CLINICAL HANDBOOK OF SCHIZOPHRENIA

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132 II. ASSESSMENT AND DIAGNOSIShave the metabolic syndrome are at an increased risk for stroke, type 2 diabetes, and coronaryheart disease.There are no universally accepted criteria for diagnosing the metabolic syndrome.The criteria proposed by the third report of the National Cholesterol Education Program(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterolin Adults (Adult Treatment Panel [ATP] III) are the most current and widely used.According to the ATP III criteria, the metabolic syndrome is identified by the presence ofthree or more of the following components: (1) central obesity, as measured by waist circumference:men > 40 inches, women > 35 inches; (2) fasting blood triglycerides greaterthan or equal to 150 mg/dl; (3) blood high-density lipoprotein (HDL) cholesterol: men
13. Co-Occurring Disorders 133can increase symptoms of disorientation and confusion. In some extreme cases, polydipsiacan lead to hyponatremia and seizures.An interdisciplinary team approach can be very useful in helping assess and treatpolydipsia. The initial goal in diagnosing this disorder is to gather baseline data and try toconfirm or rule out presence of the problem. Prior to confirming or assigning a diagnosis ofpolydipsia, other causes such as diabetes mellitus, diabetes insipidus, chronic renal failure,malignancy, pulmonary disease, and hypocalcemia should be excluded. In many cases, thisinformation is contained in medical records from the patient’s primary care providers.Multiple methods may be used to assess whether a patient has polydipsia. Observablesymptoms may include mood swings, confusion, inability to follow commands, disorientation,and rambling speech. If a patient is in an observable setting, such as an inpatient unit,clinical staff may notice an increase in water or fluid consumption. In addition, someantipsychotic medications can increase a patient’s risk for developing polydipsia. Therefore,an initial review of patient records and a medical evaluation can help confirm a diagnosis.Diagnostic lab work using urinalysis can also be used to determine whether polydipsia ispresent. Finally, weight monitoring can be used. If excessive fluid intake is suspected, patientsshould have their weight monitored. Such monitoring should be done closely, whenpossible, such as in an inpatient setting. Patients should be weighed at least twice a day, andnot after eating a large meal. If patients’ morning and evening weights differ by greater than5%, they should be closely monitored for possible seizures due to a change in electrolytes. Inaddition, it is helpful to monitor the intake of water or fluids. Two simple techniques that canbe used are intake logs or a bottle that contains the recommended amount daily of fluids.KEY POINTS• Assessment for drug and alcohol use optimally involves multiple sources of information.• Assessment should be continuous throughout treatment, because substance use disorderstend to be relapsing and remitting.• Objective measures of substance use include Breathalyzer tests and toxicology screeningof urine, blood, and hair.• Cigarette smoking, the most common addiction in schizophrenia, can be monitored withself-reported use and biological measures that test expired air and saliva or urine.• The dangerous physical consequences of infectious diseases that can cause severe medicaldisability and even death require monitoring of both high-risk behaviors and exposure tohepatitis (both B and C) and HIV.• Even patients who are currently abstinent may have infectious diseases of which they areunaware; thus, understanding patients’ past use and behavior is important.• Rates of obesity, diabetes, and metabolic syndrome are elevated among persons withschizophrenia and require close monitoring and coordination with primary care.• Weight and blood pressure can be assessed regularly in psychiatric clinics and should becomea part of routine monitoring and patient education.• Fasting blood tests for lipids and glucose are critical for identifying and tracking metabolicproblems.• Although exercise and diet are difficult to track systematically, simple logs developed for individualpatient monitoring can be helpful.REFERENCES AND RECOMMENDED READINGSBooth, M. L. (2000). Assessment of physical activity: An international perspective. Research Quarterlyfor Exercise and Sport, 71(2), 114–120.Cancer Prevention Research Center. (2007). Stages of change algorithm for the weight: Stages ofChange—Short Form. Available online at www.uri.edu/research/cprc/masures/weight01.htm
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CLINICAL HANDBOOK OF SCHIZOPHRENIA
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© 2008 The Guilford PressA Divisio
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CONTRIBUTORSDonald Addington, MD, D
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ContributorsixGillian Haddock, PhD,
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ContributorsxiRoger H. Peters, PhD,
