Thursday, October 30, 2014

21. Schizophrenia

Schizophrenia is a mental disorder that generally appears in late adolescence or early adulthood - however, it can emerge at any time in life. It is one of many brain diseases that may include delusions, loss of personality (flat affect), confusion, agitation, social withdrawal, psychosis, and bizarre behavior.

What is schizophrenia?

Individuals with schizophrenia may hear voices that are not there. Some may be convinced that others are reading their minds, controlling how they think, or plotting against them. This can distress patients severely and persistently, making them withdrawn and frantic.
Others may find it hard to make sense of what a person with schizophrenia is talking about. In some cases, the individual may spend hours completely still, without talking. On other occasions he or she may seem fine, until they start explaining what they are truly thinking.
The effects of schizophrenia reach far beyond the patient - schizophrenia does not only affect the person with the disorder. Families, friends and society are affected too. A sizable proportion of people with schizophrenia have to rely on others, because they are unable to hold a job or care for themselves.
With proper treatment, patients can lead productive lives - according to the National Institute of Mental Health1(NIMN), treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life. This does not mean that a person with schizophrenia who receives treatment cannot lead a rewarding, productive and meaningful life in his or her community.
Schizophrenia most commonly strikes between the ages of 15 to 25 among men, and about 25 to 35 in women. In many cases the disorder develops so slowly that the sufferer does not know he/she has it for a long time. While, with other people it can strike suddenly and develop fast.
Schizophrenia, possibly many illnesses combined - it is a complex, chronic, severe, and disabling brain disorder and affects approximately 1% of all adults globally. Experts say schizophrenia is probably many illnesses masquerading as one. Research indicates that schizophrenia is likely to be the result of faulty neuronal development in the brain of the fetus, which later in life emerges as a full-blown illness.
According to the University of Maryland Medical Center2, schizophrenia affects males and females equally. However, an article in the BMJ8 says that schizophrenia affects 1.4 males for every 1 female.
The Schizophrenic Disorders Clinic3 at the Stanford School of Medicine describes schizophrenia as "a thought disorder: a brain disorder that interferes with a person's ability to think clearly, manage emotions, make decisions, and relate to others."
John Forbes Nash, Jr. by Peter Badge
John Forbes Nash Jr. (born June 13, 1928) has lived
with paranoid schizophrenia.
John Nash, an American mathematician who worked at Princeton University, won the Nobel Prize in Economics and lived with paranoid schizophrenia most of his life. He eventually managed to live without medication. A film was made of his life "A Beautiful Mind", which Nash says was "loosely accurate".
A study published in The Lancet7 found that schizophrenia with active psychosis is the third most disabling condition after quadriplegia and dementia, and ahead of blindness and paraplegia.
The word schizophrenia comes from the Greek word skhizeinmeaning "to split" and the Greek word Phrenos (phren) meaning "diaphragm, heart, mind". In 1910, the Swiss psychiatrist, Eugen Bleuler (1857-1939) coined the term Schizophrenie in a lecture in Berlin on April 24th, 1908.

The brain

Our brain consists of billions of nerve cells. Each nerve cell has branches that give out and receive messages from other nerve cells.
The ending of these nerve cells release neurotransmitters - types of chemicals. These neurotransmitters carry messages from the endings of one nerve cell to the nerve cell body of another. In the brain of a person who has schizophrenia, this messaging system does not work properly.

Signs and symptoms

There is, to date, no physical or laboratory test that can absolutely diagnose schizophrenia. The doctor, a psychiatrist, will make a diagnosis based on the patient's clinical symptoms. However, physical testing can rule out some other disorders and conditions which sometimes have similar symptoms, such as seizure disorders, thyroid dysfunction, brain tumor, drug use, and metabolic disorders.
Symptoms and signs of schizophrenia will vary, depending on the individual. The symptoms are classified into four categories:
  • Positive symptoms - also known as psychotic symptoms. These are symptoms that appear, which people without schizophrenia do not have. For example, delusion.

  • Negative symptoms - these refer to elements that are taken away from the individual; loss or absence of normal traits or abilities that people without schizophrenia normally have. For example, blunted emotion.

  • Cognitive symptoms - these are symptoms within the person's thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.

  • Emotional symptoms - these are symptoms within the person's feelings. They are usually negative symptoms, such as blunted emotions.
Below is a list of the major symptoms:
  • Delusions - The patient has false beliefs of persecution, guilt of grandeur. He/she may feel things are being controlled from outside. It is not uncommon for people with schizophrenia to describe plots against them. They may think they have extraordinary powers and gifts. Some patients with schizophrenia may hide in order to protect themselves from an imagined persecution.

