Schizophrenia: Symptoms, Diagnosis, and Antipsychotic Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Schizophrenia is a chronic psychotic disorder with hallucinations, delusions, and negative symptoms. DSM-5 criteria, atypical antipsychotics, clozapine, and rehabilitation in Quebec.\">\n<meta name=\"keywords\" content=\"schizophr\u00e9nie, schizophr\u00e9nie traitement, schizophr\u00e9nie sympt\u00f4mes, antipsychotiques schizophr\u00e9nie, clozapine schizophr\u00e9nie, psychose schizophr\u00e9nie, schizophr\u00e9nie diagnostic, schizophr\u00e9nie r\u00e9habilitation, schizophr\u00e9nie premier \u00e9pisode, schizophr\u00e9nie Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Psychiatry & Family Medicine & Neurology<\/span>\n <h1>Schizophrenia<\/h1>\n\n <div class=\"co-intro\">\n Schizophrenia is a severe, chronic psychiatric disorder - among the most incapacitating - characterized by a variable combination of positive psychotic symptoms (hallucinations + delusions + disorganization of thought and behavior), negative symptoms (affective blunting + alogia + avolition + anhedonia + social withdrawal) and cognitive deficits (impaired working memory + attention + executive functions), usually evolving in acute episodes interspersed with residual phases of persistent negative and cognitive symptoms. It affects around 1 % of the world's population, regardless of culture, with no significant gender predominance - although men generally develop the disease earlier (peak incidence 18-25 years) and with a more severe picture than women (peak incidence 25-35 years, with a second peri-menopausal peak). Its pathophysiology is multifactorial, involving polygenic genetic vulnerability (heritability of 80 % - concordance in monozygotic twins of 50 %) interacting with environmental factors (obstetric complications + prenatal infections + cannabis + urbanization + immigration + early adversity) to produce neurodevelopmental abnormalities neurological development characterized by deregulation of the dopaminergic (mesolimbic hyperactivity \u2192 positive symptoms + mesocortical hypoactivity \u2192 negative and cognitive symptoms) + glutamatergic (NMDA receptor hypofunction \u2192 dissociation of information processing) and serotonergic systems. Prognosis is extremely variable: one-third of patients have a favorable course with complete remission under treatment + one-third an intermediate course with relapses and partial remissions + and one-third a severe course with persistent disability - early treatment at the first psychotic episode and long-term medication compliance are the two most important modifiable prognostic factors.\n <\/div>\n\n <h2>Symptoms \u2014 Clinical Dimensions<\/h2>\n <ul class=\"co-list\">\n <li><strong>Positive symptoms (excess or distortion of normal functions):<\/strong> auditory hallucinations (most frequent\u2014voices commenting on actions + voices conversing with each other + voices giving commands) + visual hallucinations + tactile + olfactory (less frequent) + delusions (persecution++ + reference + grandeur + control + influence + jealousy + erotomania) + disorganized thought process (tangentiality + derailment + neologisms + thought fragmentation) + disorganized or catatonic behavior<\/li>\n <li><strong>Negative symptoms (decrease or absence of normal functions):<\/strong> Emotional blunting (reduced emotional facial expression + monotonous voice) + alogia (poverty of speech + delayed responses) + avolition (inability to initiate activities) + anhedonia (inability to experience pleasure) + social withdrawal + abulia + poor hygiene + negative symptoms are the most debilitating in daily life and the least well-treated by antipsychotics<\/li>\n <li><strong>Cognitive deficits<\/strong> Working memory problems + attention and vigilance deficits + executive function disorders + slowed information processing + social cognition deficits (theory of mind) + cognitive deficits often precede psychosis and persist during symptomatic remission \u2192 main cause of functional impairment<\/li>\n <li><strong>Disorganization symptoms:<\/strong> Disorganized speech + severely disorganized behavior + catatonia (stupor + rigidity + bizarre postures + echophenomena) + inappropriate affect<\/li>\n <\/ul>\n\n <h2>DSM-5 Diagnostic Criteria<\/h2>\n <ul class=\"co-list\">\n <li><strong>Criterion A \u2014 2 or more symptoms for \u2265 1 month:<\/strong> delusional ideas + hallucinations + disorganized speech + grossly disorganized or catatonic behavior + negative symptoms + at least one of the first 3 must be present<\/li>\n <li><strong>Criterion B \u2014 Social or occupational dysfunction:<\/strong> The level of functioning in work, relationships, or self-care is significantly lower than it was before the onset of the disorder.