Schizophrenia Schizophrenia is a syndrome characterised by a broad range of cognitive, emotional and behavioural problems. The symptoms of schizophrenia are classified into positive and negative symptoms. Positive symptoms relate to an exaggeration of normal functions and commonly include hallucinations (mainly auditory), delusions, disorganised speech/formal thought disorder/bizarre/catatonic behaviour. Negative symptoms relate to the loss of normal functions and includes flattening of mood, emotional apathy, social withdrawal, self-neglect, lack of motivation and loss of pleasure. although some potential causes have been identified, the aetiology of schizophreniaremains poorly understood. GP’s are like;y to be the first contact. Evidence suggest that intervention needs to be at the earliest opportunity (see also separate guidelines for Early Psychosis). Indications For Considering Involvement Of Specialist Services • Initiation Of Treatment In Primary Care, all people with suspected or newly diagnosed Schizophrenia should be referred urgently to secondary mental health services for assessment and development of a care plan. Where diagnosis is uncertain, but some features are present, referral to the EDIT service may be appropriate (see Early Psychosis guidelines). Increased Risk To Self Or Others Refer urgently if ‘high risk’, as described in ('High Risk Factors) below. Review Of Medication - Persistent symptoms and/or persistent side-effects (including possible need to switch drug treatment). - Polypharmacy (3 or more psychotic drugs). Relapse/Signs Indicating Risk Of Relapse - Poor adherence to treatment - major life events. - Substance abuse - family conflict. Any Problem That The GP Cannot Deal With In Relation To The Patients Mental Health Needs Registers It is recognised that at the time of implementing these guidelines, practice based registers are not in place in Salford for patients with severe and enduring mental health problems. It is seen as good practice to develop such registers in the near future. Primary care professionals are best placed to monitor the physical health of people with schizophrenia and should do so regularly. Case registers will be an important means of doing so. Identifying Your Patients & Organising A Regular Review - Good Practice Points • Create a disease register, identifying patients with schizophrenia using the practice team’s knowledge. • Use the register to check that patients have been seen in the practice at least once every 6 months (see physical care flowchart from NICE, later in this document). • Invite patients for annual review assessment involving their GP together with the practice nurse or CPN where appropriate. ‘High Risk’ Factors • Evidence of intent to harm self or others. • Serious self neglect, (e.g. not eating or drinking). • A severely depressed or elevated mood. • Hallucinations (especially command) that indicate high risk (e.g. voices telling them to harm self or others). • Delusions that indicate high risk (e.g. believing that a partner or a neighbour wants to harm them). • Co-existing drug abuse. Next Page Back