schizophrenia

(skĭt'səfrē`nēə), group of severe mental disorders characterized by reality distortions resulting in unusual thought patterns and behaviors. Because there is often little or no logical relationship between the thoughts and feelings of a person with schizophrenia, the disorder has often been called "split personality." However, the condition should not be confused with multiple personalitymultiple personality,
a very rare psychological disorder in which a person has two or more distinct personalities, each with its own thoughts, feelings, and patterns of behavior.
..... Click the link for more information. , a disorder in which the individual has two or more distinct personalities that dominate at different times.

In 1896, the German psychiatrist Emil KraepelinKraepelin, Emil
, 1856–1926, German psychiatrist, educated at Würzburg (M.D., 1878). He also studied under Wilhelm Wundt in Leipzig, and was appointed professor of psychiatry at the Univ.
..... Click the link for more information. grouped what were previously considered unrelated mental diseases under the term dementia praecox. It was not until 1908, however, that an influential essay by Swiss psychiatrist Eugen BleulerBleuler, Eugen
, 1857–1939, Swiss psychiatrist. He taught (1898–1927) at the Univ. of Zürich, serving concurrently as director of Zürich's Burghölzi Asylum.
..... Click the link for more information. corrected Kraepelin's theory that the disease was an organic brain deterioration and thus incurable. Bleuler introduced the term schizophrenia to replace dementia praecox, emphasizing the dissociative phenomena in the mind and avoiding the implications of early onset and progressive brain deterioration.

Schizophrenic disorders generally begin in the late teenage years or early adulthood and tend to occur in withdrawn, seclusive individuals. The lifetime prevalence worldwide has been estimated to be just under 1%, and the disorder affects 1.5 to 2 million people in the United States alone. Symptoms include disturbances of thought, both in form and content (see delusiondelusion,
false belief based upon a misinterpretation of reality. It is not, like a hallucination, a false sensory perception, or like an illusion, a distorted perception.
..... Click the link for more information. ), and disturbances of perception, most commonly appearing as visual or aural hallucinationshallucination,
false perception characterized by a distortion of real sensory stimuli. Common types of hallucination are auditory, i.e., hearing voices or noises and visual, i.e., seeing people that are not actually present.
..... Click the link for more information. .

There are five major types of schizophrenia listed by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders. The most severe are disorganized (hebephrenic) schizophrenia, characterized by hallucinations, delusions, inappropriate laughing and crying, incoherent speech, and infantile behavior; and catatonic schizophrenia, characterized by physical rigidity or hyperactivity. Paranoid schizophrenics can often function relatively normally, although they may be disturbed by persecutory delusions and hallucinations, and they tend to exhibit argumentative behavior. The presence of a combination of symptoms from other types is classified as undifferentiated schizophrenia. Residual schizophrenia is constituted by minor symptoms, which occur as an active episode diminishes.

The cause of schizophrenia is unknown. Genetic factors appear to be involved in producing susceptibility to the condition, with studies among identical twins showing a 30%–50% concordance rate, a figure that has been confirmed by the results of adoption studies. Biochemical research suggests that high levels of the neurotransmitter dopamine, or excessive numbers of receptors for dopamine, may be at the root of schizophrenia. Medical imaging studies have revealed various physical and physiological anomalies in some patients. Other research has focused on mistiming of neural responses to stimuli in the brain. Many researchers maintain that a combination of influences, including such environmental factors as viral illness or malnutrition in the patient's mother during pregnancy, may lead to schizophrenia,

Antipsychotic drugs (see psychopharmacologypsychopharmacology
, in its broadest sense, the study of all pharmacological agents that affect mental and emotional functions. The term is usually applied more specifically to the study and synthesis of drugs used in the control of psychiatric illnesses, namely the
..... Click the link for more information. ), sometimes in conjunction with psychotherapy, have greatly improved the treatment of schizophrenia. Hospitalization is sometimes needed initially to provide basic personal needs (safety, food, and hygiene) while acute symptoms are treated. Most patients return to the community with varying degrees of independence and with good prospects for long-term remission of symptoms.

Bibliography

See R. Miller and S. Mason, Diagnosis: Schizophrenia (2002); studies by I. I. Gottesman (1991) and H. Häfner and W. F. Gattaz, ed. (1991).

Schizophrenia

A brain disorder that is characterized by bizarre mental experiences such as hallucinations and severe decrements in social, cognitive, and occupational functioning. Patients with schizophrenia demonstrate a series of biological differences when compared to other groups of psychiatric patients. However, no biological marker has yet been found to conclusively indicate the presence of schizophrenia. A diagnosis is made on the basis of a cluster of symptoms reported by the patient, and of signs identified by the clinician.

People with schizophrenia may report perceptual experiences in the absence of a perceptual stimulus. Most common are auditory hallucinations, often reported in the form of words spoken to the person with schizophrenia. The language is often derogatory, and it can be tremendously frightening. See Hallucination

People with schizophrenia often maintain beliefs that are not held by the overwhelming majority of the general population. To be considered delusions, the beliefs must be unshakable. In many cases, these beliefs may be bizarre and stem from odd experiences. In some instances, the delusions have an element of suspicion to them, such as the belief that others are planning to cause the person harm. The delusions may or may not be related to hallucinatory experiences.

Many schizophrenics suffer from social isolation, lack of motivation, lack of energy, slow or delayed speech, and diminished emotional expression, often referred to as blunted affect. They may manifest an odd outward appearance due to the severity of their disorganization. This presentation may include speech that does not follow logically or sensibly, at times to the point of being incoherent. Facial expression may be odd or inappropriate, such as laughing for no reason. In some cases, people with schizophrenia may move in a strange and awkward manner. The extreme aspect of this behavior, referred to as catatonia, has become very rare since pharmacological treatments have become available.

Perhaps the most devastating feature of schizophrenia is the cognitive impairment found in most people with the disorder. On average, such people perform in the lowest 2–10% of the general population on tests of attention, memory, abstraction, motor skills, and language abilities.

