Schizophrenia - Wikipedia, the free encyclopedia

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Schizophrenia
From Wikipedia, the free encyclopedia

Schizophrenia(pronounced/sktsfrni/ or /sktsfrini/) is a mental disorder characterizedby a disintegrationof the processof thinkingand of emotional responsiveness[1] It most commonlymanifestsas auditoryhallucinations paranoidor . , bizarredelusions or disorganizedspeech and thinking, and it is accompaniedby , significantsocial or occupationaldysfunction The onset of symptomstypicallyoccurs . [2] in young adulthood with a global lifetime prevalenceof around1.5%.[3][4] , Diagnosisis basedon the patient's self-reportedexperiencesand observedbehavior. Schizophreniahas increasinglybeen recognizedas a collectionof neurodevelopmental disordersthat involve alterationsin brain circuits.[5] Genetics early environment , , neurobiology psychologicaland social processesappearto be importantcontributory , factors; some recreationaland prescriptiondrugsappearto cause or worsen symptoms. Current psychiatricresearchis focusedon the role of neurobiology but , this inquiryhas not isolated a single organiccause. As a result of the manypossible combinationsof symptoms, there is debate about whetherthe diagnosisrepresentsa single disorderor a number of discrete syndromes Despite the etymologyof the term . from the Greek roots skhizein(, "to split") and phrn, phren- (, -; "mind"), schizophreniadoes not imply a "split mind" and it is not the same as dissociativeidentity disorder also known as "multiplepersonalitydisorder or "split " personality "a condition with which it is often confusedin public perception[6] . Unusuallyhigh dopamineactivityin the mesolimbicpathwayof the brain has been found in peoplewith schizophrenia The mainstayof treatment is antipsychotic . medication; this type of drug primarilyworks by suppressingdopamineactivity. Dosagesof antipsychoticsare generallylower than in the early decadesof their use. Psychotherapy and vocationaland social rehabilitation are also important. In more , , serious caseswhere there is risk to self and othersinvoluntaryhospitalizationmay be necessary althoughhospitalstays are shorter and less frequentthan theywere in , previoustimes.[7]

Schizophrenia
Classification and external resources

Cloth embroidered by a schizophrenia patient. ICD-10 F20. (http://apps.who.int/classifications/ apps/icd/icd10online/?gf20.htm+f20) ICD-9 295 (http://www.icd9data.com/ getICD9Code.ashx?icd9=295) 181500 (http://www.ncbi.nlm.nih.gov/ omim/181500)

OMIM

DiseasesDB 11890 (http://www.diseasesdatabase.com/ ddb11890.htm) MedlinePlus 000928 (http://www.nlm.nih.gov/ medlineplus/ency/article/000928.htm) eMedicine med/2072 (http://www.emedicine.com/ med/topic2072.htm) emerg/520 (http:// www.emedicine.com/emerg/ topic520.htm#)

The disorderis thought mainly to affect cognition, but it also usuallycontributesto F03.700.750 (http://www.nlm.nih.gov/ MeSH chronicproblems with behaviorand emotion. People with schizophreniaare likely to cgi/mesh/2008/MB_cgi? have additional(comorbid) conditions includingmajor depressionand anxiety , mode=&term=Schizophrenia&field=entry# disorders[8] the lifetime occurrenceof substanceabuseis around40%. Social ; TreeF03.700.750) problems, such as long-term unemployment povertyand homelessness are common. , , Furthermore the averagelife expectancyof peoplewith the disorderis 10 to 12 years , less than those without, due to increasedphysicalhealth problems and a higher suicide rate (about 5%).[9][10] Schizophreniahas increasinglygainedattentionamong the generalpublic and the scientificcommunity Indeed, the November11, 2010 issue of . Nature was devoted to the theme of schizophrenia[11] .

Contents
1 Signs and symptoms 1.1 Schneiderianclassification 1.2 Positive and negative symptoms 2 Diagnosis 2.1 Standardizedcriteria 2.2 Confusionwith other conditions 2.3 Subtypes 2.4 Controversiesand researchdirections 3 Causes 3.1 Genetic 3.2 Prenatal 3.3 Social 3.4 SubstanceAbuse 4 Mechanisms

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Schizophrenia - Wikipedia, the free encyclopedia 4.1 Psychological 4.2 Neural 5 Screeningand prevention 6 Management 6.1 Medication 6.2 Psychologicaland social interventions 6.3 Other 7 Prognosis 7.1 Course 7.2 Definingrecovery 7.3 Predictors 7.4 Mortality 7.5 Violence 8 Epidemiology 9 History 10 Societyand culture 10.1 Stigma 10.2 Economic Burden 10.3 Iconic cultural depictions 11 See also 12 References 13 Furtherreading 14 Externallinks

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Signs and symptoms

A persondiagnosedwith schizophreniamay experiencehallucinations(most commonlyhearingvoices), delusions(often bizarreor persecutory in nature), and disorganizedthinkingand speech. The latter mayrange from loss of train of thought, to sentencesonly looselyconnectedin meaning, to incoherenceknown as word salad in severe cases. Thereis often an observablepattern of emotionaldifficulty, for example lack of responsivenessor motivation Impairmentin social cognitionis associatedwith schizophrenia as are symptomsof paranoia, and social isolation . , commonlyoccurs. In one uncommonsubtype, the personmay be largelymute, remain motionlessin bizarrepostures or exhibit purposeless , agitation; these are signsof catatonia. Late adolescenceand early adulthoodare peak years for the onset of schizophrenia In 40% of men and 23% of womendiagnosedwith . schizophrenia the condition arose before the age of 19.[12] These are critical periodsin a youngadult's social and vocationaldevelopment To , . minimize the developmentaldisruptionassociatedwith schizophrenia much work has recentlybeen done to identifyand treat the prodromal , (pre-onset) phaseof the illness, which has been detectedup to 30 monthsbefore the onset of symptoms, but maybe presentlonger.[13] Those who go on to develop schizophreniamay experiencethe non-specific symptomsof social withdrawal irritabilityand dysphoriain the prodromal , period,[14] and transient or self-limiting psychoticsymptomsin the prodromalphasebefore psychosisbecomesapparent.[15]

Schneiderian classification
The psychiatristKurt Schneider(18871967) listed the forms of psychoticsymptomsthat he thought distinguishedschizophreniafrom other psychoticdisorders These are called first-rank symptomsor Schneiders . ' first-rank symptoms, and theyinclude delusionsof being controlledby an externalforce; the belief that thoughtsare being insertedinto or withdrawnfrom one's consciousmind; the belief that one's thoughtsare being broadcastto other people; and hearinghallucinatoryvoices that comment on one's thoughtsor actions or that have a conversationwith other hallucinatedvoices.[16] Althoughtheyhave significantlycontributedto the currentdiagnosticcriteria, the specificityof first-rank symptomshas been questioned A review of the . diagnosticstudiesconductedbetween1970 and 2005 found that these studiesallow neither a reconfirmation nor a rejectionof Schneiders claims, and suggestedthat first-rank symptomsbe de-emphasizedin future ' revisionsof diagnosticsystems.[17]

Positive and negative symptoms

Schizophreniais often describedin terms of positive and negative (or deficit) symptoms.[18] The term positive symptomsrefersto symptomsthat most individualsdo not normallyexperiencebut are presentin schizophrenia . Theyinclude delusions auditoryhallucinations and thought disorder and are typicallyregardedas , , , manifestationsof psychosis Negativesymptomsare things that are not presentin schizophrenicpersons but are . normallyfound in healthypersons, that is, symptomsthat reflect the loss or absenceof normal traits or
The term Schizophrenia was coined by Eugen Bleuler

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abilities. Common negative symptomsinclude flat or bluntedaffect and emotion, povertyof speech (alogia), inabilityto experiencepleasure (anhedonia), lack of desire to form relationships(asociality and lack of motivation(avolition). Researchsuggeststhat negative symptoms ), contributemore to poor quality of life, functionaldisability, and the burdenon others than do positive symptoms.[19]

Diagnosis
Diagnosisis basedon the self-reportedexperiencesof the person, and abnormalitiesin behaviorreportedby familymembers friendsor co, workers, followedby a clinical assessmentby a psychiatrist social worker, clinical psychologist mental health nurse or other mental health , , professional Psychiatricassessmentincludesa psychiatrichistory and some form of mental statusexamination[citation needed] . .