  • Hallucinations - hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, but seem very real to the patient.

  • Thought disorder - the person may jump from one subject to another for no logical reason. The speaker may be hard to follow. The patient's speech might be muddled and incoherent. In some cases the patient may believe that somebody is messing with his/her mind.
Other symptoms schizophrenia patients may experience include:
  • Lack of motivation (avolition) - the patient loses his/her drive. Everyday automatic actions, such as washing and cooking are abandoned. It is important that those close to the patient understand that this loss of drive is due to the illness, and has nothing to do with slothfulness.

  • Poor expression of emotions - responses to happy or sad occasions may be lacking, or inappropriate.

  • Social withdrawal - when a patient with schizophrenia withdraws socially it is often because he/she believes somebody is going to harm them. Other reasons could be a fear of interacting with other humans because of poor social skills.

  • Unaware of illness - as the hallucinations and delusions seem so real for the patients, many of them may not believe they are ill. They may refuse to take medications which could help them enormously for fear of side-effects, for example.

  • Cognitive difficulties - the patient's ability to concentrate, remember things, plan ahead, and to organize himself/herself are affected. Communication becomes more difficult.
Recent developments on the symptoms of schizophrenia from MNT news
Impaired eye movements linked to schizophrenia - researchers from the University of British Columbia explained in the Journal of Neuroscience that people with schizophrenia find it harder to follow a moving dot on a computer screen.

What causes schizophrenia?

Nobody has been able to pinpoint one single cause. Experts believe several factors are generally involved in contributing to the onset of schizophrenia.
The likely factors do not work in isolation, either. Evidence does suggest that genetic and environmental factors generally act together to bring about schizophrenia. Evidence indicated that the diagnosis of schizophrenia has an inherited element, but it is also significantly influenced by environmental triggers. In other words, imagine your body is full of buttons, and some of those buttons result in schizophrenia if somebody comes and presses them enough times and in the right sequences.
The buttons would be your genetic susceptibility, while the person pressing them would be the environmental factors.
Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:
  • Your genes

    If there is no history of schizophrenia in your family your chances of developing it are less than 1%. However, that risk rises to 10% if one of your parents was/is a sufferer.

    A gene that is probably the most studied "schizophrenia gene" plays a surprising role in the brain: It controls the birth of new neurons in addition to their integration into existing brain circuitry, according to an article published by Cell.

    A Swedish study found that schizophrenia and bipolar disorder have the same genetic causes.

    Thirteen locations in the human genetic code may help explain the cause of schizophrenia - a study involving 59,000 people, 5,001 of whom had been diagnosed with schizophrenia, identified 22 genome locations, with 13 new ones that are thought to be involved in the development of schizophrenia.

    The scientists added that of particular importance to schizophrenia were two genetically-determined processes - the "micro-RNA 137" pathway and the "calcium channel pathway".

    Principal investigator, Professor Patrick Sullivan, of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine, said "This study gives us the clearest picture to date of two different pathways that might be going wrong in people with schizophrenia. Now we need to concentrate our research very urgently on these two pathways in our quest to understand what causes this disabling mental illness."

  • Chemical imbalance in the brain

    Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They also believe that this imbalance is most likely caused by your genes making you susceptible to the illness. Some researchers say other the levels of other neurotransmitters, such as serotonin, may also be involved.

    Changes in key brain functions, such as perception, emotion and behavior lead experts to conclude that the brain is the biological site of schizophrenia.

    Schizophrenia could be caused by faulty signaling in the brain, according to research published in the journalMolecular Psychiatry.

  • Family relationships

    Although there is no evidence to prove or even indicate that family relationships might cause schizophrenia, some patients with the illness believe family tension may trigger relapses.

  • Environment

    Although there is yet no definite proof, many suspect that prenatal or perinatal trauma, and viral infections may contribute to the development of the disease. Perinatal means "occurring about 5 months before and up to one month after birth".

    Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocussed. This can trigger relationship problems, divorce and unemployment. These factors are often blamed for the onset of the disease, when really it was the other way round - the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.

  • Some drugs

    Cannabis and LSD are known to cause schizophrenia relapses. According to the State Government of Victoria6 in Australia, for people with a predisposition to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode in what can be a disabling condition that lasts for the rest of their lives.

    The National Library of Medicine9 says that some prescription drugs, such as steroids and stimulants, can cause psychosis.

