Schizophrenia - Revision history

Danbot: Remove incorrect AntibioticDose entries (Quinine/Clotrimazole were wrong drugs from corrupted page data - should have been Risperidone/Clozapine)

2026-03-20T12:13:43Z

Remove incorrect AntibioticDose entries (Quinine/Clotrimazole were wrong drugs from corrupted page data - should have been Risperidone/Clozapine)

← Older revision		Revision as of 12:13, 20 March 2026
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	{{General ED Psychiatric Management}}		{{General ED Psychiatric Management}}


	~~===Antibiotic Dosing===~~
	~~====Adult====~~
	*{{AntibioticDose\|drug=Quinine\|dose=<65 yo, 1st episode; 1-3 mg/day PO divided qd/bid; Max: 16mg/day; <65 yo, maintenance; 1-4 mg/day PO divided qd/bid; 65+ yo; 1-4 mg/day PO divided qd/bid; Doses >4 mg/day rarely more effective\|context=Schizophrenia\|disease=Schizophrenia\|population=Adult}}
	*{{AntibioticDose\|drug=Clotrimazole\|dose=150-300mg PO BID; start: 12.5mg PO QD-bid, increase by 25-50mg/day to target 300-450mg/day in divided doses by day 14; then may increase by up to 100mg/day q3-7days;; max 900mg/day; retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d; taper dose over 1-2 weeks to DC\|context=Schizophrenia, resistant\|disease=Schizophrenia\|population=Adult}}
	*{{AntibioticDose\|drug=Clotrimazole\|dose=150-300mg PO BID; start, increase, retitrate, and DC as above\|context=Suicide prevention, schizophrenia-associated\|disease=Schizophrenia\|population=Adult}}
	~~====Pediatric====~~
	*{{AntibioticDose\|drug=Quinine\|dose=1-6 mg/day PO divided qd/bid\|context=Schizophrenia\|disease=Schizophrenia\|population=Pediatric}}

	==Disposition==		==Disposition==

Danbot: Add Quinine and Clotrimazole AntibioticDose entries

2026-03-20T11:00:54Z

Add Quinine and Clotrimazole AntibioticDose entries

← Older revision		Revision as of 11:00, 20 March 2026
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	==Management==		==Management==
	{{General ED Psychiatric Management}}		{{General ED Psychiatric Management}}


			===Antibiotic Dosing===
			====Adult====
			*{{AntibioticDose\|drug=Quinine\|dose=<65 yo, 1st episode; 1-3 mg/day PO divided qd/bid; Max: 16mg/day; <65 yo, maintenance; 1-4 mg/day PO divided qd/bid; 65+ yo; 1-4 mg/day PO divided qd/bid; Doses >4 mg/day rarely more effective\|context=Schizophrenia\|disease=Schizophrenia\|population=Adult}}
			*{{AntibioticDose\|drug=Clotrimazole\|dose=150-300mg PO BID; start: 12.5mg PO QD-bid, increase by 25-50mg/day to target 300-450mg/day in divided doses by day 14; then may increase by up to 100mg/day q3-7days;; max 900mg/day; retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d; taper dose over 1-2 weeks to DC\|context=Schizophrenia, resistant\|disease=Schizophrenia\|population=Adult}}
			*{{AntibioticDose\|drug=Clotrimazole\|dose=150-300mg PO BID; start, increase, retitrate, and DC as above\|context=Suicide prevention, schizophrenia-associated\|disease=Schizophrenia\|population=Adult}}
			====Pediatric====
			*{{AntibioticDose\|drug=Quinine\|dose=1-6 mg/day PO divided qd/bid\|context=Schizophrenia\|disease=Schizophrenia\|population=Pediatric}}

	==Disposition==		==Disposition==

ClaireLewis at 15:00, 11 October 2019

2019-10-11T15:00:55Z

← Older revision		Revision as of 15:00, 11 October 2019
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	**Family history of suicide		**Family history of suicide
	**Prior attempt		**Prior attempt
			*Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms to psychiatric disorder when etiology is in fact organic)
			**Patients with schizophrenia have significantly higher rates of stroke<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333</ref>, CAD<ref>Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333. </ref>, DM<ref>Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.
			</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV<ref>Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.</ref>
			**All cause mortality rate is 200-250% higher for patients with schizophrenia than general population<ref>https://www.who.int/mental_health/management/info_sheet.pdf</ref>

	==Clinical Features==		==Clinical Features==
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Psychiatric Disorders with Psychotic Symptoms DDX}}		{{Psychiatric Disorders with Psychotic Symptoms DDX}}
			*[[Depression]]/mood disorder

	===Organic Causes===		===Organic Causes===
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	*[[Encephalitis]]		*[[Encephalitis]]
	*[[Thyroid (Main)]]		*[[Thyroid (Main)]]
	*Toxin ingestion		*[[Toxicology (main)\|Toxin ingestion]]
	*Medication effect		*Medication effect

	~~===Nonorganic Causes===~~		*See [[altered mental status]]
	*~~Mood Disorder~~

	==Evaluation==		==Evaluation==
	Rule out other organic causes including substance abuse, medication effect or other medical conditions. Consider emergency psychiatric evaluation in addition to medical evaluation.		*Rule out other organic causes including substance abuse, medication effect or other medical conditions
			*Consider whether acute medical condition may be exacerbating psych symptoms
			*Consider emergency psychiatric evaluation in addition to medical evaluation.

