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| '''For patient information click [[Schizophrenia (patient information)|here]]''' | | '''For patient information click [[Schizophrenia (patient information)|here]]''' |
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| Caption = [[Eugen Bleuler]] (1857–1939) coined the term "Schizophrenia" in 1908 | | | Caption = [[Eugen Bleuler]] (1857–1939) coined the term "Schizophrenia" in 1908 | |
| Width = 125 | | | Width = 125 | |
| DiseasesDB = 11890 |
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| ICD10 = {{ICD10|F|20||f|20}} |
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| ICD9 = {{ICD9|295}} |
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| ICDO = |
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| OMIM = 181500 |
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| MedlinePlus = 000928 |
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| MeshName = Schizophrenia |
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| MeshNumber = F03.700.750 |
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| }} | | }} |
| {{Schizophrenia}} | | {{Schizophrenia}} |
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| {{CMG}} | | {{CMG}}; {{AE}} {{JH}}, {{I.D.}} |
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| ==Overview==
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| <!--Para1: Definition, symptoms and diagnosis-->
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| '''Schizophrenia''', from the [[Ancient Greek|Greek]] roots ''schizein'' (σχίζειν, "to split") and ''phrēn'', ''phren-'' (φρήν, φρεν-, "[[mind]]"), is a psychiatric diagnosis that describes a mental illness characterized by impairments in the [[perception]] or expression of reality, most commonly manifesting as auditory [[hallucination]]s, paranoid or bizarre [[delusion]]s or [[thought disorder|disorganized speech and thinking]] in the context of significant social or occupational dysfunction. Onset of symptoms typically occurs in young adulthood,<ref name="castle1991">Castle E, Wessely S, Der G, Murray RM (1991). "The incidence of operationally defined schizophrenia in Camberwell 1965–84," British Journal of Psychiatry 159: 790–794. PMID 1790446</ref> with approximately 0.4–0.6%<ref>Bhugra, D. (2005). [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1140960 The global prevalence of schizophrenia.] PLoS Medicine, 2 (5), 372–373. PMID 15916460</ref><ref name="fn_34">Goldner EM, Hsu L, Waraich P, Somers JM (2002). Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature. ''Canadian Journal of Psychiatry'', 47(9), 833–43. PMID 12500753</ref> of the population affected. Diagnosis is based on the patient's self-reported experiences and observed behavior. No laboratory test for schizophrenia exists.
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| <!--Para2:lack of validity/controversies-->
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| Studies suggest that [[genetics]], early environment, [[neurobiology]] and psychological and social processes are important contributory factors. Current psychiatric research is focused on the role of neurobiology, but a clear organic cause has not been found. Due to the many possible combinations of symptoms, there is debate about whether the diagnosis represents a single disorder or a number of discrete syndromes. For this reason, [[Eugen Bleuler]] termed the disease ''the schizophrenias'' (plural) when he coined the name. Despite its [[etymology]], schizophrenia is not synonymous with [[dissociative identity disorder]], previously known as multiple personality disorder or split personality; in popular culture the two are often confused.
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| <!--Para3: Dopamine hypothesis and treatment-->
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| Increased [[dopamine|dopaminergic activity]] in the [[mesolimbic pathway]] of the brain is a consistent finding. The mainstay of treatment is pharmacotherapy with [[antipsychotic]] medications; these primarily work by suppressing dopamine activity. Dosages of antipsychotics are generally lower than in the early decades of their use. Psychotherapy, vocational and social rehabilitation are also important. In more serious cases—where there is risk to self and others—involuntary hospitalization may be necessary, though hospital stays are less frequent and for shorter periods than they were in previous years.
