Diagnostic Features Course

This disorder, at some point in the illness, Schizophrenia usually starts between the late
involves a psychotic phase (with delusions, teens and the mid-30s, whereas onset prior to
hallucinations, or grossly bizarre/disorganized adolescence is rare (although cases with age at
speech and behavior). This psychotic phase must onset of 5 or 6 years have been reported).
last for at least one month (or less if successfully Schizophrenia can also begin later in life (e.g.,
treated). Schizophrenia also causes impairment in after age 45 years), but this is uncommon.
social or vocational functioning which must last Usually the onset of Schizophrenia occurs a few
for at least 6 months. The psychotic phase is not years earlier in men than women. The onset may
due to a medical condition, medication, or illegal be abrupt or insidious. Usually Schizophrenia
drug. starts gradually with a prepsychotic phase of
Complications
increasing negative symptoms (e.g., social
withdrawal, deterioration in hygiene and
grooming, unusual behavior, outbursts of anger,
Individuals with this disorder may develop and loss of interest in school or work). A few
significant loss of interest or pleasure. Likewise, months or years later, a psychotic phase develops
some may develop mood abnormalities (e.g., (with delusions, hallucinations, or grossly
inappropriate smiling, laughing, or silly facial bizarre/disorganized speech and behavior).
expressions; depression, anxiety or anger). Often Individuals who have an onset of Schizophrenia
there is day-night reversal (i.e., staying up late at later in their 20's or 30's are more often female,
night and then sleeping late into the day). The have less evidence of structural brain
individual may show a lack of interest in eating or abnormalities or cognitive impairment, and
may refuse food as a consequence of delusional display a better outcome. Schizophrenia usually
beliefs. Often movement is abnormal (e.g., persists, continuously or episodically, for a life-
pacing, rocking, or apathetic immobility). time. Complete remission (i.e., a return to full
Frequently there are significant cognitive premorbid functioning) is uncommon. Some
impairments (e.g., poor concentratiion, poor individuals appear to have a relatively stable
memory, and impaired problem-solving ability). course, whereas others show a progressive
The majority of individuals with Schizophrenia worsening associated with severe disability. The
are unaware that they have a psychotic illness. psychotic symptoms usually respond to treatment
This poor insight is neurologically caused by with antipsychotic medication, whereas the
illness, rather than simply being a coping negative symptoms are less responsive to
behavior. This is comparable to the lack of antipsychotic medication. Often the negative
awareness of neurological deficits seen in stroke. symptoms steadily become more prominent
This poor insight predisposes the individual to during the course of Schizophrenia.
noncompliance with treatment and has been
found to be predictive of higher relapse rates, Outcome
increased number of involuntary hospitalizations,
poorer functioning, and a poorer course of illness. The best outcomes are associated with early and
Depersonalization, derealization, and somatic persistent treatment with antipsychotic
concerns may occur and sometimes reach medication soon after the onset of Schizophrenia.
delusional proportions. Motor abnormalities (e.g.,Other factors that are associated with a better
grimacing, posturing, odd mannerisms, ritualistic prognosis include good premorbid adjustment,
or stereotyped behavior) are sometimes present. acute onset, later age at onset, good insight, being
female, precipitating events, associated mood
The life expectancy of individual with disturbance, brief duration of psychotic
Schizophrenia is shorter than that of the general symptoms, good interepisode functioning,
population for a variety of reasons. Suicide is an minimal residual symptoms, absence of structural
important factor, because approximately 10% of brain abnormalities, normal neurological