The onset of schizophrenia generally occurs in people in the late teens to early twenties. However, schizophrenia is possible throughout the life span. While the onset of symptoms is abrupt in some people, others experience a more insidious process, including extreme social withdrawal, reduced motivation, mood changes, and cognitive and functional decline. The course of schizophrenia is normally characterized by episodes of relative remission in which only subtle symptoms remain, and episodes of exacerbation of symptoms, which are often caused by failure to continue treatment.

It is likely that there are various forms of schizophrenia, perhaps with different causes. Although schizophrenia appears to be inherited in some cases, the influence of genes is far from complete. Many arguments have been put forth regarding environmental factors that could cause schizophrenia. Very few of these theories are consistently supported.

Magnetic resonance imaging (MRI) has revealed that people with schizophrenia often have changes in the structure of their brain such as enlargement of the cerebral ventricles (the fluid-filled spaces in the brain close to the midline). Various brain regions have been found to be smaller in patients with schizophrenia, including the frontal cortex, temporal lobes, and hippocampi. In addition, studies of patients with schizophrenia have found patterns of abnormal activation of the brain while performing tests of memory and problem solving. See Brain, Medical imaging

Either a pharmacological or behavioral approach may be used in treating schizophrenia. A variety of antipsychotic medications have been used, and research continues into how to minimize the side effects which are often associated with such drugs. There are several targets for behavioral treatments in schizophrenia. Structured training programs have attempted to teach patients how to function more effectively in social, occupational, and independent living domains. Family interventions have been designed to provide a supportive environment for patients, and have been demonstrated to reduce risk of relapse. Another behavioral treatment area is teaching patients how to cope with hallucinations and delusions. Most patients with schizophrenia do not spontaneously recognize their symptoms as unusual and their experiences as unreal. Cognitive-behavioral treatments have been employed to help patients realize the nature of their symptoms and to develop plans for coping with them. See Psychopharmacology, Psychotherapy

schizophrenia

See PSYCHOSIS.

Schizophrenia

the commonest mental illness, characterized by the variety of its manifestations and by its tendency to become chronic.

As early as the 17th century, T. Willis observed adolescents who lost their childhood talents and became “grumbling fools” as young adults. In 1857 the French psychiatrist B. A. Morel identified dementia praecox as a form of “hereditary degeneration.” In the 1860’s and 1870’s the German psychiatrists K. L. Kahlbaum and E. Hecker described hebephrenia and catatonia. In 1888 the French psychiatrist V. Magnan identified the chronic hallucinatory-delusional psychoses that end in apathy and feeblemindedness. In 1898, E. Kraepelin classified these forms under the single heading of dementia praecox. E. Bleuler considered the splitting, or breakdown, of the unity of the psyche to be the most important symptom of the disease, and in 1911 he proposed that it be called schizophrenia. Bleuler, however, regarded schizophrenia—as many subsequent researchers did—only as a group of related diseases.

Progress in the study of schizophrenia is associated with the names of such Russian psychiatrists as V. Kh. Kandinskii, S. S. Korsakov, and P. B. Gannushkin. The different manifestations and varying course of schizophrenia were responsible for the lack of uniformity in nosologic definitions of the disease. In France, only the malignant form (that is, process schizophrenia) is regarded as schizophrenia, whereas in Great Britain and in the Scandinavian countries most forms of schizophrenia are treated as constitutionally or psychogenically determined separate psychoses. Some investigators divide this disorder into primary (or genuine) and symptomatic schizophrenia.

The causes of schizophrenia and the mechanisms of its development are still unclear. Most investigators consider it an endogenous disease in which hereditary predisposition is a factor. The importance of heredity in this respect has been confirmed by research studies of twins affected with schizophrenia. The hereditary factor varies in different forms of the disease. When the disease follows a constant course, members of the patient’s family often show symptoms of a deep schizoid psychopathy. In cases of intermittent bouts of schizophrenia, this form of the disease often develops in the patient’s close relatives as well. However, schizophrenia is not classified as one of the hereditary diseases proper; compared to the latter, it is far more prevalent, affecting approximately 0.8 percent of the population.

Studies of higher nervous activity in schizophrenics show the presence of protective inhibition (in the form of hypnotic phases) and foci of sluggish excitation. Electroencephalography and quantitative analysis are used in order to determine the abnormalities in the brain’s electrical activity that are characteristic of schizophrenia. Biological and biochemical studies have shown that immunological and other changes take place and that such changes vary with the form of schizophrenia. Neurochemical data indicate that in schizophrenia the metabolism of biogenic amines and enzymes is impaired. According to some investigators, the histological changes that occur in schizophrenia involve injury to the cerebral cortex; according to others, injury to the subcortical region.

Schizophrenia is usually classified according to the predominant symptoms or the specific course of the disease. To a greater or lesser degree, all forms of schizophrenia are progressive. According to the course of the disease, two basic types are distinguished—unintermittent and intermittent schizophrenia.

Unintermittent schizophrenia. Unintermittent schizophrenia is marked from its very onset by steadily intensifying disturbances (as manifested in reduced mental functioning) combined with monotonous “productive” symptoms, such as hallucinations. This type is subdivided into process, progressive, and nonprogressive schizophrenia.

Process schizophrenia usually develops in teen-agers and young adults and is generally known as hebephrenia. It is characterized by steadily progressive inactivity, emotional hypesthesia, and regressive behavior, accompanied by diverse but rudimentary productive symptoms. When it occurs in childhood, this form of schizophrenia (known as pseudo-oligophrenia) results in mental retardation.

Progressive schizophrenia is manifested in the form of a paranoid syndrome, which includes paranoia and paraphrenia; it usually occurs after the age of 30. It is marked by systematized delusions (for example, hypochondria or delusions of persecution or grandeur), combined with manifestations of psychic automatism—what is known as the Clérambault-Kandinskii syndrome, named after V. Kh. Kandinskii and the French psychiatrist G. de Clérambault (1872–1934); this consists of the feeling of being forcibly controlled by an outside influence and estrangement from one’s own mental activity, ending with paraphrenia. In some cases the delusions and hallucinations coexist with proper behavior and the ability to continue working; this is known as monomania or partial insanity, as it was called by 19th-century psychiatrists. Sometimes the disease does not develop beyond the stage of systematized delusions (paranoid schizophrenia).

