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Contents Schizophrenia
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Schizophrenia is a mental disorder characterized by abnormal behavior, strange speech, and a decreased ability to understand
Schizophrenia
Interaction reality.[2] Other symptoms include false beliefs, unclear or confused thinking, hearing voices that do not exist, reduced social
engagement and emotional expression, and lack of motivation.[2][3] People with schizophrenia often have additional mental health
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About Wikipedia problems such as anxiety, depression, or substance-use disorders.[11] Symptoms typically come on gradually, begin in young
Community portal adulthood, and, in many cases, never resolve.[3][6]
Recent changes
The causes of schizophrenia include environmental and genetic factors.[5] Possible environmental factors include being raised in a city,
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cannabis use during adolescence, certain infections, the age of a person's parents, and poor nutrition during pregnancy.[5][12] Genetic
Tools factors include a variety of common and rare genetic variants.[13] Diagnosis is based on observed behavior, the person's reported
What links here experiences and reports of others familiar with the person.[6] During diagnosis, a person's culture must also be taken into account.[6] As
Related changes of 2013, there is no objective test.[6] Schizophrenia does not imply a "split personality" or dissociative identity disorder, conditions with
Upload file which it is often confused in public perception.[14]
Special pages
Permanent link The mainstay of treatment is antipsychotic medication, along with counselling, job training, and social rehabilitation.[2][5] It is unclear
Page information whether typical or atypical antipsychotics are better.[15] In those who do not improve with other antipsychotics, clozapine may be
Wikidata item tried.[5] In more serious situations where there is risk to self or others, involuntary hospitalization may be necessary, although hospital
Cite this page stays are now shorter and less frequent than they once were.[16]
Self-portrait of a person with schizophrenia,
In other projects About 0.3% to 0.7% of people are affected by schizophrenia during their lifetimes.[9] In 2013, there were an estimated 23.6 million representing their distorted perception of reality
Wikimedia Commons cases globally.[17] Males are more often affected and on average experience more severe symptoms.[2] About 20% of people eventually Pronunciation /ˌskɪtsəˈfriːniə/, UK also /ˌskɪdzə-/,
Wikiquote do well, and a few recover completely.[6] About 50% have lifelong impairment.[18] Social problems, such as long-term unemployment, US also /-ˈfrɛniə/[1]
poverty, and homelessness, are common.[6][19] The average life expectancy of people with the disorder is 10–25 years less than that of Specialty Psychiatry
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the general population.[8] This is the result of increased physical health problems and a higher suicide rate (about 5%).[9][20] In 2015, an Symptoms False beliefs, confused thinking,
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estimated 17,000 people worldwide died from behavior related to, or caused by, schizophrenia.[10] hearing voices others do not[2][3]
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Printable version
Complications Suicide, heart disease, lifestyle
Contents [hide] diseases[4]
Languages 1 Signs and symptoms Usual onset Ages 16 to 30[3]
1.1 Symptom organization Duration Chronic[3]
Deutsch
1.2 Cognitive dysfunction
Español Causes Environmental and genetic factors[5]
Français 1.3 Onset
Risk factors Family history, cannabis use, problems
2 Causes during pregnancy, being raised in a
Italiano 2.1 Genetic city, older father[5]
Русский 2.2 Environment Diagnostic Based on observed behavior, reported
Tagalog 3 Mechanisms method experiences, and reports of others
Tiếng Việt familiar with the person[6]
4 Diagnosis
4.1 Criteria Differential Substance misuse, Huntington's
89 more diagnosis disease, mood disorders (bipolar
4.2 Subtypes
disorder), autism[7]
Edit links 4.3 Differential diagnosis
Treatment Counselling, job training[2][5]
5 Prevention
Medication Antipsychotics[5]
6 Management
Prognosis 18–20 years shorter life
6.1 Medication
expectancy[8][4]
6.2 Psychosocial
Frequency ~0.5%[9]
7 Prognosis
Deaths ~17,000 (2015)[10]
8 Epidemiology
9 History
10 Society and culture
10.1 Violence
11 Research directions
12 References
13 External links

Signs and symptoms

Video summary (script)
See also: Basic symptoms of schizophrenia

People with schizophrenia may experience hallucinations (most reported are hearing voices), delusions (often bizarre or persecutory
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. Social withdrawal, sloppiness of dress and hygiene, and loss of motivation and judgment
are all common in schizophrenia.[21]