<\/li>\n <li><strong>Criterion C \u2014 Duration:<\/strong> continuous signs of the disorder for at least 6 months (including at least 1 month of active Criterion A symptoms) + may include prodromal and residual phases<\/li>\n <li><strong>Criterion D - Exclusion of Schizoaffective Disorder and Bipolar Disorder<\/strong><\/li>\n <li><strong>Criterion E - Exclusion of a general medical condition or substance<\/strong><\/li>\n <li><strong>Criterion F \u2014 Relationship with ASD:<\/strong> if a history of autism spectrum disorder \u2014 diagnosis of schizophrenia only if prominent hallucinations or delusions for \u2265 1 month<\/li>\n <\/ul>\n\n <h2>Differential diagnosis<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Diagnosis<\/th>\n <th>Distinctive elements<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Schizoaffective disorder<\/td>\n <td>Affective episodes (major depression + mania) concomitant with psychotic symptoms + represent a substantial portion of the total duration<\/td>\n <\/tr>\n <tr>\n <td>Bipolar disorder with psychotic features<\/td>\n <td>Psychotic symptoms confined to mood episodes (mania + depression) + euthymia between episodes<\/td>\n <\/tr>\n <tr>\n <td>Major depressive disorder with psychotic features<\/td>\n <td>Mood-congruent psychosis (depressive themes) + confined to depressive episodes<\/td>\n <\/tr>\n <tr>\n <td>Substance-induced psychosis<\/td>\n <td>Cannabis + cocaine + amphetamines + psilocybin + ketamine \u2192 psychosis occurring during intoxication or withdrawal \u2192 resolution upon cessation of the substance (but may trigger true schizophrenia in vulnerable individuals)<\/td>\n <\/tr>\n <tr>\n <td>Organic psychosis (medical condition)<\/td>\n <td>Temporal lobe epilepsy + cerebral lupus + autoimmune encephalitis (anti-NMDAR) + neurosyphilis + Wilson's disease + hyperglycemia + hyponatremia + severe hypothyroidism \u2192 laboratory workup + EEG + brain MRI + systematic neuronal antibodies in the first psychotic episode<\/td>\n <\/tr>\n <tr>\n <td>Schizotypal personality disorder<\/td>\n <td>No frank psychosis + mild perceptual distortions + magical thinking + chronic social isolation without an acute episode<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Assessment after the first psychotic episode<\/h2>\n <ul class=\"co-list\">\n <li><strong>Biological tests :<\/strong> Kidney function tests + ionogram + blood glucose + creatinine + liver panel + TSH + calcium + B12 + folate + serologies (HIV + syphilis + hepatitis) + urine drug screen (cannabis + cocaine + amphetamines + opioids) + blood copper + ceruloplasmin if young patient (Wilson's disease)<\/li>\n <li><strong>Anti-neuronal antibodies<\/strong> Systematic testing for anti-NMDAR, anti-LGI1, anti-CASPR2, anti-AMPAR, and anti-GABA-B antibodies during the first psychotic episode to rule out autoimmune encephalitis (anti-NMDAR encephalitis = a treatable organic cause of psychosis)<\/li>\n <li><strong>EEG<\/strong> if temporal epilepsy suspicion + or paroxysmal symptoms<\/li>\n <li><strong>Brain MRI<\/strong> Systematic assessment in the first psychotic episode to rule out an organic cause (tumor, demyelination, focal atrophy, leukodystrophy)<\/li>\n <li><strong>Basal metabolic assessment:<\/strong> Weight + BMI + waist circumference + fasting blood glucose + lipid profile + BP \u2192 before initiation of antipsychotics (reference for monitoring induced metabolic syndrome)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Anti-NMDA receptor encephalitis<em>Anti-NMDAR encephalitis<\/em>) is an organic and potentially curable cause of severe acute psychosis\u2014particularly in young women\u2014that can be mistaken for early-onset schizophrenia. The presentation combines psychosis + agitation + catatonia + epilepsy + dysautonomia + abnormal movements. Systematically testing for anti-NMDAR antibodies (blood + CSF) at the first psychotic episode prevents treating autoimmune encephalitis, which requires immunotherapy + and investigation for ovarian teratoma, with antipsychotics alone.