Schizophrenia (1 of 3):
Schizophrenia (/ˌskɪtsɵˈfrɛniə/ or/ˌskɪtsɵˈfriːniə/) is a mental disorder often characterized by abnormal social behavior and failure to recognize what is real. Common symptoms include false beliefs, unclear or confused thinking, auditory hallucinations, reduced social engagement and emotional expression, and lack of motivation. Diagnosis is based on observed behavior and the person's reported experiences.
Genetics and early environment, as well aspsychological and social processes, appear to be important contributory factors. Some recreational and prescription drugs appear to cause or worsen symptoms. The many possible combinations of symptoms have triggered debate about whether the diagnosis represents a single disorder or a number of separate syndromes. Despite the origin of the term, from Greek skhizein, meaning "to split", and phrēn, meaning "mind", schizophrenia does not imply a "split personality" or "multiple personality disorder" — a condition with which it is often confused in public perception.[1] Rather, the term means a "splitting of mental functions", reflecting the presentation of the illness.[2]
The mainstay of treatment is antipsychoticmedication, which primarily suppressesdopamine receptor activity. Counseling, job training and social rehabilitation are also important in treatment. In more serious cases—where there is risk to self or others—involuntary hospitalization may be necessary, although hospital stays are now shorter and less frequent than they once were.[3]
Symptoms begin typically in young adulthood, and about 0.3–0.7% of people are affected during their lifetime.[4] In 2013 there was estimated to be 23.6 million cases globally.[5] The disorder is thought to mainly affect the ability to think, but it also usually contributes to chronic problems with behavior and emotion. People with schizophrenia are likely to have additional conditions, including major depression andanxiety disorders; the lifetime occurrence ofsubstance use disorder is almost 50%.[6]Social problems, such as long-term unemployment, poverty, and homelessness are common. The average life expectancy of people with the disorder is ten to twenty five years less than the average life expectancy.[7]This is the result of increased physical health problems and a higher suicide rate (about 5%).[4][8] In 2013 an estimated 16,000 people died from behavior related-to or caused by schizophrenia.[9]
Symptoms
Self-portrait of a person with schizophrenia, representing that individual's perception of the distorted experience of reality in the disorder
Individuals with schizophrenia may experience hallucinations (most reported arehearing voices), delusions (often bizarre orpersecutory in nature), and disorganized thinking and speech. The last may range from loss of train of thought, to sentences only loosely connected in meaning, to speech that is not understandable known as word salad in severe cases. Social withdrawal, sloppiness of dress and hygiene, and loss of motivation and judgment are all common in schizophrenia.[10] There is often an observable pattern of emotional difficulty, for example lack of responsiveness.[11]Impairment in social cognition is associated with schizophrenia,[12] as are symptoms ofparanoia. Social isolation commonly occurs.[13] Difficulties in working and long-term memory, attention, executive functioning, and speed of processing also commonly occur.[4] In one uncommon subtype, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation, all signs ofcatatonia.[14] About 30 to 50% of people with schizophrenia fail to accept that they have an illness or their recommended treatment.[15]Treatment may have some effect on insight.[16] People with schizophrenia often find facial emotion perception to be difficult.[17]
Positive and negative
Schizophrenia is often described in terms ofpositive and negative (or deficit) symptoms.[18] Positive symptoms are those that most individuals do not normally experience but are present in people with schizophrenia. They can include delusions, disordered thoughts and speech, and tactile,auditory, visual, olfactory and gustatoryhallucinations, typically regarded as manifestations of psychosis.[19]Hallucinations are also typically related to the content of the delusional theme.[20] Positive symptoms generally respond well to medication.[20]
Negative symptoms are deficits of normal emotional responses or of other thought processes, and are less responsive to medication.[10] They commonly include flat expressions or little emotion, poverty of speech, inability to experience pleasure, lack of desire to form relationships, and lack of motivation. Negative symptoms appear to contribute more to poor quality of life, functional ability, and the burden on others than do positive symptoms.[21] People with greater negative symptoms often have a history of poor adjustment before the onset of illness, and response to medication is often limited.[10][22]
Onset
See also: Pediatric schizophrenia
Late adolescence and early adulthood are peak periods for the onset of schizophrenia,[4]critical years in a young adult's social and vocational development.[23] In 40% of men and 23% of women diagnosed with schizophrenia, the condition manifested itself before the age of 19.[24] To minimize the developmental disruption associated with 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.[23] Those who go on to develop schizophrenia may experience transient or self-limiting psychotic symptoms[25] and the non-specific symptoms of social withdrawal, irritability, dysphoria,[26] and clumsiness[27]during the prodromal phase.
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