Chronic psychotic disorder with positive, negative and cognitive symptoms present for ≥6 months (≥1 month of active symptoms).
Clinical features
- • Auditory hallucinations, delusions
- • Thought insertion/withdrawal/broadcast
- • Disorganised speech and behaviour
- • Negative: blunted affect, avolition, alogia
Investigations
- • Exclude organic cause: drug screen, FBC, U&E, LFT, TFT, HIV, syphilis, MRI brain if atypical
- • Baseline metabolic profile and ECG before antipsychotics
Management
- • Oral atypical antipsychotic titrated over 4–6 weeks
- • CBT for psychosis and family intervention
- • Depot if adherence poor
- • Clozapine after two failed adequate trials
- • Physical health monitoring annually
Complications
- • Metabolic syndrome
- • Suicide (≈5% lifetime)
- • Tardive dyskinesia
- • Neuroleptic malignant syndrome
Clinical pearls
- • Duration of untreated psychosis predicts outcome — refer early to early-intervention services
Related in WardRound
Educational — verify locally.