<\/span>\n <\/div>\n\n <h2>Pharmacological treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Second-generation (atypical) antipsychotics \u2014 first-line:<\/strong> risperidone (2\u20138 mg\/day) + olanzapine (10\u201320 mg\/day) + quetiapine (300\u2013750 mg\/day) + aripiprazole (10\u201330 mg\/day) + ziprasidone (120\u2013160 mg\/day) + paliperidone (6\u201312 mg\/day) + lurasidone (40\u2013160 mg\/day) + asenapine \u2192 effective on positive symptoms + different side effect profile depending on the molecule + weight gain ++ (olanzapine) + metabolic syndrome + diabetes + dyslipidemia + prolactinemia (risperidone) + prolonged QTc (ziprasidone + quetiapine)<\/li>\n <li><strong>1st-generation antipsychotics (typical \u2014 2nd line):<\/strong> haloperidol + fluphenazine + chlorpromazine \u2192 effective on positive symptoms but little effect on negative symptoms + high risk of extrapyramidal symptoms (EPS): parkinsonism + acute dystonia + akathisia + tardive dyskinesia \u2192 reserved for refractory forms + or for acute phase IV + or if cost is a constraint<\/li>\n <li><strong>Clozapine (Clozaril\u00ae) \u2014 reserved for refractory schizophrenia:<\/strong> indicated after failure of 2 adequate antipsychotics (dose + duration) + most effective on positive AND negative symptoms + reduces suicidal risk (only antipsychotic with this indication) + dreaded side effects: agranulocytosis (0.5\u20131 % \u2014 mandatory weekly CBC monitoring \u00d7 18 weeks + monthly thereafter) + dose-dependent seizures + myocarditis + major weight gain + hypersalivation + sedation<\/li>\n <li><strong>Long-acting antipsychotics (LAIs \u2014 depot injectables):<\/strong> Risperidone (Risperdal Consta\u00ae \u2014 2 weeks) + Paliperidone (Invega Sustenna\u00ae monthly + Invega Trinza\u00ae quarterly) + Aripiprazole (Abilify Maintena\u00ae monthly + Aristada\u00ae 6 weeks) + Haloperidol decanoate + Fluphenazine decanoate \u2192 improve adherence + reduce relapses \u2192 to be preferred from the first episode if adherence is problematic<\/li>\n <\/ul>\n\n <h2>Non-pharmacological treatment and rehabilitation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Psychoeducation<\/strong> for the patient and family + understanding of the illness + recognition of relapse signs + importance of adherence + reduction of family expressed emotion (EE) which increases the risk of relapse<\/li>\n <li><strong>Cognitive Behavioral Therapy for Psychosis (CBTp):<\/strong> Reduces distress related to hallucinations and delusions + improves functioning + recommended as a complement to pharmacological treatment<\/li>\n <li><strong>Cognitive remediation:<\/strong> Structured cognitive training programs (memory + attention + executive functions) \u2192 modest but significant improvement in cognitive performance and functioning<\/li>\n <li><strong>Psychosocial Rehabilitation:<\/strong> Social skills retraining + Individual Placement and Support (IPS) employment support + supervised housing + community resources \u2192 improved social and vocational integration<\/li>\n <li><strong>Early intervention for first episode:<\/strong> early psychosis intervention programs (EPIP \u2014 Early Psychosis Intervention Program in Quebec) \u2192 specialized teams + intensive follow-up + reduced time to treatment \u2192 significantly improves long-term prognosis<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Psychiatric emergency<\/div>\n <p>Call 911 or go immediately to the psychiatric emergency room if a person presents with a first episode of acute psychosis (hallucinations + delusions + disorganized behavior + significant agitation) OR if a person known to have schizophrenia experiences a severe relapse with agitation OR suicidal ideation OR behavior dangerous to themselves or others. Schizophrenia is associated with a suicide risk 10 to 20 times higher than the general population \u2014 suicidal ideation should always be assessed. For outpatient follow-up of stable schizophrenia and coordination with psychiatric teams, Clinique Omicron offers consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's Nurse Practitioners (NPs) provide follow-up care for patients with stabilized schizophrenia in coordination with psychiatric teams. This includes monitoring antipsychotic treatment and its metabolic effects (blood glucose, lipids, weight, blood pressure), blood count monitoring for patients on clozapine, managing common medical comorbidities (smoking, diabetes, cardiovascular issues), referrals to psychiatric emergencies during relapses, and referrals to psychosocial rehabilitation programs available in Quebec. Consultations are available at several service points across Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not replace the advice of a doctor or psychiatrist. Schizophrenia is a complex illness requiring specialized psychiatric care. Antipsychotics should never be stopped abruptly without medical advice \u2014 stopping suddenly significantly increases the risk of psychotic relapse. If thoughts of self-harm arise, consult a doctor or call 1-866-CALL (277-3553) \u2014 the Quebec provincial crisis line.