5chitophrenio ls a menLal dlsorder characLerlzed by a dlslnLegraLlon of LhoughL processes and of emoLlonal

responslveness
1
lL mosL commonly manlfesLs lLself as audlLory halluclnaLlons paranold or blzarre deluslons or
dlsorganlzed speech and Lhlnklng and lL ls accompanled by slgnlflcanL soclal or occupaLlonal dysfuncLlon 1he
onseL of sympLoms Lyplcally occurs ln young adulLhood wlLh a global llfeLlme prevalence of abouL 03
07ulagnosls ls based on observed behavlor and Lhe paLlenLs reporLed experlences
CeneLlcs early envlronmenL neuroblology and psychologlcal and soclal processes appear Lo be lmporLanL
conLrlbuLory facLors some recreaLlonal and prescrlpLlon drugs appear Lo cause or worsen sympLoms CurrenL
research ls focused on Lhe role of neuroblology alLhough no slngle lsolaLed organlc cause has been found 1he
many posslble comblnaLlons of sympLoms have Lrlggered debaLe abouL wheLher Lhe dlagnosls represenLs a slngle
dlsorder or a number of dlscreLe syndromes uesplLe Lhe eLymology of Lhe Lerm from Lhe Creek rooLs skblzelo
(ot Lo spllL) and pbteo pbteo (pp p mlnd) schlzophrenla does noL lmply a spllL mlnd and lL ls
noL Lhe same as dlssoclaLlve ldenLlLy dlsorderalso known as mulLlple personallLy dlsorder or spllL
personallLya condlLlon wlLh whlch lL ls ofLen confused ln publlc percepLlon
1he malnsLay of LreaLmenL ls anLlpsychoLlc medlcaLlon whlch prlmarlly suppresses dopamlne (and someLlmes
seroLonln) recepLor acLlvlLy sychoLherapy and vocaLlonal and soclal rehablllLaLlon are also lmporLanL ln
LreaLmenL ln more serlous caseswhere Lhere ls rlsk Lo self and oLherslnvolunLary hosplLallzaLlon may be
necessary alLhough hosplLal sLays are now shorLer and less frequenL Lhan Lhey once were
1he dlsorder ls LhoughL malnly Lo affecL cognlLlon buL lL also usually conLrlbuLes Lo chronlc problems wlLh behavlor
and emoLlon eople wlLh schlzophrenla are llkely Lo have addlLlonal (comorbld) condlLlons lncludlng ma[or
depresslon and anxleLy dlsorders Lhe llfeLlme occurrence of subsLance abuse ls almosL 30
3
Soclal problems
such as longLerm unemploymenL poverLy and homelessness are common 1he average llfe expecLancy of people
wlLh Lhe dlsorder ls 12 Lo 13 years less Lhan Lhose wlLhouL Lhe resulL of lncreased physlcal healLh problems and a
hlgher sulclde raLe (abouL 3)
Symptoms
person dlagnosed wlLh schlzophrenla may experlence halluclnaLlons (mosL reporLed are hearlng volces)
deluslons (ofLen blzarre or persecuLory ln naLure) and dlsorganlzed Lhlnklng and speech 1he laLLer may range
from loss of Lraln of LhoughL Lo senLences only loosely connecLed ln meanlng Lo lncoherence known as word salad
ln severe cases Soclal wlLhdrawal slopplness of dress and hyglene and loss of moLlvaLlon and [udgmenL are all
common ln schlzophrenla 1here ls ofLen an observable paLLern of emoLlonal dlfflculLy for example lack of
responslveness lmpalrmenL ln soclal cognlLlon ls assoclaLed wlLh schlzophrenla as are sympLoms of paranola
soclal lsolaLlon commonly occurs ln one uncommon subLype Lhe person may be largely muLe remaln moLlonless
ln blzarre posLures or exhlblL purposeless aglLaLlon all slgns of caLaLonla
LaLe adolescence and early adulLhood are peak perlods for Lhe onseL of schlzophrenla crlLlcal years ln a young
adulLs soclal and vocaLlonal developmenL ln 40 of men and 23 of women dlagnosed wlLh schlzophrenla Lhe
condlLlon manlfesLed lLself before Lhe age of 19 1o mlnlmlze Lhe developmenLal dlsrupLlon assoclaLed wlLh
schlzophrenla much work has recenLly been done Lo ldenLlfy and LreaL Lhe prodromal (preonseL) phase of Lhe
lllness whlch has been deLecLed up Lo 30 monLhs before Lhe onseL of sympLoms 1hose who go on Lo develop
schlzophrenla may experlence LranslenL or selfllmlLlng psychoLlc sympLoms