	{{General ED Psychiatric Workup}}		{{General ED Psychiatric Workup}}

Kxl328: /* Background */

2018-09-30T21:36:22Z

Background

← Older revision		Revision as of 21:36, 30 September 2018
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	==Background==		==Background==
	*A heterogeneous clinical syndrome characterized by a constellation of signs and symptoms associated with impaired occupational or social functioning involving a range of cognitive, behavioral, and emotional dysfunctions		*A heterogeneous clinical syndrome characterized by a constellation of signs and symptoms associated with impaired occupational or social functioning involving a range of cognitive, behavioral, and emotional dysfunctions
	*Suicide risk is higher in<ref>K Hor and M Taylor. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010 Nov; 24(4_supplement): 81–90.</ref>		*Suicide risk is higher in<ref>K Hor and M Taylor. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010 Nov; 24(4_supplement): 81–90.</ref>:
	**Males < 30 years of age		**Males < 30 years of age
	**Earlier in course of schizophrenia		**Earlier in course of schizophrenia

Kxl328: /* Background */

2018-09-30T21:36:06Z

Background

← Older revision		Revision as of 21:36, 30 September 2018
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	==Background==		==Background==
	A heterogeneous clinical syndrome characterized by a constellation of signs and symptoms associated with impaired occupational or social functioning involving a range of cognitive, behavioral, and emotional dysfunctions		*A heterogeneous clinical syndrome characterized by a constellation of signs and symptoms associated with impaired occupational or social functioning involving a range of cognitive, behavioral, and emotional dysfunctions
			*Suicide risk is higher in<ref>K Hor and M Taylor. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010 Nov; 24(4_supplement): 81–90.</ref>
			**Males < 30 years of age
			**Earlier in course of schizophrenia
			**Higher IQ, higher achiever as teen or young adult
			**More insight and higher executive functioning
			**Presence of depression, hopelessness, anxiety, insomnia, etc
			**Substance abuse, alcohol
			**Family history of suicide
			**Prior attempt

	==Clinical Features==		==Clinical Features==

Humanguy: Added acute psychosis and schizophreniform d/o to see also section

2016-11-11T01:21:02Z

Added acute psychosis and schizophreniform d/o to see also section

← Older revision		Revision as of 01:21, 11 November 2016
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	==See Also==		==See Also==
			*[[Acute psychosis]]
			*[[Schizophreniform disorder]]
	*[[Meningitis]]		*[[Meningitis]]
	*[[Encephalitis]]		*[[Encephalitis]]

Humanguy: Linked Criteria D to schizoaffective disorder page

2016-11-11T01:11:11Z

Linked Criteria D to schizoaffective disorder page

← Older revision		Revision as of 01:11, 11 November 2016
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	*B. For a significant portion of the time since the onset 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 (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).		*B. For a significant portion of the time since the onset 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 (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 months. This 6-month period must include at least 1 month of symptoms (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 negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).		*C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (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 negative symptoms or by two or more symptoms listed in 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 have been ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently with 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 duration of the active and residual periods of the illness.		*D. [[Schizoaffective disorder]] and depressive or bipolar disorder with psychotic features have been ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently with 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 duration of the active and residual periods of the illness.
	*E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.		*E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
	*F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent 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)		*F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent 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)

Humanguy: Added medication effect to differential

2016-11-11T01:07:58Z

Added medication effect to differential

← Older revision		Revision as of 01:07, 11 November 2016
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	*[[Encephalitis]]		*[[Encephalitis]]
	*[[Thyroid (Main)]]		*[[Thyroid (Main)]]
	*~~Tox Ingestions~~		*Toxin ingestion
			*Medication effect

	===Nonorganic Causes===		===Nonorganic Causes===

Humanguy: Removed schizoaffective disoder from nonorganic causes (added to psych d/o with psychotic symptoms)

2016-11-11T01:01:55Z

Removed schizoaffective disoder from nonorganic causes (added to psych d/o with psychotic symptoms)

← Older revision		Revision as of 01:01, 11 November 2016
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	===Nonorganic Causes===		===Nonorganic Causes===
	*[[Schizoaffective disorder]]
	*Mood Disorder		*Mood Disorder

Humanguy: Deleted "psyc eval" and added new dispo choices

2016-11-10T22:30:39Z

Deleted "psyc eval" and added new dispo choices

← Older revision		Revision as of 22:30, 10 November 2016
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	==Disposition==		==Disposition==
	*~~Psyc Eval~~		*Home with outpatient psychiatric services if stable, versus inpatient psychiatric admission if unstable

	==See Also==		==See Also==