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Aims
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  1. Aims • Overview of schizophrenia • Focus on the Role of the GP • Understand its Holistic Management

  2. General Information Poorly understood Disorder of basic psychological functions Multiple psychological processes affected No single feature is diagnostic

  3. Epidemiology 1% of population will develop schizophrenia Annual incidence 1-5 / 10000 population Onset 15 – 45 years Males = female

  4. Aetiology • Genetic • Structural • Biochemical • Perinatal

  5. Positive Symptoms Delusions Hallucinations Thought disorder Catatonia Inappropriate affect

  6. Negative Symptoms • Affective blunting • Poverty of thought • Apathy • Anhedonia / asociality • Attentional impairment

  7. Diagnosis of Schizophrenia • Auditory hallucinations • Specific delusions (incl thought disorder) • Other symptoms

  8. Acute Presentation Appearance normal, deranged, unkempt Mood incongruity, blunted affect, depression, anxiety Speech reflects an underlying thought disorder Thought pressure of thought, poverty of thought etc Loosening of association Suicidal / Homicidal Thoughts Auditory Hallucinations Delusions persecutory, about thought withdrawal Concentration impaired Insight impaired

  9. Managing Acute Psychosis Early Referral - psych liaison - IHTT - psychiatry • 1st presentations = all need psych assessment • Care & Crisis Plan • Clearly defined roles for all teams • Role of GP-initiated anti-psychotics

  10. Long-Term Management • Physical & Mental Health • Addictions • Monitor any drug side-effects • Coordinate care (holistic approach) • Re-referral if concerned

  11. Re-referral to Secondary Care • poor treatment response • non-adherence to medication • intolerable side effects from medication • substance misuse • risk to the person or others

  12. Other Therapies • ECT • CBT • Arts & Family therapies • Tx of depression • Patient education

  13. Prognosis of Schizophrenia • Full recovery is unusual • Gradual deterioration expected • 10% risk of suicide • Relapses expected

  14. Summary • If acutely psychotic = refer • GP has a central role in management • Multidisciplinary approach vital