13
and Lhe nonspeclflc sympLoms of
soclal wlLhdrawal lrrlLablllLy dysphorla and clumslness

durlng Lhe prodromal phase
Schne|der|an c|ass|f|cat|on
1he Lerm schlzophrenla was colned by Lugen 8leuler
1he psychlaLrlsL kurL Schnelder (18871967) llsLed Lhe forms of psychoLlc sympLoms LhaL he LhoughL dlsLlngulshed
schlzophrenla from oLher psychoLlc dlsorders 1hese are called ltsttook symptoms or Schnelders flrsLrank
sympLoms 1hey lnclude deluslons of belng conLrolled by an exLernal force Lhe bellef LhaL LhoughLs are belng
lnserLed lnLo or wlLhdrawn from ones consclous mlnd Lhe bellef LhaL ones LhoughLs are belng broadcasL Lo oLher
people and hearlng halluclnaLory volces LhaL commenL on ones LhoughLs or acLlons or LhaL have a conversaLlon
wlLh oLher halluclnaLed volces lLhough Lhey have slgnlflcanLly conLrlbuLed Lo Lhe currenL dlagnosLlc crlLerla Lhe
speclflclLy of flrsLrank sympLoms has been quesLloned revlew of Lhe dlagnosLlc sLudles conducLed beLween
1970 and 2003 found LhaL Lhey allow nelLher a reconflrmaLlon nor a re[ecLlon of Schnelders clalms and suggesLed
LhaL flrsLrank sympLoms be deemphaslzed ln fuLure revlslons of dlagnosLlc sysLems
9os|t|ve and negat|ve symptoms
Schlzophrenla ls ofLen descrlbed ln Lerms of poslLlve and negaLlve (or deflclL) sympLoms oslLlve sympLoms are
Lhose LhaL mosL lndlvlduals do noL normally experlence buL are presenL ln people wlLh schlzophrenla 1hey can
lnclude deluslons dlsordered LhoughLs and speech and LacLlle audlLory vlsual olfacLory and gusLaLory
halluclnaLlons Lyplcally regarded as manlfesLaLlons of psychosls
19
PalluclnaLlons are also Lyplcally relaLed Lo Lhe
conLenL of Lhe deluslonal Lheme oslLlve sympLoms generally respond well Lo medlcaLlon negaLlve sympLoms are
deflclLs of normal emoLlonal responses or of oLher LhoughL processes and respond less well Lo medlcaLlon 1hey
commonly lnclude flaL or blunLed affecL and emoLlon poverLy of speech (alogla) lnablllLy Lo experlence pleasure
(anhedonla) lack of deslre Lo form relaLlonshlps (asoclallLy) and lack of moLlvaLlon (avollLlon) 8esearch suggesLs
LhaL negaLlve sympLoms conLrlbuLe more Lo poor quallLy of llfe funcLlonal dlsablllLy and Lhe burden on oLhers
Lhan do poslLlve sympLoms eople wlLh promlnenL negaLlve sympLoms ofLen have a hlsLory of poor ad[usLmenL
before Lhe onseL of lllness and response Lo medlcaLlon ls ofLen llmlLed
Causes
comblnaLlon of geneLlc and envlronmenLal facLors play a role ln Lhe developmenL of schlzophrenla eople wlLh a
famlly hlsLory of schlzophrenla who suffer a LranslenL or selfllmlLlng psychosls have a 2040 chance of belng
dlagnosed one year laLer
Genet|c
LsLlmaLes of herlLablllLy vary because of Lhe dlfflculLy ln separaLlng Lhe effecLs of geneLlcs and Lhe envlronmenL
1he greaLesL rlsk for developlng schlzophrenla ls havlng a flrsLdegree relaLlve wlLh Lhe dlsease (rlsk ls 63) more
Lhan 40 of monozygoLlc Lwlns of Lhose wlLh schlzophrenla are also affecLed lL ls llkely LhaL many genes are
lnvolved each of small effecL Many posslble candldaLes have been proposed lncludlng speclflc copy number
varlaLlons nC1CP4 and hlsLone proLeln locl number of genomewlde assoclaLlons such as zlnc flnger proLeln
804 have also been llnked 1here appears Lo be slgnlflcanL overlap ln Lhe geneLlcs of schlzophrenla and blpolar
dlsorder
ssumlng a heredlLary basls one quesLlon from evoluLlonary psychology ls why genes LhaL lncrease Lhe llkellhood
of psychosls evolved assumlng Lhe condlLlon would have been maladapLlve from an evoluLlonary polnL of vlew
Cne Lheory lmpllcaLes genes lnvolved ln Lhe evoluLlon of language and human naLure buL so far all Lheorles have
been dlsproved or remaln unsubsLanLlaLed
Lnv|ronment