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| <!--Para4: Impairment/chronicity and Comorbidity-->
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| The disorder is primarily thought to affect [[cognition]], but it also usually contributes to chronic problems with [[human behavior|behavior]] and [[emotion]]. People diagnosed with schizophrenia are likely to be diagnosed with [[Comorbidity|comorbid]] conditions, including [[clinical depression]] and [[anxiety disorders]]; the lifetime [[prevalence]] of [[substance abuse]] is typically around 40%. Social problems, such as long-term unemployment, poverty and homelessness, are common and [[life expectancy]] is decreased; the average life expectancy of people with the disorder is 10 to 12 years less than those without, owing to increased physical health problems and a high [[suicide]] rate.<ref name="Brown_Barraclough_2000">Brown S, Inskip H, Barraclough B. (2000) Causes of the excess mortality of schizophrenia. ''Br J Psychiatry'', 177, 212-7. PMID 11040880</ref>
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| ===Diagnostic issues and controversies===
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| Schizophrenia as a diagnostic entity has been criticised as lacking in scientific validity or reliability,<ref name="Bentall1992">Bentall RP (1992) ''Reconstructing Schizophrenia''. London: Routledge. ISBN 0415075246</ref><ref name="Boyle2002">Boyle M (2002) ''Schizophrenia: A Scientific Delusion?''. London: Routledge. ISBN 0415227186</ref> part of a larger [[Biopsychiatry controversy|criticism]] of the validity of psychiatric diagnoses in general. One alternative suggests that the issues with the diagnosis would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill. This approach appears consistent with research on [[schizotypy]] and of a relatively high prevalence of psychotic experiences<ref name="fn_5">Verdoux H, van Os J (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. ''Schizophrenia Research'', 54(1–2), 59–65. PMID 11853979</ref><ref name="fn_65">LC, van Os J. (2001). The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8),1125–41. PMID 11702510</ref> and often non-distressing delusional beliefs<ref name="fn_67">Peters ER, Day S, McKenna J, Orbach G(2005). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). ''Schizophrenia Bulletin'', 30, 1005–22. PMID 15954204</ref> amongst the general public.<ref name="Johns_vanOs_2001">Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8), 1125–41. PMID 11702510.</ref>
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| Another criticism is that the definitions used for criteria lack consistency;<ref name="David1999">David AS (1999) On the impossibility of defining delusions. ''Philosophy, Psychiatry and Psychology'', 6 (1), 17–20</ref> this is particularly relevant to the evaluation of [[delusion#Diagnostic issues and controversies|delusion]]s and [[thought disorder#Diagnostic issues and controversies|thought disorder]]. More recently, it has been argued that psychotic symptoms are not a good basis for making a diagnosis of schizophrenia as "psychosis is the 'fever' of mental illness — a serious but nonspecific indicator".<ref name="fn_6">Tsuang MT, Stone WS, Faraone SV (2000). Toward reformulating the diagnosis of schizophrenia. ''American Journal of Psychiatry'', 157(7), 1041–1050. PMID 10873908</ref>
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| Perhaps because of these factors, studies examining the [[diagnosis]] of schizophrenia have typically shown relatively low or inconsistent levels of diagnostic reliability. Most famously, David Rosenhan's 1972 study, published as ''[[Rosenhan experiment|On being sane in insane places]]'', demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable.<ref>Rosenhan D (1973). On being sane in insane places. ''Science'', 179, 250-8. PMID 4683124[http://www.stanford.edu/~kocabas/onbeingsane.pdf Full text as PDF]</ref> More recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at best.<ref name="fn_7">McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). Spurious precision: procedural validity of diagnostic assessment in psychotic disorders. ''American Journal of Psychiatry'', 152 (2), 220–3. PMID 7840355</ref> This, and the results of earlier studies of diagnostic reliability (which typically reported even lower levels of agreement) have led some critics to argue that the diagnosis of schizophrenia should be abandoned.<ref name="fn_8">Read J (2004) Does 'schizophrenia' exist? Reliability and validity. In Read J, Mosher LR, Bentall RP (eds) ''Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia''. ISBN 1-58391-906-6</ref>
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| In 2004 in Japan, the Japanese term for schizophrenia was changed from ''Seishin-Bunretsu-Byo'' (mind-split-disease) to ''Tōgō-shitchō-shō'' ([[integration disorder]]).<ref name="Sato">Sato M (2004). Renaming schizophrenia: a Japanese perspective. ''World Psychiatry'', 5(1), 53–5. PMID 16757998</ref> In 2006, campaigners in the UK, under the banner of Campaign for Abolition of the Schizophrenia Label, argued for a similar rejection of the diagnosis of schizophrenia and a different approach to the treatment and understanding of the symptoms currently associated with it.<ref name="schizophrenia_invalid">[http://news.bbc.co.uk/2/hi/health/6033013.stm Schizophrenia term use 'invalid'.] BBC News Online, ([[9 October]] [[2006]]). Retrieved on [[2007-05-16]]. </ref>
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| Alternatively, other proponents have put forward using the presence of specific [[neurocognitive deficit]]s to make a diagnosis. These take the form of a reduction or impairment in basic psychological functions such as [[memory]], [[attention]], [[executive function]] and [[problem solving]]. It is these sorts of difficulties, rather than the psychotic symptoms (which can in many cases be controlled by [[antipsychotic]] medication), which seem to be the cause of most [[disability]] in schizophrenia. However, this argument is relatively new and it is unlikely that the method of diagnosing schizophrenia will change radically in the near future.<ref name="GreenSchizophreniaBook">Green MF (2001) ''Schizophrenia Revealed: From Neurons to Social Interactions''. New York: W.W. Norton. ISBN 0393703347</ref>
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| The diagnosis of schizophrenia has been used for political rather than therapeutic purposes; in the Soviet Union an additional sub-classification of [[sluggishly progressing schizophrenia]] was created. Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), this diagnosis was used for the purpose of silencing political dissidents or forcing them to recant their ideas by the use of forcible confinement and treatment.<ref name="Wilkinson1986">Wilkinson G (1986) Political dissent and "sluggish" schizophrenia in the Soviet Union. ''Br Med J (Clin Res Ed)'', 293(6548), 641-2. PMID 3092963</ref> In 2000 there were similar concerns regarding detention and 'treatment' of practitioners of the Falun Gong movement by the Chinese government. This led the [[American Psychiatric Association|American Psychiatric Association's]] ''Committee on the Abuse of Psychiatry and Psychiatrists'' to pass a resolution to urge the [[World Psychiatric Association]] to investigate the situation in China.<ref name="Lyons2001">Lyons D (2001). Soviet-style psychiatry is alive and well in the People's Republic. ''British Journal of Psychiatry'', 178, 380–381. PMID 11282823</ref>
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| ==Treatment and services==
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| {{main|Treatment of schizophrenia}} | |
| [[Image:Chlorpromazine-3D-vdW.png|thumb|Molecule of [[chlorpromazine]], which revolutionized treatment of schizophrenia in the 1950s.]]