Standardized criteria
The most widelyused standardizedcriteriafor diagnosingschizophreniacome from the AmericanPsychiatricAssociation Diagnosticand 's StatisticalManualof MentalDisorders versionDSM-IV-TR, and the World HealthOrganization InternationalStatisticalClassificationof , 's Diseasesand Related HealthProblems the ICD-10. The latter criteriaare typicallyused in Europeancountries while the DSM criteriaare used , , in the United States and the rest of the world, as well as prevailingin researchstudies. The ICD-10 criteriaput more emphasison Schneiderian first-rank symptoms, although, in practice, agreementbetweenthe two systems is high.[20] Accordingto the revised fourth edition of the Diagnosticand StatisticalManual of MentalDisorders(DSM-IV-TR), to be diagnosedwith schizophrenia three diagnosticcriteriamust be met:[21] , 1. Characteristicsymptoms Two or more of the following, each presentfor much of the time duringa one-month period (or less, if : symptomsremittedwith treatment). Delusions Hallucinations Disorganizedspeech, which is a manifestationof formalthought disorder Grosslydisorganizedbehavior(e.g. dressinginappropriately cryingfrequently or catatonicbehavior , ) Negativesymptoms: Bluntedaffect (lack or decline in emotionalresponse), alogia (lack or decline in speech), or avolition (lack or decline in motivation ) If the delusionsare judged to be bizarre, or hallucinationsconsist of hearingone voice participatingin a runningcommentaryof the patient's actions or of hearingtwo or more voices conversingwith each other, only that symptomis requiredabove. The speech disorganizationcriterion is only met if it is severe enoughto substantiallyimpair communication . 2. Social/occupationaldysfunction For a significantportion of the time since the onset of the disturbance one or more major areas of : , functioningsuch as work, interpersonalrelations, or self-care, are markedlybelow the level achievedprior to the onset. 3. Duration Continuoussignsof the disturbancepersistfor at least six months. This six-month period must include at least one month of : symptoms(or less, if symptomsremittedwith treatment). If signsof disturbanceare presentfor more than a month but less than six months, the diagnosisof schizophreniformdisorderis applied.[21] Psychoticsymptomslastingless than a month may be diagnosedas brief psychoticdisorder and variousconditionsmaybe classedas psychotic , disordernot otherwisespecified. Schizophreniacannotbe diagnosedif symptomsof mood disorderare substantiallypresent(although schizoaffectivedisordercould be diagnosed), or if symptomsof pervasivedevelopmentaldisorderare presentunless prominentdelusionsor hallucinationsare also present, or if the symptomsare the direct physiologicalresult of a generalmedicalcondition or a substance such as , abuseof a drug or medication.

Confusion with other conditions

Psychoticsymptomsmay be presentin severalother mental disorders includingbipolar disorder [22] borderlinepersonalitydisorder [23] drug , , , intoxicationand drug-inducedpsychosis Delusions("non-bizarre") are also presentin delusionaldisorder and social withdrawalin social . , anxietydisorder avoidantpersonalitydisorderand schizotypalpersonalitydisorder Schizophreniais complicatedwith obsessive-compulsive , . disorder(OCD) considerablymore often than could be explainedby pure chance, althoughit can be difficultto distinguishobsessionsthat occur in OCD from the delusionsof schizophrenia[24] . A more generalmedicaland neurologicalexaminationmay be neededto rule out medicalillnesses which mayrarelyproducepsychotic schizophrenia -like symptoms,[21] such as metabolicdisturbance systemic infection, syphilis, HIV infection, epilepsy and brain lesions. It may , , be necessaryto rule out a delirium, which can be distinguishedby visual hallucinations acute onset and fluctuatinglevel of consciousness and , , indicatesan underlyingmedicalillness. Investigationsare not generallyrepeatedfor relapseunless there is a specific medicalindicationor possibleadverse effectsfrom antipsychoticmedication. "Schizophrenia does not mean dissociativeidentity disorder " formerlyand still widelyknown as "multiplepersonalities "despite the etymologyof the word (Greek = "I split").

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Subtypes
The DSM-IV-TR containsfive sub-classificationsof schizophrenia althoughthe developersof DSM-5 are recommendingtheybe droppedfrom , [25] the new classification : , Paranoidtype: Wheredelusionsand hallucinationsare presentbut thought disorder disorganizedbehavior, and affectiveflatteningare absent. (DSM code 295.3/ICD code F20.0) Disorganizedtype: Named hebephrenicschizophreniain the ICD. Wherethought disorderand flat affect are presenttogether. (DSM code 295.1/ICD code F20.1) Catatonictype: The subjectmay be almost immobileor exhibit agitated, purposelessmovement. Symptomscan include catatonicstupor and waxy flexibility (DSM code 295.2/ICD code F20.2) . , Undifferentiatedtype: Psychoticsymptomsare presentbut the criteriafor paranoid, disorganized or catatonictypes have not been met. (DSM code 295.9/ICD code F20.3) Residualtype: Wherepositive symptomsare presentat a low intensityonly. (DSM code 295.6/ICD code F20.5) The ICD-10 definestwo additionalsubtypes. : Post-schizophrenicdepression A depressiveepisode arising in the aftermathof a schizophrenicillness where some low-level schizophrenicsymptomsmay still be present. (ICD code F20.4) : Simpleschizophrenia Insidiousand progressivedevelopmentof prominentnegative symptomswith no history of psychoticepisodes. (ICD code F20.6)

Controversiesand research directions

The scientificvalidityof schizophrenia and its definingsymptomssuch as delusionsand hallucinations have been criticised[26][27] In 2006, a , , . group of consumersand mental health professionalsfrom the UK, underthe banner of Campaignfor Abolitionof the SchizophreniaLabel, argued for a rejectionof the diagnosisof schizophreniabasedon its heterogeneityand associatedstigma, and called for the adoptionof a biopsychosocialmodel. OtherUK psychiatristsopposedthe move arguingthat the term schizophreniais a useful, even if provisionalconcept.[28]
[29] [30] Similarly, there is an argumentthat the underlyingissues would be better addressedas a spectrumof conditions or as individualdimensions along which everyonevaries ratherthan by a diagnosticcategorybasedon an arbitrarycut-off betweennormal and ill.[31] This approachappears consistentwith researchon schizotypy and with a relativelyhigh prevalenceof psychoticexperiences mostlynon-distressingdelusionalbeliefs, , , among the generalpublic.[32][33][34] In concordancewith this observation psychologistEdgar Jones, and psychiatristsTony David and Nassir , Ghaemi, surveyingthe existingliteratureon delusions pointedout that the consistencyand completenessof the definitionof delusion have been , found wanting by many; delusionsare neither necessarilyfixed, nor false, nor involve the presenceof incontrovertibleevidence.[35][36][37]