Nonprogressive schizophrenia (also called latent, mild, pseudoneurotic, or psychopathiclike schizophrenia) is marked by the predominance of obsessions, cenesthesiopathy (vague sensations of bodily distress), manifestations of hypochrondria and hysteria combined with pronounced autism (predominance of self-centeredness and active withdrawal from the outside world), persistent asthenia, and emotional impoverishment.

Intermittent schizophrenia. Intermittent schizophrenia is characterized by the polymorphous development of various productive symptoms, such as affective delusions and dreams; mental disturbances appear only after an attack. Intermittent schizophrenia is subdivided into intermittent-progressive and periodic schizophrenia. The productive symptoms of intermittent schizophrenia, which outnumber the negative symptoms, are keenly perceptible to the senses, affective, and labile, and they are accompanied by feelings of confusion and excitation.

The clinical picture of intermittent-progressive schizophrenia is dominated by acute delusional fantasies, the automatism of the Clérambault-Kandinskii syndrome, and catatonic excitement. The vividness, plasticity, and affectivity of such disorders are less pronounced than in the case of periodic schizophrenia. Negative effects become evident after the first attack is over, sometimes growing more intense after each successive attack. The disease takes an almost unintermittent course and represents an intermediate variety between intermittent and unintermittent schizophrenia. In other cases, the negative manifestations occurring after the first attack either remain unchanged, in spite of successive similar attacks, or grow more intense after the fourth or fifth attack or even later—that is, irregularly. It is not unusual for a single attack of schizophrenia to occur, followed by a change in personality (for example, in the form of persistent asthenia).

Periodic schizophrenia (also called recurrent or schizo-affective) is marked by excitation, confusion, affective-delusional and oneiric incidents, and minor personality changes.

Unlike progressive and process schizophrenia, the intermittent and nonprogressive forms of the disease may occur at any age. It has been established that specific forms of schizophrenia are sexrelated. Process schizophrenia and unintermittently progressive schizophrenia are found more frequently in men than in women (the ratio being 3:1), whereas intermittent schizophrenia is more common in women (the ratio here being reversed). The overall incidence of the disease, however, is approximately the same among men and women.

Treatment. Treatment depends on the form of and the stage reached by the disease; it includes insulin therapy (where hypoglycemia is induced by injecting insulin), electroconvulsive therapy, occupational therapy, and psychotropic agents. Prophylactic measures are primarily directed at preventing acute manifestations of the disease and achieving more extended remission; they consist of preventive treatment—that is, small “maintenance” doses of psychotropic agents and proper working and living habits.

The high level of organization of inpatient and especially outpatient care, treatment by psychotropic agents, and occupational rehabilitation are significantly reducing the rate of permanent disability caused by schizophrenia. As research continues in this area, the opportunities for work rehabilitation are growing steadily. It is only the severe forms of schizophrenia that justify placing patients on disability, exempting them from military service, or limiting their choice of occupation. It is precisely for this reason that schizophrenia requires the kind of diagnosis known as binomial, which identifies not only the disease but also its specific form and course.

REFERENCES

Shizofreniia [Klinika, patogenez, lechenie]. Moscow, 1969.
Shizofreniia: Mul’tidistsiplinarnoe issledovanie. Moscow, 1972.
Psychiatrie der Gegenwart, 2nd ed., vol. 2, part 1. Berlin, 1972.

A. V. SNEZHNEVSKII

schizophrenia

[‚skit·sə′frē·nē·ə] (psychology) A group of mental disorders characterized by withdrawal from reality and by alterations in thinking, feeling, and concept formations. Also known as dementia praecox.

schizophrenia

any of a group of psychotic disorders characterized by progressive deterioration of the personality, withdrawal from reality, hallucinations, delusions, social apathy, emotional instability, etc.

schizophrenia

Schizophrenia

Definition

Schizophrenia is a psychotic disorder (or a group of disorders) marked by severely impaired thinking, emotions, and behaviors. Schizophrenic patients are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colors, and other features of their environment. Most schizophrenics, if untreated, gradually withdraw from interactions with other people, and lose their ability to take care of personal needs and grooming.The prevalence of schizophrenia is thought to be about 1% of the population around the world; it is thus more common than diabetes, Alzheimer's disease, or multiple sclerosis. In the United States and Canada, patients with schizophrenia fill about 25% of all hospital beds. The disorder is considered to be one of the top ten causes of long-term disability worldwide.

Description

The course of schizophrenia in adults can be divided into three phases or stages. In the acute phase, the patient has an overt loss of contact with reality (psychotic episode) that requires intervention and treatment. In the second or stabilization phase, the initial psychotic symptoms have been brought under control but the patient is at risk for relapse if treatment is interrupted. In the third or maintenance phase, the patient is relatively stable and can be kept indefinitely on antipsychotic medications. Even in the maintenance phase, however, relapses are not unusual and patients do not always return to full functioning.The English term schizophrenia comes from two Greek words that mean "split mind." It was observed around 1908, by a Swiss doctor named Eugen Bleuler, to describe the splitting apart of mental functions that he regarded as the central characteristic of schizophrenia.Recently, some psychotherapists have begun to use a classification of schizophrenia based on two main types. People with Type I, or positive schizophrenia, have a rapid (acute) onset of symptoms and tend to respond well to drugs. They also tend to suffer more from the "positive" symptoms, such as delusions and hallucinations. People with Type II, or negative schizophrenia, are usually described as poorly adjusted before their schizophrenia slowly overtakes them. They have predominantly "negative" symptoms, such as withdrawal from others and a slowing of mental and physical reactions (psychomotor retardation).There are five subtypes of schizophrenia:

Paranoid

The key feature of this subtype of schizophrenia is the combination of false beliefs (delusions) and hearing voices (auditory hallucinations), with more nearly normal emotions and cognitive functioning (cognitive functions include reasoning, judgment, and memory). The delusions of paranoid schizophrenics usually involve thoughts of being persecuted or harmed by others or exaggerated opinions of their own importance, but may also reflect feelings of jealousy or excessive religiosity. The delusions are typically organized into a coherent framework. Paranoid schizophrenics function at a higher level than other subtypes, but are at risk for suicidal or violent behavior under the influence of their delusions.