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PREFACESchizophrenia is arguably th
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Prefacexvcorporation of environment
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CONTENTSI. CORE SCIENCE AND BACKGRO
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ContentsxixCHAPTER 27 Illness Self-
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ContentsxxiCHAPTER 59 Sexuality 604
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CHAPTER 1HISTORY OF SCHIZOPHRENIAAS
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1. History of Schizophrenia 5ularly
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1. History of Schizophrenia 7PSYCHO
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1. History of Schizophrenia 9The ne
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1. History of Schizophrenia 11Since
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1. History of Schizophrenia 13Belli
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2. Epidemiology 15al., 2006), which
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2. Epidemiology 17not generally fou
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2. Epidemiology 19• Intrauterine
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2. Epidemiology 21function in socia
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2. Epidemiology 23KEY POINTS• Sch
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CHAPTER 3BIOLOGICAL THEORIESJONATHA
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3. Biological Theories 27cortex (in
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3. Biological Theories 29unchanged
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3. Biological Theories 31raclopride
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3. Biological Theories 33drives, mo
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CHAPTER 4BRAIN IMAGINGLISA T. EYLER
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4. Brain Imaging 37yet to be strong
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4. Brain Imaging 39with neuroleptic
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4. Brain Imaging 41events. However,
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4. Brain Imaging 43KEY POINTS• On
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5. Neuropathology 45TABLE 5.1. Summ
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5. Neuropathology 47schizophrenia i
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5. Neuropathology 49has been report
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5. Neuropathology 51also been demon
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5. Neuropathology 53results, especi
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CHAPTER 6GENETICSSTEPHEN J. GLATTTh
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6. Genetics 57Question 2: What Are
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6. Genetics 59nia. Each individual
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6. Genetics 61degree relatives desp
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6. Genetics 632A receptor (HTR2A) a
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CHAPTER 7ENVIRONMENTAL PRE-AND PERI
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7. Environmental Pre- and Perinatal
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8. Psychosocial Factors 75Steinberg
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8. Psychosocial Factors 77in terms
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8. Psychosocial Factors 79This mode
Page 103 and 104: 8. Psychosocial Factors 81KEY POINT
Page 105 and 106: 9. Psychopathology 83ations; change
Page 107 and 108: 9. Psychopathology 85sity School of
Page 109 and 110: 9. Psychopathology 87or “loose as
Page 111 and 112: 9. Psychopathology 89lished WHO. Th
Page 113 and 114: CHAPTER 10COGNITIVE FUNCTIONINGIN S
Page 115 and 116: 10. Cognitive Functioning in Schizo
Page 123 and 124: 11. Course and Outcome 101DIAGNOSIS
Page 125 and 126: 11. Course and Outcome 103TABLE 11.
Page 127 and 128: 11. Course and Outcome 105DOMAINS O
Page 129 and 130: 11. Course and Outcome 107mation gi
Page 131 and 132: 11. Course and Outcome 109quency of
Page 133 and 134: 11. Course and Outcome 111to a smal
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Page 139 and 140: CHAPTER 12DIAGNOSTIC INTERVIEWINGAB
Page 141 and 142: 12. Diagnostic Interviewing 119psyc
Page 143 and 144: 12. Diagnostic Interviewing 121not
Page 145 and 146: 12. Diagnostic Interviewing 123tual
Page 147 and 148: CHAPTER 13ASSESSMENT OFCO-OCCURRING
Page 149 and 150: Time-Line Follow-BackThe Time-Line
Page 151 and 152: Testing and Risk Assessment for Inf
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Page 157 and 158: CHAPTER 14ASSESSMENT OFPSYCHOSOCIAL
Page 159 and 160: 14. Assessment of Psychosocial Func
Page 161 and 162: TABLE 14.1. Measures of Psychosocia
Page 167 and 168: CHAPTER 15TREATMENT PLANNINGALEXAND
Page 169 and 170: 15. Treatment Planning 147WHAT DOES
Page 171 and 172: 15. Treatment Planning 149TABLE 15.