LnvlronmenLal facLors assoclaLed wlLh Lhe developmenL of schlzophrenla lnclude Lhe llvlng envlronmenL drug use
and prenaLal sLressors arenLlng sLyle seems Lo have no effecL alLhough people wlLh supporLlve parenLs do beLLer
Lhan Lhose wlLh crlLlcal parenLs Llvlng ln an urban envlronmenL durlng chlldhood or as an adulL has conslsLenLly
been found Lo lncrease Lhe rlsk of schlzophrenla by a facLor of Lwo even afLer Laklng lnLo accounL drug use eLhnlc
group and slze of soclal group CLher facLors LhaL play an lmporLanL role lnclude soclal lsolaLlon and lmmlgraLlon
relaLed Lo soclal adverslLy raclal dlscrlmlnaLlon famlly dysfuncLlon unemploymenL and poor houslng condlLlons
1here ls evldence LhaL chlldhood experlences of abuse or Lrauma are rlsk facLors for a dlagnosls of schlzophrenla
laLer ln llfe
5ubstonce obuse
number of drugs have been assoclaLed wlLh Lhe developmenL of schlzophrenla lncludlng cannabls cocalne and
ampheLamlnes bouL half of Lhose wlLh schlzophrenla use drugs and/or alcohol excesslvely 1he role of cannabls
could be causal buL oLher drugs may be used only as coplng mechanlsms Lo deal wlLh depresslon anxleLy
boredom and lonellness
Cannabls ls assoclaLed wlLh a dosedependenL lncrease ln Lhe rlsk of developlng a psychoLlc dlsorder lrequenL use
has been correlaLed wlLh Lwlce Lhe rlsk of psychosls and schlzophrenla
33
however Lhe causallLy of Lhls llnk has
been quesLloned and lL remalns conLroverslal mpheLamlne cocalne and Lo a lesser exLenL alcohol can resulL ln
psychosls LhaL presenLs very slmllarly Lo schlzophrenla
339
lLhough noL generally belleved Lo be a cause of
schlzophrenla schlzophrenlcs as a group use nlcoLlne aL much greaLer raLes Lhan Lhe general populaLlon
Prenoto/
lacLors such as hypoxla and lnfecLlon or sLress and malnuLrlLlon ln Lhe moLher durlng feLal developmenL may
resulL ln a sllghL lncrease ln Lhe rlsk of schlzophrenla laLer ln llfe eople dlagnosed wlLh schlzophrenla are more
llkely Lo have been born ln wlnLer or sprlng (aL leasL ln Lhe norLhern hemlsphere) whlch may be a resulL of
lncreased raLes of vlral exposures ln uLero 1hls dlfference ls abouL 3 Lo 8
,echan|sms
number of aLLempLs have been made Lo explaln Lhe llnk beLween alLered braln funcLlon and schlzophrenla Cne
of Lhe mosL common ls Lhe dopamlne hypoLhesls whlch aLLrlbuLes psychosls Lo Lhe mlnds faulLy lnLerpreLaLlon of
Lhe mlsflrlng of dopamlnerglc neurons
9sycho|og|ca|
Many psychologlcal mechanlsms have been lmpllcaLed ln Lhe developmenL and malnLenance of schlzophrenla
CognlLlve blases have been ldenLlfled ln Lhose wlLh Lhe dlagnosls or Lhose aL rlsk especlally when under sLress or ln
confuslng slLuaLlons Some cognlLlve feaLures may reflecL global neurocognlLlve deflclLs such as memory loss whlle
oLhers may be relaLed Lo parLlcular lssues and experlences
uesplLe a demonsLraLed appearance of blunLed affecL recenL flndlngs lndlcaLe LhaL many lndlvlduals dlagnosed
wlLh schlzophrenla are emoLlonally responslve parLlcularly Lo sLressful or negaLlve sLlmull and LhaL such senslLlvlLy
may cause vulnerablllLy Lo sympLoms or Lo Lhe dlsorder Some evldence suggesLs LhaL Lhe conLenL of deluslonal
bellefs and psychoLlc experlences can reflecL emoLlonal causes of Lhe dlsorder and LhaL how a person lnLerpreLs
such experlences can lnfluence sympLomaLology 1he use of safeLy behavlors Lo avold lmaglned LhreaLs may
conLrlbuLe Lo Lhe chronlclLy of deluslons lurLher evldence for Lhe role of psychologlcal mechanlsms comes from
Lhe effecLs of psychoLheraples on sympLoms of schlzophrenla
Neuro|og|ca|
luncLlonal magneLlc resonance lmaglng (fM8l) and oLher braln lmaglng Lechnologles allow for Lhe sLudy of
dlfferences ln braln acLlvlLy ln people dlagnosed wlLh schlzophrenla 1he lmage shows Lwo levels of Lhe braln wlLh
