Clinical Management of the Schizophrenic Patient (Drug and Other Therapies)

1. Overview & Management Framework

Schizophrenia management is lifelong and biopsychosocial: antipsychotic pharmacotherapy is necessary but not sufficient — it must be combined with psychoeducation, family work, and psychosocial rehabilitation.

• Lifetime completed-suicide rate ~10–13% (≈20× the general population); 20–50% attempt. Always ask about suicidal thoughts. (Gajdos lecture)
• Patients are far more often victims of crime than perpetrators — a point the lecture stresses against stigma.
• Goals: control acute symptoms → prevent relapse → restore functioning → keep a good therapeutic alliance.
• Treatment phases: (1) acute (control psychosis/agitation), (2) stabilisation, (3) maintenance (relapse prevention).
• Mechanism backbone (PSY-5.25/5.27): all antipsychotics act on dopamine. Therapeutic effect = D2 antagonism in the mesolimbic pathway. Blockade of the nigrostriatal pathway → EPS; blockade of the tuberoinfundibular pathway → hyperprolactinaemia.

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