Rural Emergency Medicine

This is part of the Med in Small Doses series, which aims to give you a snapshot of a disease or disorder. For information about the series, or common abbreviations click here.

International Prev. 0.5-1.0%. M = F. Males have worse outcomes. 

CFs: A useful mnemonic is HD N CD. Think High Definition And CD.
H: hallucinations
D: delusions

N: Negative symptoms (flat affect, social withdrawal, poverty of speech)

C: catatonic or grossly disorganized behavior
D: Disorganized speech

  • Hallucinations
  • Delusions
  • Disorganised behaviour
  • Thought disorder
  • Catatonia
  • Social withdrawal
  • Emotional flattening
  • Anhedonia
  • Reluctance to perform everyday tasks
PATHOGenetic Factors (accounts for ~80%) & Environmental Factors play a role.
Cortex – atrophy, larger ventricles &temporal lobe volume
Limbic systemsize of amygdala, hippocampus and parahippocampal gyrus.
More marked on left side.
Thalamus volume

Dx Criteria:
  • Psychotic symptoms for over a month 
  • Impaired psychosocial function 
  • Continuous signs of illness for over 6 months 
  • Not explained by prominent mood disorder

Tx: Long-term planning & Family Education are important aspects.
Antipsychotics - Typical (e.g. Haloperidol & Flupenthixol) & Atypical (e.g. Clozapine & Risperidone)
Mood stabilisers (e.g. Lithium - 'Gold Standard'; or Clozapine)  & Psychosocial therapy

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