Schizophrenia is a mental disorder characterized by abnormal social behavior and failure to understand reality. Common symptoms include false beliefs, unclear or confused thoughts, hearing voices that others do not, reducing social engagement and emotional expression, and lack of motivation. People with schizophrenia often have additional mental health problems such as anxiety disorders, depression, or substance use. Symptoms usually appear gradually, starting in young adulthood, and lasting longer.
The causes of schizophrenia include environmental and genetic factors. Possible environmental factors include being raised in the city, use of marijuana during adolescence, certain infections, parental ages and malnutrition during pregnancy. Genetic factors include various common and rare genetic variants. The diagnosis is based on the observed behavior, the person reports the experiences and reports of others who are familiar with the person. During diagnosis, one's culture must also be taken into account. In 2013 there is no objective test. Schizophrenia does not imply "multiple personality" or "dissociative identity disorder" - a condition that is often confusing in public perception.
The mainstay of treatment is the antipsychotic drug, along with counseling, job training and social rehabilitation. It is unclear whether typical or atypical antipsychotics are better. In those who do not improve with other antipsychotics, clozapine can be tried. In more serious situations where there is a risk to yourself or others, unauthorized hospital care may be necessary, even though the hospital stay is now shorter and less frequent than before.
Approximately 0.3-0.7% of people are exposed to schizophrenia during their lifetime. In 2013 it is estimated there are 23.6 million cases globally. Men are more commonly affected, and on average experience more severe symptoms. About 20% of people do well and some heal completely. Approximately 50% experience a lifetime decline. Social problems, such as long-term unemployment, poverty and homelessness are common. The average life expectancy of people with this disorder is ten to twenty five years less than for the general population. This is the result of an increase in physical health problems and a higher suicide rate (about 5%). By 2015, about 17,000 people worldwide die from behavior related to, or caused by, schizophrenia.
Video Schizophrenia
Signs and symptoms
Individuals with schizophrenia may experience hallucinations (most commonly heard are hearing sounds), delusions (often strange or torture in nature), and irregular thoughts and speeches. The latter can range from the loss of the train of thought, until the sentences are only loosely connected in a sense, to the unintelligible utterance known as the word salad. Social withdrawal, carelessness of clothing and cleanliness, and loss of motivation and judgment are all common in schizophrenia.
The distortion of self-experience is like feeling as if one's thoughts or feelings do not really belong to someone to believe that the mind is being put into one's mind, sometimes called passive phenomena, is also common. Often there are emotional distress patterns that can be observed, such as lack of response. Disorders in social cognition are associated with schizophrenia, as are the symptoms of paranoia. Social isolation is common. Difficulties in work and long-term memory, attention, executive function, and processing speed are also common. In an unusual subtype, the person may be mostly mute, remain immobile in strange postures, or show aimless agitation, all signs of catatonia. People with schizophrenia often find facial perceptions to be difficult. It is not clear what a phenomenon called "blocking thinking," in which the person who speaks suddenly becomes silent for a few seconds to a minute, occurs in schizophrenia.
About 30 to 50 percent of people with schizophrenia fail to accept that they have the disease or adhere to the recommended treatment. Treatment may have some effect on outlook.
People with schizophrenia may have high rates of irritable bowel syndrome but they often do not mention it unless specifically requested. Psychogenic polydipsia, or excessive fluid intake in the absence of physiological reasons for drinking, is relatively common in people with schizophrenia.
Organization symptoms
Schizophrenia is often described in the form of positive and negative symptoms (or deficits). Positive symptoms are symptoms that most people do not experience, but are present in people with schizophrenia. They can include delusions, irregular thoughts and speech, and touch, auditory, visual, olfactory and gustatory hallucinations, usually considered a manifestation of psychosis. Hallucinations are also usually associated with delusional theme content. Positive symptoms generally respond well to drugs.
Negative symptoms are normal emotional response deficits or other thought processes, and are less responsive to drugs. They usually include flat expression or slight emotion, speech poverty, inability to experience pleasure, lack of willingness to form relationships, and lack of motivation. Negative symptoms appear to contribute more to poor quality of life, functional ability, and burden on others than positive symptoms. People with larger negative symptoms often have a poor history of adjustment before the onset of the disease, and drug responses are often limited.
The validity of positive and negative constructs has been challenged by factor analysis studies observing the grouping of three dimensional symptoms. While different terminology is used, the dimensions for hallucinations, dimensions for disorganization, and dimensions for negative symptoms are usually described.