NancyAndreasen a leadingfigure in schizophreniaresearch has criticizedthe currentDSM-IV and ICD-10 criteriafor sacrificingdiagnostic , , validityfor the sake of artificiallyimprovingreliability. She arguesthat overemphasison psychosisin the diagnosticcriteria, while improving diagnosticreliability, ignoresmore fundamentalcognitive impairmentsthat are harder to assess due to large variationsin presentation[38][39] . This view is supportedby other psychiatrists[40] In the same vein, Ming Tsuangand colleaguesargue that psychoticsymptomsmay be a . common end-state in a varietyof disorders includingschizophrenia ratherthan a reflectionof the specific etiologyof schizophrenia and warn , , , [30] that there is little basis for regardingDSMs operationaldefinitionas the "true" constructof schizophrenia . NeuropsychologistMichael Foster Green went further in suggestingthe presenceof specific neurocognitivedeficits maybe used to constructphenotypesthat are alternatives to those that are purelysymptom -based. These deficits take the form of a reduction or impairmentin basic psychologicalfunctionssuch as memory, attention, executivefunctionand problemsolving.[41][42] The exclusionof affectivecomponentsfrom the criteriafor schizophrenia despite their ubiquityin clinical settings, has also caused contention. , This exclusionin the DSM has resultedin a "ratherconvoluted separatedisorder " schizoaffectivedisorder [40] Citing poor interraterreliability . , some psychiatristshave totally contestedthe concept of schizoaffectivedisorderas a separateentity.[43][44] The categoricaldistinctionbetween mood disordersand schizophrenia known as the Kraepeliniandichotomy has also been challengedby data from genetic epidemiology[45] , , . An approachbroadlyknown as the anti-psychiatrymovement, most active in the 1960s, opposes the orthodoxmedicalview of schizophreniaas an illness.[46] PsychiatristThomasSzaszarguesthat psychiatricpatients are individualswith unconventionalthoughtsand behaviorthat society diagnosesas a methodof social control, and thereforethe diagnosisof "schizophrenia is merelya form of social construction[47] The Hearing " . VoicesMovementarguesthat manypeoplediagnosedas psychoticneed their experiencesto be acceptedand valuedratherthan medicalized .

Causes
Main article: Causes of schizophrenia

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Schizophrenia - Wikipedia, the free encyclopedia While the reliabilityof the diagnosisintroducesdifficultiesin measuringthe relativeeffect of genes and environment(for example, symptomsoverlapto some extent with severe bipolar disorderor major depression evidencesuggeststhat genetic and environmentalfactors can act in combinationto result ), in schizophrenia[49] Evidencesuggeststhat the diagnosisof schizophreniahas a significantheritable . componentbut that onset is significantlyinfluencedby environmentalfactors or stressors.[50] The idea of an inherentvulnerability(or diathesis) in some people, which can be unmaskedby biological , psychologicalor environmentalstressors, is known as the stress-diathesismodel.[51] An alternative idea that biological psychologicaland social factors are all importantis known as the , "biopsychosocial model. "

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Genetic
Estimatesof the heritabilityof schizophreniatend to vary owing to the difficultyof separatingthe [48] Data from a PET study suggests effectsof geneticsand the environmentalthoughtwin and adoptionstudieshave suggesteda high level that the less the frontal lobes are of heritability(the proportionof variationbetweenindividualsin a populationthat is influencedby activated (red) during a working genetic factors).[52] It has been suggestedthat schizophreniais a condition of complex inheritance , memory task, the greater the with manydifferent potentialgeneseach of small effect, with differentpathwaysfor different increase in abnormal dopamine individuals Some have suggestedthat severalgenetic and other risk factors need to be presentbefore . activity in the striatum (green), a personbecomesaffectedbut this is still uncertain.[53] Candidategeneslinked to an increasedrisk of thought to be related to the schizophreniaand bipolar disorderas found in recent genome wide associationstudiesappearto be neurocognitive deficits in [54] partlyseparateand partlyoverlappingbetweenthe two disorders Metaanalysesof genetic linkage schizophrenia. studieshave producedevidenceof chromosomalregionsincreasingsusceptibility[55] which interacts , directly with the Disruptedin Schizophrenia1 (DISC1) gene protein[56] more recentlythe zinc finger protein 804A.[57] has been implicatedas well as the chromosome6 HLAregion.[58] However a large and comprehensivegenetic study found no evidenceof any significantassociation , with any of 14 previouslyidentifiedcandidategenes.[59] Schizophrenia in a small minorityof cases, has been associatedwith rare deletionsor , duplicationsof tiny DNA sequences(known as copy number variants) disproportionatelyoccurringwithin genesinvolvedin neuronalsignaling and brain developmenthuman cognitive, behavioral and psychologicalvariation.[60][61][62] Relations have been found betweenautismspectrum / , disordersand schizophreniabasedon duplicationsand deletionsof chromosomes researchshowed that schizophreniaand autismare ; significantlymore common in combinationwith 1q21.1 deletion syndrome velo-cardio-facial syndromeand Phelan-McDermidsyndrome , . Duplicationsof parts of the chrmosomeswhich are oppositesof these syndromesshow more autism-results. Researchon autism/schizophrenia relations for chromosome15 (15q13.3), chromosome16 (16p13.1) and chromosome17 (17p12) are inconclusive[63] . Assuminga hereditarygenetic basis, one question for evolutionarypsychologyis whygenesthat increasethe likelihood of the condition evolved, assumingthe condition would have been maladaptivefrom an evolutionary /reproductivepoint of view. One theoryimplicatesgenes involved in the evolutionof languageand human nature, but so far all theorieshave been disprovedor remain unsubstantiated[64][65] .

Prenatal
Causal factors are thought to initiallycome togetherin early neurodevelopmentto increasethe risk of later developingschizophrenia One . curiousfinding is that peoplediagnosedwith schizophreniaare more likely to have been born in winter or spring, (at least in the northern hemisphere [66] Thereis now evidencethat prenatalexposureto infectionsincreasesthe risk for developingschizophrenialater in life, ). providingadditionalevidencefor a link betweenin utero developmentalpathologyand risk of developingthe condition.[67]

Social
Livingin an urbanenvironmenthas been consistentlyfound to be a risk factor for schizophrenia[68][69] Social disadvantagehas been found to . [70] be a risk factor, includingpoverty and migrationrelated to social adversity racial discrimination familydysfunction unemploymentor poor , , , [71] housingconditions . Childhoodexperiencesof abuseor trauma have also been implicatedas risk factors for a diagnosisof schizophrenia later in life.[72][73] Parentingis not held responsiblefor schizophreniabut unsupportivedysfunctionalrelationshipsmaycontributeto an increasedrisk.[74][75]

Substance Abuse
See also: Dual diagnosis and Schizophreniaand smoking Structureof a typicalchemicalsynapse In a recent study of peoplewith schizophreniaand a substanceabuse disorder over a ten year period, "substantialproportionswere above , cutoffsselectedby dual diagnosisclients as indicatorsof recovery."[76] Althoughabout half of all patients with schizophreniause drugsor alcohol, and the vast majority use tobacco, a clear causal connection