Page 173 and 174: 15. Treatment Planning 151Poor adhe
Page 175 and 176: Occupational/School Functioning15.
Page 177: 15. Treatment Planning 155Drake, R.
Page 181 and 182: CHAPTER 16ANTIPSYCHOTICSERIC C. KUT
Page 183 and 184: 16. Antipsychotics 161for at least
Page 185 and 186: TABLE 16.3. Dosing of the First-Gen
Page 187 and 188: 16. Antipsychotics 165are not avail
Page 189 and 190: 16. Antipsychotics 167• Therapeut
Page 191 and 192: 17. Side Effects of Antipsychotics
Page 201 and 202: 18. Clozapine 179Plasma concentrati
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18. Clozapine 183linergic effects t
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18. Clozapine 185• Common side ef
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19. Other Medications 187agitation
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19. Other Medications 189Small, ope
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19. Other Medications 191ANTIDEPRES
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19. Other Medications 193sation in
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19. Other Medications 195Citrome, L
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20. Electroconvulsive Therapy 197TA
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20. Electroconvulsive Therapy 199FI
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Missed SeizuresIf no seizure occurs
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20. Electroconvulsive Therapy 203(C
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PART IVPSYCHOSOCIAL TREATMENT
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208 IV. PSYCHOSOCIAL TREATMENTdisin
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210 IV. PSYCHOSOCIAL TREATMENTFIGUR
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212 IV. PSYCHOSOCIAL TREATMENTschiz
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CHAPTER 22FAMILY INTERVENTIONCHRIST
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216 IV. PSYCHOSOCIAL TREATMENTTABLE
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218 IV. PSYCHOSOCIAL TREATMENTcommi
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220 IV. PSYCHOSOCIAL TREATMENTother
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222 IV. PSYCHOSOCIAL TREATMENTtient
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224 IV. PSYCHOSOCIAL TREATMENTButzl
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CHAPTER 23COGNITIVE-BEHAVIORAL THER
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228 IV. PSYCHOSOCIAL TREATMENTThe a
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230 IV. PSYCHOSOCIAL TREATMENTAndre
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234 IV. PSYCHOSOCIAL TREATMENTtion.
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236 IV. PSYCHOSOCIAL TREATMENTnever
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238 IV. PSYCHOSOCIAL TREATMENTwith
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CHAPTER 24SOCIAL SKILLS TRAININGWEN
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242 IV. PSYCHOSOCIAL TREATMENTeach
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244 IV. PSYCHOSOCIAL TREATMENTThe m
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246 IV. PSYCHOSOCIAL TREATMENTCogni
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248 IV. PSYCHOSOCIAL TREATMENT• S
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250 IV. PSYCHOSOCIAL TREATMENTThe d
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252 IV. PSYCHOSOCIAL TREATMENTNone
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254 IV. PSYCHOSOCIAL TREATMENT• I
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256 IV. PSYCHOSOCIAL TREATMENTnance
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260 IV. PSYCHOSOCIAL TREATMENTMcGur
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262 IV. PSYCHOSOCIAL TREATMENTalong
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264 IV. PSYCHOSOCIAL TREATMENTappro
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266 IV. PSYCHOSOCIAL TREATMENTKEY P
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CHAPTER 27ILLNESS SELF-MANAGEMENT T
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270 IV. PSYCHOSOCIAL TREATMENTensur
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272 IV. PSYCHOSOCIAL TREATMENTReduc
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274 IV. PSYCHOSOCIAL TREATMENTgage
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276 IV. PSYCHOSOCIAL TREATMENTTABLE
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278 IV. PSYCHOSOCIAL TREATMENTInnov
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280 IV. PSYCHOSOCIAL TREATMENTpredi
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282 IV. PSYCHOSOCIAL TREATMENTCogni
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284 IV. PSYCHOSOCIAL TREATMENTGoal
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286 IV. PSYCHOSOCIAL TREATMENTthey
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288 IV. PSYCHOSOCIAL TREATMENTas nu
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290 IV. PSYCHOSOCIAL TREATMENTway h
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292 IV. PSYCHOSOCIAL TREATMENTThe r
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294 IV. PSYCHOSOCIAL TREATMENT• T
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296 IV. PSYCHOSOCIAL TREATMENTsetti
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CHAPTER 30SELF-HELP ACTIVITIESFREDE
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300 IV. PSYCHOSOCIAL TREATMENThelp,
