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Adapted, with permission, from Med Lett Drugs Ther 2004;2:13 TMP-SMZ is a mixture of 1 part trimethoprim and 5 parts sulfamethoxazole 3 Fluoroquinolones include ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, and others (see text) Gemifloxacin, levofloxacin, and moxifloxacin have the best activity against gram-positive organisms, including penicillin-resistant S pneumoniae and methicillin-sensitive S aureus Activity against enterococci and S epidermidis is variable 4 Erythromycin estolate is best absorbed orally but carries the highest risk of hepatitis; erythromycin stearate and erythromycin ethylsuccinate are also available 5 All tetracyclines have similar activity against most microorganisms Minocycline and doxycycline have increased activity against S aureus 6 Penicillin G is preferred for parenteral injection; penicillin V for oral administration to be used only in treating infections due to highly sensitive organisms 7 Most intravenous cephalosporins (with the exception of ceftazidime) have good activity against gram-positive cocci 8 Infections caused by isolates with intermediate resistance may respond to high doses of penicillin, cefotaxime, or ceftriaxone Infections caused by highly resistant strains should be treated with vancomycin Many strains of penicillin-resistant pneumococci are resistant to macrolides, cephalosporins, tetracyclines, and TMP-SMZ 9 Parenteral nafcillin or oxacillin; oral dicloxacillin, cloxacillin, or oxacillin 10 Addition of gentamicin indicated only for severe enterococcal infections (eg, endocarditis, meningitis) 11 Aminoglycosides gentamicin, tobramycin, amikacin, netilmicin should be chosen on the basis of local patterns of susceptibility 12 Antipseudomonal penicillins: ticarcillin, piperacillin 13 Resistance is common and susceptibility testing should be done 14 Ciprofloxacin has inferior antichlamydial activity compared with newer fluoroquinolones Key: , alone or combined with

Schizoaffective disorders are those cases that fail to fit comfortably either in the schizophrenic or in the affective categories They are usually cases with affective symptoms that precede or develop concurrently with psychotic manifestations There has been increasing interest in studying prodromal schizophrenia with a goal to early treatment

Schizophreniform disorders are similar in their symptoms to schizophrenic disorders except that the duration of prodromal, acute, and residual symptoms is more than 1 week but less than 6 months

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may trigger explosive outbursts, whereas at other times there may be no overt response whatsoever (catatonia) When paranoid ideation is present, the patient is often irritable and less cooperative Delusions (false beliefs) are characteristic of paranoid thinking, and they usually take the form of a preoccupation with the supposedly threatening behavior exhibited by other individuals This ideation may cause the patient to adopt active countermeasures such as locking doors and windows, taking up weapons, covering the ceiling with aluminum foil to counteract radar waves, and other bizarre efforts Somatic delusions revolve around issues of bodily decay or infestation Perceptual distortions usually include auditory hallucinations visual hallucinations are more commonly associated with organic mental states and may include illusions (distortions of reality) such as figures changing in size or lights varying in intensity Cenesthetic hallucinations (eg, a burning sensation in the brain, feeling blood flowing in blood vessels) occasionally occur Lack of humor, feelings of dread, depersonalization (a feeling of being apart from the self), and fears of annihilation may be present Any of the above symptoms generate higher anxiety levels, with heightened arousal and occasional panic and suicidal ideation, as the individual fails to cope The development of the acute episode in schizophrenia frequently is the end product of a gradual decompensation Frustration and anxiety appear early, followed by depression and alienation, along with decreased effectiveness in day-today coping This often leads to feelings of panic and increasing disorganization, with loss of the ability to test and evaluate the reality of perceptions The stage of so-called psychotic resolution includes delusions, autistic preoccupations, and psychotic insight, with acceptance of the decompensated state The process is frequently complicated by the use of caffeine, alcohol, and other recreational drugs Life expectancy of schizophrenics is as much as 20% shorter than that of cohorts in the general population (usually because of a higher mortality rate in younger people) Polydipsia may produce water intoxication with hyponatremia characterized by symptoms of confusion, lethargy, psychosis, seizures, and occasionally death in any psychiatric disorder, but most commonly in schizophrenia These problems exacerbate the schizophrenic symptoms Possible pathogenetic factors in polydipsia include a hypothalamic defect, inappropriate antidiuretic hormone (ADH) secretion, neuroleptic medications (anticholinergic effects, stimulation of hypothalamic thirst center, effect on ADH), smoking (nicotine and syndrome of inappropriate antidiuretic hormone [SIADH]), psychotic thought processes (delusions), and other medications (eg, diuretics, antidepressants, lithium, alcohol) Other causes of polydipsia must be ruled out (eg, diabetes mellitus, diabetes insipidus, renal disease).

8:

These disorders last less than 1 week They are the result of psychological stress The shorter duration is significant and correlates with a more acute onset and resolution as well as a much better prognosis

Brain abnormalities occur in 40% of patients who develop psychotic symptoms after age 60 The psychotic symptoms are typical, and there are other findings such as low IQ scores and diminished cognitive function

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