Schizophrenia

For other uses, see Schizophrenia (disambiguation).

Schizophrenia
Embroidery art with nonlinear text sewn into it with multiple colors of thread
Cloth embroidered by a person diagnosed with schizophrenia
SpecialtyPsychiatry[1]
SymptomsHallucinations, delusions, disorganized thinking and behavior, flat or inappropriate affect[2][3]
ComplicationsHarm to self or others, social isolation, cognitive issues, heart disease, lifestyle diseases,[4] obesity and type 2 diabetes arising from antipsychotic medication[5][6]
Usual onsetAges 16 to 30[3]
DurationChronic[3]
CausesEnvironmental and genetic factors[7]
Risk factorsFamily history, cannabis use in adolescence, consumption of hallucinogens or amphetamines,[8] problems during pregnancy, childhood adversity, being born or raised in a city[7][9]
Diagnostic methodBased on observed behavior, reported experiences, and reports of others familiar with the person[10]
Differential diagnosisSubstance use disorder, Huntington's disease, mood disorders (bipolar disorder, major depressive disorder), autism,[11] borderline personality disorder,[12] schizophreniform disorder, schizotypal personality disorder, schizoid personality disorder, antisocial personality disorder, psychotic depression, anxiety, disruptive mood dysregulation disorder, sleep paralysis
ManagementCounseling, life skills training[2][7]
MedicationAntipsychotics[7]
Prognosis20–28 years shorter life expectancy[13][14]
Frequency~0.32% (1 in 300) of the global population is affected.[15]
Deaths~17,000 (2015)[16]

Schizophrenia is a mental disorder[17][7] characterized variously by hallucinations (typically, hearing voices), delusions, disorganized thinking and behavior,[10] and flat or inappropriate affect.[7] Symptoms develop gradually and typically begin during young adulthood and are never resolved.[3][10] There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person.[10] For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months (according to the DSM-5) or one month (according to the ICD-11).[10][18] Many people with schizophrenia have other mental disorders, especially mood disorders, anxiety disorders, and obsessive–compulsive disorder.[10]

About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime.[19] In 2017, there were an estimated 1.1 million new cases and in 2022 a total of 24 million cases globally.[2][20] Males are more often affected and on average have an earlier onset than females.[2] The causes of schizophrenia may include genetic and environmental factors.[7] Genetic factors include a variety of common and rare genetic variants.[21] Possible environmental factors include being raised in a city, childhood adversity, cannabis use during adolescence, infections, the age of a person's mother or father, and poor nutrition during pregnancy.[7][22]

About half of those diagnosed with schizophrenia will have a significant improvement over the long term with no further relapses, and a small proportion of these will recover completely.[10][23] The other half will have a lifelong impairment.[24] In severe cases, people may be admitted to hospitals.[23] Social problems such as long-term unemployment, poverty, homelessness, exploitation, and victimization are commonly correlated with schizophrenia.[25][26] Compared to the general population, people with schizophrenia have a higher suicide rate (about 5% overall) and more physical health problems,[27][28] leading to an average decrease in life expectancy by 20[13] to 28 years.[14] In 2015, an estimated 17,000 deaths were linked to schizophrenia.[16]

The mainstay of treatment is antipsychotic medication, including olanzapine and risperidone, along with counseling, job training, and social rehabilitation.[7] Up to a third of people do not respond to initial antipsychotics, in which case clozapine is offered.[29] In a network comparative meta-analysis of 15 antipsychotic drugs, clozapine was significantly more effective than all other drugs, although clozapine's heavily multimodal action may cause more significant side effects.[30] In situations where doctors judge that there is a risk of harm to self or others, they may impose short involuntary hospitalization.[31] Long-term hospitalization is used on a small number of people with severe schizophrenia.[32] In some countries where supportive services are limited or unavailable, long-term hospital stays are more common.[33]