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betweendrug use and schizophreniahas been difficultto prove. The two most often used explanationsfor this are "substanceuse causes Neurotransmitter Synaptic schizophrenia and "substanceuse is a consequenceof schizophrenia " ", vesicle and theyboth may be correct.[77] A 2007 meta-analysisestimatedthat Reuptake Axon cannabisuse is statisticallyassociatedwith a dose-dependentincreasein Voltagepump terminal risk of developmentof psychoticdisorders includingschizophrenia , , gated Ca++ though the authorsadmit that some uncertaintyabout causalitystill channel remains.[78] For example, cannabisuse has increaseddramaticallyin severalcountriesover the past few decades, though contraryto predictions Receptor Synaptic the rates of psychosisand schizophreniahave generallynot increased.[79] Postsynaptic [80][81] cleft density Psychoticindividualsmay also use drugsto cope with unpleasantstates Dendrite such as depression anxiety, boredomand loneliness becausedrugs , , increase"feel-good" neurotransmitterslevel.[82] Variousstudieshave shownthat amphetaminesincreasesthe concentrationsof dopaminein the synapticcleft, therebyheighteningthe responseof the post-synaptic neuron.[83] However regardingpsychosisitself, it is well understoodthat methamphetamineand cocaine use can result in methamphetamine or , cocaine-inducedpsychosisthat presentvery similar symptomatology(sometimeseven misdiagnosedas schizophrenia and maypersisteven ) when users remain abstinent.[84] The same can also be said for alcohol-inducedpsychosis though to a somewhatlesserextent.[85][86][87] ,

Mechanisms
Psychological
A number of psychologicalmechanismshave been implicatedin the developmentand maintenanceof schizophrenia Cognitivebiases that have . been identifiedin those with a diagnosisor those at risk, especiallywhen understress or in confusingsituations, include excessiveattentionto potentialthreats, jumpingto conclusions makingexternalattributions impairedreasoningabout social situationsand mental states, difficulty , , distinguishinginner speech from speech from an externalsource, and difficultieswith early visual processingand maintainingconcentration[88] . [89][90][91] Some cognitive featuresmay reflect global neurocognitivedeficits in memory, attention, problem -solving, executivefunctionor social cognition, while others may be related to particularissues and experiences[74][92] . Despite a common appearanceof "bluntedaffect", recent findingsindicatethat manyindividualsdiagnosedwith schizophreniaare emotionally responsive particularlyto stressfulor negative stimuli, and that such sensitivitymaycause vulnerabilityto symptomsor to the disorder [93][94] , . [95] Some evidencesuggeststhat the content of delusionalbeliefsand psychoticexperiencescan reflect emotionalcausesof the disorder and , [96][97][98][99] that how a personinterpretssuch experiencescan influencesymptomatology . The use of "safetybehaviors" to avoid imagined threatsmay contributeto the chronicityof delusions [100] Furtherevidencefor the role of psychologicalmechanismscomes from the effectsof . psychotherapieson symptomsof schizophrenia[101] .

Neural
Studiesusing neuropsychologicaltests and brain imagingtechnologiessuch as fMRIand PET to examine functionaldifferencesin brain activity have shownthat differencesseem to most commonlyoccur in the frontallobes, hippocampusand temporallobes.[102] These differenceshave been linked to the neurocognitivedeficits often associatedwith schizophrenia[103] . Particularfocus has been placed upon the functionof dopaminein the mesolimbicpathwayof the brain. This focus largelyresultedfrom the accidentalfinding that a drug group which blocksdopamine function known as the phenothiazines could reducepsychoticsymptoms. It is also supportedby the , , fact that amphetamines which trigger the release of dopamine, mayexacerbatethe psychotic , symptomsin schizophrenia[104] An influentialtheory, known as the Dopaminehypothesisof . schizophrenia proposedthat excessactivationof D2 receptorswas the cause of (the positive symptoms , of) schizophrenia Althoughpostulatedfor about 20 years basedon the D2 blockadeeffect common to . all antipsychotics it was not until the mid-1990s that PET and SPET imagingstudiesprovided , supportingevidence. This explanationis now thought to be simplistic, partlybecausenewer antipsychoticmedication(called atypicalantipsychoticmedication) can be equallyeffectiveas older medication(called typical antipsychoticmedication), but also affectsserotonin functionand mayhave slightlyless of a dopamineblockingeffect.[105] Interesthas also focusedon the neurotransmitterglutamateand the reducedfunctionof the NMDA glutamatereceptorin schizophrenia This has largelybeen suggestedby abnormallylow levels of . [106] glutamatereceptorsfound in postmortembrains of peoplepreviouslydiagnosedwith schizophrenia and the discoverythat the glutamateblockingdrugssuch as phencyclidineand ketaminecan mimic the 30-11-2010 07:51:01

Functional magnetic resonance imaging and other brain imaging technologies allow for the study of differences in brain activity among people diagnosed with schizophrenia

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symptomsand cognitive problems associatedwith the condition.[107] The fact that reducedglutamatefunctionis linked to poor performanceon tests requiringfrontallobe and hippocampalfunctionand that glutamatecan affect dopaminefunction all of which have been implicatedin , schizophrenia have suggestedan importantmediating(and possiblycausal) role of glutamatepathwaysin schizophrenia[108] Positive symptoms , . [109] fail howeverto respondto glutamatergicmedication. A commonlyknown side effect associatedwith schizo-affectivepatients known as akathisia(mistakenfor schizophrenicsymptoms) was found to be associatedwith increasedlevels of norepinephrine[110] Data supports the efficacyof novel antipsychoticswhich deal with agonism of the . [111] NDMAglutamatereceptors , associatedwith regulatinguptakeof norepinephrine[112] which in turn affectsthe traffickingof glutamate.[113] , This, as well as the data noting exacerbationof positive symptomsin users of norepinephrine -agonizingamphetamine suggeststhat , schizophreniamayin fact have a greaterassociationwith abnormal norepinephrine -reuptake kinetics and less with dopamine, which mayin fact be responsiblefor a large part of the mechanismof glutamaterelease.[113] It would be greatly beneficialfor further researchto be done in this area, particularlyin the metabolismof variousessential amino acids and their pro- and inhibitoryeffectson neurotransmitterbalance. Therehave also been findingsof differencesin the size and structureof certain brain areas in schizophrenia A 2006 metaanlaysisof MRI . studiesfound that whole brain and hippocampalvolume are reducedand that ventricularvolume is increasedin patients with a first psychotic episode relativeto healthycontrols. The averagevolumetricchangesin these studiesare howeverclose to the limit of detectionby MRI methods, so it remainsto be determinedwhetherschizophreniais a neurodegenerativeprocessthat beginsat about the time of symptomonset, or whetherit is better characterisedas a neurodevelopmental rocessthat producesabnormal brain volumes at an early age.[114] In first episode p psychosistypical antipsychoticslike haloperidolwere associatedwith significantreductionsin gray matter volume, whereasatypical antipsychoticslike olanzapinewere not.[115] Studiesin non-human primates found gray and white matter reductionsfor both typical and atypicalantipsychotics[116] . A 2009 meta-analysisof diffusiontensor imagingstudiesidentifiedtwo consistentlocationsof reducedfractionalanisotropy(roughly the level of organizationof neural connections) in schizophrenia The authorssuggestthat two networksof white matter tracts maybe affectedin . schizophrenia with the potentialfor "disconnection of the gray matter regionswhich theylink.[117] DuringfMRIstudies, greaterconnectivity , " in the brain's default networkand task-positive networkhas been observedin patients diagnosedwith schizophrenia and mayreflect excessive , attentionalorientationtoward introspectionand toward extrospection respectively The greateranti-correlationbetweenthe two networks , . suggestsexcessiverivalrybetweenthe networks [118] .

