Psychosis: Schizophrenia and Related Disorders

Abstract

Mental disorders are the greatest source of medical and occupational morbidity among active-duty US military service members. Psychotic disorders, in particular schizophrenia and schizoaffective disorder, are among the most severe mental disorders and account for a substantial portion of hospitalizations and medical retirements. Service members who are medically retired due to schizophrenia or a related disorder generally have their care transferred to the Department of Veterans Affairs (VA), where comprehensive evidence-based treatment services are available that can effectively address all stages of the illness. This chapter focuses on schizophrenia because the evidence base for its clinical management is the best developed, but the principles of and strategies for treating schizophrenia are broadly applicable to related disorders, including schizoaffective disorder. Each illness stage-acute episode (initial and stabilization phases), maintenance and relapse prevention, and recovery-is discussed in detail, together with its unique challenges and treatment goals. Common comorbid conditions that can complicate the recognition and treatment of schizophrenia and related disorders-for example, post-traumatic stress disorder-also are considered. Finally, VA and non-VA systems of care are compared to provide a broader context for the discussion.