individuals with Schizophrenia commit suicide - functioning, a family history of Mood Disorder,
and between 20% and 40% make at least one and no family history of Schizophrenia.
suicide attempt. There is an increased risk of Familial Pattern
assaultive and violent behavior. The major
predictors of violent behavior are male gender,
younger age, past history of violence, The first-degree biological relatives of individuals
noncompliance with antipsychotic medication, with Schizophrenia have a risk for Schizophrenia
and excessive substance use. However, it should that is about 10 times greater than that of the
be noted that most individuals with Schizophrenia general population. Concordance rates for
are not more dangerous to others than those in the Schizophrenia are higher in monozygotic
general population. (identical) twins than in dizygotic (fraternal)
twins. The existence of a substantial discordance
Comorbidity rate in monozygotic twins also indicates the
importance of environmental factors.
Alcoholism and drug abuse worsen the course of Treatment
this illness, and are frequently associated with it.
From 80% to 90% of individuals with
Schizophrenia are regular cigarette smokers. Antipsychotic medication shortens the duration of
Anxiety and phobias are common in psychosis in Schizophrenia, and prevents
Schizophrenia, and there is an increased risk of recurrences (but psychotic relapses can still occur
Obsessive-Compulsive Disorder and Panic under stress). Usually it takes years before
Disorder. Schizotypal, Schizoid, or Paranoid individuals can accept that they have
Personality Disorder may sometimes precede the Schizophrenia and need medication. When
onset of Schizophrenia. individuals stop their antipsychotic medication, it
may take months (or even years) before they
Diagnostic Tests suffer a psychotic relapse. Most, however, relapse
within weeks. After each psychotic relapse there
No laboratory test has been found to be diagnostic is increased intellectual impairment.
of this disorder. However, individuals with
Schizophrenia often have a number of (non- Antipsychotic medication (+/- antidepressant
diagnostic) neurological abnormalities. They have medication +/- antianxiety medication) usually
enlargement of the lateral ventricles, decreased prevents suicide, minimizes rehospitalization, and
brain tissue, decreased volume of the temporal dramatically improves social functioning.
lobe and thalamus, a large cavum septum Unfortunately, even on antipsychotic medication,
pellucidi, and hypofrontality (decreased blood most individuals with Schizophrenia can't return
flow and metabolic functioning of the frontal to gainful employment due to the intellectual
lobes). They also have a number of cognitive impairments caused by this illness (e.g., poor
deficits on psychological testing (e.g., poor concentration, poor memory, impaired problem-
attention, poor memory, difficulty in changing solving, inability to "multi-task", and apathy).
response set, impairment in sensory gating, Life-long treatment with antipsychotic medication
abnormal smooth pursuit and saccadic eye is essential for recovery from Schizophrenia.
movements, slowed reaction time, alterations in Individuals also require long-term emotional and
brain laterality, and abnormalities in evoked financial support from their families. Most
potential electrocephalograms). individuals with Schizophrenia qualify for
government (or insurance) disability pensions.
Prevalence
Social rehabilitation (e.g., club-houses,
supervised social activities) and
Schizophrenia is the fourth leading cause of sheltered/volunteer employment are also
disability in the developed world (for ages 15-44), essential. Certain illicit drugs, especiallycannabis
and Schizophrenia is observed worldwide. ("pot"), have been shown to actually cause
Lifetime prevalence varies from 0.5% to 1.5%. Schizophrenia.
The incidence of Schizophrenia is slightly higher
in men than women. Negative symptoms (e.g.,
social withdrawal, lack of motivation, flat
emotions) tend to predominate in men; whereas
depressive episodes, paranoid delusions, and
hallucinations tend to predominate in women.