Tests and diagnosis

A schizophrenia diagnosis is carried out by observing the actions of the patient. If the doctor suspects possible schizophrenia, they will need to know about the patient's medical and psychiatric history.
Certain tests will be ordered to rule out other illnesses and conditions that may trigger schizophrenia-like symptoms. Examples of some of the tests may include:
  • Blood tests - to determine CBC (complete blood count) as well as some other blood tests.

  • Imaging studies - to rule out tumors, problems in the structure of the brain, and other conditions/illnesses

  • Psychological evaluation - a specialist will assess the patient's mental state by asking about thoughts, moods, hallucinations, suicidal traits, violent tendencies or potential for violence, as well as observing their demeanor and appearance.
Schizophrenia - Diagnostic Criteria
Patients must meet the criteria laid down in the DSM (Diagnostic and Statistical Manual of Mental Disorders). It is an American Psychiatric Association manual that is used by health care professionals to diagnose mental illnesses and conditions.
The health care professional needs to exclude other possible mental health disorders, such as bipolar disorder orschizoaffective disorder.
It is also important to establish that the signs and symptoms have not been caused by, for example, a prescribed medication, a medical condition, or substance abuse.
Also, the patient must:
  • Have at least two of the following typical symptoms of schizophrenia -

    - Delusions
    - Disorganized or catatonic behavior
    - Disorganized speech
    - Hallucinations
    - Negative symptoms that are present for much of the time during the last four weeks.

  • Experience considerable impairment in the ability to attend school, carry out their work duties, or carry out every day tasks

  • Have symptoms which persist for six months or more
Sometimes, the person with schizophrenia may find their symptoms frightening, and conceal them from others. If there is severe paranoia, they may be suspicious of family or friends who try to help. There are many elements in disease that make it difficult to confirm a schizophrenia diagnosis.
Recent developments on schizophrenia from MNT news
Collecting neurons from the nose to diagnose schizophrenia - researchers from Tel Aviv University, Israel, reported in Neurobiology of Disease that collecting neurons from the nose of the patient may be a rapid way to test for schizophrenia.
Noam Shomron of TAU's Sackler Faculty of Medicine, and team describe how they devised a potential way of diagnosing schizophrenia by testing microRNA molecules found in the neurons inside the patient's nose. A sample can be taken via a simple biopsy.
Shomron believes this could become a "more sure-fire" way of diagnosing schizophrenia than ever before. It may also be a way of detecting the devastating disease earlier on. Schizophrenia treatment is usually much more effective if it can start during the early stages.
Are autism and schizophrenia related? - when seen at first glance, autism and schizophrenia appear to be completely different disorders. However, a discovery made by researchers at Tel Aviv University's Sackler Faculty of Medicine and the Sheba Medical Center showed that the two disorders have similar roots, and are linked to other mental conditions, such as bipolar disorder.
Both schizophrenia and autism share come traits, including a limited ability to lead a normal life function in the real world, as well as cognitive and social dysfunction.
The scientists found a genetic link between the two disorders, which causes a higher risk within families. Dr. Mark Weiser and team found that people with a sibling with schizophrenia had a twelve-fold higher chance of having autism than those without schizophrenia in the family.
Schizophrenia genetically linked to four other mental illnesses or disorders - researchers the Cross Disorders Group of the Psychiatric Genomic Consortium reported that schizophrenia, major depressive disorder, bipolar disorder, autism spectrum disorders, and ADHD (attention-deficit hyperactivity disorder) share the same common inherited genetic faults.
Does schizophrenia begin in the womb? Stem cell study says yes - researchers from the Salk Institute in California have demonstrated that neurons from skin cells of patients with schizophrenia behave oddly in early stages of development, supporting the theory that schizophrenia begins in the womb.
The researchers, who published their results in the journal Molecular Psychiatry, say their findings could provide clues for how to detect and treat the disease early.
Researchers identify genetic mutations that may cause schizophrenia - Schizophrenia affects around 2.4 million adults in the US. The exact cause of the condition is unknown, but past research has suggested that genetics may play a part. Now, investigators from the Columbia University Medical Center in New York, NY, have uncovered clues that may build on this concept. The research team published their findings in the journalNeuron.
Schizophrenia and cannabis use may have genetic link - There is growing evidence that cannabis use is a cause of schizophrenia and now a new study led by King's College London, UK, also finds increased cannabis use and schizophrenia may have genes in common.
How a genetic variation 'may increase schizophrenia risk' - The exact causes of schizophrenia are unknown, but past research has suggested that some individuals with the condition possess certain genetic variations. Now, researchers at Johns Hopkins University School of Medicine in Baltimore, MD, say they have begun to understand how one schizophrenia-related genetic variation influences brain cell development.
Researchers identify more than 80 new genes linked to schizophrenia - What causes schizophrenia has long baffled scientists. But in what is deemed the largest ever molecular genetic study of schizophrenia, a team of international researchers has pinpointed 108 genes linked to the condition - 83 of which are newly discovered - that may help identify its causes and pave the way for new treatments.
Schizophrenia 'made up of eight specific genetic disorders' - Past studies have indicated that rather than being a single disease, schizophrenia is a collection of different disorders. Now, a new study by researchers at Washington University in St. Louis, MO, claims the condition consists of eight distinct genetic disorders, all of which present their own specific symptoms.