Distortions of self-experience such as feeling as if one's thoughts or feelings are not really one's own to believing thoughts are being inserted into
one's mind, sometimes termed passivity phenomena, are also common.[22] There is often an observable pattern of emotional difficulty, for example
lack of responsiveness.[23] Impairment in social cognition is associated with schizophrenia,[24] as are symptoms of paranoia. Social isolation
commonly occurs.[25] Difficulties in working and long-term memory, attention, executive functioning, and speed of processing also commonly
occur.[9] In one uncommon subtype, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation, all My Eyes at the Moment of the
signs of catatonia.[26] People with schizophrenia often find facial emotion perception to be difficult.[27] It is unclear if the phenomenon called "thought Apparitions by German artist August
blocking", where a talking person suddenly becomes silent for a few seconds to minutes, occurs in schizophrenia.[28][29] Natterer, who had schizophrenia

About 30 to 50 percent of people with schizophrenia fail to accept that they have an illness or comply with their recommended treatment.[30]
Treatment may have some effect on insight.[31]

People with schizophrenia may have a high rate of irritable bowel syndrome, but they often do not mention it unless specifically asked.[32] Psychogenic polydipsia, or excessive fluid intake in
the absence of physiological reasons to drink, is relatively common in people with schizophrenia.[33]
Symptom organization
Schizophrenia is often described in terms of positive and negative (or deficit) symptoms.[34] Positive symptoms are those that most people 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 gustatory hallucinations, typically regarded as manifestations of psychosis.[35] Hallucinations are also typically related
to the content of the delusional theme.[36] Positive symptoms generally respond well to medication.[36]

Negative symptoms are deficits of normal emotional responses or of other thought processes, and are less responsive to medication.[21] 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 positive Cloth embroidered by a person
diagnosed with schizophrenia
symptoms do.[18][37] People with greater negative symptoms often have a history of poor adjustment before the onset of illness, and response to
medication is often limited.[21][38]

The validity of the positive and negative construct has been challenged by factor analysis studies observing a three dimension grouping of symptoms. Different terminology is used, but a
dimension for hallucinations, a dimension for disorganization, and a dimension for negative symptoms are usually described.[39]

Cognitive dysfunction
Deficits in cognitive abilities are widely recognized as a core feature of schizophrenia.[40][41][42] The extent of the cognitive deficits someone experiences is a predictor of how functional they
will be, the quality of occupational performance, and how successful they will be in maintaining treatment.[43] The presence and degree of cognitive dysfunction in people with schizophrenia
has been reported to be a better indicator of functionality than the presentation of positive or negative symptoms.[40] The deficits impacting the cognitive function are found in a large number
of areas: working memory, long-term memory,[44][45] verbal declarative memory,[46] semantic processing,[47] episodic memory,[43] attention,[18] learning (particularly verbal learning).[44]
Deficits in verbal memory are the most pronounced in someone with schizophrenia, and are not accounted for by deficit in attention. Verbal memory impairment has been linked to a
decreased ability in those with schizophrenia to semantically encode (process information relating to meaning), which is cited as a cause for another known deficit in long-term memory.[44]
When given a list of words, healthy people remember positive words more frequently (known as the Pollyanna principle), but people with schizophrenia tend to remember all words equally
regardless of their connotations, suggesting that the experience of anhedonia impairs the semantic encoding of the words.[44] These deficits have been found in people before the onset of the
illness to some extent.[40][42][48] First-degree family members of those with schizophrenia and other high-risk people also show a degree of deficit in cognitive abilities, and specifically in
working memory.[48] A review of the literature on cognitive deficits in people with schizophrenia shows that the deficits may be present in early adolescence, or as early as childhood.[40] The
deficits which a person with schizophrenia presents tend to remain the same over time in most patients, or follow an identifiable course based upon environmental variables.[40][44]

Although the evidence that cognitive deficits remain stable over time is reliable and abundant,[43][44] much of the research in this domain focuses on methods to improve attention and
working memory.[44][45] Efforts to improve learning ability in people with schizophrenia using a high- versus low-reward condition and an instruction-absent or instruction-present condition
revealed that increasing reward leads to poorer performance while providing instruction leads to improved performance, highlighting that some treatments may exist to increase cognitive
performance.[44] Training people with schizophrenia to alter their thinking, attention, and language behaviors by verbalizing tasks, engaging in cognitive rehearsal, giving self-instructions,
giving coping statements to the self to handle failure, and providing self-reinforcement for success, significantly improves performance on recall tasks.[44] This type of training, known as self-
instructional (SI) training, produced benefits such as lower number of nonsense verbalizations and improved recall when distracted.[44]

