Schizophrenia Classification and external resources
Eugen Bleuler (1857–1939) coined the term "Schizophrenia" in 1908
ICD-10	F20.
ICD-9	295
OMIM	181500
DiseasesDB	11890
MedlinePlus	000928
eMedicine	med/2072  emerg/520
MeSH	F03.700.750

Schizophrenia (pronounced /ˌskɪtsəˈfriːniə/), from the 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 hallucinations, paranoid or bizarre delusions or disorganized speech and thinking in the context of significant social or occupational dysfunction. Paul Eugen Bleuler ( April 30, 1857 – July 15, 1939) was a Swiss psychiatrist most notable for his contributions to the The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The 2007 version of the ICD is available online at http//wwwwho The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books The Ancient Greek language is the historical stage in the development of the Hellenic language family spanning the Archaic (c The root is the primary lexical unit of a Word, which carries the most significant aspects of semantic content and cannot be reduced into smaller constituents MIND ( Moving In New Directions) (est 1975 is an alternative education high school in Montreal, Quebec, Canada. Psychiatry is a medical specialty which exists to study, prevent, and treat Mental disorders in Humans Psychiatric In Psychology and the Cognitive sciences perception is the process of attaining awareness or understanding of sensory Information. Reality, in everyday usage means "the state of things as they actually exist" A hallucination, in the broadest sense is a Perception in the absence of a stimulus. A delusion is commonly defined as a fixed False Belief and is used in everyday language to describe a belief that is either false fanciful or derived from Deception In Psychiatry, thought disorder or formal thought disorder is a term used to describe a pattern of disordered language use that is presumed to reflect disordered thinking Onset of symptoms typically occurs in young adulthood,^[1] with approximately 0. 4–0. 6%^[2][3] of the population affected. Diagnosis is based on the patient's self-reported experiences and observed behavior. No laboratory test for schizophrenia currently exists. ^[4]

Studies suggest that genetics, early environment, neurobiology and psychological and social processes are important contributory factors. Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is Neurobiology is the study of cells of the Nervous system and the organization of these cells into functional circuits that process information and mediate behavior Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and Current psychiatric research is focused on the role of neurobiology, but no single organic cause has 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. Paul Eugen Bleuler ( April 30, 1857 – July 15, 1939) was a Swiss psychiatrist most notable for his contributions to the 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. Etymology is the study of the History of Words &mdash when they entered a language from what source and how their form and meaning have changed over time Dissociative Identity Disorder ( DID) as defined by the American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders (DSM Popular culture (or pop culture) is the Culture — patterns of human activity and the symbolic structures that give such activities significance and importance —

Increased dopaminergic activity in the mesolimbic pathway of the brain is a consistent finding. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates The mesolimbic pathway is one of the Neural pathways in the Brain that links the Ventral tegmentum in the Midbrain to the Nucleus accumbens The mainstay of treatment is pharmacotherapy with antipsychotic medications; these primarily work by suppressing dopamine activity. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. 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. ^[5]

The disorder is primarily thought to affect cognition, but it also usually contributes to chronic problems with behavior and emotion. Cognition is a concept used in different ways by different disciplines but is generally accepted to mean the process of awareness or thought For the Björk song see Human Behaviour Human behavior is the collection of Behaviors exhibited by Human beings and influenced by An emotion is a mental and physiological state associated with a wide variety of feelings thoughts and behaviours People diagnosed with schizophrenia are likely to be diagnosed with comorbid conditions, including clinical depression and anxiety disorders;^[6] the lifetime prevalence of substance abuse is typically around 40%. In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Anxiety disorder is a blanket term covering several different forms of abnormal pathological anxieties Fears and Phobias In clinical usage "fear" In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given Substance abuse is the overindulgence in and dependence of a Drug or other chemical leading to effects that are detrimental to the individual's physical and mental health 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. Life expectancy is the average number of years of life remaining at a given age ^[7]

Signs and symptoms

A person experiencing schizophrenia may demonstrate symptoms such as disorganized thinking, auditory hallucinations, and delusions. In Psychiatry, thought disorder or formal thought disorder is a term used to describe a pattern of disordered language use that is presumed to reflect disordered thinking A hallucination, in the broadest sense is a Perception in the absence of a stimulus. A delusion is commonly defined as a fixed False Belief and is used in everyday language to describe a belief that is either false fanciful or derived from Deception In severe cases, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation; these are signs of catatonia. A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician Catatonic is a syndrome of psychic and motoric-disturbances In the current Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association The current classification of psychoses holds that symptoms need to have been present for at least one month in a period of at least six months of disturbed functioning. A schizophrenia-like psychosis of shorter duration is termed a schizophreniform disorder. Schizophreniform disorder is characterized by the presence of criterion A symptoms of Schizophrenia. ^[4] No one sign is diagnostic of schizophrenia, and all can occur in other medical and psychiatric conditions. ^[4]

Social isolation commonly occurs and may be due to a number of factors. Impairment in social cognition is associated with schizophrenia, as are the active symptoms of paranoia from delusions and hallucinations, and the negative symptoms of apathy and avolition. Social cognition is the study of how people process social information especially its encoding storage retrieval and application to social situations Avolition is a psychological state characterized by general lack of desire drive or motivation to pursue meaningful goals Many people diagnosed with schizophrenia avoid potentially stressful social situations that may exacerbate mental distress. ^[8]

Late adolescence and early adulthood are peak years for the onset of schizophrenia. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. To minimize the effect of schizophrenia, much work has recently been done to identify and treat the prodromal (pre-onset) phase of the illness, which has been detected up to 30 months before the onset of symptoms, but may be present longer. In Medicine, a prodrome is an early non-specific Symptom (or set of symptoms indicating the start of a Disease before specific symptoms occur ^[9] Those who go on to develop schizophrenia may experience the non-specific symptoms of social withdrawal, irritability and dysphoria in the prodromal period,^[10] and transient or self-limiting psychotic symptoms in the prodromal phase before psychosis becomes apparent. Dysphoria (from Greek δύσφορος (dysphoros from δυσ- difficult and φέρω to bear is generally characterized as an unpleasant or uncomfortable mood such as sadness ^[11]

Schneiderian classification

The psychiatrist Kurt Schneider (1887–1967) listed the forms of psychotic symptoms that he thought distinguished schizophrenia from other psychotic disorders. This article is about the German psychiatrist For the World War I ace see Kurt Schneider (aviator. These are called first-rank symptoms or Schneider's first-rank symptoms, and they include delusions of being controlled by an external force; the belief that thoughts are being inserted into or withdrawn from one's conscious mind; the belief that one's thoughts are being broadcast to other people; and hearing hallucinatory voices that comment on one's thoughts or actions or that have a conversation with other hallucinated voices. This article is about the German psychiatrist For the World War I ace see Kurt Schneider (aviator. ^[12] The reliability of first-rank symptoms has been questioned,^[13] although they have contributed to the current diagnostic criteria.

Positive and negative symptoms

Schizophrenia is often described in terms of positive (or productive) and negative (or deficit) symptoms. ^[14] Positive symptoms include delusions, auditory hallucinations, and thought disorder, and are typically regarded as manifestations of psychosis. A delusion is commonly defined as a fixed False Belief and is used in everyday language to describe a belief that is either false fanciful or derived from Deception A hallucination, in the broadest sense is a Perception in the absence of a stimulus. In Psychiatry, thought disorder or formal thought disorder is a term used to describe a pattern of disordered language use that is presumed to reflect disordered thinking Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic Negative symptoms are so-named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat or blunted affect and emotion, poverty of speech (alogia), anhedonia, and lack of motivation (avolition). Blunted affect is the scientific term describing a lack of Emotional reactivity on the part of an individual An emotion is a mental and physiological state associated with a wide variety of feelings thoughts and behaviours Speech refers to the processes associated with the production and perception of Sounds used in Spoken language. In Psychology, alogia (Greek α- “without” and λόγος “speech” or poverty of speech, is a general lack of additional unprompted content seen in normal In Psychology, anhedonia ( Greek αν- an- without + ηδονή hēdonē pleasure) is an inability to experience Motivation is the reason or reasons for engaging in a particular behavior especially Human behavior as studied in Philosophy, Conflict, Economics Avolition is a psychological state characterized by general lack of desire drive or motivation to pursue meaningful goals Despite the appearance of blunted affect, recent studies indicate that there is often a normal or even heightened level of emotionality in schizophrenia, especially in response to stressful or negative events. ^[15] A third symptom grouping, the disorganization syndrome, is commonly described, and includes chaotic speech, thought, and behaviour. There is evidence for a number of other symptom classifications. ^[16]