areas LhaL were more acLlve ln healLhy conLrols Lhan ln schlzophrenla paLlenLs shown ln red durlng an fM8l sLudy
of worklng memory
1hose wlLh a dlagnosls of schlzophrenla have changes ln boLh braln sLrucLure and chemlsLry SLudles uslng
neuropsychologlcal LesLs and braln lmaglng Lechnologles such as fM8l and L1 Lo examlne funcLlonal dlfferences ln
braln acLlvlLy have shown LhaL dlfferences seem Lo mosL commonly occur ln Lhe fronLal lobes hlppocampus and
Lemporal lobes 8educLlons ln braln volume smaller Lhan Lhose found ln lzhelmers dlsease have been reporLed
ln areas of Lhe fronLal corLex and Lemporal lobes lL ls uncerLaln wheLher Lhese volumeLrlc changes are progresslve
or preexlsL prlor Lo Lhe onseL of Lhe dlsease 1hese dlfferences have been llnked Lo Lhe neurocognlLlve deflclLs
ofLen assoclaLed wlLh schlzophrenla 8ecause neural clrculLs are alLered lL has alLernaLlvely been suggesLed LhaL
schlzophrenla should be LhoughL of as a collecLlon of neurodevelopmenLal dlsorders
arLlcular aLLenLlon has been pald Lo Lhe funcLlon of dopamlne ln Lhe mesollmblc paLhway of Lhe braln 1hls focus
largely resulLed from Lhe accldenLal flndlng LhaL phenoLhlazlne drugs whlch block dopamlne funcLlon could
reduce psychoLlc sympLoms lL ls also supporLed by Lhe facL LhaL ampheLamlnes whlch Lrlgger Lhe release of
dopamlne may exacerbaLe Lhe psychoLlc sympLoms ln schlzophrenla
36
1he lnfluenLlal dopamlne hypoLhesls of
schlzophrenla proposed LhaL excesslve acLlvaLlon of u
2
recepLors was Lhe cause of (Lhe poslLlve sympLoms of)
schlzophrenla lLhough posLulaLed for abouL 20 years based on Lhe u
2
blockade effecL common Lo all
anLlpsychoLlcs lL was noL unLll Lhe mld1990s LhaL L1 and SL1 lmaglng sLudles provlded supporLlng evldence
1he dopamlne hypoLhesls ls now LhoughL Lo be slmpllsLlc parLly because newer anLlpsychoLlc medlcaLlon (aLyplcal
anLlpsychoLlc medlcaLlon) can be [usL as effecLlve as older medlcaLlon (Lyplcal anLlpsychoLlc medlcaLlon) buL also
affecLs seroLonln funcLlon and may have sllghLly less of a dopamlne blocklng effecL
lnLeresL has also focused on Lhe neuroLransmlLLer gluLamaLe and Lhe reduced funcLlon of Lhe nMu gluLamaLe
recepLor ln schlzophrenla largely because of Lhe abnormally low levels of gluLamaLe recepLors found ln Lhe
posLmorLem bralns of Lhose dlagnosed wlLh schlzophrenla and Lhe dlscovery LhaL gluLamaLeblocklng drugs such
as phencyclldlne and keLamlne can mlmlc Lhe sympLoms and cognlLlve problems assoclaLed wlLh Lhe condlLlon
39

8educed gluLamaLe funcLlon ls llnked Lo poor performance on LesLs requlrlng fronLal lobe and hlppocampal
funcLlon and gluLamaLe can affecL dopamlne funcLlon boLh of whlch have been lmpllcaLed ln schlzophrenla have
suggesLed an lmporLanL medlaLlng (and posslbly causal) role of gluLamaLe paLhways ln Lhe condlLlon 8uL poslLlve
sympLoms fall Lo respond Lo gluLamaLerglc medlcaLlon
|agnos|s
Schlzophrenla ls dlagnosed based on crlLerla ln elLher Lhe merlcan sychlaLrlc ssoclaLlons loqoostlc ooJ
5totlstlcol Mooool o Meotol lsotJets verslon uSMlv18 or Lhe World PealLh CrganlzaLlons lnLernaLlonal
SLaLlsLlcal ClasslflcaLlon of ulseases and 8elaLed PealLh roblems Lhe lCu10 1hese crlLerla use Lhe selfreporLed
experlences of Lhe person and reporLed abnormallLles ln behavlor followed by a cllnlcal assessmenL by a menLal
healLh professlonal SympLoms assoclaLed wlLh schlzophrenla occur along a conLlnuum ln Lhe populaLlon and musL
reach a cerLaln severlLy before a dlagnosls ls made s of 2009 Lhere ls no ob[ecLlve LesL
Cr|ter|a
1he lCu10 crlLerla are Lyplcally used ln Luropean counLrles whlle Lhe uSMlv18 crlLerla are used ln Lhe unlLed
SLaLes and Lhe resL of Lhe world and are prevalllng ln research sLudles 1he lCu10 crlLerla puL more emphasls on