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| The concept of a cure as such remains controversial, as there is no consensus on the definition, although some criteria for the remission of symptoms have recently been suggested.<ref name="fn_63">van Os J, Burns T, Cavallaro R, ''et al'' (2006). Standardized remission criteria in schizophrenia. ''Acta Psychiatrica Scandinavica'', 113(2), 91–5. PMID 16423159</ref> <!-- and they are...?--> The effectiveness of schizophrenia treatment is often assessed using standardized methods, one of the most common being the [[PANSS|positive and negative syndrome scale]] (PANSS).<ref name="fn_68">Kay SR, Fiszbein A, Opler LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. ''Schizophrenia Bulletin'', 13(2), 261–76. PMID 3616518</ref>
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| Management of symptoms and improving function is thought to be more achievable than a cure. Treatment was revolutionized in the mid 1950s with the development and introduction of [[chlorpromazine]].<ref name="Turner2007">{{cite journal | author=Turner T. | title=Unlocking psychosis | journal=Brit J Med | year=2007 | volume=334 | issue=suppl | pages=s7 }}</ref> A [[recovery model]] is increasingly adopted, emphasizing hope, empowerment and social inclusion.<ref name="Bellack06">Bellack AS. (2006) Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. ''Schizophr Bull.'' Jul;32(3):432-42. PMID 16461575</ref>
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| Hospitalization may occur with severe episodes of schizophrenia. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or [[involuntary commitment]]). Long-term inpatient stays are now less common due to [[deinstitutionalization]], although can still occur.<ref name="BeckerKilian2006">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 Supplement'', 429, 9–16. PMID 16445476</ref> Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment<ref>McGurk, SR, Mueser KT, Feldman K, Wolfe R, Pascaris A (2007). Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. ''Am J Psychiatry.'' Mar;164(3):437–41. PMID 17329468</ref> and patient-led support groups.
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| In many non-Western societies, schizophrenia may only be treated with more informal, community-led methods. The outcome for people diagnosed with schizophrenia in non-Western countries may actually be better than for people in the West.<ref name="fn_41">Kulhara P (1994). Outcome of schizophrenia: some transcultural observations with particular reference to developing countries. ''European Archives of Psychiatry and Clinical Neuroscience'', 244(5), 227–35. PMID 7893767</ref> The reasons for this effect are not clear, although cross-cultural studies are being conducted.
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| ===Psychological and social interventions===
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| [[Psychotherapy]] is also widely recommended and used in the treatment of schizophrenia, although services may often be confined to pharmacotherapy because of reimbursement problems or lack of training.<ref>Moran, M (2005). [http://pn.psychiatryonline.org/cgi/content/full/40/22/24-b Psychosocial Treatment Often Missing From Schizophrenia Regimens.] ''Psychiatr News'' [[November 18]] [[2005]], Volume 40, Number 22, page 24. Retrieved on [[2007-05-17]].</ref>
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| [[Cognitive behavioral therapy]] (CBT) is used to reduce symptoms and improve related issues such as [[self-esteem]], social functioning, and insight. Although the results of early trials were inconclusive,<ref name="fn_38">Cormac I, Jones C, Campbell C (2002). Cognitive behaviour therapy for schizophrenia. ''Cochrane Database of [[systematic review]]s'', (1), CD000524. PMID 11869579</ref> more recent reviews suggest that CBT can be an effective treatment for the psychotic symptoms of schizophrenia.<ref name="fn_39">Zimmermann G, Favrod J, Trieu VH, Pomini V (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. ''Schizophrenia Research'', 77, 1–9. PMID 16005380</ref> Another approach is cognitive remediation therapy, a technique aimed at remediating the [[neurocognitive deficit]]s sometimes present in schizophrenia. Based on techniques of [[neuropsychological rehabilitation]], early evidence has shown it to be cognitively effective, with some improvements related to measurable changes in brain activation as measured by [[fMRI]].<ref name="fn_40">Wykes T, Brammer M, Mellers J, ''et al'' (2002). Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia. ''British Journal of Psychiatry'', 181, 144–52. PMID 12151286</ref> A similar approach known as cognitive enhancement therapy, which focuses on social cognition as well as neurocognition, has shown efficacy.<ref>Hogarty GE, Flesher S, Ulrich R, Carter M, ''et al'' (2004). Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. ''Arch Gen Psychiatry.'' Sep;61(9):866–76.PMID 15351765</ref>