Diagnosis

Diagnosis is based on the self-reported experiences of the person as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a psychiatrist, social worker, clinical psychologist or other clinician in a clinical assessment. A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders Social work is a discipline involving the application of Social theory and research methods to study and improve the lives of people groups and societies Clinical psychology includes the scientific study and application of Psychology for the purpose of understanding preventing There is a list of criteria that must be met for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms. ^[4]

An initial assessment includes a comprehensive history and physical examination by a physician. Although there are no biological tests which confirm schizophrenia, tests are carried out to exclude medical illnesses which may rarely present with psychotic schizophrenia-like symptoms. ^[4] These include blood tests measuring TSH to exclude hypo- or hyperthyroidism, basic electrolytes and serum calcium to rule out a metabolic disturbance, full blood count including ESR to rule out a systemic infection or chronic disease, and serology to exclude syphilis or HIV infection; two commonly ordered investigations are EEG to exclude epilepsy, and a CT scan of the head to exclude brain lesions. Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a Peptide hormone synthesized and secreted by Thyrotrope cells in the Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 Inborn errors of metabolism comprise a large class of genetic Diseases involving disorders of Metabolism. A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is The erythrocyte sedimentation rate (ESR also called a sedimentation rate, sed rate, or Biernacki Reaction, is the rate at which Red blood cells Systemic infection is a generic term for Infection caused by Microorganisms in animals or plants where the Causal agent (the Microbe) has spread Serology is the scientific study of blood serum. In practice the term usually refers to the Diagnostic identification of antibodies in the serum Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. Computed tomography (CT is a Medical imaging method employing Tomography. It is important to rule out a delirium which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness and indicates an underlying medical illness. Delirium is an acute and relatively sudden (developing over hours to days decline in attention-focus perception and Cognition. There are several psychiatric illnesses which may present with psychotic symptoms other than schizophrenia. These include bipolar disorder,^[17] borderline personality disorder,^[18] drug intoxication, brief drug-induced psychosis, and schizophreniform disorder. Borderline personality disorder ( BPD) is a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV Personality Schizophreniform disorder is characterized by the presence of criterion A symptoms of Schizophrenia.

Investigations are not generally repeated for relapse unless there is a specific medical indication. These may include serum blood sugar level (BSL) if olanzapine has been prescribed previously, liver function tests if chlorpromazine, or creatine phosphokinase (CPK) to exclude neuroleptic malignant syndrome. Blood sugar, used in a physiological context is a misnomer and misleading Olanzapine ( Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, or in combination with Fluoxetine Symbyax) is Liver function tests (LFTs or LFs which include liver enzymes, are groups of Clinical biochemistry laboratory blood assays designed to give information about the Chlorpromazine (as chlorpromazine Hydrochloride, abbreviated CPZ, marketed in the US as Thorazine) is a Phenothiazine Antipsychotic Creatine kinase (CK also known as creatine phosphokinase (CPK or phosphocreatine kinase, is an Enzyme ( expressed by various tissue types Neuroleptic malignant syndrome (NMS is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Assessment and treatment are usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others.

The most widely used criteria for diagnosing schizophrenia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the current version being DSM-IV-TR, and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, currently the ICD-10. The American Psychiatric Association (APA is the main Professional organization of Psychiatrists and trainee psychiatrists in the United States, and the The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The latter criteria are typically used in European countries while the DSM criteria are used in the USA or the rest of the world, as well as prevailing in research studies. The ICD-10 criteria put more emphasis on Schneiderian first rank symptoms although, in practice, agreement between the two systems is high. This article is about the German psychiatrist For the World War I ace see Kurt Schneider (aviator. ^[19] The WHO has developed the tool SCAN (Schedules for Clinical Assessment in Neuropsychiatry) which can be used for diagnosing a number of psychiatric conditions, including schizophrenia. SCAN or Schedules for Clinical Assessment in Neuropsychiatry is a set of tools created by WHO aimed at diagnosing and measuring Mental

DSM IV-TR Criteria

To be diagnosed with schizophrenia, a person must display:^[4]

• Characteristic symptoms: Two or more of the following, each present for a significant portion of time during a one-month period (or less, if successfully treated)
  • delusions
  • hallucinations
  • disorganized speech (e. A delusion is commonly defined as a fixed False Belief and is used in everyday language to describe a belief that is either false fanciful or derived from Deception A hallucination, in the broadest sense is a Perception in the absence of a stimulus. g. , frequent derailment or incoherence; speaking in abstracts). --> Abstraction is the process or result of generalization by reducing the information See thought disorder. In Psychiatry, thought disorder or formal thought disorder is a term used to describe a pattern of disordered language use that is presumed to reflect disordered thinking
  • grossly disorganized behavior (e. g. dressing inappropriately, crying frequently) or catatonic behavior
  • negative symptoms, i. Catatonic is a syndrome of psychic and motoric-disturbances In the current Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association e. , affective flattening (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation). Blunted affect is the scientific term describing a lack of Emotional reactivity on the part of an individual In Psychology, alogia (Greek α- “without” and λόγος “speech” or poverty of speech, is a general lack of additional unprompted content seen in normal Avolition is a psychological state characterized by general lack of desire drive or motivation to pursue meaningful goals

Note: Only one of these symptoms is required if delusions are bizarre or hallucinations consist of hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing with each other.

• Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset.

• Duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if successfully treated).

Additional criteria are also given that exclude the diagnosis; thus schizophrenia cannot be diagnosed if symptoms of mood disorder or pervasive developmental disorder are present, or the symptoms are the direct result of a substance (e. A mood disorder is the term given for a group of diagnoses in the DSM IV TR classification system where a disturbance in the person's emotional mood is hypothesised The diagnostic category pervasive developmental disorders (PDD as opposed to Specific developmental disorders (SDD refers to a group of five disorders characterized g. , abuse of a drug/medication) or a general medical condition.

Subtypes

Historically, schizophrenia in the West was classified into simple, catatonic, hebephrenic (now known as disorganized), and paranoid. The term Western world, the West or the Occident ( Latin: occidens -sunset -west as distinct from the Orient) can have multiple meanings Catatonic is a syndrome of psychic and motoric-disturbances In the current Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association Disorganized schizophrenia is a subtype of Schizophrenia as defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV code 295 The DSM contains five sub-classifications of schizophrenia:

• paranoid type: where delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent (DSM code 295. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association Paranoia is a disturbed thought process characterized by excessive Anxiety or Fear, often to the point of Irrationality and Delusion. 3/ICD code F20. 0)
• disorganized type: named 'hebephrenic schizophrenia' in the ICD. Disorganized schizophrenia is a subtype of Schizophrenia as defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV code 295 Where thought disorder and flat affect are present together (DSM code 295. 1/ICD code F20. 1)
• catatonic type: prominent psychomotor disturbances are evident. Catatonic is a syndrome of psychic and motoric-disturbances In the current Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association Symptoms can include catatonic stupor and waxy flexibility (DSM code 295. Waxy flexibility is a psychomotor symptom of catatonic schizophrenia which leads to a decreased response to stimuli and a tendency to remain in an immobile posture 2/ICD code F20. 2)
• undifferentiated type: psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types have not been met (DSM code 295. 9/ICD code F20. 3)
• residual type: where positive symptoms are present at a low intensity only (DSM code 295. 6/ICD code F20. 5)

The ICD-10 recognises a further two subtypes:

• post-schizophrenic depression: a depressive episode arising in the aftermath of a schizophrenic illness where some low-level schizophrenic symptoms may still be present (ICD code F20. 4)
• simple schizophrenia: insidious but progressive development of prominent negative symptoms with no history of psychotic episodes (ICD code F20. 6)

