Citation

Rydell P, Strålin P. Lakartidningen 2015; 112(42): e1842.

Copyright

(Copyright © 2015, Sveriges Lakarforbund)

DOI

unavailable

PMID

unavailable

Abstract

A thorough investigation is warranted when a person presents to health care services with signs and symptoms of schizophrenia. Positive (hallucinations and delusions) as well as negative symptoms (blunted affect, avolition, and loss of speech content) should be assessed in order to confirm the diagnosis. Further, psychosocial functioning must be evaluated. Cognitive impairment is common in persons with psychotic illness, often leading to serious disability. Treatment planning should be based on shared decision-making involving both patients and their families. Suicide risk is elevated in people with schizophrenia, and acts of violence are somewhat overrepresented, especially when substance abuse is present. However, the risk of violence is overvalued, often colored by fear of mental illness. Risk assessments should be based on careful clinical evaluation. Established assessment scales may provide further information. A coherent, structured treatment plan that includes both pharmacotherapy and psychosocial interventions is of utmost importance in preventing both suicidal behavior and acts of violence. Case management in a multiprofessional "Assertive Community Treatment" (ACT) setting should be used as an organizational model for psychiatric teams caring for persons with first onset psychoses as well as those with long-term psychotic illness. Collaboration between psychiatric and social services is central and mandatory by law. Models for collaboration need to be examined further. © 2015, Swedish Medical Association. All rights reserved.

Language: sv