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302 IV. PSYCHOSOCIAL TREATMENTbeen
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304 IV. PSYCHOSOCIAL TREATMENTdiagn
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PART VSYSTEMS OF CARE
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310 V. SYSTEMS OF CAREcial to addre
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312 V. SYSTEMS OF CAREneeded servic
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314 V. SYSTEMS OF CAREformed by cas
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316 V. SYSTEMS OF CARE4. Conducting
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318 V. SYSTEMS OF CAREvere mental i
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320 V. SYSTEMS OF CAREents receivin
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322 V. SYSTEMS OF CAREculties in ge
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324 V. SYSTEMS OF CAREIn such a sit
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326 V. SYSTEMS OF CAREFIGURE 32.1.
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328 V. SYSTEMS OF CAREREFERENCES AN
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330 V. SYSTEMS OF CAREDESCRIPTION O
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332 V. SYSTEMS OF CAREfor ACT have
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334 V. SYSTEMS OF CAREvices compare
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336 V. SYSTEMS OF CAREA team leader
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338 V. SYSTEMS OF CAREof leverage t
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340 V. SYSTEMS OF CAREcare of thems
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342 V. SYSTEMS OF CAREframework for
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344 V. SYSTEMS OF CAREaccount the v
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346 V. SYSTEMS OF CAREthat deinstit
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348 V. SYSTEMS OF CARETypes of Resi
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350 V. SYSTEMS OF CARESupportive Ho
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352 V. SYSTEMS OF CAREate assistanc
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CHAPTER 35TREATMENT INJAILS AND PRI
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356 V. SYSTEMS OF CARElikely to rem
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358 V. SYSTEMS OF CAREtitled Effect
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360 V. SYSTEMS OF CAREgering, becau
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362 V. SYSTEMS OF CAREior problems.
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364 V. SYSTEMS OF CAREAmerican Psyc
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CHAPTER 36FIRST-EPISODE PSYCHOSISDO
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36. First-Episode Psychosis 369TABL
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36. First-Episode Psychosis 371have
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36. First-Episode Psychosis 373The
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36. First-Episode Psychosis 375divi
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36. First-Episode Psychosis 377Supp
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36. First-Episode Psychosis 379(200
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37. Treatment of the Schizophrenia
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38. Older Individuals 391TABLE 38.1
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38. Older Individuals 393answer, an
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38. Older Individuals 395rates (69%
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38. Older Individuals 397Patterson,
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39. Aggression, Violence, and Psych
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CHAPTER 40HOUSING INSTABILITYAND HO
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40. Housing Instability and Homeles
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41. Medical Comorbidity 425Medical
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41. Medical Comorbidity 427search s
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41. Medical Comorbidity 429TABLE 41
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41. Medical Comorbidity 431Caring f
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41. Medical Comorbidity 433Counseli
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41. Medical Comorbidity 435REFERENC
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CHAPTER 42INTELLECTUAL DISABILITYAN
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42. Intellectual Disability and Oth
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CHAPTER 43TRAUMA AND POSTTRAUMATICS
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43. Trauma and Posttraumatic Stress
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CHAPTER 44MANAGEMENT OFCO-OCCURRING
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44. Management of Co-Occurring Subs
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CHAPTER 45PARENTINGJOANNE NICHOLSON
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45. Parenting 473THE IMPACT OF PARE
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TABLE 45.1. Antipsychotic Medicatio
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Guidelines for Prescribing Antipsyc
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45. Parenting 479provide safe space
