Michael D. Jibson and Rajiv Tandon
University of Michigan Health System
Ann Arbor, Michigan
The clinical course of schizophrenia typically involves a recurring pattern of acute psychotic episodes, during which the patient experiences significant worsening of positive symptoms, including delusions, hallucinations, thought disorganization, and catatonia. In fact, repeated periods of acute psychosis are among the hallmarks of schizophrenic illness. However, deterioration in the basic realms of life is equally significant in the clinical presentation of schizophrenia. Loss of social, occupational, and personal interests is an important, and potentially devastating, aspect of the illness.
In general, acute episodes of illness are defined by a worsening of active psychotic symptoms, and treatment of an episode focuses on the control of these symptoms. However, optimal treatment of schizophrenia requires attention to all areas of pathology, even during the acute phase. This chapter addresses the treatment of acute episodes of schizophrenia, focusing on the rapid and complete control of psychotic symptoms, but with attention to the implications of such treatment for the longer course of the illness.