Schnelderlan flrsLrank sympLoms ln pracLlce agreemenL beLween Lhe Lwo sysLems ls hlgh
ccordlng Lo Lhe revlsed fourLh edlLlon of Lhe loqoostlc ooJ 5totlstlcol Mooool o Meotol lsotJets (uSMlv18)
Lo be dlagnosed wlLh schlzophrenla Lhree dlagnosLlc crlLerla musL be meL
1 CharacLerlsLlc sympLoms 1wo or more of Lhe followlng each presenL for much of Lhe Llme durlng a one
monLh perlod (or less lf sympLoms remlLLed wlLh LreaLmenL)
4 ueluslons
4 PalluclnaLlons
4 ulsorganlzed speech whlch ls a manlfesLaLlon of formal LhoughL dlsorder
4 Crossly dlsorganlzed behavlor (eg dresslng lnapproprlaLely crylng frequenLly) or caLaLonlc
behavlor
4 negaLlve sympLoms 8lunLed affecL (lack or decllne ln emoLlonal response) alogla (lack or decllne
ln speech) or avollLlon (lack or decllne ln moLlvaLlon)
lf Lhe deluslons are [udged Lo be blzarre or halluclnaLlons conslsL of hearlng one volce parLlclpaLlng ln a
runnlng commenLary of Lhe paLlenLs acLlons or of hearlng Lwo or more volces converslng wlLh each oLher
only LhaL sympLom ls requlred above 1he speech dlsorganlzaLlon crlLerlon ls only meL lf lL ls severe
enough Lo subsLanLlally lmpalr communlcaLlon
2 Soclal or occupaLlonal dysfuncLlon lor a slgnlflcanL porLlon of Lhe Llme slnce Lhe onseL of Lhe dlsLurbance
one or more ma[or areas of funcLlonlng such as work lnLerpersonal relaLlons or selfcare are markedly
below Lhe level achleved prlor Lo Lhe onseL
3 SlgnlflcanL duraLlon ConLlnuous slgns of Lhe dlsLurbance perslsL for aL leasL slx monLhs 1hls slxmonLh
perlod musL lnclude aL leasL one monLh of sympLoms (or less lf sympLoms remlLLed wlLh LreaLmenL)
lf slgns of dlsLurbance are presenL for more Lhan a monLh buL less Lhan slx monLhs Lhe dlagnosls of
schlzophrenlform dlsorder ls applled sychoLlc sympLoms lasLlng less Lhan a monLh may be dlagnosed as brlef
psychoLlc dlsorder and varlous condlLlons may be classed as psychoLlc dlsorder noL oLherwlse speclfled
Schlzophrenla cannoL be dlagnosed lf sympLoms of mood dlsorder are subsLanLlally presenL (alLhough
schlzoaffecLlve dlsorder could be dlagnosed) or lf sympLoms of pervaslve developmenLal dlsorder are presenL
unless promlnenL deluslons or halluclnaLlons are also presenL or lf Lhe sympLoms are Lhe dlrecL physlologlcal resulL
of a general medlcal condlLlon or a subsLance such as abuse of a drug or medlcaLlon
Subtypes
1he uSMlv18 conLalns flve subclasslflcaLlons of schlzophrenla alLhough Lhe developers of uSM3 are
recommendlng Lhey be dropped from Lhe new classlflcaLlon
O aranold Lype ueluslons or audlLory halluclnaLlons are presenL buL LhoughL dlsorder dlsorganlzed
behavlor or affecLlve flaLLenlng are noL ueluslons are persecuLory and/or grandlose buL ln addlLlon Lo
Lhese oLher Lhemes such as [ealousy rellgloslLy or somaLlzaLlon may also be presenL (uSM code
2933/lCu code l200)
O ulsorganlzed Lype named bebepbteolc scblzopbteolo ln Lhe lCu Where LhoughL dlsorder and flaL affecL
are presenL LogeLher (uSM code 2931/lCu code l201)
O CaLaLonlc Lype 1he sub[ecL may be almosL lmmoblle or exhlblL aglLaLed purposeless movemenL
SympLoms can lnclude caLaLonlc sLupor and waxy flexlblllLy (uSM code 2932/lCu code l202)
O undlfferenLlaLed Lype sychoLlc sympLoms are presenL buL Lhe crlLerla for paranold dlsorganlzed or
caLaLonlc Lypes have noL been meL (uSM code 2939/lCu code l203)
O 8esldual Lype Where poslLlve sympLoms are presenL aL a low lnLenslLy only (uSM code 2936/lCu code
l203)
1he lCu10 deflnes Lwo addlLlonal subLypes
O osLschlzophrenlc depresslon depresslve eplsode arlslng ln Lhe afLermaLh of a schlzophrenlc lllness
where some lowlevel schlzophrenlc sympLoms may sLlll be presenL (lCu code l204)
O Slmple schlzophrenla lnsldlous and progresslve developmenL of promlnenL negaLlve sympLoms wlLh no
hlsLory of psychoLlc eplsodes (lCu code l206)
