| Aspect | Positive Symptoms | Negative Symptoms |
|---|---|---|
| Definition | Excess or distortion of normal functions | Absence or diminution of normal functions |
| Main Types | Delusions, hallucinations, disorganized speech/behavior | Flat affect, social withdrawal, avolition |
| Response to Treatment | Usually respond to typical antipsychotics | Improve with atypical antipsychotics |
| Impact on Function | Dramatic, acute episodes | Gradual, chronic deterioration |
| Prognosis | Better response to treatment | More resistant to treatment |
| Subtype | Main Features | Delusions/Hallucinations | Disorganization | Social/Occupational Impact | Prognosis |
|---|---|---|---|---|---|
| Disorganized | All symptoms present | Bizarre, fragmented, unsystematized | Grossly disorganized speech/behavior | Marked deterioration | Poor |
| Paranoid | Preoccupation with delusions/hallucinations | Prominent and systematic | Minimal | Less deterioration | Best |
| Catatonic | Catatonic features dominate | Present but not prominent | Motor disturbances | Profound deterioration | Variable |
| Undifferentiated | Intermediate form | Less than paranoid type | Less than disorganized type | Intermediate deterioration | Intermediate |
| Residual | Partial improvement | Minimal | Minimal | Less deterioration | Better |
| Simple | Only negative symptoms | None (no positive symptoms) | Minimal | Very gradual but profound | Worst |
| Factor | Males | Females | General Population |
|---|---|---|---|
| Lifetime Prevalence | 1% | 1% | 1% |
| Peak Age of Onset | 15-25 years | 25-33 years | 15-35 years |
| Gender Ratio | Equal prevalence | Equal prevalence | 1:1 |
| Socioeconomic Status | Higher in lower SES | Higher in lower SES | More prevalent in lower SES |
| Environmental Factors | Immigration, urbanization | Immigration, urbanization | High density population |
| Aspect | Typical Antipsychotics | Atypical Antipsychotics |
|---|---|---|
| Mechanism | D2 receptor antagonists | Dopamine-serotonin antagonists/partial agonists |
| Examples | Haloperidol, Chlorpromazine, Trifluoperazine | Clozapine, Risperidone, Olanzapine |
| Efficacy | 60-70% response for positive symptoms | Effective for both positive and negative symptoms |
| Side Effects | High extrapyramidal side effects | Lower extrapyramidal side effects |
| Target Symptoms | Positive symptoms mainly | Both positive and negative symptoms |
| Cost | Generally less expensive | More expensive |
| Side Effect Category | Typical Antipsychotics | Atypical Antipsychotics |
|---|---|---|
| Extrapyramidal | High risk (dystonia, parkinsonism, akathisia, tardive dyskinesia) | Low risk |
| Metabolic | Weight gain, minimal diabetes risk | Significant weight gain, diabetes risk (especially clozapine/olanzapine) |
| Cardiovascular | Orthostatic hypotension, arrhythmias | Less common |
| Hematological | Rare | Agranulocytosis risk with clozapine |
| Endocrine | Hyperprolactinemia | Less hyperprolactinemia |
| Cognitive | Anticholinergic effects | Minimal cognitive impairment |
| Side Effect | Frequency | Onset | Treatment | Severity |
|---|---|---|---|---|
| Acute Dystonia | 10% of cases | After single dose | Anticholinergics, antihistamines, benzodiazepines | Emergency |
| Parkinsonism | 15% of cases | Gradual | Oral anticholinergics | Moderate |
| Akathisia | Variable | Any time | Reduce dose, propranolol, benzodiazepines | Emergency |
| Tardive Dyskinesia | After prolonged use | Months to years | Stop drug, switch to atypicals | Serious |
| Neuroleptic Malignant Syndrome | Rare | Any time | Stop drug, supportive care, bromocriptine | Emergency |
| Aspect | High Potency | Low Potency |
|---|---|---|
| Examples | Haloperidol, Trifluoperazine | Chlorpromazine |
| Dose Required | Lower doses | Higher doses |
| Extrapyramidal Effects | Higher risk | Lower risk |
| Sedation | Less sedating | More sedating |
| Anticholinergic Effects | Lower | Higher |
| Orthostatic Hypotension | Lower risk | Higher risk |
| Drug | Mechanism | Strengths | Major Side Effects | Special Considerations |
|---|---|---|---|---|
| Clozapine | 5-HT2/D2 antagonist | Most effective for treatment-resistant cases | Agranulocytosis, weight gain, diabetes | Requires regular blood monitoring |
| Risperidone | 5-HT2/D2 antagonist | Good efficacy, available as depot | Hyperprolactinemia, weight gain | Available as long-acting injection |
| Olanzapine | 5-HT2/D2 antagonist | Good for negative symptoms | Significant weight gain, diabetes | High metabolic risk |