Diagnostic issues and controversies

Schizophrenia as a diagnostic entity has been criticised as lacking in scientific validity or reliability,^[20][21] part of a larger criticism of the validity of psychiatric diagnoses in general. The biopsychiatry controversy is the dispute over the scientific basis of Biological psychiatry theory and practice 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. Spectrum disorder in Psychiatry is a term used to describe a Mental disorder when there is thought to be "not a unitary disorder but rather a syndrome composed This approach appears consistent with research on schizotypy and of a relatively high prevalence of psychotic experiences^[22][23] and often non-distressing delusional beliefs^[24] amongst the general public. Schizotypy is a psychological concept which describes a continuum of personality characteristics and experiences related to Psychosis and in particular ^[23]

Another criticism is that the definitions used for criteria lack consistency;^[25] this is particularly relevant to the evaluation of delusions and thought disorder. A delusion is commonly defined as a fixed False Belief and is used in everyday language to describe a belief that is either false fanciful or derived from Deception In Psychiatry, thought disorder or formal thought disorder is a term used to describe a pattern of disordered language use that is presumed to reflect disordered thinking 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". ^[26]

Perhaps because of these factors, studies examining the diagnosis of schizophrenia have typically shown relatively low or inconsistent levels of diagnostic reliability. Diagnosis is the identification by Process of elimination, of the nature of anything Most famously, David Rosenhan's 1972 study, published as On being sane in insane places, demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable. David L Rosenhan is an American Psychologist. He is best known for the Rosenhan experiment. The Rosenhan experiment was a famous experiment into the validity of psychiatric Diagnosis conducted by David Rosenhan in 1972 ^[27] More recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at best. ^[28] 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. ^[29]

In 2004 in Japan, the Japanese term for schizophrenia was changed from Seishin-Bunretsu-Byo (mind-split-disease) to Tōgō-shitchō-shō (integration disorder). Tōgō-shitchō-shō (統合失調症 or integration disorder is a Japanese psychiatric diagnosis that replaced the previous diagnostic category of Seishin Bunretsu ^[30] 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. ^[31]

Alternatively, other proponents have put forward using the presence of specific neurocognitive deficits to make a diagnosis. Neurocognitive is a term used to describe Cognitive functions closely linked to the function of particular areas Neural pathways or cortical networks in These take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving. In Psychology, memory is an organism's ability to store retain and subsequently retrieve information Attention is the Cognitive process of selectively concentrating on one aspect of the environment while ignoring other things Problem solving forms part of thinking. Considered the most complex of all intellectual functions problem solving has been defined as higher-order Cognitive 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. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. However, this argument is relatively new and it is unlikely that the method of diagnosing schizophrenia will change radically in the near future. ^[32]

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. The Union of Soviet Socialist Republics (USSR was a constitutionally Socialist state that existed in Eurasia from 1922 to 1991 Sluggishly progressing schizophrenia or sluggish schizophrenia was a category of Schizophrenia diagnosed by Psychiatrists in the Soviet 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. ^[33] In 2000 there were similar concerns regarding detention and 'treatment' of practitioners of the Falun Gong movement by the Chinese government. Falun Gong was introduced to the general public by Li Hongzhi (李洪志 in Changchun, China, in 1992 Falun Gong ( or Falun Dafa is a spiritual practice founded in China by Li Hongzhi （李洪志） in 1992 This led the 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. The American Psychiatric Association (APA is the main Professional organization of Psychiatrists and trainee psychiatrists in the United States, and the The World Psychiatric Association (WPA is an international umbrella organisation of psychiatric societies Talk People's Republic of China) PEOPLE'S REPUBLIC OF CHINA ARTICLE GUIDELINES ^[34]

Epidemiology

Schizophrenia occurs equally in males and females although typically appears earlier in men with the peak ages of onset being 20–28 years for males and 26–32 years for females. ^[1] Much rarer are instances of childhood-onset^[35] and late- (middle age) or very-late-onset (old age) schizophrenia. ^[36] The lifetime prevalence of schizophrenia, that is, the proportion of individuals expected to experience the disease at any time in their lives, is commonly given at 1%. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given A 2002 systematic review of many studies, however, found a lifetime prevalence of 0. A systematic review is a Literature review focused on a single question which tries to identify appraise select and synthesize all high quality research evidence relevant to 55%. ^[3] Despite the received wisdom that schizophrenia occurs at similar rates throughout the world, its prevalence varies across the world,^[37] within countries,^[38] and at the local and neighbourhood level. ^[39] One particularly stable and replicable finding has been the association between living in an urban environment and schizophrenia diagnosis, even after factors such as drug use, ethnic group and size of social group have been controlled for. Urbanizationn (also spelled urbanisation) is the physical growth of Urban areas into rural or natural land as a result of population in-migration to an existing Drugs can be used in many different ways as detailed below Medication See also Medication People can use drugs to relieve pain or discomfort or to cure In Sociology, a group can be defined as two or more Humans that interact with one another accept expectations and obligations as members of the group and share a ^[40] Schizophrenia is known to be a major cause of disability. In a 1999 study of 14 countries, active psychosis was ranked the third-most-disabling condition, after quadriplegia and dementia and before paraplegia and blindness. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic Quadriplegia, also known as tetraplegia, is a Symptom in which a human experiences Paralysis affecting all four limbs although not necessarily total paralysis Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Paraplegia is an impairment in motor and/or sensory function of the lower extremities Blindness is the condition of lacking Visual perception due to Physiological or Neurological factors ^[41]

Causes

Main article: Causes of schizophrenia

Data from a PET study^[42] suggests that the less the frontal lobes are activated (red) during a working memory task, the greater the increase in abnormal dopamine activity in the striatum (green), thought to be related to the neurocognitive deficits in schizophrenia. Schizophrenia is a psychiatric Diagnosis that describes a mental disorder characterized by impairments in the Perception or expression of Reality Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the The frontal lobe is an area in the Brain of Mammals It is located at the front of each Cerebral hemisphere and positioned anterior to (in front of the Working memory (also referred to as Short term memory, depending on the specific theory is a theoretical construct within Cognitive psychology that refers to the Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates The striatum is a subcortical (ie inside rather than on the outside part of the Telencephalon. Neurocognitive is a term used to describe Cognitive functions closely linked to the function of particular areas Neural pathways or cortical networks in

While the reliability of the diagnosis introduces difficulties in measuring the relative effect of genes and environment (for example, symptoms overlap to some extent with severe bipolar disorder or major depression), evidence suggests that genetic and environmental factors can act in combination to result in schizophrenia. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression In Epidemiology, environmental factors are those determinants of disease that are not transmitted genetically. ^[43] Evidence suggests that the diagnosis of schizophrenia has a significant heritable component but that onset is significantly influenced by environmental factors or stressors. ^[44] The idea of an inherent vulnerability (or diathesis) in some people, which can be unmasked by biological, psychological or environmental stressors, is known as the stress-diathesis model. ^[45] The idea that biological, psychological and social factors are all important is known as the "biopsychosocial" model.