|fferent|a|
See also uual dlagnosls
sychoLlc sympLoms may be presenL ln several oLher menLal dlsorders lncludlng blpolar dlsorder borderllne
personallLy dlsorder drug lnLoxlcaLlon and druglnduced psychosls ueluslons (nonblzarre) are also presenL ln
deluslonal dlsorder and soclal wlLhdrawal ln soclal anxleLy dlsorder avoldanL personallLy dlsorder and schlzoLypal
personallLy dlsorder Schlzophrenla ls comorbld wlLh obsesslvecompulslve dlsorder (CCu) conslderably more
ofLen Lhan could be explalned by pure chance alLhough lL can be dlfflculL Lo dlsLlngulsh obsesslons LhaL occur ln
CCu from Lhe deluslons of schlzophrenla
more general medlcal and neurologlcal examlnaLlon may be needed Lo rule ouL medlcal lllnesses whlch may
rarely produce psychoLlc schlzophrenlallke sympLoms such as meLabollc dlsLurbance sysLemlc lnfecLlon syphllls
Plv lnfecLlon epllepsy and braln leslons lL may be necessary Lo rule ouL a dellrlum whlch can be dlsLlngulshed by
vlsual halluclnaLlons acuLe onseL and flucLuaLlng level of consclousness and lndlcaLes an underlylng medlcal
lllness lnvesLlgaLlons are noL generally repeaLed for relapse unless Lhere ls a speclflc meJlcol lndlcaLlon or posslble
adverse effecLs from anLlpsychoLlc medlcaLlon
9revent|on
Lvldence for Lhe effecLlveness of early lnLervenLlon ls lnconcluslve Whlle Lhere ls some evldence LhaL early
lnLervenLlon ln Lhose wlLh a psychoLlc eplsode may lmprove shorL Lerm ouLcomes Lhere ls llLLle beneflL from Lhese
measures afLer flve years LLempLlng Lo prevenL schlzophrenla ln Lhe prodrome phase ls of uncerLaln beneflL and
Lherefore as of 2009 ls noL recommended revenLlon ls dlfflculL as Lhere are no rellable markers for Lhe laLer
developmenL of Lhe dlsease

,anagement
1he prlmary LreaLmenL of schlzophrenla ls anLlpsychoLlc medlcaLlons ofLen ln comblnaLlon wlLh psychologlcal and
soclal supporLs PosplLallzaLlon may occur for severe eplsodes elLher volunLarlly or (lf menLal healLh leglslaLlon
allows lL) lnvolunLarlly LongLerm hosplLallzaLlon ls uncommon slnce delnsLlLuLlonallzaLlon beglnnlng ln Lhe 1930s
alLhough sLlll occurs CommunlLy supporL servlces lncludlng dropln cenLers vlslLs by members of a communlLy
menLal healLh Leam supporLed employmenL and supporL groups are common Some evldence lndlcaLes LhaL
regular exerclse has a poslLlve effecL on Lhe physlcal and menLal healLh of Lhose wlLh schlzophrenla
,ed|cat|on
8lsperldone (Lrade name 8lsperdal) ls a common aLyplcal anLlpsychoLlc medlcaLlon
1he flrsLllne psychlaLrlc LreaLmenL for schlzophrenla ls anLlpsychoLlc medlcaLlon whlch can reduce Lhe poslLlve
sympLoms of psychosls ln abouL 714 days nLlpsychoLlcs however fall Lo slgnlflcanLly amelloraLe Lhe negaLlve
sympLoms and cognlLlve dysfuncLlon
1he cholce of whlch anLlpsychoLlc Lo use ls based on beneflLs rlsks and cosLs lL ls debaLable wheLher as a class
Lyplcal or aLyplcal anLlpsychoLlcs are beLLer 8oLh have equal dropouL and sympLom relapse raLes when Lyplcals
are used aL low Lo moderaLe dosages 1here ls a good response ln 4030 a parLlal response ln 3040 and
LreaLmenL reslsLance (fallure of sympLoms Lo respond saLlsfacLorlly afLer slx weeks Lo Lwo of Lhree dlfferenL
anLlpsychoLlcs) ln 20 of people Clozaplne ls an effecLlve LreaLmenL for Lhose who respond poorly Lo oLher drugs
buL lL has Lhe poLenLlally serlous slde effecL of agranulocyLosls (lowered whlLe blood cell counL) ln 14
WlLh respecL Lo slde effecLs Lyplcal anLlpsychoLlcs are assoclaLed wlLh a hlgher raLe of exLrapyramldal slde effecLs
whlle aLyplcals are assoclaLed wlLh conslderable welghL galn dlabeLes and rlsk of meLabollc syndrome
77
Whlle
aLyplcals have fewer exLrapyramldal slde effecLs Lhese dlfferences are modesL Some aLyplcals such as queLlaplne