Treatment options

The UK's National Health Service4 says it is important that schizophrenia is diagnosed as early as possible, because the chances of a recovery are much greater the earlier it is treated.
Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of medication, psychological counseling, and self-help resources.
Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in hospital. In many parts of the world care is delivered in the community, rather than in hospital.
The primary schizophrenia treatment is medication. Sadly, compliance is a major problem. Compliance, in medicine, means following the medication regimen. People with schizophrenia often go off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them as well.
The Cleveland Clinic5 says that the patient must continue taking medication even when symptoms are gone, otherwise they will come back.
The majority of patients go off their medication within the first year of treatment. In order to address this, successful schizophrenia treatment needs to consist of a life-long regimen of both drug and psychosocial, support therapies. The medication can help control the patient's hallucinations and delusions, but it cannot help them learn to communicate with others, get a job, and thrive in society.
Although a significant number of people with schizophrenia live in poverty, this does not have to be the case. A person with schizophrenia who complies with the treatment regimen long-term will be able to lead a happy and productive life.
The first time a person experiences schizophrenia symptoms can be very unpleasant. He/she may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a schizophrenia sufferer receives the full support of his/her family, friends, and community services when onset appears for the first time.
The medical management of schizophrenia generally involves drugs for psychosis, depression and anxiety. This is because schizophrenia is a combination of thought disorder, mood disorder and anxiety disorder.
The most common antipsychotic drugs are Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), and Clozapine (Clozaril):
  • Risperidone (Risperdal) - introduced in America in 1994. This drug is less sedating than other atypical antipsychotics. There is a higher probability, compared to other atypical antipsychotics, of extrapyramidal symptoms (affecting the extrapyramidal motor system, a neural network located in the brain that is involved in the coordination of movement). Although weight gain and diabetes are possible risks, they are less likely to happen, compared with Clozapine or Olanzapine.

  • Olanzapine (Zyprexa) - approved in the USA in 1996. A typical dose is 10 to 20 mg per day. Risk of extrapyramidal symptoms is low, compared to Risperidone. This drug may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.

  • Quetiapine (Seroquel) - came onto the market in America in 1997. Typical dose is between 400 to 800 mg per day. If the patient is resistant to treatment the dose may be higher. The risk of extrapyramidal symptoms is low, compared to Risperidone. There is a risk of weight gain and diabetes, however the risk is lower than Clozapine or Olanzapine.

  • Ziprasidone (Geodon) - became available in the USA in 2001. Typical doses range from 80 to 160 mg per day. This drug can be given orally or by intramuscular administration. The risk of extrapyramidal symptoms is low. The risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiacarrhythmia, and must not be taken together with other drugs that also have this side effect.

  • Clozapine (Clozaril) - has been available in the USA since 1990. A typical dose ranges from 300 to 700 mg per day. It is very effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors. Patients must have their blood regularly monitored as it can affect the white blood cell count. The risk of weight gain and diabetes is significant.
Recent developments on schizophrenia treatment from MNT news
Researchers at the University of Iowa found that higher dosages of anti-psychotic medications resulted in the loss of more brain tissue. They also found that brain scans after patients' first psychotic episode revealed that they had less brain tissue than healthy people without schizophrenia.
Head investigator, Professor Nancy Andreasen, said "This was a very upsetting finding. We spent a couple of years analyzing the data more or less hoping we had made a mistake. But in the end, it was a solid finding that wasn't going to go away, so we decided to go ahead and publish it. The impact is painful because psychiatrists, patients, and family members don't know how to interpret this finding. 'Should we stop using antipsychotic medication? Should we be using less?'"