Genetic

Estimates of the heritability of schizophrenia tend to vary owing to the difficulty of separating the effects of genetics and the environment although twin studies have suggested a high level of heritability. In Genetics, Heritability is the proportion of phenotypic variation in a population that is attributable to genetic variation among individuals Twin studies are one of a family of designs in Behavior genetics which aid the study of individual differences by highlighting the role of environmental and genetic ^[46] It is likely that schizophrenia is a condition of complex inheritance, with several genes possibly interacting to generate risk for schizophrenia or the separate components that can co-occur leading to a diagnosis. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance ^[47] Genetic studies have suggested that genes that raise the risk for developing schizophrenia are non-specific, and may also raise the risk of developing other psychotic disorders such as bipolar disorder. ^[48][49] Recent research has suggested that rare deletions or duplications of tiny DNA sequences within genes (known as copy number variants) are also linked to increased risk for schizophrenia. ^[50]

Prenatal

It is thought that causal factors can initially come together in early neurodevelopment, including during pregnancy, to increase the risk of later developing schizophrenia. The study of neural development draws on both Neuroscience and Developmental biology to describe the cellular and molecular mechanisms by which complex Nervous One curious finding is that people diagnosed with schizophrenia are more likely to have been born in winter or spring, (at least in the northern hemisphere). Northern Hemisphere is the half of a Planet that is North of the Equator —the word hemisphere literally means 'half ball' ^[51] There is now evidence that prenatal exposure to infections increases the risk for developing schizophrenia later in life, providing additional evidence for a link between in utero developmental pathology and risk of developing the condition. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female ^[52]

Social

Living in an urban environment has been consistently found to be a risk factor for schizophrenia. ^[53][40] Social disadvantage has been found to be a risk factor, including poverty^[54] and migration related to social adversity, racial discrimination, family dysfunction, unemployment or poor housing conditions. ^[55] Childhood experiences of abuse or trauma have also been implicated as risk factors for a diagnosis of schizophrenia later in life. ^[56][57] Parenting is not held responsible for schizophrenia but unsupportive dysfunctional relationships may contribute to an increased risk. ^[58][59]

Substance use

See also: dual diagnosis

The relationship between schizophrenia and drug use is complex, meaning that a clear causal connection between drug use and schizophrenia has been difficult to distinguish. The term dual diagnosis is used to describe the comorbid condition of a person considered to be suffering from a mental illness and a Substance abuse There is strong evidence that using certain drugs can trigger either the onset or relapse of schizophrenia in some people. It may also be the case, however, that people with schizophrenia use drugs to overcome negative feelings associated with both the commonly prescribed antipsychotic medication and the condition itself, where negative emotion, paranoia and anhedonia are all considered to be core features. Paranoia is a disturbed thought process characterized by excessive Anxiety or Fear, often to the point of Irrationality and Delusion. In Psychology, anhedonia ( Greek αν- an- without + ηδονή hēdonē pleasure) is an inability to experience ^[60] Amphetamines trigger the release of dopamine and excessive dopamine function is believed to be at least partly responsible for the psychotic symptoms of schizophrenia (a theory known as the dopamine hypothesis of schizophrenia). Amphetamine, and related drugs such as Methamphetamine are a group of drugs that act by increasing levels of Norepinephrine, Serotonin, and Dopamine The dopamine hypothesis of schizophrenia or the dopamine hypothesis of psychosis is a model attributing symptoms of Schizophrenia (like psychoses) to a This is, in part, supported by the fact that amphetamines reliably worsen the symptoms of schizophrenia. ^[61] Schizophrenia can be triggered by heavy use of hallucinogenic or stimulant drugs. The general group of pharmacological agents commonly known as hallucinogens can be divided into three broad categories Psychedelics, Dissociatives ^[62] One study suggests that cannabis use can contribute to psychosis, though the researchers suspected cannabis use was only a small component in a broad range of factors. Cannabis, also known as marijuana or marihuana, or ganja (from Hindi / Sanskrit: गांजा gānjā hemp) is a ^[63]

Psychological

A number of psychological mechanisms have been implicated in the development and maintenance of schizophrenia. Cognitive biases that have been identified in those with a diagnosis or those at risk, especially when under stress or in confusing situations, include excessive attention to potential threats, jumping to conclusions, making external attributions, impaired reasoning about social situations and mental states, difficulty distinguishing inner speech from speech from an external source, and difficulties with early visual processing and maintaining concentration. For an article about the conceptual problems of the mind see Cognitive closure (philosophy. Attribution is a concept in Social psychology referring to how individuals explain behaviors of others " Theory of mind " is the ability to attribute mental states—beliefs intents desires pretending knowledge etc ^{[64][65][66][67]} Some cognitive features may reflect global neurocognitive deficits in memory, attention, problem-solving, executive function or social cognition, while others may be related to particular issues and experiences. Neurocognitive is a term used to describe Cognitive functions closely linked to the function of particular areas Neural pathways or cortical networks in In Psychology, memory is an organism's ability to store retain and subsequently retrieve information Attention is the Cognitive process of selectively concentrating on one aspect of the environment while ignoring other things Problem solving forms part of thinking. Considered the most complex of all intellectual functions problem solving has been defined as higher-order Cognitive Social cognition is the study of how people process social information especially its encoding storage retrieval and application to social situations ^[68][58] Despite a common appearance of "blunted affect", recent findings indicate that many individuals diagnosed with schizophrenia are highly emotionally responsive, particularly to stressful or negative stimuli, and that such sensitivity may cause vulnerability to symptoms or to the disorder. ^[69][70][71] Some evidence suggests that the content of delusional beliefs and psychotic experiences can reflect emotional causes of the disorder, and that how a person interprets such experiences can influence symptomology. ^{[72][73][74][75]} Further evidence for the role of psychological mechanisms comes from the effects of therapies on symptoms of schizophrenia. ^[76]

Neural

Functional magnetic resonance imaging and other brain imaging technologies allow for the study of differences in brain activity among people diagnosed with schizophrenia. Functional MRI or functional Magnetic Resonance Imaging (fMRI is a type of specialized MRI scan Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/ Pharmacology of the Brain

Studies using neuropsychological tests and brain imaging technologies such as fMRI and PET to examine functional differences in brain activity have shown that differences seem to most commonly occur in the frontal lobes, hippocampus, and temporal lobes. Neuropsychological tests are specifically designed tasks used to measure a psychological function known to be linked to a particular Brain structure or pathway Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/ Pharmacology of the Brain Functional MRI or functional Magnetic Resonance Imaging (fMRI is a type of specialized MRI scan Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the The frontal lobe is an area in the Brain of Mammals It is located at the front of each Cerebral hemisphere and positioned anterior to (in front of the The hippocampus is a part of the Forebrain, located in the medial Temporal lobe. The temporal lobes are parts of the cerebrum that are involved in speech, Memory, and Hearing. ^[77] These differences have been linked to the neurocognitive deficits often associated with schizophrenia. Neurocognitive is a term used to describe Cognitive functions closely linked to the function of particular areas Neural pathways or cortical networks in ^[78] The role of antipsychotic medication, which nearly all those studied had taken, in causing such abnormalities is also unclear. ^[79]

Particular focus has been placed upon the function of dopamine in the mesolimbic pathway of the brain. The mesolimbic pathway is one of the Neural pathways in the Brain that links the Ventral tegmentum in the Midbrain to the Nucleus accumbens This focus largely resulted from the accidental finding that a drug group which blocks dopamine function, known as the phenothiazines, could reduce psychotic symptoms. Phenothiazine is the Organic compound with the formula S(C6H42NH An influential theory, known as the Dopamine hypothesis of schizophrenia, proposed that a malfunction involving dopamine pathways was the cause of (the positive symptoms of) schizophrenia. The dopamine hypothesis of schizophrenia or the dopamine hypothesis of psychosis is a model attributing symptoms of Schizophrenia (like psychoses) to a This theory is now thought to be overly simplistic as a complete explanation, partly because newer antipsychotic medication (called atypical antipsychotic medication) can be equally effective as older medication (called typical antipsychotic medication), but also affects serotonin function and may have slightly less of a dopamine blocking effect. The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions Typical antipsychotics (sometimes referred to as first generation antipsychotics, conventional antipsychotics, classical neuroleptics, or major tranquilizers Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates ^[80]

Interest has also focused on the neurotransmitter glutamate and the reduced function of the NMDA glutamate receptor in schizophrenia. Glutamic acid (abbreviated as Glu or E) is one of the 20 Alpha Amino acids It is not among the human Essential amino acids Its The NMDA receptor ( NMDAR) is an Ionotropic receptor for Glutamate ( NMDA ( N -methyl D -aspartate is a name of its selective This has largely been suggested by abnormally low levels of glutamate receptors found in postmortem brains of people previously diagnosed with schizophrenia^[81] and the discovery that the glutamate blocking drugs such as phencyclidine and ketamine can mimic the symptoms and cognitive problems associated with the condition. Glutamate receptors are Transmembrane receptors located on Neuron membranes Phencyclidine (a complex clip of the chemical name phenylcyclohexylpiperidine, commonly initialised as PCP) is a Dissociative drug Ketamine is a drug for use in human and veterinary medicine developed by Parke-Davis (today a part of Pfizer) in 1962 ^[82] The fact that reduced glutamate function is linked to poor performance on tests requiring frontal lobe and hippocampal function and that glutamate can affect dopamine function, all of which have been implicated in schizophrenia, have suggested an important mediating (and possibly causal) role of glutamate pathways in schizophrenia. The frontal lobe is an area in the Brain of Mammals It is located at the front of each Cerebral hemisphere and positioned anterior to (in front of the The hippocampus is a part of the Forebrain, located in the medial Temporal lobe. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates ^[83] Further support of this theory has come from preliminary trials suggesting the efficacy of coagonists at the NMDA receptor complex in reducing some of the positive symptoms of schizophrenia. ^[84]