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| Family Therapy or Education, which addresses the whole family system of an individual with a diagnosis of schizophrenia, has been consistently found to be beneficial, at least if the duration of intervention is longer-term.<ref>McFarlane WR, Dixon L, Lukens E, Lucksted A (2003). Family psychoeducation and schizophrenia: a review of the literature. ''J Marital Fam Ther.'' Apr;29(2):223–45. PMID 12728780 </ref><ref>Glynn SM, Cohen AN, Niv N (2007). New challenges in family interventions for schizophrenia. '' Expert Rev Neurother.'' Jan;7(1):33–43. PMID 17187495</ref><ref>Pharoah F, Mari J, Rathbone J, Wong W. (2006) [http://www.cochrane.org/reviews/en/ab000088.html Family intervention for schizophrenia] Cochrane Database of Systematic Reviews, Issue 4</ref> Aside from therapy, the impact of schizophrenia on families and the burden on carers has been recognized, with the increasing availability of self-help books on the subject.<ref>{{cite book | author = Jones, S., Hayward, P. | title = Coping with Schizophrenia: A Guide for Patients, Families and Caregivers | publisher = Oneworld Pub. | date = 2004 | location = Oxford, England | id = ISBN 1-85168-344-5}}</ref><ref>{{cite book | last = Torrey | first = EF | authorlink = E. Fuller Torrey | title = Surviving Schizophrenia: A Manual for Families, Consumers, and Providers (5th Edition) | publisher = HarperCollins | date = 2006 | id = ISBN 0-06-084259-8}}</ref> There is also some evidence for benefits from social skills training, although there have also been significant negative findings.<ref>Kopelowicz A, Liberman RP, Zarate R (2006). Recent advances in social skills training for schizophrenia. ''Schizophr Bull.'' 2006 Oct;32 Suppl 1:S12–23. PMID 16885207 </ref><ref>American Psychiatric Association (2004) Practice Guideline for the Treatment of Patients With Schizophrenia. Second Edition.</ref> Some studies have explored the possible benefits of music therapy and other creative therapies.<ref>Talwar N, Crawford MJ, Maratos A, Nur U, McDermott O, Procter S (2006). Music therapy for in-patients with schizophrenia: Exploratory randomised controlled trial. ''The British Journal of Psychiatry.'' Nov;189:405–9. PMID 17077429 [http://bjp.rcpsych.org/cgi/content/abstract/189/5/405 Full text available.] </ref><ref>Ruddy R, Milnes D. (2005) [http://www.cochrane.org/reviews/en/ab000088.html Art therapy for schizophrenia or schizophrenia-like illnesses.] Cochrane Database of Systematic Reviews, Issue 4</ref><ref>Ruddy RA, Dent-Brown K. (2007) [http://www.cochrane.org/reviews/en/ab005378.html Drama therapy for schizophrenia or schizophrenia-like illnesses.] Cochrane Database of Systematic Reviews, Issue 1.</ref>
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| ===Other===
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| [[Electroconvulsive therapy]] is not considered a [[first line treatment]] but may be prescribed in cases where other treatments have failed. It is more effective where symptoms of catatonia are present,<ref>{{cite journal |author=Greenhalgh J, Knight C, Hind D, Beverley C, Walters S |year=2005 |month=March |title= Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies.|journal= Health Technol Assess.|volume= 9|issue=9 |pages=1-156 |url=http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15774232 (abstract) |accessdate= 2007-06-17}}</ref> and is recommended for use under [[National Institute for Health and Clinical Excellence|NICE]] guidelines in the UK for catatonia if previously effective, though there is no recommendation for use for schizophrenia otherwise.<ref>{{cite web |url=http://www.nice.org.uk/page.aspx?o=TA059 |title= The clinical effectiveness and cost effectiveness of electroconvulsive Therapy (ECT) for depressive illness, schizophrenia, catatonia and mania.|accessdate=2007-06-17 |author= National Institute for Health and Clinical Excellence|year= 2003|month=April |publisher= National Institute for Health and Clinical Excellence|language= English}}</ref> [[Psychosurgery]] has now become a rare procedure and is not a recommended treatment for schizophrenia.<ref name="Mashour_et_al_2005">Mashour GA, Walker EE, Martuza RL. (2005) Psychosurgery: past, present, and future. ''Brain Research: Brain Research Reviews'', 48 (3), 409-19. PMID 15914249</ref>
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| An unconventional approach is the use of omega-3 fatty acids, with one study finding some benefits from their use as a dietary supplement.<ref>Peet M, Stokes C (2005). Omega-3 fatty acids in the treatment of psychiatric disorders. Drugs, 65(8), 1051–9. PMID 15907142</ref>
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| Service-user led movements have become integral to the recovery process in [[Europe]] and [[United States|America]]; groups such as the [[Hearing Voices Network]] and the [[Paranoia Network]] have developed a self-help approach that aims to provide support and assistance outside the traditional medical model adopted by mainstream psychiatry. By avoiding framing personal experience in terms of criteria for [[mental illness]] or [[mental health]], they aim to destigmatize the experience and encourage individual responsibility and a positive self-image. Partnerships between hospitals and consumer-run groups are becoming more common, with services working toward remediating social withdrawal, building social skills and reducing rehospitalization.<ref name="Goering_et_al_2006">Goering P, Durbin J, Sheldon CT, Ochocka J, Nelson G, Krupa T. Who uses consumer-run self-help organizations?