Cognitive dysfunction
The deficit in cognitive abilities is widely recognized as a core feature of schizophrenia. The broad cognitive deficits of individual experience are predictors of how an individual will function, the quality of job performance, and how successful individuals will be in maintaining care. The presence and extent of cognitive dysfunction in individuals with schizophrenia has been reported as a better indicator of functionality than presentation of positive or negative symptoms. The deficits that affect cognitive function are found in a large number of areas: working memory, long-term memory, verbal declarative memory, semantic processing, episodic memory, attention, learning (especially verbal learning). Deficits in verbal memory are the most prominent in individuals with schizophrenia, and are not noted by deficits in attention. Verbal memory impairment has been associated with decreased ability in individuals with schizophrenia to encode semantics (process information relating to meaning), cited as the cause of other known deficits in long-term memory. When given a list of words, healthy individuals more often remember positive words (known as Pollyanna principles); However, individuals with schizophrenia tend to remember all words equally regardless of their connotations, suggesting that anhedonic experiences undermine the semantic coding of words. This deficit has been found in individuals before the onset of the disease to some extent. First-degree family members of individuals with schizophrenia and other high-risk individuals also exhibit deficit levels in cognitive abilities, and particularly in working memory. A literature review of cognitive deficits in individuals with schizophrenia suggests that deficits may be present early in adolescence, or as early as childhood. The deficits experienced by individuals with schizophrenia tend to remain the same over time in most patients, or follow an identifiable path based on environmental variables.
Although the evidence that cognitive deficits remain stable over time is reliable and abundant, much of the research in this domain focuses on methods of increasing attention and working memory. Attempts to improve learning ability in individuals with schizophrenia using high-versus low-reward conditions and absent or present-instruction conditions reveal that increased awards lead to poorer performance while providing instruction leading to improved performance, highlighting that some treatments may be present to improve cognitive performance. Train individuals with schizophrenia to change their thinking, attention, and language behavior by exposing tasks, engaging in cognitive exercises, self-instruction, self-addressing to deal with failure, and providing self-reinforcement for success, significantly improving performance at remember the task. This type of training, known as self-instructional training (SI), results in benefits such as lower amounts of nonsense verbalization and increased memory impairment.
Onset
Early adolescence and early adulthood were the peak periods for the onset of schizophrenia, the critical years in the social and vocational development of young adults. In 40% of men and 23% of women diagnosed with schizophrenia, the condition manifests before the age of 19 years. The onset of this disease usually occurs in women than in men. To minimize developmental disorders associated with schizophrenia, much work has recently been done to identify and treat the prodrome phase (pre-onset) disease, which has been detected up to 30 months before the onset of symptoms. Those who continue to develop schizophrenia may experience temporary psychotic symptoms or self-limiting and non-specific symptoms of social withdrawal, irritability, dysphoria, and awkwardness before the onset of the disease. Children who continue to develop schizophrenia may also show a decrease in intelligence, decreased motor development (achieving milestone such as slow walking), insulated play preferences, social anxiety, and poor school performance.
Maps Schizophrenia
Cause
The combination of genetic and environmental factors plays a role in the development of schizophrenia. People with a family history of schizophrenia who have temporary psychosis have a 20-40% chance of being diagnosed one year later.
Genetic
The approximate heritability of schizophrenia is about 80%, which implies that 80% of individual differences in schizophrenia risk are explained by individual differences in genetics. These estimates vary because of the difficulty in separating genetic and environmental influences. The single largest risk factor for developing schizophrenia is to have first-degree relatives with the disease (risk is 6.5%); more than 40% of monozygotic twins from those with schizophrenia were also affected. If one parent is exposed to risk is about 13% and if both are exposed to almost 50% risk.
Many genes are known to be involved in schizophrenia, each small effect and unknown transmission and expression. The sum of these effect sizes into a polygenic risk score can account for at least 7% of the variability in the obligations for schizophrenia. About 5% of cases of schizophrenia are understood at least in part due to the variant of rare copy number (CNV), including 22q11, 1q21 and 16p11. This rare CNV increases the risk of an individual developing disorders as much as 20-fold, and is often comorbid with autism and intellectual disability. There is a genetic relationship between the common variant that causes schizophrenia and bipolar disorder, reversed genetic correlation with intelligence and no genetic correlation with immune disorders.
Environment
Environmental factors associated with the development of schizophrenia include environmental, drug use, and prenatal stress.
Maternal stress has been associated with an increased risk of schizophrenia, possibly in association with reelin. Maternal stress has been observed to cause hypermethylation and hence the lack of reelin expression, which in animal models leads to decreased GABAergic neurons, a common finding in schizophrenia. Maternal nutritional deficiencies, as observed during hunger, 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 the development of the fetal nerve through pro-inflammatory proteins such as IL-8 and TNF.
The nurturing style does not seem to have much effect, though people with supportive parents are better than critical or hostile parents. Child trauma, parental death, and being bullied or abused increase the risk of psychosis. 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, even after taking into account the use of drugs, ethnic groups, and the size of social groups. Other factors that play an important role include social isolation and immigration related to social difficulties, racial discrimination, family dysfunction, unemployment, and poor housing conditions.
It has been hypothesized that in some people, the development of schizophrenia is associated with bowel dysfunction as seen with non-celiac gluten sensitivity or abnormalities in intestinal flora. A subgroup of people with schizophrenia presents 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 IgG anti-gliadin or anti-gliadin IgA antibodies.
