Detailed Description

ZYPREXA is approved for the treatment of schizophrenia, for acute mania of bipolar disorder, and for maintenance treatment in bipolar disorder.

Diagnosis

Schizophrenia is a complex illness or group of disorders characterized by hallucinations, delusions, behavioral disturbances, and disrupted social functioning and associated symptoms in what is usually an otherwise clear sensorium.

Characteristics of Schizophrenia

  • The positive symptoms include delusions and hallucinations1
  • The negative symptoms include emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and lacks content, and a lack of pleasure or interest in life11

How Patients With Schizophrenia May Present to Healthcare Providers

  • Delusions
  • Hallucinations
  • Trouble organizing thoughts
  • Strange or unpredictable behavior
  • Trouble with body language
  • Difficulty creating complete thoughts
  • Problems working toward goals

Identifying Schizophrenia

The differential diagnosis of schizophrenia and other psychiatric conditions that may manifest psychotic symptoms is difficult and best done from a longitudinal perspective over the course of the illness.

Diagnoses Confused With Schizophrenia

Psychosis, which is characterized by a disturbance in or loss of contact with reality, may include symptoms of schizophrenia. A number of medical conditions can induce psychosis:

  • Substance abuse and drug toxicity
  • Central nervous system lesions
  • Head trauma
  • Infections
  • Endocrine disease
  • Systemic lupus erythematosus and multiple sclerosis
  • Cerebrovascular disease
  • Huntington's disease
  • Parkinson's disease
  • Migraine headache or temporal arteritis
  • Pellagra or pernicious anemia
  • Porphyria
  • Withdrawal states, such as those caused by alcohol and benzodiazepines
  • Delirium and dementia
  • Sensory deprivation or overstimulation


  1. National Alliance on Mental Illness. About Mental Illness: Schizophrenia. Available at: http://www.nami.org. Accessed June 27, 2006.

Diagnosis

Physicians face a number of problems in diagnosing bipolar I disorder:

  • As many as 7 in 10 patients are initially misdiagnosed1
  • 30% of patients presenting with depressive symptoms may have bipolar I disorder2
  • On average, 3.5 misdiagnoses and 4 consultations occur before a patient receives an accurate diagnosis1
  • ~1 in 3 patients will seek help for over 10 years before being accurately diagnosed1
  1. National Depressive and Manic-Depressive Association (NDMDA) Constituent Survey; Chicago, Ill: 2001.
  2. 1.Manning JS, et al. Compre Psychiatry. 1997;38:102-108.

Characteristics of Bipolar I Disorder, Manic/Mixed States

  • Requires mania for diagnosis1
  • Tends to run in families2
  • One or more manic episodes or mixed episodes have occured1
  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association; 2000:382-388.
  2. National Alliance on Mental Illness. About Mental Illness: Bipolar Disorder. Available at: http://www.nami.org. Accessed June 27, 2006.

Some Ways Bipolar Patients Present to Healthcare Providers

  • Inflated sense of self-importance
  • Less of a need for sleep
  • Loud, rapid speech
  • Racing thoughts
  • Distractability
  • Agitation or restlessness
  • Increase in goal-oriented activities
  • Unwise involvement in pleasurable but potentially risky activities
  • Significant changes in appetite and/or weight
  • Sleep problems
  • Loss of energy or fatigue
  • Trouble concentrating
  • Slowed speech, thinking, or body movements
  • Feelings of guilt or worthlessness
  • Agitation or restlessness
  • Recurring thoughts of death or suicide

Identifying Acute Bipolar I Mania

There are a number of diagnostic elements of acute bipolar I mania that may be overlooked:

  • Family history of mood disorders
  • Early age of onset (typically <25 yr) with episodic presentation
  • History of mood instability (swings)
  • Poor or erratic antidepressant treatment response
  • Multiple antidepressant failures

Diagnoses Confused With Bipolar I Disorder

  • Agitated depression
  • Treatment-resistant depression
  • Atypical depression
  • Polysubstance abuse
  • Attention deficit and hyperactivity disorder (ADHD)
  • Postpartum depression or psychosis

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Last Update: 6 Oct 15

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