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| ''American Journal of Orthopsychiatry'', 76 (3), 367-73. PMID 16981815</ref>
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| == Popular views and misconceptions ==
| | {{SK}} Schizophrenic disorder; schizophrenic psychosis |
| Views held by the public about mental disorders, including schizophrenia, may not coincide with available evidence or with the views held by some mental health professionals.
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| === Treatment === | | ==[[Schizophrenia overview|Overview]]== |
| Some psychiatrists believe patients can be discouraged by friends or family members from taking prescribed medication because of the latters' non-biological views of mental disorders.<ref Name="PsychNews00">American Psychiatric Association. Americans Still Cling to Myths About Mental Illness, Survey Finds. ''Psychiatric News.'' December 7, 2001 Volume 36 Number 23 [http://pn.psychiatryonline.org/cgi/content/full/36/23/14-a Full text]</ref> There is scientific difference of opinion about the use of medication in schizophrenia.<ref>Gould, JE. (2006) Ethical Considerations in Medication-Free Research with Schizophrenia Patients: An Expert Interview with William T. Carpenter, Jr., M.D. ''Medscape Psychiatry & Mental Health'' 2006:11(2) [http://www.medscape.com/viewarticle/546243 Full text available]</ref> Consumers' views on treatment and recovery may differ from those of mental health professionals.<ref name="Bellack06"/>
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| === Violence === | | ==[[Schizophrenia historical perspective|Historical Perspective]]== |
| The relationship between violent acts and schizophrenia is a contentious topic. One survey found that 61% of Americans judged individuals with schizophrenia as likely to commit an act of interpersonal violence, while only 17% thought such an act likely to be committed by a person described as "troubled".<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999). The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. ''[[American Journal of Public Health]].'' Sep;89(9):1339–45. PMID 10474550</ref>
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| Research on violence indicates that the percentage of people with schizophrenia who commit violent acts is several times higher than the percentage of people without any disorder, but lower than is found for disorders such as alcoholism, and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse.<ref name="Walsh02">Walsh E, Buchanan A, Fahy T (2002). Violence and schizophrenia: examining the evidence. ''British Journal of Psychiatry.'' 2002 Jun;180:490–5. PMID 12042226</ref><ref name="Stuart 03">Stuart, H (2003). Violence and mental illness: an overview. ''World Psychiatry.'' June; 2(2): 121–124. PMID 16946914 [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525086 Full text,] Retrieved on [[2007-05-17]].</ref><ref>Steadman HJ, Mulvey EP, Monahan J, ''et al'' (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. ''Archives of General Psychiatry.'' May;55(5):393–401. PMID 9596041</ref><ref>Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, ''et al'' (2006). A national study of violent behavior in persons with schizophrenia. ''Archives of General Psychiatry.'' May;63(5):490–9. PMID 16651506</ref><ref>Swanson JW, Holzer CE, Ganju VK, Jono RT. (1990) Violence and Psychiatric Disorder in the Community: Evidence From the Epidemiologic Catchment Area Surveys ''Hosp Community Psychiatry'' 41:761-770, July 1990 PMID 2142118</ref> Studies have indicated that 5 to 10% of those charged with murder in Western countries have a schizophrenia spectrum disorder.<ref name="Mullen 06">Mullen PE (2006). Schizophrenia and violence: from correlations to preventive strategies. ''Advances in Psychiatric Treatment'' 12: 239–248. [http://apt.rcpsych.org/cgi/content/abstract/12/4/239 Full text available,] Retrieved on [[2007-05-17]].</ref><ref name="fn_52">Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J (2004). Homicide and mental illness in New Zealand, 1970–2000. ''British Journal of Psychiatry'', 185, 394–8. PMID 15516547</ref><ref name="fn_53">Fazel S, Grann M (2004). Psychiatric morbidity among homicide offenders: a Swedish population study. ''American Journal of Psychiatry'', 161(11), 2129–31. PMID 15514419</ref>
| | ==[[Schizophrenia classification|Classification]]== |
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| The occurrence of [[psychosis]] in schizophrenia has sometimes been linked to a higher risk of violent acts. Findings on the specific role of delusions or hallucinations have been inconsistent, but have focused on delusional jealousy, perception of threat and command hallucinations. It has been proposed that a certain type of individual with schizophrenia may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to diagnosis.<ref name= "Mullen 06"/>
