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 |
Faculty Bio and Disclosure Declaration
Click here to view faculty bio and activity disclosures.
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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