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Schizophr\u00e9nie : sympt\u00f4mes, diagnostic et traitement antipsychotique | Clinique Omicron Psychiatrie & M\u00e9decine de famille & Neurologie Schizophr\u00e9nie La schizophr\u00e9nie est un trouble psychiatrique s\u00e9v\u00e8re et chronique \u2014 parmi les plus invalidants \u2014 caract\u00e9ris\u00e9 par une combinaison variable de sympt\u00f4mes psychotiques positifs (hallucinations + id\u00e9es d\u00e9lirantes + d\u00e9sorganisation de la pens\u00e9e et du comportement), de… <a href=\"https:\/\/cliniqueomicron.ca\/en\/schizophrenie\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Schizophrenia: Symptoms, Diagnosis, and Antipsychotic Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Schizophr\u00e9nie | Brossard | Clinique Omicron","_metasync_otto_description":"Schizophr\u00e9nie Schizophr\u00e9nie est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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\n\t\t\t\t\t\n\n\n\n\nSchizophrenia: Symptoms, Diagnosis, and Antipsychotic Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Schizophrenia is a chronic psychotic disorder with hallucinations, delusions, and negative symptoms. DSM-5 criteria, atypical antipsychotics, clozapine, and rehabilitation in Quebec.\">\n<meta name=\"keywords\" content=\"schizophr\u00e9nie, schizophr\u00e9nie traitement, schizophr\u00e9nie sympt\u00f4mes, antipsychotiques schizophr\u00e9nie, clozapine schizophr\u00e9nie, psychose schizophr\u00e9nie, schizophr\u00e9nie diagnostic, schizophr\u00e9nie r\u00e9habilitation, schizophr\u00e9nie premier \u00e9pisode, schizophr\u00e9nie Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Psychiatry & Family Medicine & Neurology<\/span>\n <h1>Schizophrenia<\/h1>\n\n <div class=\"co-intro\">\n Schizophrenia is a severe, chronic psychiatric disorder - among the most incapacitating - characterized by a variable combination of positive psychotic symptoms (hallucinations + delusions + disorganization of thought and behavior), negative symptoms (affective blunting + alogia + avolition + anhedonia + social withdrawal) and cognitive deficits (impaired working memory + attention + executive functions), usually evolving in acute episodes interspersed with residual phases of persistent negative and cognitive symptoms. It affects around 1 % of the world's population, regardless of culture, with no significant gender predominance - although men generally develop the disease earlier (peak incidence 18-25 years) and with a more severe picture than women (peak incidence 25-35 years, with a second peri-menopausal peak). Its pathophysiology is multifactorial, involving polygenic genetic vulnerability (heritability of 80 % - concordance in monozygotic twins of 50 %) interacting with environmental factors (obstetric complications + prenatal infections + cannabis + urbanization + immigration + early adversity) to produce neurodevelopmental abnormalities neurological development characterized by deregulation of the dopaminergic (mesolimbic hyperactivity \u2192 positive symptoms + mesocortical hypoactivity \u2192 negative and cognitive symptoms) + glutamatergic (NMDA receptor hypofunction \u2192 dissociation of information processing) and serotonergic systems. Prognosis is extremely variable: one-third of patients have a favorable course with complete remission under treatment + one-third an intermediate course with relapses and partial remissions + and one-third a severe course with persistent disability - early treatment at the first psychotic episode and long-term medication compliance are the two most important modifiable prognostic factors.