| Quetiapine | 5-HT2/D2 antagonist | Good for mood symptoms | Sedation, weight gain | Available as XR formulation |
| Aripiprazole | Partial D2 agonist | Low side effect profile | Akathisia, insomnia | Non-sedating, no weight gain |
| Treatment Type | Indications | Effectiveness | Duration | Considerations |
|---|---|---|---|---|
| Typical Antipsychotics | Positive symptoms | 60-70% response | Ongoing | High side effects |
| Atypical Antipsychotics | Positive and negative symptoms | Higher response rate | Ongoing | Lower side effects, higher cost |
| Psychotherapy | All types (behavioral, cognitive, supportive) | Adjunctive benefit | Ongoing | Tailored to patient condition |
| ECT | Treatment-resistant, acute cases, catatonia | 4-8 sessions up to 16 | 2-3 sessions/week | For specific indications |
| Hospitalization | Safety, compliance, acute episodes | Variable | As needed | For observation and stabilization |
| Outcome Category | Percentage | Characteristics | Treatment Response |
|---|---|---|---|
| Good Prognosis | 30% | Lead normal life | Good compliance, minimal symptoms |
| Moderate Prognosis | 30% | Moderate symptoms with variable adaptation | Partial response to treatment |
| Poor Prognosis | 40% | Significantly impaired | Usually due to non-compliance |
| Factor | Good Prognosis | Poor Prognosis |
|---|---|---|
| Onset | Acute onset | Insidious onset |
| Age of Onset | Later onset | Earlier onset |
| Premorbid Functioning | Good social/occupational function | Poor premorbid functioning |
| Subtype | Paranoid type | Simple, disorganized types |
| Compliance | Good medication compliance | Poor compliance |
| Family Support | Strong family support | Poor family support |
| Substance Use | No substance abuse | Comorbid substance abuse |
| Disorder | Duration | Main Features | Mood Symptoms | Treatment |
|---|---|---|---|---|
| Schizophrenia | At least 6 months | Delusions, hallucinations, disorganized speech/behavior | Minimal | Antipsychotics + psychotherapy |
| Schizoaffective | Variable | Schizophrenia + mood symptoms | Prominent mood symptoms | Antipsychotics + mood stabilizers |
| Schizophreniform | 1-6 months | Same as schizophrenia | Minimal | Antipsychotics |
| Brief Psychotic | 1 day to 1 month | Sudden onset, acute symptoms | Variable | Antipsychotics (short-term) |
| Delusional Disorder | At least 1 month | Delusions without other symptoms | Minimal | Antipsychotics |
| Pathway | Normal Function | Effect of Blockade | Clinical Consequence |
|---|---|---|---|
| Mesolimbic | Emotional regulation | Reduced positive symptoms | Therapeutic effect |
| Mesocortical | Executive functions | May worsen negative symptoms | Side effect |
| Nigrostriatal | Motor control | Extrapyramidal symptoms | Side effect |
| Tuberoinfundibular | Prolactin regulation | Hyperprolactinemia | Side effect |
| Emergency | Presentation | Immediate Treatment | Long-term Management |
|---|---|---|---|
| Acute Dystonia | Muscle spasms, oculogyric crisis | Anticholinergics IV/IM | Reduce dose or switch medication |
| Neuroleptic Malignant Syndrome | Fever, rigidity, altered consciousness | Stop antipsychotic, supportive care | Avoid high-potency antipsychotics |
| Akathisia | Severe restlessness | Reduce dose, propranolol | Switch to atypical antipsychotic |
| Suicidal Behavior | Self-harm ideation/attempts | Hospitalization, close monitoring | Comprehensive treatment plan |
| Aggressive Behavior | Violence toward others | Rapid tranquilization | Mood stabilizers, environmental modifications |
| Medication | Baseline Tests | Regular Monitoring | Frequency | Red Flags |
|---|---|---|---|---|
| Clozapine | CBC, liver function | CBC, glucose, lipids | Weekly for 6 months, then monthly | WBC < 3000, ANC < 1500 |
| Olanzapine | Weight, glucose, lipids | Weight, glucose, lipids | Monthly for 3 months, then quarterly | Significant weight gain, diabetes |
| Typical Antipsychotics | Baseline neurological exam | Movement disorders assessment | Monthly initially, then quarterly | Tardive dyskinesia signs |
| All Antipsychotics | Vital signs, ECG | Vital signs, prolactin | As clinically indicated | QT prolongation, hyperprolactinemia |
These comprehensive comparison tables cover all major aspects of schizophrenia and psychotic disorders from your lecture, making it easier to study and understand the key differences and similarities between various aspects of these conditions.