There have also been findings of differences in the size and structure of certain brain areas in schizophrenia, starting with the discovery of ventricular enlargement in those for whom negative symptoms were most prominent. The ventricular system is a set of structures in the Brain continuous with the Central canal of the Spinal cord. ^[85] However, this has not proven particularly reliable on the level of the individual person, with considerable variation between patients. More recent studies have shown various differences in brain structure between people with and without diagnoses of schizophrenia. ^[86] While brain structure changes have been found in people diagnosed with schizophrenia who have never been treated with antipsychotic drugs^[87] there is evidence that the medication itself might cause additional changes in the brain's structure. ^[88] However, as with earlier studies, many of these differences are only reliably detected when comparing groups of people, and are unlikely to predict any differences in brain structure of an individual person with schizophrenia.

Treatment and services

Main article: Treatment of schizophrenia

Molecule of chlorpromazine, which revolutionized treatment of schizophrenia in the 1950s. The concept of a cure as such in the treatment of Schizophrenia remains controversial as there is no consensus on the definition of "treatment" in the case of schizophrenia Chlorpromazine (as chlorpromazine Hydrochloride, abbreviated CPZ, marketed in the US as Thorazine) is a Phenothiazine Antipsychotic

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. ^[89] The effectiveness of schizophrenia treatment is often assessed using standardized methods, one of the most common being the Positive and Negative Syndrome Scale (PANSS). The PANSS or the Positive and Negative Syndrome Scale is a medical scale used for measuring symptom severity of patients with Schizophrenia. ^[90] 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. Chlorpromazine (as chlorpromazine Hydrochloride, abbreviated CPZ, marketed in the US as Thorazine) is a Phenothiazine Antipsychotic ^[91] A recovery model is increasingly adopted, emphasizing hope, empowerment and social inclusion. The Recovery Model is an approach to Mental disorder or Substance dependence (and/or from being labeled in those terms that emphasizes and supports each ^[92]

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). Involuntary commitment is the practice of using legal means or forms as part of a Mental health law to commit a person to a Mental hospital, Insane asylum Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur. Deinstitutionalisation (from de-institution-alisation is the process of replacing long-stay mental institutions with less isolated Community mental health services ^[5] 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^[93] and patient-led support groups. Assertive community treatment, or ACT, is a highly intensive and integrated approach for community mental health service delivery

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. ^[94] The reasons for this effect are not clear, although cross-cultural studies are being conducted. Cross-cultural comparisons take several forms One is comparison of case studies another is controlled comparison among variants of a common derivation and a third is comparison within a sample

Medication

The mainstay of psychiatric treatment for schizophrenia is an antipsychotic (aka "neuroleptic") medication. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. ^[95] These can reduce the "positive" symptoms of psychosis. Most antipsychotics take around 7–14 days to have their main effect.

Risperidone (trade name Risperdal) is a common atypical antipsychotic medication. Risperidone (pronounced Ris-PER-ǐ-dōn and sold under the trade name Risperdal in the Netherlands, United States, Canada, the The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions

Though expensive, the newer atypical antipsychotic drugs are usually preferred for initial treatment over the older typical antipsychotics; they are often better tolerated and associated with lower rates of tardive dyskinesia, although they are more likely to induce weight gain and obesity-related diseases. The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions A first-line treatment or first-line therapy is a Medical therapy recommended for the initial treatment of a Disease, sign or Symptom Typical antipsychotics (sometimes referred to as first generation antipsychotics, conventional antipsychotics, classical neuroleptics, or major tranquilizers Tardive dyskinesia is a variety of dyskinesia (involuntary repetitive movements manifesting as a side effect of long-term or high-dose use of Dopamine antagonists Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected ^[96] Prolactin elevations have been reported in women with schizophrenia taking atypical antipsychotics. ^[97]It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome, a rare but serious and potentially fatal neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Neuroleptic malignant syndrome (NMS is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. ^[98]

The two classes of antipsychotics are generally thought equally effective for the treatment of the positive symptoms. Some researchers have suggested that the atypicals offer additional benefit for the negative symptoms and cognitive deficits associated with schizophrenia, although the clinical significance of these effects has yet to be established. Recent reviews have refuted the claim that atypical antipsychotics have fewer extrapyramidal side effects than typical antipsychotics, especially when the latter are used in low doses or when low potency antipsychotics are chosen. ^[99]

Response of symptoms to medication is variable; "Treatment-resistant schizophrenia" is a term used for the failure of symptoms to respond satisfactorily to at least two different antipsychotics. ^[100] Patients in this category may be prescribed clozapine,^[101] a medication of superior effectiveness but several potentially lethal side effects including agranulocytosis and myocarditis. Clozapine (sold as Clozaril, Leponex, Fazaclo, Froidir; Gen-Clozapine in Canada Clozaril, Denzapine, Agranulocytosis is an acute condition involving a severe and dangerous Leukopenia particularly of neutrophils causing a Neutropenia in the circulating blood In Medicine ( Cardiology) myocarditis is Inflammation of the Myocardium, the muscular part of the Heart. ^[102] Clozapine may have the additional benefit of reducing propensity for substance abuse in schizophrenic patients. ^[103] For other patients who are unwilling or unable to take medication regularly, long-acting depot preparations of antipsychotics may be given every two weeks to achieve control. Typical antipsychotics (sometimes referred to as first generation antipsychotics, conventional antipsychotics, classical neuroleptics, or major tranquilizers The United States of America and Australia are two countries with laws allowing the forced administration of this type of medication on those who refuse but are otherwise stable and living in the community. Outpatient commitment refers to Mental health law which allows the compulsory community-based treatment of individuals with Mental illness. Some findings have found that in the longer-term some individuals may do better not taking antipsychotics. ^[104] Despite the promising results of early pilot trials,^[105] omega-3 fatty acids failed to improve schizophrenic symptoms, according to the most recent meta-analysis. n −3 fatty acids (popularly referred to as ω−3 fatty acids or omega-3 fatty acids) are a family of unsaturated Fatty acids that In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses ^[106]

Psychological and social interventions

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. Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living ^[107]

Cognitive behavioral therapy (CBT) is used to reduce symptoms and improve related issues such as self-esteem, social functioning, and insight. See also Cognitive Therapy Cognitive Behavioral Therapy ( CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions interpretations In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth Although the results of early trials were inconclusive,^[108] more recent reviews suggest that CBT can be an effective treatment for the psychotic symptoms of schizophrenia. ^[109] Another approach is cognitive remediation therapy, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Neurocognitive is a term used to describe Cognitive functions closely linked to the function of particular areas Neural pathways or cortical networks in 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. Rehabilitation of sensory and Cognitive function typically involves methods for retraining Neural pathways or training new neural pathways to regain or improve neurocognitive Functional MRI or functional Magnetic Resonance Imaging (fMRI is a type of specialized MRI scan ^[110] A similar approach known as cognitive enhancement therapy, which focuses on social cognition as well as neurocognition, has shown efficacy. ^[111]

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. Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of Psychotherapy that works with families ^{[112][113][114]} 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. ^[115][116] There is also some evidence for benefits from social skills training, although there have also been significant negative findings. ^[117][118] Some studies have explored the possible benefits of music therapy and other creative therapies. ^{[119][120][121]}

