Shrinks In Sneakers

Tag: schizoaffective disorder

  • Breaking Barriers: Streamlining Clozapine Access for Patients in Need

    Breaking Barriers: Streamlining Clozapine Access for Patients in Need

    Happy Friday Everyone, todays post is a topic near and dear to my heart

    Clozapine is the most effective medication available for treating schizophrenia. In my work in community mental health, many of my patients could greatly benefit from clozapine, but significant barriers make access difficult. A large portion of my patients are homeless and frequently lost to follow-up, which complicates the already burdensome REMS (Risk Evaluation and Mitigation Strategy) program. To ensure access to this life-saving treatment, adjustments to the REMS program are necessary. One solution could be eliminating the requirement to report completed monitoring and post results on a central database. Additionally, restrictions that delay pharmacies from distributing clozapine should be removed. Finally, we need to reevaluate the frequent and, quite frankly, excessive monitoring of absolute neutrophil counts (ANC). These changes could significantly improve access for patients who need this critical medication.

  • Schizoaffective Disorder: A Confusing Diagnosis

    Schizoaffective Disorder: A Confusing Diagnosis

    Introduction: 

    • Schizoaffective disorder has features of both schizophrenia and mood disorders (bipolar and depression). 
    • Two sub types: depressed type and bipolar type 
    • The diagnosis can get complicated because primary mood disorders can have psychotic features (MMD with psychotic features or bipolar disorder with psychotic features), patients with schizophrenia can have mood symptom most commonly depression. 

    Epidemiology:

    • The lifetime prevalence is less than 1%, the most recent data indicates 0.3% but I would say there is a range between 0.5-0.8%
    • More women have the depressed type greater than 2:1 ratio 
    • Equal number of men and women have the bipolar type 
    • The cause of schizoaffective disorder is unknown. It may be a type of schizophrenia, a type of mood disorder, but most likely it’s a spectrum that combines all these things.
    • Schizoaffective disorder has a better prognosis than schizophrenia but a worse prognosis than primary mood disorders. 
    • Patients are said to have a nondeteriorating course and respond better to lithium than patients with schizophrenia. 

    Diagnosis:

    • Schizoaffective disorder combines the features of both schizophrenia and affective mood disorders. 
    • If the mood is primarily manic, it’s called schizoaffective disorder bipolar type 
    • If the mood is primarily depressed it’s called depressed type 
    • The mood component should be present for the majority > 50% of the total illness 
    • You must have a two-week period where psychotic symptoms and are present in the absence of mood symptoms

    Treatment:

    • Treatment will depend on the predominant symptoms. If the patient has more mania than a mood stabilizer will be used (e.g., lithium) 
    • For psychotic symptoms, dopamine blocking medications will be used (e.g., risperidone) 
    • For depressive symptoms serotonin reuptake inhibitors will be used (e.g., sertraline)