Disorganized

Disorganized schizophrenia (formerly called hebephrenic schizophrenia) is marked by disorganized speech, thinking, and behavior on the patient's part, coupled with flat or inappropriate emotional responses to a situation (affect). The patient may act silly or withdraw socially to an extreme extent. Most patients in this category have weak personality structures prior to their initial acute psychotic episode.

Catatonic

Catatonic schizophrenia is characterized by disturbances of movement that may include rigidity, stupor, agitation, bizarre posturing, and repetitive imitations of the movements or speech of other people. These patients are at risk for malnutrition, exhaustion, or self-injury. This subtype is presently uncommon in Europe and the United States. Catatonia as a symptom is most commonly associated with mood disorders.

Undifferentiated

Patients in this category have the characteristic positive and negative symptoms of schizophrenia but do not meet the specific criteria for the paranoid, disorganized, or catatonic subtypes.

Residual

This category is used for patients who have had at least one acute schizophrenic episode but do not presently have strong positive psychotic symptoms, such as delusions and hallucinations. They may have negative symptoms, such as withdrawal from others, or mild forms of positive symptoms, which indicate that the disorder has not completely resolved.The risk of schizophrenia among first-degree biological relatives is ten times greater than that observed in the general population. Furthermore the presence of the same disorder is higher in monozygotic twins (identical twins) than in dizygotic twins (nonidentical twins). The research concerning adoption studies and identical twins also supports the notion that environmental factors are important, because not all relatives who have the disorder express it. There are several chromosomes and loci (specific areas on chromosomes which contain mutated genes), which have been identified. Research is actively ongoing to elucidate the causes, types and variations of these mutations.Most patients are diagnosed in their late teens or early twenties, but the symptoms of schizophrenia can emerge at any age in the life cycle. The male/female ratio in adults is about 1.2:1. Male patients typically have their first acute episode in their early twenties, while female patients are usually closer to age 30 when they are recognized with active symptoms.Schizophrenia is rarely diagnosed in preadolescent children, although patients as young as five or six have been reported. Childhood schizophrenia is at the upper end of the spectrum of severity and shows a greater gender disparity. It affects one or two children in every 10,000; the male/female ratio is 2:1.

Causes and symptoms

Theories of causality

One of the reasons for the ongoing difficulty in classifying schizophrenic disorders is incomplete understanding of their causes. It is thought that these disorders are the end result of a combination of genetic, neurobiological, and environmental causes. A leading neurobiological hypothesis looks at the connection between the disease and excessive levels of dopamine, a chemical that transmits signals in the brain (neurotransmitter). The genetic factor in schizophrenia has been underscored by recent findings that first-degree biological relatives of schizophrenics are ten times as likely to develop the disorder as are members of the general population.Prior to recent findings of abnormalities in the brain structure of schizophrenic patients, several generations of psychotherapists advanced a number of psychoanalytic and sociological theories about the origins of schizophrenia. These theories ranged from hypotheses about the patient's problems with anxiety or aggression to theories about stress reactions or interactions with disturbed parents. Psychosocial factors are now thought to influence the expression or severity of schizophrenia rather than cause it directly.As of 2004, migration is a social factor that is known to influence people's susceptibility to psychosis. Psychiatrists in Europe have noted the increasing rate of schizophrenia and other psychotic disorders among immigrants to almost all Western European countries. Black immigrants from Africa or the Caribbean appear to be especially vulnerable. The stresses involved in migration include family breakup, the need to adjust to living in large urban areas, and social inequalities in the new country.Another hypothesis suggests that schizophrenia may be caused by a virus that attacks the hippocampus, a part of the brain that processes sense perceptions. Damage to the hippocampus would account for schizophrenic patients' vulnerability to sensory overload. As of 2004, researchers are focusing on the possible role of the herpes simplex virus (HSV) in schizophrenia, as well as human endogenous retroviruses (HERVs). The possibility that HERVs may be associated with schizophrenia has to do with the fact that antibodies to these retroviruses are found more frequently in the blood serum of patients with schizophrenia than in serum from control subjects.

Symptoms of schizophrenia

Patients with a possible diagnosis of schizophrenia are evaluated on the basis of a set or constellation of symptoms; there is no single symptom that is unique to schizophrenia. In 1959, the German psychiatrist Kurt Schneider proposed a list of so-called first-rank symptoms, which he regarded as diagnostic of the disorder.These symptoms include:

delusions
somatic
hallucinations
hearing voices commenting on the patient's behavior
thought insertion or thought withdrawal

Somatic hallucinations refer to sensations or perceptions concerning body organs that have no known medical cause or reason, such as the notion that one's brain is radioactive. Thought insertion and/or withdrawal refer to delusions that an outside force (for example, the FBI, the CIA, Martians, etc.) has the power to put thoughts into one's mind or remove them.POSITIVE SYMPTOMS. The positive symptoms of schizophrenia are those that represent an excessive or distorted version of normal functions. Positive symptoms include Schneider's first-rank symptoms as well as disorganized thought processes (reflected mainly in speech) and disorganized or catatonic behavior. Disorganized thought processes are marked by such characteristics as looseness of associations, in which the patient rambles from topic to topic in a disconnected way; tangentially, which means that the patient gives unrelated answers to questions; and "word salad," in which the patient's speech is so incoherent that it makes no grammatical or linguistic sense. Disorganized behavior means that the patient has difficulty with any type of purposeful or goal-oriented behavior, including personal self-care or preparing meals. Other forms of disorganized behavior may include dressing in odd or inappropriate ways, sexual self-stimulation in public, or agitated shouting or cursing.NEGATIVE SYMPTOMS. Schizophrenia includes three so-called negative symptoms. They are called negative because they represent the lack or absence of behaviors. The negative symptoms that are considered diagnostic of schizophrenia are a lack of emotional response (affective flattening), poverty of speech, and absence of volition or will. In general, the negative symptoms are more difficult for doctors to evaluate than the positive symptoms.