The Soteria model is alternative to inpatient hospital treatment using a minimal medication approach. Soteria is a milieu -therapeutic recovery method characterized by its founder as "the 24 hour a day application of interpersonal phenomenologic interventions 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. The social environment (context, also known as the Milieu, is the identical or similar Social positions and Social roles as a whole that influence the individuals The Recovery Model is an approach to Mental disorder or Substance dependence (and/or from being labeled in those terms that emphasizes and supports each "^[122] Although research evidence is limited, a 2008 systematic review found the programme equally as effective as treatment with medication in people diagnosed with first and second episode schizophrenia. ^[123]

Other

Electroconvulsive therapy is not considered a first line treatment but may be prescribed in cases where other treatments have failed. Electroconvulsive therapy ( ECT) also known as electroshock, is a controversial psychiatric treatment in which Seizures are electrically induced A first-line treatment or first-line therapy is a Medical therapy recommended for the initial treatment of a Disease, sign or Symptom It is more effective where symptoms of catatonia are present,^[124] and is recommended for use under NICE guidelines in the UK for catatonia if previously effective, though there is no recommendation for use for schizophrenia otherwise. ^[125] Psychosurgery has now become a rare procedure and is not a recommended treatment for schizophrenia. For the Tourniquet album refer to Psycho Surgery. Psychosurgery is a subset of Neurosurgery ( Surgery ^[126]

Service-user led movements have become integral to the recovery process in Europe and 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. The United States of America —commonly referred to as the The Hearing Voices Network is a self-help user-run organization for people who 'hear voices' The Paranoia Network, founded in November 2003, is a self-help user-run organisation in Sheffield, England, for people who have paranoid or 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. Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as Mental health is a term used to describe either a level of cognitive or Emotional wellbeing or an absence of a Mental disorder. Partnerships between hospitals and consumer-run groups are becoming more common, with services working toward remediating social withdrawal, building social skills and reducing rehospitalization. ^[127]

Prognosis

John Nash, an American mathematician, began showing signs of paranoid schizophrenia during his college years. The United States of America —commonly referred to as the A mathematician is a person whose primary area of study and research is the field of Mathematics. Despite refusing to take his prescribed medication, Nash continued his studies and was awarded the Nobel Prize in 1994. The Nobel Prize (Nobelpriset (Nobelprisen is a Swedish prize established in the 1895 will of Swedish chemist Alfred Nobel; it was first awarded in Peace, Literature His life was the source of the biography A Beautiful Mind and the subsequent film adaptation. A Beautiful Mind is a 2001 American Biographical film about John Forbes Nash, the Nobel Laureate in Economics.

Numerous international studies have demonstrated favorable long-term outcomes for around half of those diagnosed with schizophrenia, with substantial variation between individuals and regions. ^[128] One retrospective study found that about a third of people made a full recovery, about a third showed improvement but not a full recovery, and a third remained ill. ^[129] A clinical study using strict recovery criteria (concurrent remission of positive and negative symptoms and adequate social and vocational functioning continuously for two years) found a recovery rate of 14% within the first five years. ^[130] A 5-year community study found that 62% showed overall improvement on a composite measure of symptomatic, clinical and functional outcomes. ^[131] Rates are not always comparable across studies because an exact definition of what constitutes recovery has not been widely accepted, although standardized criteria have been suggested. ^[89]

The World Health Organization conducted two long-term follow-up studies involving more than 2,000 people suffering from schizophrenia in different countries. These studies found patients have much better long-term outcomes in developing countries (India, Colombia and Nigeria) than in developed countries (USA, UK, Ireland, Denmark, Czech Republic, Slovakia, Japan, and Russia),^[132] despite the fact antipsychotic drugs are typically not widely available in poorer countries, raising questions about the effectiveness of such drug-based treatments. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country Colombia (kəˈlʌmbɪə officially the Republic of Colombia () is a country in northwestern South America. Nigeria, officially named the Federal Republic of Nigeria, is a federal Constitutional republic comprising thirty-six states and one Federal The United States of America —commonly referred to as the The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located Ireland ( Irish: Éire, ˈeːrʲə is a country in north-western Europe. The Kingdom of Denmark ( ˈd̥ænmɑɡ̊ (archaic ˈd̥anmɑːɡ̊ commonly known as Denmark, is a country in the Scandinavian region of northern Europe The Czech Republic ( ˈt͡ʃɛskaː ˈrɛpuˌblɪka short form in Česko ˈt͡ʃɛskɔ also called Czechia, Slovakia (long form Slovak Republic; Slovak:, long form, is a Landlocked country in Central Europe with a population of over five million For a topic outline on this subject see List of basic Japan topics. Russia (Россия Rossiya) or the Russian Federation ( Rossiyskaya Federatsiya) is a transcontinental Country extending

Several factors are associated with a better prognosis: Being female, acute (vs. insidious) onset of symptoms, older age of first episode, predominantly positive (rather than negative) symptoms, presence of mood symptoms and good premorbid functioning. ^[133][134] Most studies done on this subject, however, are correlational in nature, and a clear cause-and-effect relationship is difficult to establish. Evidence is also consistent that negative attitudes towards individuals with schizophrenia can have a significant adverse impact. In particular, critical comments, hostility, authoritarian and intrusive or controlling attitudes (termed high 'Expressed emotion' or 'EE' by researchers) from family members have been found to correlate with a higher risk of relapse in schizophrenia across cultures. Expressed emotion (EE a qualitative measure of the 'amount' of emotion displayed typically in the family setting usually by a family or care takers ^[135]

Mortality

In a study of over 168,000 Swedish citizens undergoing psychiatric treatment, schizophrenia was associated with an average life expectancy of approximately 80–85% of that of the general population. Women with a diagnosis of schizophrenia were found to have a slightly better life expectancy than that of men, and as a whole, a diagnosis of schizophrenia was associated with a better life expectancy than substance abuse, personality disorder, heart attack and stroke. Substance abuse is the overindulgence in and dependence of a Drug or other chemical leading to effects that are detrimental to the individual's physical and mental health Personality disorder, formerly referred to as a Character Disorder is a class of mental disorders characterized by rigid and on-going patterns of feeling thinking and behavior Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain ^[136] There is a high suicide rate associated with schizophrenia; a recent study showed that 30% of patients diagnosed with this condition had attempted suicide at least once during their lifetime. ^{[137] [138]}Another study suggested that 10% of persons with schizophrenia die by suicide. ^[139] Other identified factors include smoking, poor diet, little exercise and the negative health effects of psychiatric drugs. ^[7]

Violence

The relationship between violent acts and schizophrenia is a contentious topic. Current research indicates that the percentage of people with schizophrenia who commit violent acts is 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. Alcoholism is a term with multiple and sometimes conflicting definitions Substance abuse is the overindulgence in and dependence of a Drug or other chemical leading to effects that are detrimental to the individual's physical and mental health ^{[140][141][142][143][144]} Studies have indicated that 5% to 10% of those charged with murder in Western countries have a schizophrenia spectrum disorder. ^{[145][146][147]}

The occurrence of psychosis in schizophrenia has sometimes been linked to a higher risk of violent acts. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic 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. An Intelligence Quotient or IQ is a score derived from one of several different Standardized tests attempting to measure Intelligence. ^[145]

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. ^[148][149] Another consistent finding is a link to substance misuse, particularly alcohol,^[150] 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,^[151] and is also an issue in clinical services^[152] and in the wider community. ^[153]

Screening and prevention

There are no reliable markers for the later development of schizophrenia although research is being conducted into how well a combination of genetic risk plus non-disabling psychosis-like experience predicts later diagnosis. ^[154] People who fulfil the 'ultra high-risk mental state' criteria, that include a family history of schizophrenia plus the presence of transient or self-limiting psychotic experiences, have a 20–40% chance of being diagnosed with the condition after one year. ^[155] The use of psychological treatments and medication has been found effective in reducing the chances of people who fulfill the 'high-risk' criteria from developing full-blown schizophrenia. ^[156] However, the treatment of people who may never develop schizophrenia is controversial, in light of the side-effects of antipsychotic medication; particularly with respect to the potentially disfiguring tardive dyskinesia and the rare but potentially lethal neuroleptic malignant syndrome. Tardive dyskinesia is a variety of dyskinesia (involuntary repetitive movements manifesting as a side effect of long-term or high-dose use of Dopamine antagonists Neuroleptic malignant syndrome (NMS is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. ^[157] The most widely used form of preventative health care for schizophrenia takes the form of public education campaigns that provide information on risk factors, early detection and treatment options. ^[158]