\n <\/div>\n\n <h2>Symptoms \u2014 Clinical Dimensions<\/h2>\n <ul class=\"co-list\">\n <li><strong>Positive symptoms (excess or distortion of normal functions):<\/strong> auditory hallucinations (most frequent\u2014voices commenting on actions + voices conversing with each other + voices giving commands) + visual hallucinations + tactile + olfactory (less frequent) + delusions (persecution++ + reference + grandeur + control + influence + jealousy + erotomania) + disorganized thought process (tangentiality + derailment + neologisms + thought fragmentation) + disorganized or catatonic behavior<\/li>\n <li><strong>Negative symptoms (decrease or absence of normal functions):<\/strong> Emotional blunting (reduced emotional facial expression + monotonous voice) + alogia (poverty of speech + delayed responses) + avolition (inability to initiate activities) + anhedonia (inability to experience pleasure) + social withdrawal + abulia + poor hygiene + negative symptoms are the most debilitating in daily life and the least well-treated by antipsychotics<\/li>\n <li><strong>Cognitive deficits<\/strong> Working memory problems + attention and vigilance deficits + executive function disorders + slowed information processing + social cognition deficits (theory of mind) + cognitive deficits often precede psychosis and persist during symptomatic remission \u2192 main cause of functional impairment<\/li>\n <li><strong>Disorganization symptoms:<\/strong> Disorganized speech + severely disorganized behavior + catatonia (stupor + rigidity + bizarre postures + echophenomena) + inappropriate affect<\/li>\n <\/ul>\n\n <h2>DSM-5 Diagnostic Criteria<\/h2>\n <ul class=\"co-list\">\n <li><strong>Criterion A \u2014 2 or more symptoms for \u2265 1 month:<\/strong> delusional ideas + hallucinations + disorganized speech + grossly disorganized or catatonic behavior + negative symptoms + at least one of the first 3 must be present<\/li>\n <li><strong>Criterion B \u2014 Social or occupational dysfunction:<\/strong> The level of functioning in work, relationships, or self-care is significantly lower than it was before the onset of the disorder.<\/li>\n <li><strong>Criterion C \u2014 Duration:<\/strong> continuous signs of the disorder for at least 6 months (including at least 1 month of active Criterion A symptoms) + may include prodromal and residual phases<\/li>\n <li><strong>Criterion D - Exclusion of Schizoaffective Disorder and Bipolar Disorder<\/strong><\/li>\n <li><strong>Criterion E - Exclusion of a general medical condition or substance<\/strong><\/li>\n <li><strong>Criterion F \u2014 Relationship with ASD:<\/strong> if a history of autism spectrum disorder \u2014 diagnosis of schizophrenia only if prominent hallucinations or delusions for \u2265 1 month<\/li>\n <\/ul>\n\n <h2>Differential diagnosis<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Diagnosis<\/th>\n <th>Distinctive elements<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Schizoaffective disorder<\/td>\n <td>Affective episodes (major depression + mania) concomitant with psychotic symptoms + represent a substantial portion of the total duration<\/td>\n <\/tr>\n <tr>\n <td>Bipolar disorder with psychotic features<\/td>\n <td>Psychotic symptoms confined to mood episodes (mania + depression) + euthymia between episodes<\/td>\n <\/tr>\n <tr>\n <td>Major depressive disorder with psychotic features<\/td>\n <td>Mood-congruent psychosis (depressive themes) + confined to depressive episodes<\/td>\n <\/tr>\n <tr>\n <td>Substance-induced psychosis<\/td>\n <td>Cannabis + cocaine + amphetamines + psilocybin + ketamine \u2192 psychosis occurring during intoxication or withdrawal \u2192 resolution upon cessation of the substance (but may trigger true schizophrenia in vulnerable individuals)<\/td>\n <\/tr>\n <tr>\n <td>Organic psychosis (medical condition)<\/td>\n <td>Temporal lobe epilepsy + cerebral lupus + autoimmune encephalitis (anti-NMDAR) + neurosyphilis + Wilson's disease + hyperglycemia + hyponatremia + severe hypothyroidism \u2192 laboratory workup + EEG + brain MRI + systematic neuronal antibodies in the first psychotic episode<\/td>\n <\/tr>\n <tr>\n <td>Schizotypal personality disorder<\/td>\n <td>No frank psychosis + mild perceptual distortions + magical thinking + chronic social isolation without an acute episode<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Assessment after the first psychotic episode<\/h2>\n <ul class=\"co-list\">\n <li><strong>Biological tests :<\/strong> Kidney function tests + ionogram + blood glucose + creatinine + liver panel + TSH + calcium + B12 + folate + serologies (HIV + syphilis + hepatitis) + urine drug screen (cannabis + cocaine + amphetamines + opioids) + blood copper + ceruloplasmin if young patient (Wilson's disease)<\/li>\n <li><strong>Anti-neuronal antibodies<\/strong> Systematic testing for anti-NMDAR, anti-LGI1, anti-CASPR2, anti-AMPAR, and anti-GABA-B antibodies during the first psychotic episode to rule out autoimmune encephalitis (anti-NMDAR encephalitis = a treatable organic cause of psychosis)<\/li>\n <li><strong>EEG<\/strong> if temporal epilepsy suspicion + or paroxysmal symptoms<\/li>\n <li><strong>Brain MRI<\/strong> Systematic assessment in the first psychotic episode to rule out an organic cause (tumor, demyelination, focal atrophy, leukodystrophy)<\/li>\n <li><strong>Basal metabolic assessment:<\/strong> Weight + BMI + waist circumference + fasting blood glucose + lipid profile + BP \u2192 before initiation of antipsychotics (reference for monitoring induced metabolic syndrome)<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Anti-NMDA receptor encephalitis<em>Anti-NMDAR encephalitis<\/em>) is an organic and potentially curable cause of severe acute psychosis\u2014particularly in young women\u2014that can be mistaken for early-onset schizophrenia. The presentation combines psychosis + agitation + catatonia + epilepsy + dysautonomia + abnormal movements. Systematically testing for anti-NMDAR antibodies (blood + CSF) at the first psychotic episode prevents treating autoimmune encephalitis, which requires immunotherapy + and investigation for ovarian teratoma, with antipsychotics alone.<\/span>\n <\/div>\n\n <h2>Pharmacological treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Second-generation (atypical) antipsychotics \u2014 first-line:<\/strong> risperidone (2\u20138 mg\/day) + olanzapine (10\u201320 mg\/day) + quetiapine (300\u2013750 mg\/day) + aripiprazole (10\u201330 mg\/day) + ziprasidone (120\u2013160 mg\/day) + paliperidone (6\u201312 mg\/day) + lurasidone (40\u2013160 mg\/day) + asenapine \u2192 effective on positive symptoms + different side effect profile depending on the molecule + weight gain ++ (olanzapine) + metabolic syndrome + diabetes + dyslipidemia + prolactinemia (risperidone) + prolonged QTc (ziprasidone + quetiapine)<\/li>\n <li><strong>1st-generation antipsychotics (typical \u2014 2nd line):<\/strong> haloperidol + fluphenazine + chlorpromazine \u2192 effective on positive symptoms but little effect on negative symptoms + high risk of extrapyramidal symptoms (EPS): parkinsonism + acute dystonia + akathisia + tardive dyskinesia \u2192 reserved for refractory forms + or for acute phase IV + or if cost is a constraint<\/li>\n <li><strong>Clozapine (Clozaril\u00ae) \u2014 reserved for refractory schizophrenia:<\/strong> indicated after failure of 2 adequate antipsychotics (dose + duration) + most effective on positive AND negative symptoms + reduces suicidal risk (only antipsychotic with this indication) + dreaded side effects: agranulocytosis (0.5\u20131 % \u2014 mandatory weekly CBC monitoring \u00d7 18 weeks + monthly thereafter) + dose-dependent seizures + myocarditis + major weight gain + hypersalivation + sedation<\/li>\n <li><strong>Long-acting antipsychotics (LAIs \u2014 depot injectables):<\/strong> Risperidone (Risperdal Consta\u00ae \u2014 2 weeks) + Paliperidone (Invega Sustenna\u00ae monthly + Invega Trinza\u00ae quarterly) + Aripiprazole (Abilify Maintena\u00ae monthly + Aristada\u00ae 6 weeks) + Haloperidol decanoate + Fluphenazine decanoate \u2192 improve adherence + reduce relapses \u2192 to be preferred from the first episode if adherence is problematic<\/li>\n <\/ul>\n\n <h2>Non-pharmacological treatment and rehabilitation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Psychoeducation<\/strong> for the patient and family + understanding of the illness + recognition of relapse signs + importance of adherence + reduction of family expressed emotion (EE) which increases the risk of relapse<\/li>\n <li><strong>Cognitive Behavioral Therapy for Psychosis (CBTp):<\/strong> Reduces distress related to hallucinations and delusions + improves functioning + recommended as a complement to pharmacological treatment<\/li>\n <li><strong>Cognitive remediation:<\/strong> Structured cognitive training programs (memory + attention + executive functions) \u2192 modest but significant improvement in cognitive performance