Onset
See also: Schizophrenia in children

Late adolescence and early adulthood are peak periods for the onset of schizophrenia,[9] critical years in a young adult's social and vocational development.[49] In 40% of men and 23% of
women diagnosed with schizophrenia, the condition manifested itself before the age of 19.[50] The most general symptoms of schizophrenia tend to appear between ages 16 and 30.[3][6] The
onset of the disorder is usually between ages 18 and 25 for men and between 25 and 35 for women.[51] 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 disorder, which has been detected up to 30 months before the onset of symptoms.[49] Those who go on to
develop schizophrenia may experience transient or self-limiting psychotic symptoms[52] and the non-specific symptoms of social withdrawal, irritability, dysphoria,[53] and clumsiness before
the onset of the disease.[54] Children who go on to develop schizophrenia may also demonstrate decreased intelligence, decreased motor development (reaching milestones such as walking
slowly), isolated play preference, social anxiety, and poor school performance.[55][56][57]

Causes
Main article: Causes of schizophrenia

A combination of genetic and environmental factors play a role in the development of schizophrenia.[9][14] People with a family history of schizophrenia who have a transient psychosis have a
20–40% chance of being diagnosed one year later.[58]

Genetic
Estimates of the heritability of schizophrenia is around 80%, which implies that 80% of the individual differences in risk to schizophrenia is associated with genetics.[59] These estimates vary
because of the difficulty in separating genetic and environmental influences.[60] The greatest single risk factor for developing schizophrenia is having a first-degree relative with the disease
(risk is 6.5%); more than 40% of monozygotic twins of those with schizophrenia are also affected.[14] If one parent is affected the risk is about 13% and if both are affected the risk is nearly
50%.[59] Results of candidate gene studies of schizophrenia have generally failed to find consistent associations,[61] and the genetic loci identified by genome-wide association studies as
associated with schizophrenia explain only a small fraction of the variation in the disease.[62]

Many genes are known to be involved in schizophrenia, each of small effect and unknown transmission and expression.[13][63] The summation of these effect sizes into a polygenic risk score
can explain at least 7% of the variability in liability for schizophrenia.[64] Around 5% of cases of schizophrenia are understood to be at least partially attributable to rare copy number variants
(CNVs), including 22q11, 1q21 and 16p11.[65] These rare CNVs increase the risk of someone developing the disorder by as much as 20-fold, and are frequently comorbid with autism and
intellectual disabilities.[65] There is a genetic relation between the common variants which cause schizophrenia and bipolar disorder, an inverse genetic correlation with intelligence and no
genetic correlation with immune disorders.[66]

Environment
Environmental factors associated with the development of schizophrenia include the living environment, drug use, and prenatal stressors.[9]

Maternal stress has been associated with an increased risk of schizophrenia, possibly in association with reelin. Maternal Stress has been observed to lead to hypermethylation and therefore
under-expression of reelin, which in animal models leads to reduction in GABAergic neurons, a common finding in schizophrenia.[67] Maternal nutritional deficiencies, such as those observed
during a famine, as well as maternal obesity have also been identified as possible risk factors for schizophrenia. Both maternal stress and infection have been demonstrated to alter fetal
neurodevelopment through pro-inflammatory proteins such as IL-8 and TNF.[68][69]

Parenting style seems to have no major effect, although people with supportive parents do better than those with critical or hostile parents.[14] Childhood trauma, death of a parent, and being
bullied or abused increase the risk of psychosis.[70][71] Living in an urban environment during childhood or as an adult has consistently been found to increase the risk of schizophrenia by a
factor of two,[9][14] even after taking into account drug use, ethnic group, and size of social group.[72] Other factors that play an important role include social isolation and immigration related
to social adversity, racial discrimination, family dysfunction, unemployment, and poor housing conditions.[14][73]

It has been hypothesized that in some people, development of schizophrenia is related to intestinal tract dysfunction such as seen with non-celiac gluten sensitivity or abnormalities in the
intestinal flora.[74] A subgroup of persons with schizophrenia present an immune response to gluten different from that found in people with celiac, with elevated levels of certain serum
biomarkers of gluten sensitivity such as anti-gliadin IgG or anti-gliadin IgA antibodies.[75]

Substance use

About half of those with schizophrenia use drugs or alcohol excessively.[76] Amphetamine, cocaine, and to a lesser extent alcohol, can result in a transient stimulant psychosis or alcohol-
related psychosis that presents very similarly to schizophrenia.[14][77] Although it is not generally believed to be a cause of the illness, people with schizophrenia use nicotine at much higher
rates than the general population.[78]
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