How common is schizophrenia?

The prevalence of schizophrenia globally varies slightly, depending on which report you look at, from about 0.7% to 1.2% of the adult population in general. Most of these percentages refer to people suffering from schizophrenia "at some time during their lives".
An Australian study found that schizophrenia is more common in developed nations than developing ones. It also found that the illness is less widespread than previously thought. Estimates of 10 per 1,000 people should be changed to 7 or 8 per 1,000 people, the study concluded.
In the USA about 2.2 million adults, or about 1.1% of the population age 18 and older in a given year have schizophrenia.
Schizophrenia is not a 'very' common disease. Approximately 1% of people throughout the globe suffer from schizophrenia (or perhaps a little less than 1% in developing countries) at some point in their lives. It is estimated that about 1.2% of Americans, a total of 3.2 million people, have the disorder at some point in their lives. Globally, about 1.5 million people each year are diagnosed with schizophrenia. In the UK it is estimated that about 600,000 people have schizophrenia.

and Psychosis

Schizophrenia Information & Treatment Introduction

Schizophrenia and PsychosisThroughout recorded history, the disorder we now know as schizophrenia has been a source of bewilderment. Those suffering from the illness once were thought to be possessed by demons and were feared, tormented, exiled or locked up forever.
In spite of advances in the understanding of its causes, course and treatment, schizophrenia continues to confound both health professionals and the public. It is easier for the average person to cope with the idea of cancer than it is to understand the odd behavior, hallucinations or strange ideas of the person with schizophrenia.
As with many mental disorders, the causes of schizophrenia are poorly understood. Friends and family commonly are shocked, afraid or angry when they learn of the diagnosis. People often imagine a person with schizophrenia as being more violent or out-of-control than a person who has another kind of serious mental illness. But these kinds of prejudices and misperceptions can be readily corrected.
Expectations become more realistic as schizophrenia is better understood as a disorder that requires ongoing -- often lifetime -- treatment. Demystification of the illness, along with recent insights from neuroscience and neuropsychology, gives new hope for finding more effective treatments for an illness that previously carried a grave prognosis.
Schizophrenia is characterized by a broad range of unusual behaviors that cause profound disruption in the lives of people suffering from the condition, as well as in the lives of the people around them. Schizophrenia strikes without regard to gender, race, social class or culture.

Delusions & Hallucinations Are Common in Schizophrenia

One of the most obvious kinds of impairment caused by schizophrenia involves how a person thinks. The individual can lose much of the ability to rationally evaluate his or her surroundings and interactions with others. They often believe things that are untrue, and may have difficulty accepting what they see as "true" reality.
Schizophrenia most often includes hallucinations and/or delusions, which reflect distortions in the perception and interpretation of reality. The resulting behaviors may seem bizarre to the casual observer, even though they may be consistent with the schizophrenic's abnormal perceptions and beliefs.
For instance, someone with schizophrenia may act in an extremely paranoid manner -- purchasing multiple locks for their doors, always checking behind them as they walk in public, refusing to talk on the phone. Without context, these behaviors may seem irrational or illogical. But to someone with schizophrenia, these behaviors may reflect a reasonable reaction their false beliefs that others are out to get them or lock them up.
Nearly one-third of those diagnosed with schizophrenia will attempt suicide. About 10 percent of those with the diagnosis will commit suicide within 20 years of the beginning of the disorder. Patients with schizophrenia are not likely to share their suicidal intentions with others, making life-saving interventions more difficult. The risk of depression needs special mention due to the high rate of suicide in these patients. The most significant risk of suicide in schizophrenia is among males under 30 who have some symptoms of depression and a relatively recent hospital discharge. Other risks include imagined voices directing the patient toward self-harm (auditory command hallucinations) and intense false beliefs (delusions).
The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight and judgment, people with schizophrenia may be less able to judge and control the temptations and resulting difficulties associated with drug or alcohol abuse.
In addition, it is not uncommon for people suffering from this disorder to try to "self-medicate" their otherwise debilitating symptoms with mind-altering drugs. The abuse of such substances, most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery.
Do you have schizophrenia? Take the test