and functioning<\/li>\n <li><strong>Psychosocial Rehabilitation:<\/strong> Social skills retraining + Individual Placement and Support (IPS) employment support + supervised housing + community resources \u2192 improved social and vocational integration<\/li>\n <li><strong>Early intervention for first episode:<\/strong> early psychosis intervention programs (EPIP \u2014 Early Psychosis Intervention Program in Quebec) \u2192 specialized teams + intensive follow-up + reduced time to treatment \u2192 significantly improves long-term prognosis<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Psychiatric emergency<\/div>\n <p>Call 911 or go immediately to the psychiatric emergency room if a person presents with a first episode of acute psychosis (hallucinations + delusions + disorganized behavior + significant agitation) OR if a person known to have schizophrenia experiences a severe relapse with agitation OR suicidal ideation OR behavior dangerous to themselves or others. Schizophrenia is associated with a suicide risk 10 to 20 times higher than the general population \u2014 suicidal ideation should always be assessed. For outpatient follow-up of stable schizophrenia and coordination with psychiatric teams, Clinique Omicron offers consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's Nurse Practitioners (NPs) provide follow-up care for patients with stabilized schizophrenia in coordination with psychiatric teams. This includes monitoring antipsychotic treatment and its metabolic effects (blood glucose, lipids, weight, blood pressure), blood count monitoring for patients on clozapine, managing common medical comorbidities (smoking, diabetes, cardiovascular issues), referrals to psychiatric emergencies during relapses, and referrals to psychosocial rehabilitation programs available in Quebec. Consultations are available at several service points across Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not replace the advice of a doctor or psychiatrist. Schizophrenia is a complex illness requiring specialized psychiatric care. Antipsychotics should never be stopped abruptly without medical advice \u2014 stopping suddenly significantly increases the risk of psychotic relapse. If thoughts of self-harm arise, consult a doctor or call 1-866-CALL (277-3553) \u2014 the Quebec provincial crisis line.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Schizophr\u00e9nie : sympt\u00f4mes, diagnostic et traitement antipsychotique | Clinique Omicron Psychiatrie & M\u00e9decine de famille & Neurologie Schizophr\u00e9nie La schizophr\u00e9nie est un trouble psychiatrique s\u00e9v\u00e8re et chronique \u2014 parmi les plus invalidants \u2014 caract\u00e9ris\u00e9 par une combinaison variable de sympt\u00f4mes psychotiques positifs (hallucinations + id\u00e9es d\u00e9lirantes + d\u00e9sorganisation de la pens\u00e9e et du comportement), de… <a href=\"https:\/\/cliniqueomicron.ca\/en\/schizophrenie\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Schizophrenia: Symptoms, Diagnosis, and Antipsychotic Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Schizophr\u00e9nie | Brossard | Clinique Omicron","_metasync_otto_description":"Schizophr\u00e9nie Schizophr\u00e9nie est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Schizophrenie | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Schizophr\u00e9nie Schizophr\u00e9nie est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la...","_metasync_otto_twitter_title":"Schizophrenie | Clinique Omicron","_metasync_otto_twitter_description":"Schizophr\u00e9nie Schizophr\u00e9nie est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0 la...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Schizophr\u00e9nie : sympt\u00f4mes, diagnostic et traitement antipsychotique | Clinique Omicron","_aioseo_description":"La schizophr\u00e9nie est un trouble psychotique chronique avec hallucinations d\u00e9lires sympt\u00f4mes n\u00e9gatifs cognitifs. DSM-5 crit\u00e8res, risp\u00e9ridone olanzapine aripiprazole, clozapine r\u00e9fractaire NFS, APLA observance et r\u00e9habilitation au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-26T19:37:35+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-24948","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t<meta name=\"description\" content=\"Schizophr\u00e9nie Schizophr\u00e9nie est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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