Diagnosis

A doctor must make a diagnosis of schizophrenia on the basis of a standardized list of outwardly observable symptoms, not on the basis of internal psychological processes. There are no specific laboratory tests that can be used to diagnose schizophrenia. Researchers have, however, discovered that patients with schizophrenia have certain abnormalities in the structure and functioning of the brain compared to normal test subjects. These discoveries have been made with the help of imaging techniques such as computed tomography scans (CT scans).When a psychiatrist assesses a patient for schizophrenia, he or she will begin by excluding physical conditions that can cause abnormal thinking and some other behaviors associated with schizophrenia. These conditions include organic brain disorders (including traumatic injuries of the brain), temporal lobe epilepsy, Wilson's disease, prion diseases, Huntington's chorea, and encephalitis. The doctor will also need to rule out heavy metal poisoning and substance abuse disorders, especially amphetamine use.After ruling out organic disorders, the clinician will consider other psychiatric conditions that may include psychotic symptoms or symptoms resembling psychosis. These disorders include mood disorders with psychotic features; delusional disorder; dissociative disorder not otherwise specified (DDNOS) or multiple personality disorder; schizotypal, schizoid, or paranoid personality disorders; and atypical reactive disorders. In the past, many individuals were incorrectly diagnosed as schizophrenic. Some patients who were diagnosed prior to the changes in categorization should have their diagnoses, and treatment, reevaluated. In children, the doctor must distinguish between psychotic symptoms and a vivid fantasy life, and also identify learning problems or disorders. After other conditions have been ruled out, the patient must meet a set of criteria specified:

the patient must have two (or more) of the following symptoms during a one-month period: delusions; hallucinations; disorganized speech; disorganized or catatonic behavior; negative symptoms
decline in social, interpersonal, or occupational functioning, including self-care
the disturbed behavior must last for at least six months
mood disorders, substance abuse disorders, medical conditions, and developmental disorders have been ruled out

Treatment

The treatment of schizophrenia depends in part on the patient's stage or phase. Psychotic symptoms and behaviors are considered psychiatric emergencies, and persons showing signs of psychosis are frequently taken by family, friends, or the police to a hospital emergency room. A person diagnosed as psychotic can be legally hospitalized against his or her will, particularly if he or she is violent, threatening to commit suicide, or threatening to harm another person. A psychotic person may also be hospitalized if he or she has become malnourished or ill as a result of failure to feed, dress appropriately for the climate, or otherwise take care of him- or herself.A patient having a first psychotic episode should be given a CT or MRI (magnetic resonance imaging) scan to rule out structural brain disease.

Antipsychotic medications

The primary form of treatment of schizophrenia is antipsychotic medication. Antipsychotic drugs help to control almost all the positive symptoms of the disorder. They have minimal effects on disorganized behavior and negative symptoms. Between 60-70% of schizophrenics will respond to antipsychotics. In the acute phase of the illness, patients are usually given medications by mouth or by intramuscular injection. After the patient has been stabilized, the antipsychotic drug may be given in a long-acting form called a depot dose. Depot medications last for two to four weeks; they have the advantage of protecting the patient against the consequences of forgetting or skipping daily doses. In addition, some patients who do not respond to oral neuroleptics have better results with depot form. Patients whose long-term treatment includes depot medications are introduced to the depot form gradually during their stabilization period. Most people with schizophrenia are kept indefinitely on antipsychotic medications during the maintenance phase of their disorder to minimize the possibility of relapse.As of the early 2000s, the most frequently used antipsychotics fall into two classes: the older dopamine receptor antagonists, or DAs, and the newer serotonin dopamine antagonists, or SDAs. (Antagonists block the action of some other substance; for example, dopamine antagonists counteract the action of dopamine.) The exact mechanisms of action of these medications are not known, but it is thought that they lower the patient's sensitivity to sensory stimuli and so indirectly improve the patient's ability to interact with others.DOPAMINE RECEPTOR ANTAGONIST. The dopamine antagonists include the older antipsychotic (also called neuroleptic) drugs, such as haloperidol (Haldol), chlorpromazine (Thorazine), and fluphenazine (Prolixin). These drugs have two major drawbacks: it is often difficult to find the best dosage level for the individual patient, and a dosage level high enough to control psychotic symptoms frequently produces extrapyramidal side effects, or EPS. EPSs include parkinsonism, in which the patient cannot walk normally and usually develops a tremor; dystonia, or painful muscle spasms of the head, tongue, or neck; and akathisia, or restlessness. A type of long-term EPS is called tardive dyskinesia, which features slow, rhythmic, automatic movements. Schizophrenics with AIDS are especially vulnerable to developing EPS.SEROTONIN DOPANINE ANTAGONISTS. The serotonin dopamine antagonists, also called atypical antipsychotics, are newer medications that include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa). The SDAs have a better effect on the negative symptoms of schizophrenia than do the older drugs and are less likely to produce EPS than the older compounds. The newer drugs are significantly more expensive in the short term, although the SDAs may reduce long-term costs by reducing the need for hospitalization. They are also presently unavailable in injectable forms. The SDAs are commonly used to treat patients who respond poorly to the DAs. However, many psychotherapists now regard the use of these atypical antipsychotics as the treatment of first choice; in particular, clozapine appears to be more effective than other antipsychotics in controlling persistent aggression in some patients.NEWER DRUGS. Some newer antipsychotic drugs have been approved by the Food and Drug administration (FDA) in the early 2000s. These drugs are sometimes called second-generation antipsychotics or SGAs. Aripiprazole (Abilify), which is classified as a partial dopaminergic agonist, received FDA approval in August 2003. Two drugs that are still under investigation, a neurokinin antagonist and a serotonin 2A/2C antagonist respectively, show promise in the treatment of schizophrenia and schizoaffective disorder.

