Q. A 35 year old lady is diagnosed to have schizophrenia. Her doctor
starts her on traditional antipsychotics. The patient reports back to the clinic after two
weeks. The husband is disappointed and says that "she has taken her medicines
regularly but there is no improvement in her condition". On questioning, the
physician finds that she has not developed any new signs or symptoms. What should be the
next line of management?
a. Reassure the patient
b. Change the medicine
c. Add an atypical antipsychotic
d. Think of an different diagnosis
e. Order an MRI of the brain with Gadolinium
The answer is.(a) For treatment of schizophrenia start low dose antipsychotic. Do not increase the dose or change medicine for 4-6 weeks, unless unsatisfactory side effects or extra pyramidal symptoms develop that are not amenable to treatment . Most Patients respond in 2-6 weeks.
Q. A 35 year old schizophrenic lady shows poor grooming. For the past few months she has
started working in the night shift to avoid contact with people. Her family informs that
she was indifferent to the news of her father’s death. Her social and professional
relations are deteriorating consistently. She does not show any other neurological signs
and symptoms. Which of the following antipsychotic drugs would be most appropriate for
her?
a. Chlorpromazine
b. Haloperidol
c. Loxapine
d. Clozapine
e.Thioridazine
The answer is (d) This patient is showing negative symptoms- deficit of
some normal function or missing from normal behavior. Negative Symptoms include
flat affect, thought blocking, poor grooming, cognitive disturbances, social withdrawal,
lack of motivation, impoverished speech content. These symptoms respond
better to atypical antipsychotics than to traditional antipsychotic. Atypical
antipsychotics are -clozapine, olanzapine, risperidone, ziprasidone, Quetiapine,
Sertindole etc.
Positive symptoms are sensations/activities occuring in addition to normal expected sensation/behavior e.g. delusions, hallucinatiosn, agitation & talkativeness.