Review Question - QID 106915

The first psychotic break in men with schizophrenia typically occurs by age 25 or earlier. A poor prognosis is associated with earlier age of onset (which is associated with a male gender), a positive family history, and mostly negative symptoms.

Schizophrenia is a psychotic disorder often characterized by auditory hallucinations, delusions, and disorganized speech and behavior. The first psychotic break typically occurs between ages 15 and 25 in men, and ages 25-30 in women. The first-line treatment for schizophrenia includes typical or atypical antipsychotics. Typical antipsychotics are useful in treating positive symptoms (hallucinations, delusions), and atypical antipsychotics are useful for treating both positive and negative symptoms (social withdrawal, flat affect). While the major side effect of typical antipsychotics is extrapyramidal symptoms, the major side effect of atypical antipsychotics is metabolic syndrome though the most dopaminergic atypical antipsychotic - risperiodone - can also cause extrapyramidal symptoms.

When approaching this question the diagnosis is clearly schizophrenia given the disorganized thoughts and appearance. The key to this question is knowing risk factors which can be memorized or reasoned out. It is more likely that if you have had a disease for longer (early age of onset) or are predisposed with genetics (family history) that your prognosis may be worse than an individual without this history. Though substance abuse may be a risk factor it is important to consider that recent marijuana use may actually be exacerbating the symptoms (thus they are not as severe). For this reason before ever making a diagnosis of schizophrenia it is always important to first rule out substance abuse.

Incorrect answers:
Answer 1: In the United States, the rates of schizophrenia are equal in men and women. In developing countries, schizophrenia is more common in men. Males typically present with an earlier age of onset. That being said earlier age of onset is a better answer as it directly answers the question.

Answer 2: Mostly positive symptoms is not associated with a poor prognosis. Rather, mostly negative symptoms is associated with a poorer prognosis.

Answer 4: Family history is a risk factor for schizophrenia.

Answer 5: A history of marijuana use increases the likelihood of developing schizophrenia. Recent use of marijuana may actually make an alternative diagnosis more likely (intoxication).

The rates of substance abuse and suicide are particularly high in patients with schizophrenia. Patients with a history of drug abuse and medication non-adherence are particularly at risk for committing suicide (1).