| | ==[[Schizophrenia pathophysiology|Pathophysiology]]== |
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| A consistent finding is that individuals with a diagnosis of schizophrenia are often the victims of violent crime—at least 14 times more often than they are perpetrators.<ref>Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. ''Psychiatric Services.'' Oct;52(10):1358–66. PMID 11585953</ref><ref name="fn_55">Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J (2005). Victimization of patients with schizophrenia and related disorders. ''Australia and New Zealand Journal of Psychiatry'', 39(3), 169-74. (1), 187–9. PMID 15701066</ref> Another consistent finding is a link to substance misuse, particularly alcohol,<ref name="fn_51">Walsh E, Gilvarry C, Samele C, ''et al'' (2004). Predicting violence in schizophrenia: a prospective study. ''Schizophrenia Research'', 67(2–3), 247-52. PMID 14984884</ref> among the minority who commit violent acts. Violence by or against individuals with schizophrenia typically occurs in the context of complex social interactions within a family setting,<ref> Solomon PL, Cavanaugh MM, Gelles RJ (2005). Family Violence among Adults with Severe Mental Illness. ''Trauma, Violence, & Abuse'', Vol. 6, No. 1, 40–54. PMID 15574672[http://tva.sagepub.com/cgi/content/abstract/6/1/40 Full text available.]</ref> and is also an issue in clinical services<ref>Chou KR, Lu RB, Chang M (2001). Assaultive behavior by psychiatric in-patients and its related factors. ''Journal of Nursing Research.'' Dec;9(5):139–51. PMID 11779087</ref> and in the wider community.<ref>Logdberg B, Nilsson LL, Levander MT, Levander S (2004). Schizophrenia, neighbourhood, and crime. ''Acta Psychiatrica Scandinavica,'' 110(2) Page 92. PMID 15233709 [http://www.blackwell-synergy.com/links/doi/10.1111/j.1600-0047.2004.00322.x/abs/ Full text available,] Retrieved on [[2007-05-16]]</ref>
| | ==[[Schizophrenia causes|Causes]]== |
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| ==Alternative approaches== | | ==[[Schizophrenia differential diagnosis|Differentiating Schizophrenia from other Diseases]]== |
| An approach broadly known as the [[anti-psychiatry]] movement, most active in the 1960s, opposes the orthodox medical view of schizophrenia as an illness.<ref name="Cooper1969">Cooper D (1969) ''The Dialectics of Liberation''. London: Penguin Books Ltd. ISBN 0140210296</ref> Psychiatrist [[Thomas Szasz]] argued that psychiatric patients are not ill rather individuals with unconventional thoughts and behavior that make society uncomfortable.<ref name="Szasz1984">Szasz T (1984) ''The Myth of Mental Illness: Foundations of a Theory of Personal Contact (revised edition''. New York: Harper and Row. ISBN 0060911514</ref> He argues that society unjustly seeks to control them by classifying their behavior as an illness and forcibly treating them as a method of social control. According to this view, "schizophrenia" does not actually exist but is merely a form of [[Social constructionism|social construction]], created by society's concept of what constitutes normality and abnormality. Szasz has never considered himself to be "anti-psychiatry" in the sense of being against psychiatric treatment, but simply believes that treatment should be conducted between consenting adults, rather than imposed upon anyone against his or her will. Similarly, psychiatrists R. D. Laing, [[Silvano Arieti]], Theodore Lidz and Colin Ross<ref> {{cite book | last = Colin | first = Ross | title = Schizophrenia: Innovations in Diagnosis and Treatment | publisher = Haworth Press | date = 2004 | isbn = 0789022699}} </ref> have argued that the symptoms of what is called mental illness are comprehensible reactions to impossible demands that society and particularly family life places on some sensitive individuals. Laing, Arieti, Lidz and Ross were notable in valuing the ''content'' of [[psychosis|psychotic]] experience as worthy of interpretation, rather than considering it simply as a secondary but essentially meaningless marker of underlying psychological or neurological distress. Laing described eleven case studies of people diagnosed with schizophrenia and argued that the content of their actions and statements was meaningful and logical in the context of their family and life situations.<ref>R.D. Laing's and Aaron Esterson. ''Sanity, Madness and the Family'' (1964)</ref> In the books ''Schizophrenia and the Family'' and ''The Origin and Treatment of Schizophrenic Disorders'' Lidz and his colleagues explain their belief that parental behaviour can result in mental illness in children. Arieti's ''Interpretation of Schizophrenia'' won the 1975 scientific National Book Award in the United States.
