Schizophrenia Case Series, Part 1: Managing Acute Psychosis in Schizophrenia
neuroscienceCME Medical Simulation
 | Patient Info: Ricardo, a 20-year-old male, has been brought to the Emergency Department after exhibiting delusional and erratic behavior at work. He is combative and uncooperative. He is otherwise healthy and has never been treated for a psychiatric disorder. |
This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Pharmacists (ACPE)
Credit Expiration Date:
Saturday, April 3, 2010
 | Rakesh Jain, MD, MPH Director, Adult and Child Psychopharmacology Research R/D Clinical Research, Inc. Lake Jackson, TX |
The management of schizophrenia is complex, and perhaps one of the most challenging decision
points is how to manage the first-episode, acutely psychotic patient. Accurate assessment of
prodromal and current symptoms is important to early diagnosis, which in turn is critical to initiating
appropriate and aggressive treatment. Clinical decisions made at the first episode can impact long-term
outcome. The use of sensitive and reliable assessment tools and laboratory tests, including
toxicology testing, plays an important role in accurate diagnosis. Diagnosis of first episode can be
complicated; although psychotic episodes are often recognized by a defining event, some symptoms
are normally present but actively hidden by the patient and/or unnoticed by family and friends
for a number of months, thus delaying the perceived need for medical intervention. The period of
time between the development of psychotic symptoms and the initial presentation for treatment
is known as the duration of untreated psychosis (DUP); DUP is one of the strongest predictors of
future outcomes.(1,2) Evidence-based acute management strategies that provide effective symptom
control are critical to setting the stage for optimizing long-term outcome. Early, evidence-based,
and targeted management with effective therapies can reduce DUP and improve the likelihood of
remission. In the short term, the majority of patients treated with antipsychotics achieve remission,
with estimates ranging between 70% to 87%.(3) However, remission rates over the long term are
significantly lower, particularly in patients with substance abuse or other comorbidities associated
with generally poorer outcome.
- Weiden PJ, Buckley PF, Grody M. Understanding and treating "first-episode" schizophrenia. Psychiatr Clin North Am 2007;30:481-510.
- Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 2005;162:1785-1804.
- Freudenreich O, Holt DJ, Cather C, Goff DC. The evaluation and management of patients with first-episode schizophrenia: a selective, clinical review of diagnosis, treatment, and prognosis. Harv Rev Psychiatry 2007;15:189-211.
To provide mental healthcare practitioners with strategies drawn from the latest evidence for assessing, diagnosing, and treating acutely psychotic patients presenting to the Emergency Department in order to facilitate stabilization in the acute phase and support positive long-term outcome.
At the end of this CE activity, participants should be able to:
- Conduct appropriate assessment and differential diagnosis of acutely psychotic patients presenting to the Emergency Department.
- Evaluate available pharmacological options for managing symptoms in acutely psychotic patients.
- Develop a treatment plan consisting of both pharmacological and behavioral approaches to stabilize the acutely psychotic patient.
Physicians, physician assistants, and other healthcare professionals with an interest in mental health.
CME Outfitters, LLC, gratefully acknowledges an educational grant from Wyeth Pharmaceuticals and Solvay Pharmaceuticals in support of this CE activity.
CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CME Outfitters, LLC, designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.
CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.5 contact hours (0.05 CEUs)
Universal Program Number: 376-000-09-009-H01-P
Activity Type: knowledge-based
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Rakesh Jain, MD, MPH
Rakesh Jain, MD, MPH, is Director of Psychiatric Drug Research for the R/D Clinical Research Center at Lake Jackson, Texas.
Dr. Jain attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a National Institute/Center for Disease Control Competitive Traineeship. His research thesis focused on alcohol abuse issues. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.
After graduate school, Dr. Jain completed a postdoctoral fellowship in Research Psychiatry with the Gerontology Center of the University of Texas Mental Sciences Institute in Houston. He received the National Research Service Award for the support of the postdoctoral fellowship. After this, he served a three-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston as well as a two-year fellowship in Child and Adolescent Psychiatry.
Dr. Jain is currently involved in multiple research projects studying the effects of medications on short-term and long-term treatment of depression, anxiety, pain/mood overlap disorders, and psychosis in adult and child/adolescent populations. He is the author of several articles on the issue of mood and pain conditions. He serves on several Boards focusing on drug development and disease state education. He was recently named “Public Citizen of the Year” by the National Association of Social Workers, Gulf Coast Chapter, in recognition of community and peer education and championing of mental health issues. He was also recently awarded the “Extra Mile Award” by the local school district, in recognition of the service to the children of the school district and consultation to the teachers and counselors.
Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all its CE activities. Faculty must disclose to the participants any significant relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.
Dr. Jain has disclosed that he receives research support from Abbott Laboratories, Addrenex Pharmaceuticals, Inc., Aspect Medical Systems, Inc., Forest Laboratories, Inc., Eli Lilly and Company, and Pfizer Inc. He is on the speakers bureaus of Cyberonics, Inc., GlaxoSmithKline, Jazz Pharmaceuticals, Eli Lilly and Company, Pfizer Inc., Shire Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc. Dr. Jain serves as a consultant to Addrenex Pharmaceuticals, Inc., IMPAX Laboratories, Inc., Eli Lilly and Company, and Shire Pharmaceuticals.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.
CME Outfitters, LLC, the faculty, Wyeth Pharmaceuticals, and Solvay Pharmaceuticals do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
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