Screening and prevention

Thereare no reliablemarkersfor the later developmentof schizophreniaalthoughresearchis being conductedinto how well a combinationof genetic risk plus non-disablingpsychosis -like experiencepredictslater diagnosis.[119] People who fulfill the 'ultra high-risk mental state' criteria, that include a familyhistory of schizophreniaplus the presenceof transient or self-limiting psychoticexperiences have a 2040% , chance of being diagnosedwith the condition after one year.[120] The use of psychologicaltreatmentsand medicationhas been found effective in reducingthe chancesof peoplewho fulfill the 'high-risk' criteriafrom developingfull-blown schizophrenia[121] However the treatmentof . , peoplewho may never develop schizophreniais controversial[122] in light of the side-effectsof antipsychoticmedication; particularlywith , respectto the potentiallydisfiguringtardive dyskinesiaand the rare but potentiallylethal neurolepticmalignantsyndrome [123] The most widely . used form of preventativehealth care for schizophreniatakes the form of public educationcampaignsthat provide informationon risk factors and early symptoms, with the aim to improvedetectionand provide treatmentearlier for those experiencingdelays.[124] The new clinical approachearly interventionin psychosisis a secondarypreventionstrategyto preventfurther episodesand preventthe long term disability associatedwith schizophrenia .

Management
Main article: Treatmentof schizophrenia The effectivenessof schizophreniatreatment is often assessedusing standardizedmethods, one of the most common being the Positive and NegativeSyndromeScale (PANSS).[125] Managementof symptomsand improvingfunctionis thought to be more achievablethan a cure. Treatmentwas revolutionizedin the mid-1950s with the developmentand introductionof chlorpromazine[126] A . recoverymodel is increasinglyadopted, emphasizinghope, empowermentand social inclusion [127] . Hospitalizationmay occur with severe episodesof schizophrenia This can be voluntaryor (if mental . health legislationallowsit) involuntary(called civil or involuntarycommitment). Long-term inpatient stays are now less common due to deinstitutionalization althoughcan still occur.[7] Following(or in , lieu of) a hospitaladmission, supportservicesavailablecan include drop-in centers, visits from membersof a communitymental health team or AssertiveCommunityTreatmentteam, supported [128] employment and patient-led supportgroups .

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Schizophrenia - Wikipedia, the free encyclopedia In many non-Westernsocieties, schizophreniamay be treated with more informal, community -led methods only. Multiple internationalsurveysby the World HealthOrganizationover severaldecades have indicatedthat the outcome for peoplediagnosedwith schizophreniain non-Westerncountriesis on averagebetter there than for peoplein the West.[129]

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Molecule of chlorpromazine (trade name Thorazine), which revolutionized treatment of schizophrenia in the 1950s

Medication
The first line psychiatrictreatment for schizophreniais antipsychoticmedication.[130] These can reducethe positive symptomsof psychosis . Most antipsychoticstake around714 days to have their main effect. Currentlyavailableantipsychoticsfail, however, to significantly amelioratethe negative symptoms, and the improvementson cognitionmaybe attributedto the practiceeffect.[131][132][133][134] The newer atypicalantipsychoticdrugsare usuallypreferredfor initial treatmentover the older typical antipsychotic althoughtheyare expensiveand are more likely to induceweight gain and obesity, related diseases[135] In 20052006, resultsfrom a major randomizedtrial sponsoredby the US . National Instituteof MentalHealth(ClinicalAntipsychoticTrialsof InterventionEffectiveness or , [136] CATIE) found that a representativefirst-generationantipsychotic perphenazine was as effective , , as and more cost-effectivethan severalnewer drugstaken for up to 18 months. The atypical antipsychoticwhich patients were willing to continue for the longest, olanzapine was associatedwith , considerableweight gain and risk of metabolicsyndrome Clozapinewas most effectivefor people . with a poor responseto other drugs, but it had troublesomeside effects. Becausethe trial excluded patients with tardive dyskinesia its relevanceto these peopleis unclear.[137] , Becauseof their reportedlylower risk of side effectsthat affect mobility, atypicalantipsychoticshave been first-line treatment for early-onset schizophreniafor manyyears before certain drugsin this class were approvedby the Foodand DrugAdministrationfor use in childrenand teenagerswith schizophrenia This advantagecomes at the cost of an increasedrisk of metabolicsyndromeand . obesity, which is of concernin the context of long-term use begun at an early age. Especiallyin the case of childrenand teenagerswho have schizophrenia medicationshouldbe used in combinationwith , [12] individualtherapyand family-basedinterventions .

Risperidone (trade name Risperdal) is a common atypical antipsychotic medication

Recent reviewshave refutedthe claim that atypicalantipsychoticshave fewerextrapyramidalside effectsthan typical antipsychotics especiallywhen the latter are used in low doses or when low potencyantipsychoticsare chosen.[138] , Prolactinelevationshave been reportedin womenwith schizophreniataking atypicalantipsychotics[139] It remainsunclear whetherthe newer . antipsychoticsreducethe chancesof developingneurolepticmalignantsyndrome a rare but serious and potentiallyfatal neurologicaldisorder , most often caused by an adverse reactionto neurolepticor antipsychoticdrugs.[140] Responseof symptomsto medicationis variable: treatment-resistantschizophreniais a term used for the failure of symptomsto respond satisfactorilyto at least two differentantipsychotics[141] Patientsin this categorymaybe prescribedclozapine [142] a medicationof superior . , effectivenessbut severalpotentiallylethal side effectsincludingagranulocytosisand myocarditis.[143] For other patients who are unwillingor unableto take medicationregularly long-acting depot preparationsof antipsychoticsmaybe given everytwo weeks to achieve control. The , United States and Australiaare two countrieswith laws allowingthe forced administrationof this type of medicationon those who refuse, but are otherwisestable and living in the community.

Psychological and social interventions

Psychotherapyis also widelyrecommendedand used in the treatment of schizophrenia althoughservicesmayoften be confinedto , pharmacotherapy becauseof reimbursementproblems or lack of training.[144] Cognitivebehavioraltherapy(CBT) is used to targetspecific symptoms[145][146][147] and improverelated issues such as self-esteem, social [148] functioning and insight. Althoughthe resultsof early trials were inconclusive , as the therapyadvancedfrom its initial applicationsin the mid 1990s, CBT has become an effectivetreatment to reducepositive and negative symptomsof schizophrenia as well as improving , [149][150] functioning . However in a 2010 article in PsychologicalMedicineentitled, "Cognitivebehavioraltherapyfor the major psychiatric , disorder does it reallywork?",[151] Lynch, Laws& McKennafound that no trial employingboth blindingand psychologicalplacebo has found : CBT to be effectivein either reducingsymptomsor preventingrelapsein schizophrenia . Anotherapproachis cognitive remediation, a techniqueaimed at remediatingthe neurocognitivedeficits sometimespresentin schizophrenia . Based on techniquesof neuropsychologicalrehabilitation early evidencehas shownit to be cognitivelyeffective, with some improvements , related to measurablechangesin brain activationas measuredby fMRI.[152][153] A similar approachknown as cognitive enhancementtherapy , which focuseson social cognitionas well as neurocognition has shownefficacy.[154] ,