Prepsychotic (Prodromal) Or Psychotic (Active) Phase

Postpsychotic (Residual) Phase

Core Problems in Prepsychotic or Postpsychotic Core Problems in Psychotic Phase

Phase
• Social and/or Occupational
• Social and/or Occupational Impairment Impairment [1], [2]
• Apathy • Delusions or Hallucinations
• Disorganized or Bizarre Behavior
• Apathy
• Impaired Communication With Words
• Impaired Communication With Emotions
Common Associated Problems in Prepsychotic or Common Associated Problems in Psychotic Phase
Postpsychotic Phase
• Lack of Physical Exercise
• Lack of Physical Exercise • Poor Sexual Interest or Ability
• Poor Sexual Interest or Ability • Distrust or Suspiciousness
• Increased Smoking • Increased Smoking
• Sad or Depressed Mood • Sad or Depressed Mood
• Poor Concentration or Attention • Poor Concentration or Attention
• Poor Memory • Generalized Worry
• Impaired Executive Functioning (planning, • Poor Memory
problem-solving)
• Impaired Executive Functioning (planning,
• Lack of Insight problem-solving)
• Solitary Lifestyle • Lack of Insight
• Indifference To Others • Mistrust of Friends
• Lack of Self-Confidence • Solitary Lifestyle
• Shyness • Indifference To Others
• Lack of Emotion
• Lack of Self-Confidence
 • Shyness
• Difficulty Handling Conflict
Problems in Prepsychotic or Postpsychotic Phase Problems in Psychotic Phase When Severe
When Severe
• Poor Money Management
• Distrust or Suspiciousness • Physical Violence
• Mistrust of Friends • Obsessive Thinking or Compulsive Rituals
• Difficulty Handling Conflict • Risk of Harming Self
• Poor Money Management • Poor Grooming and Hygiene
• Risk of Harming Self • Need for Institutional Care
• Impaired Communication With Words
• Impaired Communication With Emotions
• Poor Grooming and Hygiene
• Need for Institutional Care
No one understands what causes schizophrenia, as no single cause explains all cases of schizophrenia.
Genetics, birth defects, environmental triggers and imbalances of the neurotransmitter dopamine are
possible causes of schizophrenia symptoms.

Genetics and Causes of Schizophrenia

Identical twin studies prove that genetics play a role in schizophrenia. If one identical twin develops
schizophrenia symptoms, the other twin has a 40 to 50 percent chance of developing the mental illness,
according to the National Institute of Mental Health (NIMH). Studies have also shown that having a parent or
sibling with schizophrenia increases a person's schizophrenia risk to 10 percent, compared with 1 percent for
the general population.

Genetic variables don't explain all schizophrenia cases. Many people with schizophrenia have no family
history of schizophrenia symptoms.

Dopamine Imbalances as Causes of Schizophrenia

Dopamine imbalances are possible causes of schizophrenia. Dopamine is a brain neurotransmitter that
relays brain nerve cell impulses. Dopamine's exact role in schizophrenia is unclear, but some researchers
have observed that the brains of subjects with schizophrenia have more dopamine receptors than those of
the general population.

Antipsychotic medication, the most common schizophrenia treatment, blocks the absorption of dopamine. By
blocking the brain's receptors, antipsychotic medication reduces the severity of schizophrenia symptoms.

Not all schizophrenia researchers believe dopamine imbalances are causes of schizophrenia. Antipsychotic
drugs block dopamine levels very quickly, but schizophrenia symptoms don't improve until after weeks of
treatment. Antipsychotics may affect brain chemistry and improve schizophrenia symptoms in as-yet
unknown ways.

Researchers skeptical of the dopamine theory note that new generations of schizophrenia medication block
both serotonin and dopamine receptors, and appear to be more effective treatments for "negative"
schizophrenia symptoms such as social withdrawal and deadened emotions.
Environmental Factors
Pregnancy is considered an environmental cause of schizophrenia. A blood protein incompatibility called Rh
incompatibility, maternal influenza and maternal malnutrition all appear to increase the child's schizophrenia
risks.

Life stressors may trigger schizophrenia in people with genetic susceptibility to the illness. Ending
relationships, leaving home and other life stressors trigger schizophrenia onset in some cases.

Brain Structure and Schizophrenia

Studies of the brain structure of persons with schizophrenia after death reveal enlarged brain ventricles,
which are cavities inside the brain containing cerebrospinal fluid. Also, some brain regions are smaller than
average. However, not all schizophrenia cases display these brain abnormalities, and many people who don't
suffer from schizophrenia have similar brain structures.

What Causes Schizophrenia?

Current schizophrenia theories suggest that no single cause of schizophrenia exists. New theories propose
that schizophrenia genetics increase susceptibility to the disorder, which is triggered by environmental
factors.

Many schizophrenia experts believe that schizophrenia is actually more than one disorder, and that
schizophrenia symptoms result from several subtly different mental disorders. Determining exactly what
causes and triggers schizophrenia symptoms is complicated, particularly because of the wide range of
symptoms among the different types of schizophrenia.