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| The concept of schizophrenia as a result of civilization has been developed further by psychologist [[Julian Jaynes]] in his 1976 book ''The Origin of Consciousness in the Breakdown of the Bicameral Mind''; he proposed that until the beginning of historic times, schizophrenia or a similar condition was the normal state of human consciousness.<ref name="Jaynes1976">Janyes J (1976) ''The Origin of Consciousness in the Breakdown of the Bicameral Mind''. Houghton Mifflin. ISBN 0395207290</ref> This would take the form of a "[[bicameral mind]]" where a normal state of low affect, suitable for routine activities, would be interrupted in moments of crisis by "mysterious voices" giving instructions, which early people characterized as interventions from the gods. Researchers into [[shamanism]] have speculated that in some cultures schizophrenia or related conditions may predispose an individual to becoming a shaman;<ref name="fn_57">Polimeni J, Reiss JP (2002). How shamanism and group selection may reveal the origins of schizophrenia. ''Medical Hypothesis'', 58(3), 244–8. PMID 12018978</ref> the experience of having access to multiple realities is not uncommon in schizophrenia, and is a core experience in many shamanic traditions. Equally, the shaman may have the skill to bring on and direct some of the [[altered state of consciousness|altered states of consciousness]] psychiatrists label as illness. [[Psychohistory|Psychohistorians]], on the other hand, accept the psychiatric diagnoses. However, unlike the current [[Biological psychiatry|medical model of mental disorders]] they argue that [[Trauma model of mental disorders#Psychohistory Table|poor parenting in tribal societies]] causes the shaman's schizoid personalities.<ref>[[Lloyd deMause|DeMause, Lloyd]], "The seven stages of historical personality" in ''The Emotional Life of Nations'' (Karnac, 2002). Available at [http://primal-page.com/ps2.htm primal-page.com,] Retrieved on [[2007-05-17]].</ref> Speculation regarding primary and important religious figures as having schizophrenia abound. Commentators such as Paul Kurtz and others have endorsed the idea that major religious figures experienced psychosis, heard voices and displayed delusions of grandeur.<ref>Kurtz, Paul (1986). ''The Transcendental Temptation: A Critique of Religion and the Paranormal'' (Prometheus Books) ISBN 0-87975-645-4</ref>
| | ==[[Schizophrenia epidemiology and demographics|Epidemiology and Demographics]]== |
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| Psychiatrist Tim Crow has argued that schizophrenia may be the evolutionary price we pay for a left brain hemisphere specialization for [[language]].<ref name="fn_56">Crow TJ (1997). Schizophrenia as failure of hemispheric dominance for language. ''Trends in Neurosciences'', 20(8), 339–343. PMID 9246721</ref> Since psychosis is associated with greater levels of right brain hemisphere activation and a reduction in the usual left brain hemisphere dominance, our language abilities may have evolved at the cost of causing schizophrenia when this system breaks down.
| | ==[[Schizophrenia risk factors|Risk Factors]]== |
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| The [[Soteria]] model is an alternative treatment to institutionalization and early use of antipsychotics.<ref>{{cite journal | author = Bola JR, Mosher LR | title = Treatment of Acute Psychosis Without Neuroleptics: Two-Year Outcomes From the Soteria Project | journal = The Journal of Nervous and Mental Disease | publisher = Lippincott Williams & Wilkins, Inc | volume = 191 | pages = 219–229 | date = April 2003 | url = http://www.moshersoteria.com/bola.pdf | format=PDF | pmid=12695732|accessdate=2007-06-13}}</ref> It is described as a milieu-therapeutic recovery method, characterized by its founder as "the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment."<ref name="mosh99">Mosher LR (1999). "Soteria and Other Alternatives to Acute Psychiatric Hospitalization: A Personal and Professional Review." Journal of Nervous and Mental Disease, 187, 142–149.</ref>
| | ==[[Schizophrenia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| A branch of [[alternative medicine]] that deals with schizophrenia is known as [[orthomolecular psychiatry]]. Some argue that schizophrenia can be treated effectively with doses of Vitamin B-3 ([[Niacin]]).<ref>Hoffer and Walker, ''Orthomolecular Nutrition''. Keats Publishing, 1978</ref> The body's adverse reactions to [[gluten]] are [[gluten-free, casein-free diet|implicated in some alternative theories]]. This theory—discussed by one author in three British journals in the 1970s<ref> Dohan FC (1970). Coeliac disease and schizophrenia. ''Lancet'', 1970 April 25;1(7652):897–8. PMID 4191543<br />*Dohan FC (1973). Coeliac disease and schizophrenia. ''British Medical Journal'', 3(5870): 51–52. PMID 4740433<br />* Dohan FC (1979). Celiac-type diets in schizophrenia. '' Am J Psychiatry'', 1979 May;136(5):732–3. PMID 434265</ref>—is unproven. A 2006 literature review suggests that gluten may be a factor for a subset of patients with schizophrenia, but further study is needed to confirm the association between gluten and schizophrenia.<ref name="Kalaydjian_AE"> Kalaydjian AE, Eaton W, Cascella N, Fasano A (2006). The gluten connection: the association between schizophrenia and celiac disease. ''Acta Psychiatr Scand.'' 2006 Feb;113(2):82–90. PMID 16423158</ref>
| | ==Diagnosis== |
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| ==References==
| | [[Schizophrenia diagnostic criteria|Diagnostic Criteria]] | [[Schizophrenia history and symptoms|History and Symptoms]] | [[Schizophrenia physical examination|Physical Examination]] | [[Schizophrenia laboratory findings|Laboratory Findings]] | [[Schizophrenia other diagnostic studies|Other Diagnostic Studies]] |
| {{reflist|2}}
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| ==Further reading== | | ==Treatment== |
| <!-- Please only include material which addresses schizophrenia in general, rather than specific aspects, or related topics -->
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| <div class="references-small">
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| * [[Richard Bentall|Bentall, R.]] (2003) ''Madness explained: Psychosis and Human Nature''. London: Penguin Books Ltd. ISBN 0-7139-9249-2
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| * [[James Fallon|Fallon, James H.]] et al. (2003) The Neuroanatomy of Schizophrenia: Circuitry and Neurotransmitter Systems. ''Clinical Neuroscience Research'' 3:77–107. Available at [http://dx.doi.org/10.1016/S1566-2772(03)00022-7 Elsevier article locater.]