and rlsperldone are assoclaLed wlLh a hlgher rlsk of deaLh compared Lo Lhe aLyplcal perphenazlne whlle clozaplne
ls assoclaLed wlLh Lhe lowesL rlsk of deaLh lL remalns unclear wheLher Lhe newer anLlpsychoLlcs reduce Lhe
chances of developlng neurolepLlc mallgnanL syndrome a rare buL serlous neurologlcal dlsorder
lor people who are unwllllng or unable Lo Lake medlcaLlon regularly longacLlng depoL preparaLlons of
anLlpsychoLlcs may be used Lo achleve conLrol When used ln comblnaLlon wlLh psychosoclal lnLervenLlons Lhey
may lmprove longLerm adherence Lo LreaLmenL
9sychosoc|a|
number of psychosoclal lnLervenLlons may be useful ln Lhe LreaLmenL of schlzophrenla lncludlng famlly Lherapy
asserLlve communlLy LreaLmenL supporLed employmenL cognlLlve remedlaLlon skllls Lralnlng cognlLlve behavloral
Lherapy (C81) Loken economlc lnLervenLlons and psychosoclal lnLervenLlons for subsLance use and welghL
managemenL lamlly Lherapy or educaLlon whlch addresses Lhe whole famlly sysLem of an lndlvldual may reduce
relapses and hosplLallzaLlons 1he evldence for C81s effecLlveness ln elLher reduclng sympLoms or prevenLlng
relapse ls mlnlmal rL or drama Lherapy have noL been wellresearched
9rognos|s
Schlzophrenla has greaL human and economlc cosLs lL resulLs ln a decreased llfe expecLancy of 1213 years
prlmarlly because of lLs assoclaLlon wlLh obeslLy sedenLary llfesLyles and smoklng wlLh an lncreased raLe of
sulclde playlng a lesser role 1hese dlfferences ln llfe expecLancy lncreased beLween Lhe 1970s and 1990s and
beLween Lhe 1990s and flrsL decade of Lhe 21sL cenLury dld noL change subsLanLlally ln a healLh sysLem wlLh open
access Lo care (llnland)
Schlzophrenla ls a ma[or cause of dlsablllLy wlLh acLlve psychosls ranked as Lhe LhlrdmosLdlsabllng condlLlon afLer
quadrlplegla and demenLla and ahead of paraplegla and bllndness pproxlmaLely LhreefourLhs of people wlLh
schlzophrenla have ongolng dlsablllLy wlLh relapses Some people do recover compleLely and oLhers funcLlon well
ln socleLy MosL people wlLh schlzophrenla llve lndependenLly wlLh communlLy supporL ln people wlLh a flrsL
eplsode of psychosls a good longLerm ouLcome occurs ln 42 an lnLermedlaLe ouLcome ln 33 and a poor
ouLcome ln 27CuLcomes for schlzophrenla appear beLLer ln Lhe developlng Lhan Lhe developed world 1hese
concluslons however have been quesLloned
1here ls a hlgher Lhan average sulclde raLe assoclaLed wlLh schlzophrenla 1hls has been clLed aL 10 buL a more
recenL analysls of sLudles and sLaLlsLlcs revlses Lhe esLlmaLe Lo 49 mosL ofLen occurrlng ln Lhe perlod followlng
onseL or flrsL hosplLal admlsslon
97
Several Llmes more (20 Lo 40) aLLempL sulclde aL leasL once 1here are a
varleLy of rlsk facLors lncludlng male gender depresslon and a hlgh lnLelllgence quoLlenL
Schlzophrenla and smoklng have shown a sLrong assoclaLlon ln sLudles worldwlde use of clgareLLes ls especlally
hlgh ln lndlvlduals dlagnosed wlLh schlzophrenla wlLh esLlmaLes ranglng from 80 Lo 90 belng regular smokers
as compared Lo 20 of Lhe general populaLlon 1hose who smoke Lend Lo smoke heavlly and addlLlonally smoke
clgareLLes wlLh hlgh nlcoLlne conLenL
Some evldence suggesLs LhaL paranold schlzophrenla may have a beLLer prospecL Lhan oLher Lypes of schlzophrenla
for lndependenL llvlng and occupaLlonal funcLlonlng
n|story
ccounLs of a schlzophrenlallke syndrome are LhoughL Lo be rare ln Lhe hlsLorlcal record before Lhe 19Lh cenLury
alLhough reporLs of lrraLlonal unlnLelllglble or unconLrolled behavlor were common deLalled case reporL ln
1797 concernlng !ames 1llly MaLLhews and accounLs by hllllpe lnel publlshed ln 1809 are ofLen regarded as Lhe
earllesL cases of Lhe lllness ln Lhe medlcal and psychlaLrlc llLeraLure Schlzophrenla was flrsL descrlbed as a dlsLlncL
