A form of mental illness which is characterised by loss of contact with reality, hallucination, delusions, abnormal thinking, flattened effect, and disturbed work and social function, occurring in a setting of clear consciousness memory and orientation.

Clinical Features

Withdrawal Generalised loss of interest in the environment. Thought disorder. Normal association of ideas is lost. Incongruency of affect is characteristic. Delusions. Hallucinations in any sensory modality. Disturbances in behaviour and motor function e.g. grimacing, odd postures, etc. History from patient and relatives is most important. Continuous signs of illness should be present for 6 months at some point in patient's life, with some signs at the time of diagnosis.

Management - General

• Psychological and Social.

Use psychiatric community nurses and social workers in involving family to understand the illness and helping the family in rehabilitation of the patient into community activities. Importance of drug compliance should be explained to relatives and patients.

Management - Pharmacologic

• Severely disturbed patient - admit;

- give chlorpromazine 100-200 mg IM and then start on oral chlorpromazine 100- 200 mg TDS OR haloperidol 5-10 mg TDS

• Mildly disturbed patient:

- manage as outpatient;

- give chlorpromazine 100 mg TDS OR haloperidol 5 mg TDS. If patient was diagnosed as a schizophrenic and missed his drugs, restart the drug as before

• Maintenance therapy, chlorpromazine 100-200 mg TDS OR haloperidol 5-10 mg TDS

• Onset of extra pyramidal side effects: reduce dose and start on benzhexol 2.5-5 mg TDS

• For patients who are not dependable about taking oral drug, depot preparations are available;

- fluphenazine decanoate 25 mg IM monthly

- haloperidol decanoate 50 mg IM monthly

- clopenthixol decanoate 200 mg IM monthly

- flupenthixol decanoate 40 mg IM monthly.

Caution: Aim to use lowest dose that is therapeutic in cases of long term use to minimize risk of side effects.

Refer If

• Poor compliance

• Inadequate dosage/therapeutic treatment up to 6 weeks

• Misdiagnosis.

Admit

• If patient is severely disturbed, violent or catatonic.

Patient Education

• Compliance to therapy is important to prevent relapses

• Relatives should bring the patient to the hospital at early signs of relapse

• Drugs may have to be taken for a long time depending on response.