Summary: General Psychiatry

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• 2 Schizophrenia

• 2.1 Schizophrenia and OCD

• Biological similarities between Schizophrenia and OCD

  1. the prefrontal and anterior cingulate cortex, caudate nucleus and thalamus have been been consistently implicated in both disorders,
  
  2. Cortico-Striato- Thalamic-Cortical loops
  
  2. dopamine and serotonin neurotransmitter systems.

• Core difference between Schizophrenia and OCD

  Obsessions in OCD are (ego-dystonic),
  delusions in schizophrenia are  (ego-syntonic).
  
  Compulsions in OCD are performed to reduce anxiety
  repetitive behaviors in schizo result from delusional beliefs / hallucinations.

• Causes of OC Symptoms in Schizophrenia

  1. Both disorders basically revolves around Cortico-Striato- Thalamic- Cortical loops
  
  2. Medication side effect
  SGA esp clozapine/olanzapine blocks D2 targeting psychotic symptom, but they also block serotonin receptor 5HT2A/2C which potentially  causing or worsening OC symptoms.

• Treatment for OCD induce Antipsychotic in Schizophrenia

  1. Wait and watch - some OC symptom may be transient in nature esp during dose titration of medication
  2. Reduce the dose of Antipsychotic, though risk of psychotic relapse is there
  3. Add on SSRI such as sertraline or escitalopram (fluvox - not preferred because of potential D2D interaction
  4. Augmentation strategy - Memantine .  Aripiprazole

• 2.2 Schizophrenia and Suicide

• How high is the risk of Suicide in Schizophrenia compared to general population

  20 times higher

• Risk factors for suicide in Schizophrenia

  Illness Factor
  Affective component
  Psychotic symptoms
  Treatment Adherence
  Insight paradox
  
  Patient Factor
  early onset
  Male sex
  Higher IQ and Educational level
  
  Social Factor
  Childhood trauma
  unemployment, living alone, single
  experiencing major losses
  Comorbid physical illnesse & Substance use disorders

• Pharmacological Approach to counter suicidality in Schizophrenia

  clozapine stands out as the most effective option for reducing suicidal behavior. Research suggests it can cut suicidality by up to 80%, with noticeable benefits often appearing after about two years of treatment.
  
    • Long-Acting Injectable Antipsychotics (LAIs): Switching from oral medication to LAIs can cut the risk of suicide death by 47%

• 2.3 Social Skill Training for Schizophrenia

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• Basis of Social Skill Training

   social learning theory
  people learn new behaviors by observing and imitating others (bandura) 
  focused upon : 
  - the improvement of social interaction
  -social performance
  -interpersonal skills.

• What are the steps of Social Skill Training in Schizophrenia

  1) client to understand the importance to learn the skill.
  2) To demonstrate (model) the skill in a role play.
  3) To engage the client in a role play
  4) Involves providing feedback to the client and suggestions for improvement.
  5) The client is encouraged to practice on his or her own.

• Skill training in SST

  Conducting skills training with family members present
  ▪ Improve family communication and problem solving
  ▪ This can reduce stress inducing situations.
  ▪ Practicality at home
  
  . Training patients in a group
  ▪ sessions are 45 to 90 minutes, meet 1-5 times per week.
  ▪ provide an opportunity for self-help and peer support,
  ▪ participants can learn from each other’s real-life experiences and efforts at problem solving.