syndrome affecLlng Leenagers and young adulLs by 8enedlcL Morel ln 1833 Lermed Jmeoce ptcoce (llLerally
early demenLla) 1he Lerm demenLla praecox was used ln 1891 by rnold lck ln a case reporL of a psychoLlc
dlsorder ln 1893 Lmll kraepelln lnLroduced a broad new dlsLlncLlon ln Lhe classlflcaLlon of menLal dlsorders
beLween Jemeotlo ptoecox and mood dlsorder (Lermed manlc depresslon and lncludlng boLh unlpolar and blpolar
depresslon) kraepelln belleved LhaL Jemeotlo ptoecox was prlmarlly a dlsease of Lhe braln and parLlcularly a form
of demenLla dlsLlngulshed from oLher forms of demenLla such as lzhelmers dlsease whlch Lyplcally occur laLer ln
llfe

1he word scblzopbteolowhlch LranslaLes roughly as spllLLlng of Lhe mlnd and comes from Lhe Creek rooLs
scblzelo (o(t Lo spllL) and pbteo pbteo (pq p mlnd)was colned by Lugen 8leuler ln 1908 and was
lnLended Lo descrlbe Lhe separaLlon of funcLlon beLween personallLy Lhlnklng memory and percepLlon 8leuler
descrlbed Lhe maln sympLoms as 4 As flaLLened Aect Aotlsm lmpalred Assoclotloo of ldeas and
Amblvoleoce
114
8leuler reallzed LhaL Lhe lllness was noL a demenLla as some of hls paLlenLs lmproved raLher Lhan
deLerloraLed and Lhus proposed Lhe Lerm schlzophrenla lnsLead 1reaLmenL was revoluLlonlzed ln Lhe mld1930s
wlLh Lhe developmenL and lnLroducLlon of chlorpromazlne
ln Lhe early 1970s Lhe dlagnosLlc crlLerla for schlzophrenla was Lhe sub[ecL of a number of conLroversles whlch
evenLually led Lo Lhe operaLlonal crlLerla used Loday lL became clear afLer Lhe 1971 uSuk ulagnosLlc SLudy LhaL
schlzophrenla was dlagnosed Lo a far greaLer exLenL ln merlca Lhan ln Lurope 1hls was parLly due Lo looser
dlagnosLlc crlLerla ln Lhe uS whlch used Lhe uSMll manual conLrasLlng wlLh Lurope and lLs lCu9 uavld
8osenhans 1972 sLudy publlshed ln Lhe [ournal 5cleoce under Lhe LlLle Cn belng sane ln lnsane places
concluded LhaL Lhe dlagnosls of schlzophrenla ln Lhe uS was ofLen sub[ecLlve and unrellable 1hese were some of
Lhe facLors leadlng Lo Lhe revlslon noL only of Lhe dlagnosls of schlzophrenla buL Lhe revlslon of Lhe whole uSM
manual resulLlng ln Lhe publlcaLlon of Lhe uSMlll ln 1980
1he Lerm scblzopbteolo ls commonly mlsundersLood Lo mean LhaL affecLed persons have a spllL personallLy
lLhough some people dlagnosed wlLh schlzophrenla may hear volces and may experlence Lhe volces as dlsLlncL
personallLles schlzophrenla does noL lnvolve a person changlng among dlsLlncL mulLlple personallLles 1he
confuslon arlses ln parL due Lo Lhe llLeral lnLerpreLaLlon of 8leulers Lerm scblzopbteolo 1he flrsL known mlsuse of
Lhe Lerm Lo mean spllL personallLy was ln an arLlcle by Lhe poeL 1 S LlloL ln 1933
Soc|ety and cu|ture
Soclal sLlgma has been ldenLlfled as a ma[or obsLacle ln Lhe recovery of paLlenLs wlLh schlzophrenla ln a large
represenLaLlve sample from a 1999 sLudy 128 of merlcans belleved LhaL lndlvlduals wlLh schlzophrenla were
very llkely Lo do someLhlng vlolenL agalnsL oLhers and 481 sald LhaL Lhey were somewhaL llkely Lo Cver 74
sald LhaL people wlLh schlzophrenla were elLher noL very able or noL able aL all Lo make declslons concernlng
Lhelr LreaLmenL and 702 sald Lhe same of money managemenL declslons 1he percepLlon of lndlvlduals wlLh
psychosls as vlolenL has more Lhan doubled ln prevalence slnce Lhe 1930s accordlng Lo one meLaanalysls
ln Lhe unlLed SLaLes Lhe cosL of schlzophrenlalncludlng dlrecL cosLs (ouLpaLlenL lnpaLlenL drugs and longLerm
care) and nonhealLh care cosLs (law enforcemenL reduced workplace producLlvlLy and unemploymenL)was
esLlmaLed Lo be $627 bllllon ln 2002
1he book and fllm A 8eootlol MloJ chronlcles Lhe llfe of !ohn lorbes nash a nobel rlzewlnnlng maLhemaLlclan
who was dlagnosed wlLh schlzophrenla