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| * Green, M.F. (2001) ''Schizophrenia Revealed: From Neurons to Social Interactions''. New York: W.W. Norton. ISBN 0-393-70334-7
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| * Keen, T. M. (1999) Schizophrenia: orthodoxy and heresies. A review of alternative possibilities. ''Journal of Psychiatric and Mental Health Nursing'', 1999, 6, 415–424. PMID 10818864
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| *[[Theodore Lidz|Lidz, Theodore]], [[Stephen Fleck]] & Alice Cornelison, ''Schizophrenia and the Family''. International Universities Press, 1965. ISBN 978-0823660018
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| * Noll, Richard (2007) ''The Encyclopedia of Schizophrenia and Other Psychotic Disorders, Third Edition'' ISBN 0-8160-6405-9
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| * [http://www.openthedoors.com/english/index.html Open The Doors - information on global programme to fight stigma and discrimination because of Schizophrenia. The World Psychiatric Association (WPA)]
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| * Read, J., Mosher, L.R., Bentall, R. (2004) ''Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia''. ISBN 1-58391-906-6. A critical approach to biological and genetic theories, and a review of social influences on schizophrenia.
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| * [http://www.sciam.com/article.cfm?chanID=sa006&articleID=000EE239-6805-1FD5-A23683414B7F0000 Scientific American Magazine (January 2004 Issue) Decoding Schizophrenia]
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| * Shaner, A., Miller, G. F., & Mintz, J. (2004). Schizophrenia as one extreme of a sexually selected fitness indicator. ''Schizophrenia Research'', 70(1), 101–109. PMID 15246469[http://www.unm.edu/~gfmiller/new_papers/shaner%20miller%202004%20schizo.pdf Full text (PDF),] Retrieved on [[2007-05-17]].
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| * [[Thomas Szasz|Szasz, T.]] (1976) ''Schizophrenia: The Sacred Symbol of Psychiatry''. New York: Basic Books. ISBN 0-465-07222-4
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| * [[Viktor Tausk|Tausk, V.]] : "Sexuality, War, and Schizophrenia: Collected [[Psychoanalytic]] Papers", Publisher: Transaction Publishers 1991, ISBN 0-88738-365-3 (On the Origin of the 'Influencing Machine' in Schizophrenia.)
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| * Wiencke, Markus (2006) ''Schizophrenie als Ergebnis von Wechselwirkungen: Georg Simmels Individualitätskonzept in der Klinischen Psychologie''. In David Kim (ed.), ''Georg Simmel in Translation: Interdisciplinary Border-Crossings in Culture and Modernity'' (pp. 123–155). Cambridge Scholars Press, Cambridge, ISBN 1-84718-060-5
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| </div>
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| | [[Schizophrenia medical therapy|Medical Therapy]] | [[Schizophrenia psychotherapy|Psychotherapy]] | [[Schizophrenia prevention|Prevention]] | [[Schizophrenia social impact|Social Impact]] | [[Schizophrenia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Schizophrenia future or investigational therapies|Future or Investigational Therapies]] |
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| [[ar:فصام]]
| | ==Case Studies== |
| [[bs:Shizofrenija]]
| | [[Schizophrenia case study one|Case #1]] |
| [[bg:Шизофрения]]
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| [[ca:Esquizofrènia]]
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| [[cs:Schizofrenie]]
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| [[da:Skizofreni]]
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| [[de:Schizophrenie]]
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| [[et:Skisofreenia]]
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| [[es:Esquizofrenia]]
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| [[eo:Skizofrenio]]
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| [[fa:روانگسیختگی]]
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| [[fr:Schizophrénie]]
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| [[gl:Esquizofrenia]]
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| [[ko:정신분열증]]
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| [[hr:Shizofrenija]]
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| [[io:Skizofrenio]]
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| [[id:Skizofrenia]]
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| [[ia:Schizophrenia]]
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| [[is:Geðklofi]]
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| [[it:Schizofrenia]]
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| [[he:סכיזופרניה]]
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| [[kl:Skizofrenii]]
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| [[ku:Şîzofrenî]]
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| [[la:Morbus dissidentiae phreneticae]]
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| [[lt:Šizofrenija]]
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| [[hu:Skizofrénia]]
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| [[ms:Skizofrenia]]
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| [[nl:Schizofrenie]]
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| [[ja:統合失調症]]
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| [[no:Schizofreni]]
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| [[pl:Schizofrenia]]
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| [[pt:Esquizofrenia]]
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| [[ro:Schizofrenie]]
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| [[qu:Waq'akay]] | |
| [[ru:Шизофрения]]
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| [[simple:Schizophrenia]]
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| [[sk:Schizofrénia]]
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| [[sr:Схизофренија]]
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| [[sh:Shizofrenija]]
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| [[fi:Skitsofrenia]]
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| [[sv:Schizofreni]]
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| [[tr:Şizofreni]]
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| [[uk:Шизофренія]]
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| [[ur:انفصام]]
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| [[zh:精神分裂症]]
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