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CHAPTER 46CHILDREN AND ADOLESCENTSJ
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46. Children and Adolescents 483pri
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46. Children and Adolescents 485TRE
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46. Children and Adolescents 487Als
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46. Children and Adolescents 489KEY
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CHAPTER 47SUICIDEMARNIN J. HEISELSu
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TABLE 47.1. Selected Risk Factors f
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Clinical Course and Symptoms of Sch
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47. Suicide 497those with schizoaff
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47. Suicide 499assessment tools can
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47. Suicide 501yet focused on suici
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47. Suicide 503ACKNOWLEDGMENTSI gra
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PART VIIPOLICY, LEGAL,AND SOCIAL IS
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508 VII. POLICY, LEGAL, AND SOCIAL
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CHAPTER 49INVOLUNTARY COMMITMENTJON
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CHAPTER 50JAIL DIVERSIONJOSEPH P. M
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PART VIIISPECIAL TOPICS
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560 VIII. SPECIAL TOPICStion, restr
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562 VIII. SPECIAL TOPICSsion criter
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564 VIII. SPECIAL TOPICSbased on ev
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CHAPTER 55RECOVERYDAVID ROELARRY DA
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568 VIII. SPECIAL TOPICSatric disab
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570 VIII. SPECIAL TOPICSA RECOVERY
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572 VIII. SPECIAL TOPICSassumes fro
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574 VIII. SPECIAL TOPICSDeegan, P.
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576 VIII. SPECIAL TOPICSwhereas ado
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578 VIII. SPECIAL TOPICSalence of d
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580 VIII. SPECIAL TOPICS• Because
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582 VIII. SPECIAL TOPICScovering pa
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584 VIII. SPECIAL TOPICSGoldberg, 1
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586 VIII. SPECIAL TOPICSthe quality
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588 VIII. SPECIAL TOPICSof-life mea
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590 VIII. SPECIAL TOPICSBecker, M.,
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CHAPTER 58SPIRITUALITY AND RELIGION
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594 VIII. SPECIAL TOPICSbe related
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596 VIII. SPECIAL TOPICSmore or les
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598 VIII. SPECIAL TOPICSing with bo
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600 VIII. SPECIAL TOPICSExpressive
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602 VIII. SPECIAL TOPICSconsumer ab
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CHAPTER 59SEXUALITYALEX KOPELOWICZR
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606 VIII. SPECIAL TOPICSmay result
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608 VIII. SPECIAL TOPICSTABLE 59.1.
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610 VIII. SPECIAL TOPICSThis second
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612 VIII. SPECIAL TOPICSFIGURE 59.1
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614 VIII. SPECIAL TOPICSTo overcome
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CHAPTER 60SCHIZOPHRENIA INAFRICAN A
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618 VIII. SPECIAL TOPICSTABLE 60.1.
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620 VIII. SPECIAL TOPICSPHARMACOTHE
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622 VIII. SPECIAL TOPICSered a part
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CHAPTER 61ETHICSABRAHAM RUDNICKCHAR
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626 VIII. SPECIAL TOPICSinterests c
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628 VIII. SPECIAL TOPICSticipant re
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630 VIII. SPECIAL TOPICSvide an eth
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632 IndexAmerican CorrectionalAssoc
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634 IndexChildren/adolescents, 481-
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636 IndexDepressive symptoms, 106,
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638 IndexFirst-episode psychosis, 1
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640 IndexInformation technology, he
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642 IndexMotor symptoms, DSM-IV-TR,
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644 IndexPregnancydosing strategies
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646 IndexRisk factorsfor co-occurri
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648 IndexSTG. See Superior temporal
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650 IndexUrine testingfor nicotine
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