The Onset of Schizophrenia

The onset of schizophrenia in most people is a gradual deterioration that occurs in early adulthood -- usually in a person's early 20s. Loved ones and friends may spot early warning signs long before the primary symptoms of schizophrenia occur. During this initial pre-onset phase, a person may seem without goals in their life, becoming increasingly eccentric and unmotivated. They may isolate themselves and remove themselves from family situations and friends. They may stop engaging in other activities that they also used to enjoy, such as hobbies or volunteering.
Warning signs that may indicate someone is heading toward an episode of schizophrenia include:
  • Social isolation and withdrawal
  • Irrational, bizarre or odd statements or beliefs
  • Increased paranoia or questioning others' motivations
  • Becoming more emotionless
  • Hostility or suspiciousness
  • Increasing reliance on drugs or alcohol (in an attempt to self-medicate)
  • Lack of motivation
  • Speaking in a strange manner unlike themselves
  • Inappropriate laughter
  • Insomnia or oversleeping
  • Deterioration in their personal appearance and hygiene
While there is no guarantee that one or more of these symptoms will lead to schizophrenia, a number of them occurring together should be cause for concern, especially if it appears that the individual is getting worse over time. This is the ideal time to act to help the person (even if it turns out not to be schizophrenia)

Schizophrenia is a mental disorder that is characterized by at least 2 of the following  symptoms, for at least one month:
  • Delusions
  • Hallucinations
  • Disorganized speech (e.g., frequent derailment or incoherence)
  • Grossly disorganized or catatonic behavior
  • A set of three negative symptoms (a “flattening” of one’s emotions, alogia, avolition; see below)
Only one of the above symptoms is required to make the diagnosis of schizophrenia if the person’s delusions are bizarreor if the hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.
Positive Symptoms
  • Delusions
  • Hallucinations
  • Disorganized thinking
  • Agitation
Negative Symptoms
  • Affective flattening- The person’s range of emotional expression is clearly diminished; poor eye contract; reduced body language
  • Alogia- A poverty of speech, such as brief, empty replies
  • Avolition – Inability to initiate and persist in goal-directed activities (such as school or work)
Although the above symptoms must be present for at least one (1) month, there also needs to be continuous signs of the disturbance that persist for at least six (6) months.  During this period, the signs of the disorder may be present in a milder form, for instance as just odd beliefs or unusual perceptual experiences. During this 6 month period, at least two of the above criteria must be met, or only the criteria of Negative Symptoms must be present — if even just in milder form.
Onset of schizophrenia prior to adolescence is rare. The peak age at onset for the first psychotic episode is in the early- to mid-20s for males and in the late-20s for females. Though active symptoms typically do not emerge until an individual is in their 20′s, oftentimes prodromal symptoms will precede the first psychotic episode, characterized by milder forms of hallucinations or delusions. For example, individuals may express a variety of unusual or odd beliefs that are not of delusional proportions (e.g., ideas of reference or magical thinking); they may have unusual perceptual experiences (e.g., sensing the presence of an unseen person); their speech may be generally understandable but vague; and their behavior may be unusual but not grossly disorganized (e.g., mumbling in public).
Individuals with schizophrenia evidence large distress and impairments in various life domains. Functioning in areas such as work, interpersonal relations, or self-care must be markedly below the level achieved prior to the onset of the symptoms to receive the diagnosis (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
Schizoaffective Disorder and Mood Disorder With Psychotic Features must be considered as alternative explanations for the symptoms and have been ruled out. The disturbance must also not be due to the direct physiological effects of use or abuse of a substance (e.g., alcohol, drugs, medications) or a general medical condition.
If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).
0.3%–0.7% of individuals appear to acquire schizophrenia. although there is reported variation by race/ethnicity, across countries, and by geographic origin for immigrants and children of immigrants. The sex ratio differs across samples and populationHostility and aggression can be associated with schizophrenia, although spontaneous or random assault is uncommon. Aggression is more frequent for younger males and for individuals with a past history of violence, non-adherence with treatment, substance abuse, and impulsivity. It should be noted that the vast majority of persons with schizophrenia are not aggressive and are more frequently victimized than are individuals in the general population.

The old criteria in the DSM-IV divided schizophrenia by different Types. Though we not longer use such specifiers in the updated DSM-5, they remain below for informational/historical purposes.

A brief list of types of schizophrenia, according to DSM-IV:

  • Paranoid schizophrenia– a person feels extremely suspicious, persecuted, grandiose, or experiences a combination of these emotions.
  • Disorganized schizophrenia  — a person is often incoherent but may not have delusions.
  • Catatonic schizophrenia– a person is withdrawn, mute, negative and often assumes very unusual postures.
  • Residual schizophrenia — a person is no longer delusion or hallucinating, but has no motivation or interest in life. These symptoms can be most devastating.


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