Psychotherapy

Most schizophrenics can benefit from psychotherapy once their acute symptoms have been brought under control by antipsychotic medication. Psychoanalytic approaches are not recommended. Behavior therapy, however, is often helpful in assisting patients to acquire skills for daily living and social interaction. It can be combined with occupational therapy to prepare the patient for eventual employment.

Family therapy

Family therapy is often recommended for the families of schizophrenic patients, to relieve the feelings of guilt that they often have as well as to help them understand the patient's disorder. The family's attitude and behaviors toward the patient are key factors in minimizing relapses (for example, by reducing stress in the patient's life), and family therapy can often strengthen the family's ability to cope with the stresses caused by the schizophrenic's illness. Family therapy focused on communication skills and problem-solving strategies is particularly helpful. In addition to formal treatment, many families benefit from support groups and similar mutual help organizations for relatives of schizophrenics.

Prognosis

One important prognostic sign is the patient's age at onset of psychotic symptoms. Patients with early onset of schizophrenia are more often male, have a lower level of functioning prior to onset, a higher rate of brain abnormalities, more noticeable negative symptoms, and worse outcomes. Patients with later onset are more likely to be female, with fewer brain abnormalities and thought impairment, and more hopeful prognoses.The average course and outcome for schizophrenics are less favorable than those for most other mental disorders, although as many as 30% of patients diagnosed with schizophrenia recover completely and the majority experience some improvement. Two factors that influence outcomes are stressful life events and a hostile or emotionally intense family environment. Schizophrenics with a high number of stressful changes in their lives, or who have frequent contacts with critical or emotionally over-involved family members, are more likely to relapse. Overall, the most important component of long-term care of schizophrenic patients is complying with their regimen of antipsychotic medications.

Key terms

Affective flattening — A loss or lack of emotional expressiveness. It is sometimes called blunted or restricted affect.Akathisia — Agitated or restless movement, usually affecting the legs and accompanied by a sense of discomfort. It is a common side effect of neuroleptic medications.Catatonic behavior — Behavior characterized by muscular tightness or rigidity and lack of response to the environment. In some patients rigidity alternates with excited or hyperactive behavior.Delusion — A fixed, false belief that is resistant to reason or factual disproof.Depot dosage — A form of medication that can be stored in the patient's body tissues for several days or weeks, thus minimizing the risk of the patient forgetting daily doses. Haloperidol and fluphenazine can be given in depot form.Dopamine receptor antagonists (DAs) — The older class of antipsychotic medications, also called neuroleptics. These primarily block the site on nerve cells that normally receive the brain chemical dopamine.Dystonia — Painful involuntary muscle cramps or spasms.Extrapyramidal symptoms (EPS) — A group of side effects associated with antipsychotic medications. EPS include parkinsonism, akathisia, dystonia, and tardive dyskinesia.First-rank symptoms — A set of symptoms designated by Kurt Schneider in 1959 as the most important diagnostic indicators of schizophrenia. These symptoms include delusions, hallucinations, thought insertion or removal, and thought broadcasting. First-rank symptoms are sometimes referred to as Schneiderian symptoms.Hallucination — A sensory experience of something that does not exist outside the mind. A person can experience a hallucination in any of the five senses. Auditory hallucinations are a common symptom of schizophrenia.Huntington's chorea — A hereditary disease that typically appears in midlife, marked by gradual loss of brain function and voluntary movement. Some of its symptoms resemble those of schizophrenia.Negative symptoms — Symptoms of schizophrenia characterized by the absence or elimination of certain behaviors. DSM-IV specifies three negative symptoms: affective flattening, poverty of speech, and loss of will or initiative.Neuroleptic — Another name for the older type of antipsychotic medications given to schizophrenic patients.Parkinsonism — A set of symptoms originally associated with Parkinson disease that can occur as side effects of neuroleptic medications. The symptoms include trembling of the fingers or hands, a shuffling gait, and tight or rigid muscles.Positive symptoms — Symptoms of schizophrenia that are characterized by the production or presence of behaviors that are grossly abnormal or excessive, including hallucinations and thought-process disorder. DSM-IV subdivides positive symptoms into psychotic and disorganized.Poverty of speech — A negative symptom of schizophrenia, characterized by brief and empty replies to questions. It should not be confused with shyness or reluctance to talk.Psychotic disorder — A mental disorder characterized by delusions, hallucinations, or other symptoms of lack of contact with reality. The schizophrenias are psychotic disorders.Serotonin dopamine antagonist (SDA) — The newer second-generation antipsychotic drugs, also called atypical antipsychotics. SDAs include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa).Wilson disease — A rare hereditary disease marked by high levels of copper deposits in the brain and liver. It can cause psychiatric symptoms resembling schizophrenia.Word salad — Speech that is so disorganized that it makes no linguistic or grammatical sense.

Resources

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, D.C.: American Psychiatric Association, 2000.Beers, Mark H., MD, and Robert Berkow, MD., editors. "Psychiatric Emergencies." Section 15, Chapter 194 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.Beers, Mark H., MD, and Robert Berkow, MD., editors. "Schizophrenia and Related Disorders." Section 15, Chapter 193 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.Wilson, Billie Ann, Margaret T. Shannon, and Carolyn L. Stang. Nurse's Drug Guide 2003. Upper Saddle River, NJ: Prentice Hall, 2003.