  1. ^ Jones D (2003) [1917]. Roach P, Hartmann J, Setter J (eds.). English Pronouncing Dictionary. Cambridge University Press. ISBN 978-3-12-539683-8.
  2. ^ a b c d "Schizophrenia Fact sheet". World Health Organization. 10 January 2022. Retrieved 23 August 2022.
  3. ^ a b c d "Schizophrenia". Health topics. US National Institute of Mental Health. April 2022. Retrieved 22 August 2022.
  4. ^ "Medicinal treatment of psychosis/schizophrenia". Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). 21 November 2012. Archived from the original on 29 June 2017. Retrieved 26 June 2017.
  5. ^ Proietto Sr J (November 2004). "Diabetes and Antipsychotic Drugs". Medsafe.
  6. ^ Holt RI (September 2019). "Association Between Antipsychotic Medication Use and Diabetes". Current Diabetes Reports. 19 (10). National Center for Biotechnology Information: 96. doi:10.1007/s11892-019-1220-8. ISSN 1534-4827. PMC 6718373. PMID 31478094.
  7. ^ a b c d e f g h i Owen MJ, Sawa A, Mortensen PB (July 2016). "Schizophrenia". The Lancet. 388 (10039): 86–97. doi:10.1016/S0140-6736(15)01121-6. PMC 4940219. PMID 26777917.
  8. ^ Miller B (2 February 2020). "Drug Psychosis May Pull the Schizophrenia Trigger". Psychiatric Times.
  9. ^ Gruebner O, Rapp MA, Adli M, Kluge U, Galea S, Heinz A (February 2017). "Cities and Mental Health". Deutsches Arzteblatt International. 114 (8): 121–127. doi:10.3238/arztebl.2017.0121. PMC 5374256. PMID 28302261.
  10. ^ a b c d e f g Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. 2013. pp. 99–105. ISBN 978-0-89042-555-8.
  11. ^ Ferri FF (2010). "Chapter S". Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd ed.). Philadelphia: Elsevier/Mosby. ISBN 978-0-323-07699-9.
  12. ^ Cite error: The named reference Paris2018 was invoked but never defined (see the help page).
  13. ^ a b Laursen TM, Nordentoft M, Mortensen PB (2014). "Excess early mortality in schizophrenia". Annual Review of Clinical Psychology. 10: 425–448. doi:10.1146/annurev-clinpsy-032813-153657. PMID 24313570.
  14. ^ a b Cite error: The named reference NIHStat was invoked but never defined (see the help page).
  15. ^ "Schizophrenia Fact Sheet and Information". World Health Organization.
  16. ^ a b Wang H, Naghavi M, Allen C, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  17. ^ "ICD-11: 6A20 Schizophrenia". World Health Organization. Retrieved 23 August 2022.
  18. ^ Cite error: The named reference Ferri2019 was invoked but never defined (see the help page).
  19. ^ Javitt DC (June 2014). "Balancing therapeutic safety and efficacy to improve clinical and economic outcomes in schizophrenia: a clinical overview". The American Journal of Managed Care. 20 (8 Suppl): S160-165. PMID 25180705.
  20. ^ James SL, Abate D (November 2018). "Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017". The Lancet. 392 (10159): 1789–1858. doi:10.1016/S0140-6736(18)32279-7. PMC 6227754. PMID 30496104.
  21. ^ van de Leemput J, Hess JL, Glatt SJ, Tsuang MT (2016). Genetics of Schizophrenia: Historical Insights and Prevailing Evidence. Advances in Genetics. Vol. 96. pp. 99–141. doi:10.1016/bs.adgen.2016.08.001. ISBN 978-0-12-809672-7. PMID 27968732.
  22. ^ Cite error: The named reference Parakh2013 was invoked but never defined (see the help page).
  23. ^ a b Vita A, Barlati S (May 2018). "Recovery from schizophrenia: is it possible?". Current Opinion in Psychiatry. 31 (3): 246–255. doi:10.1097/YCO.0000000000000407. PMID 29474266. S2CID 35299996.
  24. ^ Lawrence RE, First MB, Lieberman JA (2015). "Chapter 48: Schizophrenia and Other Psychoses". In Tasman A, Kay J, Lieberman JA, First MB, Riba MB (eds.). Psychiatry (fourth ed.). John Wiley & Sons, Ltd. pp. 798, 816, 819. doi:10.1002/9781118753378.ch48. ISBN 978-1-118-84547-9.
  25. ^ Cite error: The named reference Killaspy2014 was invoked but never defined (see the help page).
  26. ^ Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. (October 2018). "Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016". Schizophrenia Bulletin. 44 (6): 1195–1203. doi:10.1093/schbul/sby058. PMC 6192504. PMID 29762765.
  27. ^ van Os J, Kapur S (August 2009). "Schizophrenia" (PDF). Lancet. 374 (9690): 635–645. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006. S2CID 208792724. Archived from the original (PDF) on 23 June 2013. Retrieved 23 December 2011.
  28. ^ Hor K, Taylor M (November 2010). "Suicide and schizophrenia: a systematic review of rates and risk factors". Journal of Psychopharmacology. 24 (4 Suppl): 81–90. doi:10.1177/1359786810385490. PMC 2951591. PMID 20923923.
  29. ^ Siskind D, Siskind V, Kisely S (November 2017). "Clozapine Response Rates among People with Treatment-Resistant Schizophrenia: Data from a Systematic Review and Meta-Analysis". Canadian Journal of Psychiatry. 62 (11): 772–777. doi:10.1177/0706743717718167. PMC 5697625. PMID 28655284.
  30. ^ Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. (September 2013). "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis". Lancet. 382 (9896): 951–962. doi:10.1016/S0140-6736(13)60733-3. PMID 23810019. S2CID 32085212.
  31. ^ Becker T, Kilian R (2006). "Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?". Acta Psychiatrica Scandinavica. Supplementum. 113 (429): 9–16. doi:10.1111/j.1600-0447.2005.00711.x. PMID 16445476. S2CID 34615961.
  32. ^ Capdevielle D, Boulenger JP, Villebrun D, Ritchie K (September 2009). "Durées d'hospitalisation des patients souffrant de schizophrénie: implication des systèmes de soin et conséquences médicoéconomiques" [Schizophrenic patients' length of stay: mental health care implication and medicoeconomic consequences]. L'Encéphale (in French). 35 (4): 394–399. doi:10.1016/j.encep.2008.11.005. PMID 19748377.
  33. ^ Narayan KK, Kumar DS (January 2012). "Disability in a Group of Long-stay Patients with Schizophrenia: Experience from a Mental Hospital". Indian Journal of Psychological Medicine. 34 (1): 70–75. doi:10.4103/0253-7176.96164. PMC 3361848. PMID 22661812.