Mental Health Book

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Schizophrenia

Aka: Schizophrenia
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  1. See Also
    1. Psychosis
  2. Epidemiology
    1. Prevalence: 1% across all ethnicity, nationality
    2. Gender: Equal among men and women
      1. Men present in teen and early 20s
      2. Women present in their 20s and 30s
  3. Pathophysiology
    1. Polygenic condition (expression impacted by environ.)
    2. Protective factors in the family environment
      1. Uncommon criticism
      2. Straightforward communication
    3. Neurotransmitter Dopamine
      1. Increased Dopamine exacerbates positive symptoms
      2. Antipsychotics are primarily reduce Dopamine
  4. Risk Factors
    1. Family History (most significant risk)
      1. Monozygotic twin: 50% lifetime Incidence
      2. Dizygotic twin: 17% lifetime Incidence
      3. First degree relative: 6-17% lifetime Incidence
      4. Lewis (2000) Neuron 28:325-34
    2. Other risks (insufficient evidence)
      1. Socioeconomic factors
      2. Maternal infections
  5. Types
    1. See Psychosis Types
  6. Symptoms
    1. See Psychosis Symptoms
    2. Often preceded by prodromal phase
      1. Social withdrawal
      2. Loss of interest in school or work
      3. Hygiene and grooming deteriorate
      4. Angry outbursts
      5. Unusual behavior
  7. Signs
    1. See Psychosis Exam
  8. Labs
    1. See Psychosis Labs
  9. Differential Diagnosis
    1. See Psychosis Differential Diagnosis
  10. Diagnosis
    1. Schizophrenia Diagnosis
  11. Management
    1. See Neuroleptic Medications
    2. Pitfalls
      1. Atypical Antipsychotics offer no significant benefit
        1. Consider low dose first generation agents instead
      2. Patients stop their medications frequently
        1. Patients who stopped meds within 18 months: 74%
        2. Lieberman (2005) New Engl J Med 353:1209-23
      3. Delay in treatment significantly worsens prognosis
        1. Wyatt (1997) Psychol Med 27:261-8
      4. Monotherapy with a single Antipsychotic may be preferred
        1. However more than 50% of Schizophrenia patients may be on more than one Antipsychotic
        2. Consider adjunctive use of Antidepressants or mood stabilizers where appropriate
        3. Consider switching to a different Antipsychotic after an adequate duration and dose
        4. Consider Clozapine
        5. If a second Antipsychotic is required, consider an agent that balances the adverse effects of the first
        6. Barbui (2009) Schizophr Bull 35(2):458-68
  12. Prognosis
    1. High risk of Suicide (10% lifetime risk)
  13. References
    1. (2000) DSM IV, APA, p. 297-343
    2. Freedman (2003) N Engl J Med 349:1738-49
    3. Lewis (2000) Neuron 28:325-34
    4. Schultz (2007) Am Fam Physician 75:1821-9

Schizophrenia (C0036341)

Definition (MSH) A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, HALLUCINATIONS, emotional disharmony, and regressive behavior.
Definition (NCI) A major psychotic disorder characterized by abnormalities in the perception or expression of reality. It affects the cognitive and psychomotor functions. Common clinical signs and symptoms include delusions, hallucinations, disorganized thinking, and retreat from reality.
Definition (MEDLINEPLUS)

Schizophrenia is a severe, lifelong brain disorder. People who have it may hear voices, see things that aren't there or believe that others are reading or controlling their minds. In men, symptoms usually start in the late teens and early 20s. They include hallucinations, or seeing things, and delusions such as hearing voices. For women, they start in the mid-20s to early 30s. Other symptoms include

  • Unusual thoughts or perceptions
  • Disorders of movement
  • Difficulty speaking and expressing emotion
  • Problems with attention, memory and organization

No one is sure what causes schizophrenia, but your genetic makeup and brain chemistry probably play a role. Medicines can relieve many of the symptoms, but it can take several tries before you find the right drug. You can reduce relapses by staying on your medicine for as long as your doctor recommends. With treatment, many people improve enough to lead satisfying lives.