Periodicals

DeLeon, A., N. C. Patel, and M. L. Crismon. "Aripiprazole: A Comprehensive Review of Its Pharmacology, Clinical Efficacy, and Tolerability." Clinical Therapeutics 26 (May 2004): 649-666.Frankenburg, Frances R., MD. "Schizophrenia." eMedicine June 17, 2004. http://www.emedicine.com/med/topic2072.htm.Hutchinson, G., and C. Haasen. "Migration and Schizophrenia: The Challenges for European Psychiatry and Implications for the Future." Social Psychiatry and Psychiatric Epidemiology 39 (May 2004): 350-357.Meltzer, H. Y., L. Arvanitis, D. Bauer, et al. "Placebo-Controlled Evaluation of Four Novel Compounds for the Treatment of Schizophrenia and Schizoaffective Disorder." American Journal of Psychiatry 161 (June 2004): 975-984.Mueser, K. T., and S. R. McGurk. "Schizophrenia." Lancet 363 (June 19, 2004): 2063-2072.Volavka, J., P. Czobor, K. Nolan, et al. "Overt Aggression and Psychotic Symptoms in Patients with Schizophrenia Treated with Clozapine, Olanzapine, Risperidone, or Haloperidol." Journal of Clinical Psychopharmacology 24 (April 2004): 225-228.Yolken, R. "Viruses and Schizophrenia: A Focus on Herpes Simplex Virus." Herpes 11, Supplement 2 (June 2004): 83A-88A.

Organizations

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Suite 300 Arlington, VA 22201. (703) 524-7600 HelpLine: (800) 950-NAMI. http://www.nami.org/.National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. http://www.nimh.nih.gov.Schizophrenics Anonymous. 15920 W. Twelve Mile, Southfield, MI 48076. (248) 477-1983.United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFOFDA. http://www.fda.gov.

Other

"Schizophrenia." Internet Mental Health. http://www.mentalhealth.com/dis/p20-ps01.html.

schizophrenia

[skit-so-, skiz-o-fre´ne-ah] any of a large group of mental disorders (the schizophrenic disorders) characterized by mental deterioration from a previous level of functioning and characteristic disturbances of multiple psychological processes, including delusions, loosening of associations, poverty of the content of speech, auditory hallucinations, inappropriate affect, disturbed sense of self, and withdrawal from the external world. adj., adj schizophren´ic.
Because the onset is usually in adolescence or early adulthood, schizophrenia was formerly called dementia praecox, a term still used by some European psychiatrists for process schizophrenia. The term schizophrenia literally means “split personality,” referring to portions of the psyche that are contradictory; it does not mean multiple personality disorder, which is the presence of distinct, autonomous alternate personalities.
There are various theories regarding causes of schizophrenia. Biologic theories include genetics, biochemicals, and structural alterations. It is generally accepted that schizophrenics inherit a genetic vulnerability for the disease, and this interacts with environmental factors in causation.Classification. The current nomenclature classifies schizophrenia into five types. Disorganized (hebephrenic) schizophrenia is characterized by disorganized, incoherent thinking; shallow, inappropriate, and silly affect; and regressive behavior without systematized delusions. Catatonic schizophrenia is characterized by psychomotor disturbance which may involve stupor, rigidity, excitement, negativism, or posturing, or an alteration among these behaviors; associated features include mutism, stereotypy, and waxy flexibility. This type, once common, is now rare. Paranoid schizophrenia is characterized by persecutory or grandiose delusions, delusional jealousy, or hallucinations with persecutory or grandiose content. The undifferentiated type refers to cases in which there are prominent psychotic symptoms, such as delusions, hallucinations, incoherence, or grossly disorganized behavior, and which cannot be classified as one of the first three types. The residual type refers to cases in which the prominent psychotic symptoms of a previous episode have disappeared but signs of the illness, such as inappropriate affect, social withdrawal, or loosening of associations, persist.Treatment. A variety of therapeutic measures may be used to help the schizophrenic patient cope with reality and the demands of everyday living. The combination of therapies will depend on the needs of the individual patient, age and family background, and the environment in which the patient must live. Among the kinds of therapy are treatment with one of the antipsychotic agents (formerly called neuroleptics) and intensive psychotherapy for outpatients and various forms of group therapy and milieu therapy for hospitalized patients.childhood schizophrenia see pervasive developmental disorders.catatonic schizophrenia a type of schizophrenia characterized by marked psychomotor disturbance, which may include immobility (stupor or catalepsy), excessive motor activity, extreme negativism, mutism, echolalia, echopraxia, and peculiar voluntary movements such as posturing, mannerisms, grimacing, or stereotyped behaviors.latent schizophrenia older term for a type of schizophrenia characterized by clear symptoms of schizophrenia but no history of a psychotic schizophrenic episode; it includes conditions that have been called incipient, prepsychotic, prodromal, pseudoneurotic, and pseudopsychopathic schizophrenia. See schizoid personality disorder and schizotypal personality disorder.pseudoneurotic schizophrenia a form characterized by all-pervasive anxiety and a wide variety of neurotic symptoms that initially mask underlying psychotic tendencies, which may be manifest as occasional, brief psychotic episodes. It is usually considered to be more of a personality disorder; see also schizotypal personality disorder.pseudopsychopathic schizophrenia a term applied to patients in whom antisocial, impulsive, or sociopathic tendencies initially mask underlying psychotic tendencies typical of schizophrenia. It is often considered to be more of a personality disorder; see schizotypal personality disorder.schizoaffective schizophrenia schizoaffective disorder.simple schizophrenia a form characterized by gradual loss of drive, social withdrawal, and emotional apathy, but without prominent psychotic features. It is often considered to be a form of personality disorder; see schizotypal personality disorder.

schiz·o·phre·ni·a

(skiz'ō-frē'nē-ă, skit-sō-), [MIM*181500] Although z in this word is correctly given its usual English pronunciation, the Germanic pronunciation (skits-) is more often heard in the U.S.A term coined by Bleuler, synonymous with and replacing dementia praecox, denoting a common type of psychosis, characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions) and by extensive withdrawal of interest from other people and the outside world, with excessive focusing on one's own mental life. Now considered a group or spectrum of disorders rather than a single entity, with distinction sometimes made between process schizophrenia and reactive schizophrenia. The "split" personality of schizophrenia, in which individual psychic components or functions split off and become autonomous, is popularly but erroneously identified with multiple personality, in which two or more relatively complete personalities dominate by turns the psychic life of a patient. [schizo- + G. phrēn, mind]

schizophrenia

(skĭt′sə-frē′nē-ə, -frĕn′ē-ə)n.1. A heterogeneous psychiatric disorder characterized by psychotic behavior including delusions, hallucinations, withdrawal from reality, and disorganized patterns of thinking and speech.2. A situation or condition characterized by conflicting qualities, attitudes, or activities: the national schizophrenia that results from carrying out an unpopular war.