Alternative approaches

An approach broadly known as the anti-psychiatry movement, most active in the 1960s, opposes the orthodox medical view of schizophrenia as an illness. See also Psychiatry See also Biopsychiatry controversy Anti-psychiatry refers to a post-1960s configuration of groups and theoretical constructs ^[159] Psychiatrist Thomas Szasz argued that psychiatric patients are not ill, but rather individuals with unconventional thoughts and behavior that make society uncomfortable. Thomas Stephen Szasz (pronounced /sas/ born April 15, 1920 in Budapest, Hungary) is a Psychiatrist and Academic. ^[160] 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. Social control refers to social mechanisms that regulate individual and group behavior leading to conformity and compliances to the rules of a given Society or According to this view, "schizophrenia" does not actually exist but is merely a form of social construction, created by society's concept of what constitutes normality and abnormality. Social constructionism and social constructivism are sociological and psychological theories of Knowledge that consider how social phenomena develop in 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^[161] 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. Ronald David Laing ( 7 October 1927 – 23 August 1989 was a Scottish Psychiatrist who wrote extensively on Mental illness Silvano Arieti (born in Pisa, Italy on June 28, 1914 and died in New York on August 7, 1981) was a Psychiatrist Theodore Lidz ( 1 April 1910 – 16 February 2001) was an American Psychiatrist best known Colin A Ross is a Psychiatrist of Canadian origin and professional training Laing, Arieti, Lidz and Ross were notable in valuing the content of psychotic experience as worthy of interpretation, rather than considering it simply as a secondary but essentially meaningless marker of underlying psychological or neurological distress. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic 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. ^[162] In 1956, Palo Alto, Gregory Bateson and his colleagues Paul Watzlawick, Donald Jackson, and Jay Haley^[163] articulated a theory of schizophrenia, related to Laing's work, as stemming from double bind situations where a person receives different or contradictory messages. Palo Alto (ˌpæloʊˈæltoʊ from Spanish: palo: "stick" and alto: "high" i Gregory Bateson ( 9 May 1904 – 4 July 1980) was a British anthropologist, social scientist, linguist Paul Watzlawick PhD ( July 24 1921 - March 31 2007) was a theoretician in Communication Theory and Radical Constructivism Don D Jackson (1920-1968 was an American Psychiatrist best known for his pioneering work in Family therapy. Jay Douglas Haley ( July 19, 1923 – February 13, 2007) was one of the more influential psychotherapists of the 20th century A double bind is a dilemma in communication in which an individual (or group receives two or more conflicting messages and one message denies Madness was therefore an expression of this distress and should be valued as a cathartic and trans-formative experience. Catharsis ( Κάθαρσις) is a Greek word meaning "purification" "cleansing" or "clarification 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. Interpretation of Schizophrenia (first edition 1955) is a book written by Psychiatrist Silvano Arieti that won the 1975 scientific The National Book Awards are among the most eminent literary prizes in the United States.

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. Julian Jaynes ( February 27 1920 &ndash November 21 1997) was an American Psychologist, best known for his book The Origin In Psychology, bicameralism is a controversial hypothesis which argues that the human Brain once assumed a state known as a bicameral mind in which ^[164] 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. In Psychology, bicameralism is a controversial hypothesis which argues that the human Brain once assumed a state known as a bicameral mind in which Researchers into shamanism have speculated that in some cultures schizophrenia or related conditions may predispose an individual to becoming a shaman;^[165] 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 states of consciousness psychiatrists label as illness. An altered state of consciousness, (ASC also named altered state of mind is any condition which is significantly different from a normal waking Beta wave state Psychohistorians, on the other hand, accept the psychiatric diagnoses. Psychohistory is the study of the psychological motivations of historical events However, unlike the current medical model of mental disorders they argue that poor parenting in tribal societies causes the shaman's schizoid personalities. Biological psychiatry, or biopsychiatry is an approach to Psychiatry that aims to understand Mental disorder in terms of the biological function Trauma models of mental disorder (alternatively called trauma models of psychopathology) emphasise the effects of Psychological trauma, particularly in early development ^[166] 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. Paul Kurtz (born December 21, 1925 in Newark New Jersey) is Professor Emeritus of Philosophy at the State University of New York at Buffalo ^[167]

Psychiatrist Tim Crow has argued that schizophrenia may be the evolutionary price we pay for a left brain hemisphere specialization for language. Professor Tim Crow is a British Psychiatrist and researcher Much of his research is related to the causes of Schizophrenia. A language is a dynamic set of visual auditory or tactile Symbols of Communication and the elements used to manipulate them ^[168] 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.

Alternative medical treatments

A branch of alternative medicine that deals with schizophrenia is known as orthomolecular psychiatry. The term alternative medicine, as used in the modern western world encompasses any healing practice "that does not fall within the realm of conventional Medicine. Orthomolecular psychiatry is a branch of Orthomolecular medicine, an Alternative medicine known for its claims that Dietary supplements and other unorthodox Orthomolecular psychiatry considers the schizophrenias to be a group of disorders; management entails performing the appropriate diagnostic tests and then providing the appropriate therapy. ^[169] Vitamin B-3 (Niacin) has been proposed as an effective treatment in some cases. Niacin, also known as vitamin B3, is a water-soluble vitamin which prevents the deficiency disease Pellagra. ^[170] The body's adverse reactions to gluten are implicated in some alternative theories; proponents of orthomolecular psychiatric thought claim that an adverse reaction to gluten is involved in the etiology of some cases. Gluten is a composite of the proteins Gliadin and Glutenin. These exist conjoined with Starch, in the Endosperms of some A gluten-free casein-free diet (or GFCF diet) eliminates intake of the naturally-occurring proteins Gluten (found naturally in Wheat, Barley, This theory—discussed by one author in three British journals in the 1970s^[171]—is unproven. A 2006 literature review suggests that gluten may be a factor for patients with celiac disease and for a subset of patients afflicted with schizophrenia, but that further study is needed to conclusively confirm such a link. ^[172] In a 2004 Israeli study, anti-gluten antibodies were measured in 50 schizophrenic patients and a matched control group. All antibody tests in both groups were negative leading to the conclusion that "it is unlikely that there is an association between gluten sensitivity and schizophrenia. "^[173] Some researchers suggest that dietary and nutritional treatments may hold promise in the treatment of schizophrenia. ^[174]

History

Descriptions of schizophrenia-like symptoms date back to circa 2000 BC in the Book of Hearts—part of the ancient Egyptian Ebers Papyrus. Ancient Egyptian Medicine refers to the practices of healing common in Ancient Egypt from Circa 3300 BC until the Persian The Ebers Papyrus of about 1550 BC is among the most important Medical papyri of Ancient Egypt. However, study of the ancient Greek and Roman literature shows that although the general population probably had an awareness of psychotic disorders, there was no recorded condition that would meet the modern criteria for schizophrenia. The term ancient Greece refers to the period of Greek history lasting from the Greek Dark Ages ca Ancient Rome was a Civilization that grew out of a small agricultural community founded on the Italian Peninsula as early as the 10th century BC ^[175] Symptoms resembling schizophrenia were, however, reported in Arabic medical and psychological literature during the Middle Ages. In The Canon of Medicine, for example, Avicenna described a condition somewhat resembling schizophrenia which he called Junun Mufrit (severe madness), which he distinguished from other forms of madness (Junun) such as mania, rabies and manic depressive psychosis. The Canon of Medicine ( Arabic: القانون في الطب Al-Qanun fi al-Tibb " The Law of Medicine " Persian TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition Rabies (from rabies “madness rage fury” Also known as “ hydrophobia ” is a viral Zoonotic neuroinvasive disease that Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic ^[176]

Emil Kraepelin (1856–1926) refined the concept of psychosis. Emil Kraepelin ( February 15, 1856 – October 7, 1926) was a German Psychiatrist. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic

Although a broad concept of madness has existed for thousands of years, schizophrenia was only classified as a distinct mental disorder by Emil Kraepelin in 1893. Traditionally insanity or madness is the behaviour whereby a person flouts societal norms and may become a danger to himself and others Emil Kraepelin ( February 15, 1856 – October 7, 1926) was a German Psychiatrist. He was the first to make a distinction in the psychotic disorders between what he called dementia praecox (literally 'early dementia'—developed from a syndrome first outlined by psychiatrist Bénédict Morel in 1853 and labelled démence précoce) and manic depression. Dementia praecox ("premature Dementia " is a term first used in 1891 in this Latin form by Arnold Pick (1851-1924 a professor of psychiatry at the German Bénédict Augustin Morel ( November 22, 1809 – March 30, 1873) was a French physician who was born in Vienna, Austria Kraepelin believed that dementia praecox was primarily a disease of the brain,^[177] and particularly a form of dementia, distinguished from other forms of dementia, such as Alzheimer's disease, which typically occur later in life. Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Alzheimer's disease ( AD) also called Alzheimer disease or simply Alzheimer's, is the most common form of Dementia. ^[178]

The word schizophrenia—which translates roughly as "splitting of the mind" and comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind")^[179]—was coined by Eugen Bleuler in 1908 and was intended to describe the separation of function between personality, thinking, memory, and perception. The Ancient Greek language is the historical stage in the development of the Hellenic language family spanning the Archaic (c MIND ( Moving In New Directions) (est 1975 is an alternative education high school in Montreal, Quebec, Canada. Paul Eugen Bleuler ( April 30, 1857 – July 15, 1939) was a Swiss psychiatrist most notable for his contributions to the Personality psychology studies personality based on theories of individual differences Thought and thinking are mental forms and Processes respectively ("thought" is both In Psychology, memory is an organism's ability to store retain and subsequently retrieve information In Psychology and the Cognitive sciences perception is the process of attaining awareness or understanding of sensory Information. Bleuler described the main symptoms as 4 A's: flattened Affect, Autism, impaired Association of ideas and Ambivalence. ^[180] Bleuler realized that the illness was not a dementia as some of his patients improved rather than deteriorated and hence proposed the term schizophrenia instead. Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline

The term schizophrenia is commonly misunderstood to mean that affected persons have a "split personality". Although some people diagnosed with schizophrenia may hear voices and may experience the voices as distinct personalities, schizophrenia does not involve a person changing among distinct multiple personalities. The confusion arises in part due to the meaning of Bleuler's term schizophrenia (literally "split" or "shattered mind"). The first known misuse of the term to mean "split personality" was in an article by the poet T. S. Eliot in 1933. Thomas Stearns Eliot, OM (September 26 1888 – January 4 1965 was a poet Dramatist, and Literary critic. ^[181]

In the first half of the twentieth century schizophrenia was considered to be a hereditary defect, and sufferers were subject to eugenics in many countries. Eugenics is a social Philosophy which advocates the improvement of Human Hereditary traits through various forms of intervention Hundreds of thousands were sterilized, with or without consent—the majority in Nazi Germany, the United States, and Scandinavian countries. Sterilization (also spelled sterilisation) is a surgical technique leaving a male or female unable to reproduce. Nazi Germany and the Third Reich are the common English names for Germany under the regime of Adolf Hitler and the National Socialist German Workers The United States of America —commonly referred to as the Terminology and usage As a cultural term "Scandinavia" has no official definition and is subject to usage by those who identify with the culture in question as well ^[182][183] Along with other people labeled "mentally unfit", many diagnosed with schizophrenia were murdered in the Nazi "Action T4" program. Action T4 (Aktion T4 was a program in Nazi Germany spanning October 1939 until August 1941 during which physicians killed 70273 peoplespecified in Hitler's ^[184]

The diagnostic description of schizophrenia has changed over time. It became clear after the 1971 US-UK Diagnostic Study that schizophrenia was diagnosed to a far greater extent in America than in Europe. ^[185] This was partly due to looser diagnostic criteria in the US, which used the DSM-II manual, contrasting with Europe and its ICD-9. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases This was one of the factors in leading to the revision not only of the diagnosis of schizophrenia, but the revision of the whole DSM manual, resulting in the publication of the DSM-III. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association ^[186]

Sociological and cultural aspects

Popular views and misconceptions

Stigma has been identified as a major obstacle in the recovery of patients with schizophrenia. ^[187] 12. 8% of a large, representative sample of Americans in a 1999 study believed that individuals with schizophrenia were "very likely" to do something violent against others, and 48. 1% said that they were "somewhat likely" to. Over 74% said that people with schizophrenia were either "not very able" or "not able at all" to make decisions concerning their treatment, and 70. 2% said the same of money management decisions. ^[188] The perception of individuals with psychosis as violent has more than doubled in prevalence since the 1950s, according to one meta-analysis. ^[189]

As public understanding of mental illness as a neurobiological disorder is yet developing, patients may be discouraged by friends or family members from taking prescribed medication. Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as ^[190] Consumers' views on treatment and recovery may differ from those of mental health professionals. ^[92]

Cultural references

The book and film A Beautiful Mind chronicled the life of John Forbes Nash, a Nobel-Prize-winning mathematician who was diagnosed with schizophrenia. A Beautiful Mind is a 2001 American Biographical film about John Forbes Nash, the Nobel Laureate in Economics. The Nobel Prize (Nobelpriset (Nobelprisen is a Swedish prize established in the 1895 will of Swedish chemist Alfred Nobel; it was first awarded in Peace, Literature The Marathi film Devrai (Featuring Atul Kulkarni) is a presentation of a patient with schizophrenia. Marathi (mr मराठी Marāṭhī) is an Indo-Aryan language spoken by the Marathi people of what is considered western India. Atul Kulkarni (Kannadaಅತುಲ್ ಕುಲಕರ್ಣಿ, born September 10, 1965 in Karnataka, India) is an Indian Actor who has The film, set in the Konkan region of Maharashtra in Western India, shows the behavior, mentality, and struggle of the patient as well as his loved-ones. The Konkan (Marathi कोकण also called the Konkan Coast or Karavali, is a rugged section of the western coastline of India from Raigad Maharashtra ( Marathi: mahārāṣṭra, IPA) is a state located on the western coast of India. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country It also portrays the treatment of this mental illness using medication, dedication and plenty of patience by the close relatives of the patient. Other factual books have been written by relatives on family members; Australian journalist Anne Deveson told the story of her son's battle with schizophrenia in Tell me I'm Here,^[191] later made into a movie. Anne Barbara Deveson AO (born 1930 Malaya) is an Australian Writer, broadcaster, Filmmaker and Social commentator

In Bulgakov's Master and Margarita the poet Ivan Bezdomnyj is institutionalized and diagnosed with schizophrenia after witnessing the devil (Woland) predict Berlioz's death. Mikhail Afanasievich Bulgakov (Михаил Афанасьевич Булгаков, Kiev &ndash March 10, 1940, Moscow) was a Russian The Master and Margarita (Мастер и Маргарита is a novel by Mikhail Bulgakov, woven about the premise of a visit by the Devil to the The book The Eden Express by Mark Vonnegut recounts his struggle with schizophrenia and his recovering journey. The Eden Express A Memoir of Insanity, is a 1975 book by Mark Vonnegut, son of American writer Kurt Vonnegut, about his experiences Mark Vonnegut (born 11 May, 1947) is an American Pediatrician and Writer.

References

Further reading

External links

• Schizophrenia at the Open Directory Project

News, information and further description

• NPR: the sight and sounds of schizophrenia
• The current World Health Organisation definition of Schizophrenia
• Symptoms in Schizophrenia Film made in 1940 showing some of the symptoms of Schizophrenia. The Open Directory Project ( ODP) also known as dmoz (from directory
• Schizophrenics call to Church for understanding, Western Catholic Reporter
• World Fellowship for Schizophrenia and Allied Disorders - 'Information for families caring for people with mental illness'

Critical approaches to schizophrenia

• Leo, Jonathan Ph. D. , & Jay Joseph, Psy. D. Schizophrenia: Medical students are taught it's all in the genes, but are they hearing the whole story?