Assessment and management of schizophrenia

This article looks at the clinical assessment and management of individuals suffering from schizophrenia. It covers the aetiology, risk factors and clinical features of psychosis, in this case schizophrenia. Different tools and scales used to make a diagnosis of schizophrenia are also covered. Newly qualified doctors working in most specialties, but especially in a psychiatric setting, are likely to be faced with individuals experiencing symptoms of this illness. Suicide is a major risk associated with patients diagnosed with schizophrenia and there are identifiable factors which may increase or decrease this risk. These require good interview skills, clarification of current and past problems and symptoms, co-morbidity, family history and dynamics and premorbid functioning. Management includes a biopsychosocial approach and is tailored to the patient’s needs. An acute illness requires prompt action to reduce the risk that may be posed to the patient or others, as well as introduction of an early management plan to reduce long-term disability and improve prognosis, as suggested by various studies. It has been suggested that up to a quarter of first episode patients might make a complete recovery, while 50% recover after several relapses and 25% go on to develop the chronic form of the illness. The chronic illness requires regular follow-up, such as the care programme approach, which is the involvement of a multidisciplinary team in the care of the individual, with an allocated key worker.