schizophrenia

Psychiatry A heterogenous group of disorders characterized by progressive mental disturbances in thought, perception, affect, behavior, and communication that last longer than 6 months, which may be accompanied by psychotic Sx, bizarre behavior, or by negative–deficit Sx, including low levels of emotional arousal, mental activity, and social drive; schizophrenia is a diagnosis of exclusion–none of its clinical, biochemical, neuroradiologic, pathophysiologic, and psychologic features are sufficient to establish a definitive diagnosis DSM-IV Clinical Disordered thought processes and abnormal behavior–eg, hallucinations, delusions, social withdrawal, inappropriate or "blunted" affect, verbal incoherence, cognitive deficits, inappropriate or blunted affect Types Catatonic, paranoid, disorganized, undifferentiated, residual Management Antipsychotics are used to 1. ↓ hallucinations and delusions, and other thought disturbances and improve Sx of withdrawal and apathy.2. Control Sx through maintenance therapy, and.3. As long-term prophylaxis, neuroleptics include haloperidol and clozapine See Cultural schizophrenia, Disorganized schizophrenia, Fugue, Multiple personality, Paranoid schizophrenia. Cf Schizoid personality disorder. Schizophrenia-diagnostic criteria¹ A Characteristic Sx: 2 or more² of following, for a significant portion of 1+ months Delusions Disorganized (or catatonic) behavior Disorganized speech (incoherence) Hallucinations Negative symptoms, eg flattening of affect, loss of volition B Social/occupational dysfunction
C Duration 6+ months in duration with 1+ months of 'active' symptoms, defined by criteria A Exclusions Symptoms are not better accounted for by D Other mental disorders, eg Schizoaffective disorder or Mood disorder with psychotic features E Other conditions, eg substances(medication, substance of abuse) and/or general medical conditions
¹Modified from Diagnostic & Statistical Manual of Mental Disorders, 4^th ed, Washington, DC, Am Psychiatric Assn, 1994 ²Only one of criteria A is required if the delusions are bizarre, or hallucinations include 1 + 'voices in head' .

schiz·o·phre·ni·a

(skiz'ō-frē'nē-ă) A common type of psychosis, characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions), and extensive withdrawal of one's interest from other people and the outside world, the investment of it being instead in one's own mental life. [G. schizō, split + G. phrēn, mind]

schizophrenia

The commonest major psychiatric disorder affecting about 1% of Western populations and usually appearing in adolescence or early adult life. Schizophrenia is not a disease in the normal medical sense and the diagnosis is based entirely on behaviour and on the statements of the affected person. Schizophrenics are said to have DELUSIONS, HALLUCINATIONS, disordered thinking and loss of contact with reality. They indulge in non-logical free associations, appear to confuse literal and metaphorical meaning and use invented words. The cause has not been established but life case histories suggest that some schizophrenics have adopted an alternative reality as an escape from an intolerable life situation. There also appears to be some genetic basis, but this does not exclude an important environmental causation. A mutation in the serotonin receptor gene has been proposed as a cause. Schizophrenics can usually be made to conform to conventional social mores by treatment with antipsychotic drugs. Psychoanalysis has no value in the treatment of schizophrenia.

schiz·o·phre·ni·a

(skits'ō-frē'nē-ă) [MIM*181500] A common type of psychosis, characterized by abnormalities in perception, content of thought, and thought processes. [G. schizō, split + G. phrēn, mind]

Patient discussion about schizophrenia

Q. how to treat schizophrenia? A. Schizophrenia is a serious illness that should be treated with the help of a psychiatrist, because close monitoring over the medications and possible side effects is crucial. It is often treated with anti-psychotic medications, either from the older or newer generation of drugs. Some modifications are done in each patient after looking into all of the factors that take place.

Q. How can we treat a schizophrenic person? A member of my family is a schizophrenic and was diagnosed when he was 25 years old. Today at almost 60 he refuse to be treated and certain that nothing is wrong with him. The problem is me and my family feels that his illness is getting worst and we can't help him. How can we get treatment for him and if not what is the next phase we should expect to encounter?A. although the cause for schizophrenia is not yet clear- there is a treatment for it's symptoms, and it's actually very helpful. have very good results. but it has to be accompanied by psychiatric care. you will have to convince him to go threw a therapy, talk to a good psychiatrist, ask him if he has any idea. or maybe someone here can answer that question. about what to look for, here is a very informative site about it-
http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Q. Am i going to get schizophrenia and what are the signs towards it? My mother is 50 years old and i knew she was bi polar and tonight i found out she has schizophrenia too from a nurse at the hospital she was sent to for going crazy out of no where tonight. I am very different from her and i am 17 years old. My dad side of the family has no disorders. How likely am i to develop schizophrenia? What are the first symptoms? Can i see signs now? and any other info.A. Sweetheart you would not recognize a sign if it run over you. as the sickness encroaches upon your mind it also removes rational thought. you will say to your self I am not crazy there is nothing wrong with me. all the crazy Sob's around me are nuts I an not. And Honey you will believe your self. self diagnosis is a very dangerous path you are wanting to take.
Just be aware and talk to a certified psychiatrist – he’ll tell you any thing you want to know.

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Definition

Description

Paranoid

Disorganized

Catatonic

Undifferentiated

Residual

Causes and symptoms

Theories of causality

Symptoms of schizophrenia

Diagnosis

Treatment

Antipsychotic medications

Psychotherapy

Family therapy

Prognosis

Key terms

Resources

Books

Periodicals

Organizations

Other

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Synonyms for schizophrenia

noun any of several psychotic disorders characterized by distortions of reality and disturbances of thought and language and withdrawal from social contact

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