Schizophrenia

For other uses, see Schizophrenia (disambiguation).
"SCZ" redirects here. For other uses, see SCZ (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 Ärzteblatt 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.