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Familytherapyor education, which addressesthe whole familysystem of an individualwith a diagnosisof schizophrenia has been consistently , [155][156][157] found to be beneficial at least if the durationof interventionis longer-term. , Aside from therapy the effect of schizophreniaon , familiesand the burdenon carers has been recognized with the increasingavailabilityof self-help books on the subject.[158][159] Thereis also , some evidencefor benefitsfrom social skills training, althoughthere have also been significantnegative findings [160][161] Some studieshave . exploredthe possiblebenefitsof music therapyand other creativetherapies.[162][163][164] The Soteria model is alternativeto inpatienthospitaltreatment using a minimalmedicationapproach It is describedas a milieu-therapeutic . recoverymethod, characterizedby its founderas "the 24 hour a day applicationof interpersonalphenomenologicinterventionsby a nonprofessionalstaff, usuallywithout neurolepticdrug treatment, in the context of a small, homelike, quiet, supportive, protective and tolerant , social environment "[165] Althoughresearchevidenceis limited, a 2008 systematicreview found the programmeequallyas effectiveas . treatmentwith medicationin peoplediagnosedwith first and secondepisode schizophrenia[166] .

Other
Electroconvulsivetherapyis not considereda first line treatment but maybe prescribedin cases where other treatmentshave failed. It is more effectivewhere symptomsof catatoniaare present,[167] and is recommendedfor use underNICE guidelinesin the UK for catatoniaif previously effective, though there is no recommendationfor use for schizophreniaotherwise.[168] Psychosurgeryhas now become a rare procedureand is not a recommendedtreatment.[169] Service-user led movementshave become integral to the recoveryprocessin Europe and the United States; groupssuch as the HearingVoices Networkand the ParanoiaNetworkhave developeda self-help approachthat aims to provide supportand assistanceoutside the traditional medicalmodel adoptedby mainstreampsychiatry By avoidingframingpersonal experiencein terms of criteriafor mental illness or mental . health, theyaim to destigmatizethe experienceand encourageindividualresponsibilityand a positive self-image. Partnershipsbetweenhospitals and consumer-run groupsare becomingmore common, with servicesworkingtoward remediatingsocial withdrawal buildingsocial skills and , reducingrehospitalization[170] . Regularexercisecan have healthfuleffectson both the physicaland mental health and well-being of individualswith schizophrenia[171] .

Prognosis
Course
Coordinatedby the World HealthOrganizationand publishedin 2001, The InternationalStudy of Schizophrenia(ISoS) was a long-term follow-up study of 1633 individualsdiagnosedwith schizophreniaaroundthe world. Of the 75% who were availablefor follow-up, half had a favourable outcome, and 16% had a delayedrecoveryafter an early unremittingcourse. More usually the course , in the first two years predictedthe long-term course. Early social interventionwas also related to a better outcome. The findingswere held as importantin movingpatients, carers and cliniciansaway from the prevalentbelief of the chronicnature of the condition.[172] A review of major longitudinal studiesin North Americanoted this variationin outcomes, althoughoutcome was on averageworse than for other psychoticand psychiatricdisorders A moderate number of patients with schizophrenia . were seen to remit and remain well; the review raised the question that some maynot require maintenancemedication.[173] A clinical study using strict recoverycriteria(concurrentremissionof positive and negative symptoms and adequatesocial and vocationalfunctioningcontinuouslyfor two years) found a recoveryrate of 14% within the first five years.[174] A 5-year communitystudy found that 62% showed overall improvementon a composite measureof clinical and functionaloutcomes.[175] World HealthOrganizationstudieshave noted that individualsdiagnosedwith schizophreniahave much better long-term outcomesin developingcountries(India, Colombia and Nigeria) than in developedcountries(United States, United Kingdom, Ireland, Denmark, Czech Republic, Slovakia, Japan, and Russia),[176] despite antipsychoticdrugsnot being widelyavailable.
John Nash, a US mathematician, began showing signs of paranoid schizophrenia during his college years. Despite having stopped taking his prescribed medication , Nash continued his studies and was awarded the Nobel Prize in 1994. His life was depicted in the 2001 film A Beautiful Mind.

Defining recovery

Rates are not always comparableacross studiesbecauseexact definitionsof remissionand recovery have not been widelyestablished A "Remissionin SchizophreniaWorkingGroup" has proposed . standardizedremissioncriteriainvolving"improvementsin core signsand symptomsto the extent that any remainingsymptomsare of such low intensitythat theyno longer interferesignificantlywith behaviorand are below the threshold typically utilizedin justifyingan initial diagnosisof schizophrenia [177] Standardizedrecoverycriteriahave also been proposedby a number of different ".

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researchers with the statedDSM definitionsof a "completereturn to premorbidlevels of functioning or "completereturn to full functioning , " seen as inadequate impossibleto measure incompatiblewith the variabilityin how society definesnormal psychosocialfunctioning and , , , contributingto self-fulfillingpessimismand stigma.[178] Some mental health professionalsmayhave quite differentbasic perceptionsand conceptsof recoverythan individualswith the diagnosis, includingthose in the Consumer /Survivor/Ex-Patient Movement[179] One notable . limitationof nearly all the researchcriteriais failure to addressthe person's own evaluationsand feelingsabout their life. Schizophreniaand recoveryoften involve a continuingloss of self-esteem, alienationfrom friendsand family, interruptionof schooland career, and social stigma, "experiencesthat cannotjust be reversedor forgotten [127] An increasinglyinfluentialmodel definesrecoveryas a process, similar to being "in ". recovery" from drug and alcohol problems, and emphasizesa personal journeyinvolvingfactors such as hope, choice, empowerment social , inclusionand achievement[127] .

Predictors
Severalfactors have been associatedwith a better overall prognosis Beingfemale, rapid (vs. insidious onset of symptoms, older age of first : ) episode, predominantlypositive (ratherthan negative) symptoms, presenceof mood symptoms, and good pre-illness functioning[180][181] The . strengthsand internal resourcesof the individualconcerned, such as determinationor psychologicalresilience have also been associatedwith , better prognosis[173] The attitudeand level of supportfrom peoplein the individual's life can have a significantimpact; researchframedin . terms of the negative aspectsof thisthe level of critical comments, hostility, and intrusiveor controllingattitudes, termed high 'Expressed emotion'has consistentlyindicatedlinks to relapse.[182] Most researchon predictivefactors is correlationalin nature, however, and a clear cause-and-effect relationshipis often difficultto establish.

