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It is one of the major psychiatric illness in which patient experience perceptual and thought disturbances which is reflected to others in form of change in behaviour.

Generally patient start experiencing certain changes in his surroundings which he consider as 100 % real, e.g. hearing voices just like other voice which normally people around him will not experience or person may experience as if he is being observed through cameras or someone follow him which may not be true in reality. Patient relative or friend may notice changes in his behaviour and unable to understand why is he behaving like this.

Patient may experience following symptoms. Few are mentioned below

  • Hallucination (hearing voices when is it actually not there)
  • Delusions (false but firm unshakable belief, over any specific thing)
  • Feeling of being controlled
  • Feeling as if someone is following him
  • Paranoid ideation
  • People make gestures and give indirect messages
  • Perceive messages on TV, newspaper or social media as directed towards them

People around him may observe

  • Odd behaviour
  • Talking or smiling to himself,
  • Making gestures and maintaining odd posture for long peroid
  • Increased aggression for no obvious reason
  • Reduceself care, inappropriate response to change in climate
  • Remain self absorbed and staring for no obvious reason
  • Clear decline in occupational life, eg studies, work performance
  • Reduced socialization

In few patients there is high risk of suicideor homicide depending upon his ongoing thoughts. Risk of suicide is especially high during first year of start of symptoms.


Schizophrenia needs to be considered as medical problem just like any other disorder which can get better with treatment. The main problem which leads to delay in treatment is people identification and acceptance towards illness. It is unlike depression in which patient is not feeling well and want to go for treatment.  Patient consider symptoms as real rather than part of illness and family don’t seems to understand why patient behaviour is changing. They go for treatment immediately if change in behaviour is problematic eg aggression or violent behaviour.

It is suggested that if change in behaviour is noticed then psychiatric consultation should be taken so that professional can make proper assessment and if necessary, steps are taken without delay.Since patients are mostly not willing for treatment or visiting psychiatrist so family should visit and seek help.

Ideally patient should be admitted under psychiatric unit and treatment should be started as early as possible. Studies shows that early we go for treatment chances of recovery are high.  Main stay of treatment is antipsychotic but simultaneously we need to counsel family how to deal with them.

Types of Anti-psychotic:

              Typical anti psychotic

              Atypical anti psychotic

Anti psychotic is selected based on economic condition, age, gender, medical problems, family history, patient or family choice and previous response to treatment. Research has shown that efficacy of typical and atypical anti psychotics are same (except for clozapine), however they are different in term of side effects. Also some patient do respond better with typical and some with atypical anti psychotic.

According to NICE guideline, once a patient is diagnosed with Schizophrenia he should be started with an antipsychotic and build upto minimal effective dose.  Anti-psychotics generally take some time to show its effects. Depending up on its response and side effect dose is adjusted/ titrated. It is recommended that medicine should be adjusted on weekly basis so that with in 2 to 3 months one can decide if given antipsychotic is showing optimal response or not. If response is not adequate or side effects are diturbing then one need to go for second trial. If response of 2 trials (one of the trial should be of atypical antipsychotic) in not optimal then patient is considered as treatment resistant schizophrenia and in treatment resistant schizophrenia, Clozapine is indicated.

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