Schizophrenia

Schizophrenia is a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social and cognitive occupational dysfunction. Onset of the disease typically occurs in young adulthood with approximately 1% of the population affected. Diagnosis is based on the patient’s self-reported experiences and observed behavior.

Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well. No laboratory test for schizophrenia currently exists. The resulting costs to society are enormous.

Studies suggest that genetic factors, early environment, neurobiology, psychological and social processes are important contributory factors; some recreational and prescription drugs appear to cause or worsen symptoms. Increased dopamine activity in the mesolimbic pathway of the brain is consistently found in schizophrenic individuals.

In addition to the ‘positive’ symptoms (e.g hallucinations) the disorder significantly affects cognition, behavior and emotion. The cognitive deficits in patients is increasingly recognized as both a core feature of the disease and a significant contribution to the residual clinical deficits after the ‘positive’ features have been treated with either first or second generation anti-psychotics.

People with schizophrenia are likely to have additional (comorbid) conditions, including major depression and anxiety disorders. A lifetime occurrence of substance abuse is frequent. Social problems, such as long-term unemployment, poverty and homelessness, are common.

The first line psychiatric treatment for schizophrenia is antipsychotic medication. Second generation ‘atypical’ anti-psychotics are more widely used. These can reduce the positive symptoms of psychosis but they can cause weight gain and metabolic changes associated with an increased risk of diabetes and high cholesterol. Most anti-psychotics take around 7–14 days to have their main effect. Currently available anti-psychotics fail however to significantly ameliorate the negative symptoms and do not improve cognition.