Mortality
See also: Physical health in schizophrenia In a study of over 168,000 Swedish citizens undergoingpsychiatrictreatment, schizophreniawas associatedwith an averagelife expectancyof approximately8085% of that of the generalpopulation; womenwere found to have a slightlybetter life expectancythan men, and a diagnosis of schizophreniawas associatedwith an overall better life expectancythan substanceabuse, personalitydisorder heart attack and stroke.[183] , Otheridentifiedfactors include smoking,[184] poor diet, little exerciseand the negative health effectsof psychiatricdrugs.[9] Thereis a higher than averagesuicide rate associatedwith schizophrenia This has been cited at 10%, but a more recent analysisof studiesand . statistics revisesthe estimateat 4.9%, most often occurringin the period followingonset or first hospitaladmission.[185] Severaltimes more attemptsuicide.[186] Thereare a varietyof reasonsand risk factors.[187][188]

Violence
The relationshipbetweenviolent acts and schizophreniais a contentioustopic. Current researchindicatesthat the percentageof peoplewith schizophreniawho commit violent acts is higher than the percentageof peoplewithout any disorder but lower than is found for disorderssuch , as alcoholism, and the differenceis reducedor not found in same-neighbourhoodcomparisonswhen related factors are taken into account, notablysociodemographicvariablesand substancemisuse.[189] Studieshave indicatedthat 5% to 10% of those chargedwith murder in Western countrieshave a schizophreniaspectrumdisorder [190][191][192] . The occurrenceof psychosisin schizophreniahas sometimesbeen linked to a higher risk of violent acts. Findingson the specific role of delusionsor hallucinationshave been inconsistent but have focusedon delusionaljealousy perceptionof threat and commandhallucinations It , , . has been proposedthat a certain type of individualwith schizophreniamaybe most likely to offend, characterizedby a history of educational difficulties low IQ, conductdisorder early-onset substancemisuse and offendingprior to diagnosis.[190] , , Individualswith a diagnosisof schizophreniaare often the victimsof violent crimeat least 14 times more often than theyare perpetrators . [193][194] [195] Anotherconsistentfinding is a link to substancemisuse, particularlyalcohol, among the minoritywho commit violent acts. Violenceby or against individualswith schizophreniatypicallyoccursin the context of complex social interactionswithin a familysetting,[196] and is also an issue in clinical services[197] and in the wider community [198] .

Epidemiology
Schizophreniaoccursequallyin males and females, althoughtypicallyappears earlier in menthe peak ages of onset are 2028 years for males and 2632 years for females.[2] Onsetin childhoodis much rarer,[199] as is onset in middle- or old age.[200] The lifetime prevalenceof schizophrenia the proportionof individuals expectedto experiencethe disease at any time in their livesis commonlygiven at 1%. However a 2002 systematicreview of manystudiesfound a lifetime , prevalenceof 0.55%.[4] Despite the received wisdom that schizophreniaoccursat

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Schizophrenia - Wikipedia, the free encyclopedia similar rates worldwide its prevalencevaries across the world,[201] within , countries[202] and at the local and neighbourhoodlevel.[203] One particularly , stable and replicablefinding has been the associationwith living in an urban environmentand increasedincidenceof schizophrenia even after factors such as , drug use, ethnic group and size of social group have been controlledfor.[68] Schizophreniais known to be a major cause of disability. In a 1999 study of 14 countries active psychosiswas ranked the third-most-disablingcondition after , quadriplegiaand dementiaand aheadof paraplegiaand blindness [204] .

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History
Main article: Historyof schizophrenia

Disability-adjusted life year for schizophrenia per 100,000 inhabitants in 2002.

no data 185 185197 197207 207218 218229 229240 240251 251262 262273 273284 284295 295

Accountsof a schizophrenia -like syndromeare thought to be rare in the historical record before the 1800s, althoughreportsof irrational unintelligible or , , uncontrolledbehaviorwere common. A detailedcase report in 1797 concerning James Tilly Matthews and accountsby Phillipe Pinel publishedin 1809, are , often regardedas the earliestcases of the illness in the medicaland psychiatric literature.[205] Schizophreniawas first describedas a distinct syndromeaffecting teenagersand youngadults by BndictMorel in 1853, termed dmenceprcoce (literally'early dementia The term dementiapraecoxwas used in 1891 by '). Arnold Pick to in a case report of a psychoticdisorder In 1893 Emil Kraepelin . introduceda broad new distinctionin the classificationof mental disordersbetweendementiapraecoxand mood disorder(termed manic depressionand includingboth unipolarand bipolar depression Kraepelinbelieved that dementiapraecoxwas primarilya disease of the brain, ). [206] and particularlya form of dementia distinguishedfrom other forms of dementia such as Alzheimer disease, which typicallyoccur later in , , 's life.[207] The word schizophrenia which translatesroughlyas "splittingof the mind" and comes from the Greek roots schizein(, "to split") and phrn, phren- (, -, "mind")[208]was coinedby Eugen Bleulerin 1908 and was intended to describethe separationof function betweenpersonality thinking, memory, and perception Bleulerdescribedthe main symptomsas 4 A's: flattenedAffect, Autism, impaired , . Associationof ideas and Ambivalence[209] Bleulerrealizedthat the illness was not a dementiaas some of his patients improvedratherthan . deterioratedand henceproposedthe term schizophreniainstead. In the early 1970s, the diagnosticcriteriafor schizophreniawas the subjectof a number of controversieswhich eventuallyled to the operational criteriaused today. It became clear after the 1971 US-UK DiagnosticStudy that schizophreniawas diagnosedto a far greaterextent in America than in Europe.[210] This was partlydue to looser diagnosticcriteriain the US, which used the DSM-II manual, contrastingwith Europe and its ICD-9. David Rosenhan 1972 study, publishedin the journalScience underthe title On being sane in insaneplaces, concludedthat the 's diagnosisof schizophreniain the US was often subjectiveand unreliable[211] These were some of the factors in leadingto the revision not only . of the diagnosisof schizophrenia but the revision of the whole DSM manual, resultingin the publicationof the DSM-III in 1980.{subscription , required [212] } The term schizophreniais commonlymisunderstoodto mean that affectedpersons have a "split personality Althoughsome peoplediagnosed ". with schizophreniamay hear voices and may experiencethe voices as distinct personalities schizophreniadoes not involve a personchanging , among distinct multiplepersonalities The confusionarisesin part due to the literalinterpretationof Bleuler's term schizophrenia The first . . known misuse of the term to mean "split personality was in an article by the poet T. S. Eliot in 1933.[213] "

Society and culture

Stigma
Social stigma has been identifiedas a major obstacle in the recoveryof patients with schizophrenia[214] In a large, representativesample from a . 1999 study, 12.8% of Americansbelieved that individualswith schizophreniawere "very likely" to do somethingviolent against others, and 48.1% said that theywere "somewhatlikely" to. Over 74% said that peoplewith schizophreniawere either "not very able" or "not able at all" to make decisionsconcerningtheir treatment, and 70.2% said the same of moneymanagementdecisions.[215] The perceptionof individualswith psychosisas violent has more than doubledin prevalencesince the 1950s, accordingto one meta-analysis [216] . In 2002, the JapaneseSocietyof Psychiatryand Neurologychangedthe term for schizophreniafrom Seishin-Bunretsu -By (mind[217] split-disease) to Tg-shitch-sh (integrationdisorder to reducestigma, ) The new name was inspiredby the biopsychosocial model, and it increasedthe percentageof cases in which patients were informedof the diagnosisfrom 36.7% to 69.7% over three years.[218]

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Economic Burden
In the United States alone, the overall cost of schizophreniawas estimatedto be $62.7 billion in 2002.[219] These estimatesinclude health care costs (e.g. outpatient inpatient, drugs, and long-term care) and non-health care costs (e.g. law enforcement reducedworkplaceproductivity and , , , unemployment. )

Iconic cultural depictions

The book and film A BeautifulMind chronicledthe life of John ForbesNash, a Nobel Prize-winningmathematicianwho was diagnosedwith schizophrenia The Marathifilm Devrai(featuringAtul Kulkarni) is a presentationof a patient with schizophrenia The film, set in Western . . India, shows the behavior, mentality, and struggleof the patient as well as his loved-ones. Otherfactual books have been written by relatives on familymembers AustralianjournalistAnne Devesontold the story of her son's battle with schizophreniain Tell Me I'm Here,[220] later made ; into a movie. The book The Eden Expressby Mark Vonnegutrecounts his strugglewith schizophreniaand his recoveringjourney .