NIH: National Institute of Mental Health
Definition (NCI) A group of severe mental disorders in which a person has trouble telling the difference between real and unreal experiences, thinking logically, having normal emotional responses to others, and behaving normally in social situations. Symptoms include seeing, hearing, feeling things that are not there, having false ideas about what is taking place or who one is, nonsense speech, unusual behavior, lack of emotion, and social withdrawal.
Definition (CSP) class of psychoses with disturbance mainly of cognition (content and form of thought, perception, sense of self versus external world, volition) and psychomotor function, rather than affect.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D012559
ICD9 295.90, 295.9, 295
ICD10 F20, F20.9
SnomedCT 154870000, 192327003, 191528006, 191579000, 58214004, 191526005
English Schizophrenias, Disorder, Schizophrenic, Disorders, Schizophrenic, Schizophrenic Disorder, Schizophrenic Disorders, Unspecified schizophrenia, Dementia praecox, SCHIZOPHRENIAS, Schizophrenia, NOS, Schizophrenia NOS, Schizophrenia, unspecified, Unspecified schizophrenia, unspecified state, [X]Schizophrenia, unspecified, Schizophrenia all types, SCHIZOPHRENIA, SCZD, Schizophrenia, SCHIZOPHRENIC DIS, dementia praecox, schizophrenia, schizophrenic disorders, unspecified schizophrenia, SECTION 9-4 SCHIZOPHRENIAS, schizophrenia (diagnosis), Schizophrenia NOS (disorder), Dementia Praecox, [X]Schizophrenia, unspecified (disorder), Schizophrenia NOS-unspec, Unspecified schizophrenia (disorder), Schizophrenia [Disease/Finding], disorder schizophrenic, schizophrenia types, schizophrenia disorder, disorder schizophrenia, disorders schizophrenic, schizophrenias, disorders schizophrenia, disorders schizophrenics, schizophrenia type, schizophrenic disorder, type schizophrenia, Schizophrenic disorders, Schizophrenia (disorder), Schizophrenic disorders (disorder), praecox; dementia
Dutch schizofrenie NAO, dementia praecox, niet-gespecificeerde schizofrenie, niet-gespecificeerde schizofrenie, niet-gespecificeerde toestand, schizofrene stoornissen, Schizofrenie alle vormen, praecox; dementie, Schizofrenie, niet gespecificeerd, schizofrenie, Schizofrene stoornissen, Schizofrenie
French Schizophrénie SAI, Schizophrénie non précisée, état non précisé, Démence précoce, Schizophrénie non précisée, Schizophrenie tous types, Schizophrénie, Troubles schizophréniques
German Schizophrenie NNB, schizophrene Erkrankungen, unspezifische Schizophrenie,unspezifischer Zustand, unspezifische Schizophrenie, Dementia praecox, Schizophrenie, alle Formen, Schizophrenie, nicht naeher bezeichnet, Schizophrenie, Schizophrene Störungen
Italian Schizofrenia non specificata, Demenza precoce, Schizofrenia NAS, Schizofrenia non specificata, stato non specificato, Disturbi schizofrenici, Schizofrenia tutti i tipi, Schizofrenia
Portuguese Esquizofrenia NE, estado NE, Perturbações esquizofrénicas, Demência precoce, Esquizofrenia NE, Esquizofrenia todos os tipos, Demência Precoce, Esquizofrenia, Transtornos Esquizofrênicos
Spanish Esquizofrenia no especificada, estado no especificado, Demencia precoz, Trastornos esquizofrénicos, Esquizofrenia no especificada, Esquizofrenia NEOM, Esquizofrenia, todos los tipos, Demencia Precoz, [X]esquizofrenia, no especificada (trastorno), [X]esquizofrenia, no especificada, Schizophrenia NOS, esquizofrenia (trastorno), esquizofrenia no especificada (trastorno), esquizofrenia no especificada, esquizofrenia, SAI (trastorno), esquizofrenia, SAI, esquizofrenia, trastornos esquizofrénicos (trastorno), trastornos esquizofrénicos, Esquizofrenia, Trastornos Esquizofrénicos, Trastornos Esquizofrenicos
Japanese 早発性認知症, 統合失調症ＮＯＳ, 詳細不明の統合失調症、状態像詳細不明, 詳細不明の統合失調症, ｼｮｳｻｲﾌﾒｲﾉﾄｳｺﾞｳｼｯﾁｮｳｼｮｳ, ﾄｳｺﾞｳｼｯﾁｮｳｼｮｳ, ｼｮｳｻｲﾌﾒｲﾉﾄｳｺﾞｳｼｯﾁｮｳｼｮｳｼﾞｮｳﾀｲｿﾞｳｼｮｳｻｲﾌﾒｲ, ﾄｳｺﾞｳｼｯﾁｮｳｼｮｳNOS, ｿｳﾊﾂｾｲﾆﾝﾁｼｮｳ, 精神分裂病, 分裂病, 精神乖離症, 精神分裂症, 精神分裂性障害, 分裂症, 統合失調症, 精神かい離症
Swedish Schizofreni, SKIZOFRENI ALLA TYPER
Czech schizofrenie, Schizofrenní poruchy, Schizofrenie NOS, Dementia praecox, Blíže neurčená schizofrenie, Blíže neurčená schizofrenie, blíže neurčený stav, Schizofrenie
Finnish Skitsofrenia, SKITSOFRENIAN KAIKKI MUODOT
Russian SHIZOFRENIIA, SLABOUMIE RANNEE, СЛАБОУМИЕ РАННЕЕ, ШИЗОФРЕНИЯ
Norwegian SCHIZOFRENI ALLE TYPER
Danish Skizofreni alle typer
Hungarian schizophrenia minden faja, Schizophrenia, Dementia praecox, Nem meghatározott schizophrenia, nem meghatározott állapot, Schizophreniás zavarok, Schizophrenia k.m.n., Nem meghatározott schizophrenia
Korean 정신분열병, 상세불명의 정신분열병
Croatian SHIZOFRENIJA
Basque ESKIZOFRENIA, EDOZEIN MOTA
Hebrew sxizofrenia
Polish Otępienie wczesne, Schizofrenia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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