’s response to treatment during the first two to four haldol injection dosage weeks is highly predictive of long-term response, although it may take several months to achieve maximal effect. 17 patients should be given an adequate trial of therapy haldol injection dosage (at least four weeks at a therapeutic dose) before discontinuing the drug or transitioning to a different medication. 22

Studies have shown that there is no difference in effectiveness haldol injection dosage between first- and second-generation antipsychotics. 23 , 24 quality of life is also similar at one year haldol injection dosage between groups of patients treated with each drug class. 23 the main difference between these medications is their adverse haldol injection dosage effect profiles; first-generation antipsychotics most commonly cause extrapyramidal symptoms, whereas second-generation agents most commonly cause weight gain and metabolic changes. 22 , 25 – 27 adverse reactions and previous response to antipsychotic medications should haldol injection dosage be taken into account when deciding which class of medication haldol injection dosage to initiate. ADVERSE EFFECTS AND MONITORING

Extrapyramidal symptoms such as pseudoparkinsonism, akathisia (a sensation of inner restlessness and inability to be still), and dystonia are associated with first-generation antipsychotics. Patients receiving these medications should be routinely monitored for adverse haldol injection dosage effects and maintained on the lowest effective dose that controls haldol injection dosage their symptoms. Medications such as propranolol, lorazepam (ativan), amantadine, benztropine, and diphenhydramine (benadryl) are used to treat extrapyramidal symptoms. 25 tardive dyskinesia involving facial muscles generally occurs after the haldol injection dosage patient has been taking antipsychotic medications for a prolonged time. Symptoms include puffing of the cheeks, protrusion of the tongue, chewing motions, and pursing of the lips. The condition is typically irreversible, but symptoms may lessen after the medication is discontinued. Laboratory monitoring is not necessary for patients receiving first-generation antipsychotics. Patients receiving the second-generation antipsychotic clozapine (clozaril) are at high risk of agranulocytosis, and the package insert recommends a complete blood count weekly haldol injection dosage for six months, then every two weeks for an additional six months, then monthly. Clozapine is reserved for patients with severe refractory symptoms because haldol injection dosage of its increased risk of adverse effects; it should be prescribed only by a psychiatrist. 11

The most worrisome adverse effects associated with second-generation antipsychotics are metabolic changes, such as weight gain, insulin resistance, hyperglycemia, and lipid abnormalities. 15 , 25 , 27 , 28 all second-generation antipsychotics confer varying degrees of risk for metabolic changes, 28 and these effects are not dose-dependent. 29 weight gain is usually rapid in the first few haldol injection dosage weeks of treatment, then plateaus; however, this can take a year or more to occur. 27 therefore, patients should be examined frequently after initiating treatment with second-generation antipsychotics, and at least annually if they have normal baseline values. Patients with cardiovascular risk factors require more frequent monitoring. 28 , 30 table 5 outlines the recommended frequency of monitoring for haldol injection dosage patients receiving second-generation antipsychotics. 28 , 30 primary care physicians should regularly assess body mass index, fasting glucose levels, and lipid profiles, and work toward minimizing these and other cardiovascular risk factors. 8 , 30 , 31

In addition to medication, patients with schizophrenia should be offered adjunctive therapies such as haldol injection dosage cognitive behavior therapy, family interventions, and social skills training. 8 – 10 , 13 cognitive behavior therapy is the most commonly used adjunctive haldol injection dosage therapy, but a cochrane review found no clear evidence that it haldol injection dosage is superior to other talking therapies, although it may be helpful in dealing with emotions and haldol injection dosage distressing feelings. 32 A chinese study found that psychosocial treatment combined with haldol injection dosage medication improved treatment adherence, insight, and quality of life, and decreased hospital admissions. 9 patients receiving combined treatment were less likely to discontinue haldol injection dosage their medication or to relapse (absolute risk reduction = 14% and 8%; number needed to treat = 7 and 12, respectively).

There is a higher incidence of anxiety disorders, panic symptoms, posttraumatic stress disorder, and obsessive compulsive disorder in patients with schizophrenia compared with haldol injection dosage the general public. 33 medications such as selective serotonin reuptake inhibitors and anxiolytics haldol injection dosage can be helpful in treating comorbid mood disorders in these haldol injection dosage patients, but do not treat the symptoms of schizophrenia. 34

Patients with schizophrenia have a varied clinical course that may haldol injection dosage include remission, exacerbations, or a more persistent chronic illness. Among patients who remain ill despite therapy, some have a stable clinical course, whereas others experience worsening symptoms and functioning. Factors that predict the clinical course and prognosis of these haldol injection dosage patients are not understood, and there is no reliable way to predict outcomes. Approximately 20% of patients can be expected to have a positive outcome. 1

Suicide is a concern when treating patients with schizophrenia. The risk of suicide is 13 times greater in persons haldol injection dosage diagnosed with schizophrenia compared with the general public, with a lifetime risk of about 5%. 1 , 4 , 35 patients with auditory hallucinations, delusions, substance abuse, or a history of suicide attempts are at higher risk. Adequate treatment of schizophrenia and its comorbidities, along with diligent screening for risk factors, reduces the likelihood of suicide. 35 the overall mortality rate for patients with schizophrenia is haldol injection dosage two to three times higher than that of the general haldol injection dosage public. 1 , 36 most deaths are related to an increased rate of haldol injection dosage cardiovascular and respiratory diseases, stroke, cancer, and thromboembolic events. 36

In the past, schizophrenia was viewed as a disease with a poor prognosis. Currently, the disease course and response to treatment are marked by haldol injection dosage heterogeneity; differences in treatment response, disease course, and prognosis are to be expected. 5 , 12 despite adequate treatment, one-third of patients will remain symptomatic. Although most patients need some form of support, most are able to live independently and actively participate in haldol injection dosage their lives. 5

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