See also
Catastrophicschizophrenia Linguisticrelativity Mad in America Persecutorydelusions Social constructionof schizophrenia

References
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Psychiatric morbidity among homicide offenders: a Swedish population study (http://ajp.psychiatryonline.org/cgi/pmidlookup? view=long&pmid=15514419) . American Journal of Psychiatry. 2004 [cited 2008-07-04];161(11):212931. doi:10.1176/appi.ajp.161.11.2129 (http://dx.doi.org/10.1176%2Fappi.ajp.161.11.2129) . PMID 15514419. 193. ^ Brekke JS, Prindle C, Bae SW, Long JD. Risks for individuals with schizophrenia who are living in the community (http://ps.psychiatryonline.org/ cgi/pmidlookup?view=long&pmid=11585953) . Psychiatric Services. 2001 [cited 2008-07-04];52(10):135866. doi:10.1176/appi.ps.52.10.1358 (http://dx.doi.org/10.1176%2Fappi.ps.52.10.1358) . PMID 11585953. 194. ^ Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J. Victimization of patients with schizophrenia and related disorders. The Australian and New Zealand Journal of Psychiatry. 2005;39(3):16974. doi:10.1111/j.1440-1614.2005.01539.x (http://dx.doi.org/10.1111% 2Fj.1440-1614.2005.01539.x) . 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Acta Psychiatrica Scandinavica. 2004;110(2):92 7. doi:10.1111/j.1600-0047.2004.00322.x (http://dx.doi.org/10.1111%2Fj.1600-0047.2004.00322.x) . PMID 15233709. 199. ^ Kumra S. Childhood-onset schizophrenia: research update. Canadian Journal of Psychiatry. 2001;46(10):92330. PMID 11816313. 200. ^ Psychosis in the Elderly (http://books.google.com/?id=eLaMOJ9oj28C&printsec=frontcover&dq=Psychosis+in+the+Elderly) . London: Taylor and Francis.; 2005. ISBN 1841843946. p. 6. 201. ^ Jablensky A. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine Monograph Supplement. 1992;20:197. doi:10.1017/S0264180100000904 (http://dx.doi.org/10.1017% 2FS0264180100000904) . PMID 1565705. 202. ^ Kirkbride JB, Fearon P, Morgan C, et al.. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3center AeSOP study. 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London: Macmillan; 1907. 207. ^ Hansen RA, Atchison B. Conditions in occupational therapy: effect on occupational performance. Hagerstown, MD: Lippincott Williams & Wilkins; 2000. ISBN 0-683-30417-8. 208. ^ Kuhn R;. Eugen Bleuler's concepts of psychopathology. History of Psychiatry. 2004;15(3):3616. doi:10.1177/0957154X04044603 (http:// dx.doi.org/10.1177%2F0957154X04044603) . PMID 15386868. 209. ^ Stotz-Ingenlath G. Epistemological aspects of Eugen Bleuler's conception of schizophrenia in 1911 (http://www.kluweronline.com/art.pdf? issn=1386-7423&volume=3&page=153) [PDF]. Medicine, Health Care and Philosophy. 2000 [cited 2008-07-03];3(2):1539. doi:10.1023/ A:1009919309015 (http://dx.doi.org/10.1023%2FA%3A1009919309015) . PMID 11079343. 210. ^ Wing JK. International comparisons in the study of the functional psychoses. British Medical Bulletin. 1971;27(1):7781. PMID 4926366. 211. ^ Rosenhan D. On being sane in insane places. 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Further reading
Bentall, Richard. Madness explained: psychosis and human nature. London: Allen Lane; 2003. ISBN 0-7139-9249-2. Dalby, J. Thomas. Mental disease in history: a selection of translated readings. Bern: Peter Lang; 1996. ISBN 0-8204-3056-0. Fallon, James H.. The Neuroanatomy of Schizophrenia: Circuitry and Neurotransmitter Systems. Clinical Neuroscience Research. 2003 [cited 2008-07-07];3:77107. doi:10.1016/S1566-2772(03)00022-7 (http://dx.doi.org/10.1016%2FS1566-2772%2803%2900022-7) . Fleck, Stephen; Theodore Lidz; and Alice Cornelison. Schizophrenia and the family. New York: International Universities Press; 1985. ISBN 0-8236-6001-X. Keen TM. Schizophrenia: orthodoxy and heresies. A review of alternative possibilities. Journal of Psychiatric and Mental Health Nursing. 1999;6(6) :41524. doi:10.1046/j.1365-2850.1999.00237.x (http://dx.doi.org/10.1046%2Fj.1365-2850.1999.00237.x) . PMID 10818864. Laing, Ronald D.. The divided self: an existential study in sanity and madness. New York: Penguin Books; 1990. ISBN 0-14-013537-5. Lenzenweger, M.F. (2010). Schizotypy and schizophrenia: The view from experimental psychopathology. New York: Guilford Press. ISBN 978-1-60623-865-3 Noll, Richard. The Encyclopedia of Schizophrenia And Other Psychotic Disorders (Facts on File Library of Health and Living). New York: Facts on File; 2006. ISBN 0-8160-6405-9. Roazen, Paul nd Victor Tausk. Sexuality, war, and schizophrenia: collected psychoanalytic papers. New Brunswick, N.J., U.S.A: Transaction Publishers; 1991. ISBN 0-88738-365-3. (On the Origin of the 'Influencing Machine' in Schizophrenia.) Shaner A, Miller G, Mintz J. Schizophrenia as one extreme of a sexually selected fitness indicator (http://www.unm.edu/~gfmiller/new_papers/shaner %20miller%202004%20schizo.pdf) [PDF]. Schizophr. Res.. 2004 [cited 2008-07-07];70(1):1019. doi:10.1016/j.schres.2003.09.014 (http:// dx.doi.org/10.1016%2Fj.schres.2003.09.014. . PMID 15246469. Schizophrenia: the sacred symbol of psychiatry. New York: Basic Books; 1976. ISBN 0-465-07222-4. Walker Elaine, et al. Schizophrenia: Etiology and Course (http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.psych.55.090902.141950) . Annual Review of Psychology. 2004;55:40130. doi:10.1146/annurev.psych.55.090902.141950 (http://dx.doi.org/10.1146% 2Fannurev.psych.55.090902.141950) . PMID 14744221.

External links
Schizophrenia(http://www.dmoz.org/Health/Mental_Health/Disorders /Schizophrenia at the Open DirectoryProject //) NPR: the sight and sounds of schizophrenia(http://www.npr.org/programs/atc/features/2002/aug/schizophrenia /) The currentWorld HealthOrganisationdefinitionof Schizophrenia(http://www.who.int/mental_health/management schizophrenia / /en/) Symptomsin Schizophrenia(http://www.archive.org/details/Symptoms 1940) Film made in 1940 showingsome of the symptomsof Schizophrenia . Retrievedfrom "http://en.wikipedia.org/wiki/Schizophrenia " Categories Schizophrenia| Disability| Greek loanwords| Mentalillness diagnosisby DSM and ICD | Psychosis : This page was last modified on 28 November2010 at 04:55. Text is availableunderthe Creative CommonsAttribution -ShareAlikeLicense; additionalterms mayapply. See Terms of Use for details. Wikipedia is a registeredtrademarkof the Wikimedia Foundation Inc., a non-profit organization , .

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