Use of substance
About half of those with schizophrenia use drugs or alcohol excessively. Lower levels of amphetamines, cocaine, and alcohol may produce temporary stimulant psychosis or alcohol-related psychosis that is very similar to schizophrenia. Although generally not believed to be the cause of the disease, people with schizophrenia use nicotine at a much higher rate than the general population.
Alcohol abuse can sometimes lead to the development of chronic induced psychotic disorders through the mechanism of kindling. Alcohol use is not associated with previous onset of psychosis.
Cannabis can be a contributing factor to schizophrenia, potentially leading to illness in those already at risk. Increased risk may require the presence of certain genes in the individual or may be related to a pre-existing psychopathology. Initial exposure is strongly associated with increased risk. The size of the increased risk is unclear, but it appears to be in the range of two to three times greater for psychosis. Higher doses and greater frequency of use are indicators of an increased risk of chronic psychosis.
Other drugs can be used only as a coping mechanism by individuals who have schizophrenia, to deal with depression, anxiety, boredom, and loneliness.
Development factors
Factors such as hypoxia and infection, or maternal stress and malnutrition during fetal development, may lead to a slightly increased risk of schizophrenia later in life. People diagnosed with schizophrenia are more likely to be born in winter or spring (at least in the northern hemisphere), which may be a result of increased levels of exposure to the virus in the womb. Risk increases are about five to eight percent. Other infections during pregnancy or around the time of birth that may increase the risk include Toxoplasma gondi and Chlamydia .
Mechanism
A number of attempts have been made to explain the relationship between changes in brain function and schizophrenia. One of the most common is the dopamine hypothesis, which associates psychosis with a false interpretation of the mind against misguided dopaminergic neurons.
Psychological
Many psychological mechanisms have been implicated in the development and maintenance of schizophrenia. Cognitive biases have been identified in those with diagnoses or those at risk, especially when under stress or in confusing situations. Some cognitive features may reflect global neurocognitive deficits such as memory loss, while others may be associated with certain problems and experiences.
Although the appearance shows a dull effect, recent findings suggest that many individuals diagnosed with schizophrenia are emotionally responsive, especially to stress or negative stimuli, and that such sensitivity may lead to susceptibility to symptoms or disorders. Some evidence suggests that the delusional beliefs and psychotic experiences can reflect the emotional causes of the disorder, and that how one interprets the experience may affect symptomatology. The use of "security behavior" (actions such as gestures or the use of words in certain contexts) to avoid or neutralize threats imagined can actually contribute to delusional cruelty. Further evidence for the role of psychological mechanisms derives from the effects of psychotherapy on the symptoms of schizophrenia.
Neurological
Schizophrenia is associated with subtle differences in brain structure, found in forty to fifty percent of cases, and in brain chemistry during acute psychotic states. Studies using neuropsychological tests and brain imaging technologies such as fMRI and PET to examine differences in function in brain activity have shown that differences seem to be most common in the frontal lobe, hippocampus and temporal lobes. The decrease in brain volume is most prominent in the gray matter structure, and correlates with the duration of the disease, although white matter abnormalities have also been found. A progressive increase in ventricular volume as well as progressive reduction in gray matter in the frontal, parietal, and temporal lobes has also been observed. These differences have been associated with a neurocognitive deficit often associated with schizophrenia. Because neural circuits are altered, it's an alternative to have suggested that schizophrenia can be regarded as a neurodevelopmental disorder with psychosis occurring as an end-stage that might be preventable. There is a debate about whether treatment with antipsychotics itself can lead to a reduction in brain volume.
Particular attention has been paid to dopamine function in the mesolimbic pathway of the brain. This focus is largely derived from the unintentional finding that phenothiazine drugs, which block the function of dopamine, can alleviate psychotic symptoms. This is also supported by the fact that amphetamines, which trigger dopamine release, may exacerbate psychotic symptoms in schizophrenia. The influential dopamine hypothesis of schizophrenia suggests that overactivation of D 2 receptor is the cause (positive symptom) of schizophrenia. Although postulated for about 20 years under the general D 2 blockade effect for all antipsychotics, it was not until the mid-1990s that PET and SPET imaging studies provided supporting evidence. While D2/D3 dopamine receptors are elevated in schizophrenia, the effect size is small, and is only seen in naive schizophrenics. On the other hand, presinaptic dopamine metabolism and release increased although there was no difference in dopamine transporters. The synthesis of altered dopamine in the nigrostriatal system has been confirmed in several studies in humans. Hypoactivity of dopamine D1 receptor activation in the prefrontal cortex has also been observed. D2 receptor stimulation hyperactivity and relative hypoactivity of D1 receptor stimulation are thought to contribute to cognitive dysfunction by interfering with the signal to noise ratio in cortical microkircuits. The dopamine hypothesis is now considered simplistic, in part because newer antipsychotic drugs (atypical antipsychotic drugs) can be as effective as older drugs (typical antipsychotic drugs), but also affect serotonin function and may have little dopamine-blocking effect.
Interest also focused on glutamate neurotransmitters and reduced function of NMDA glutamate receptors in schizophrenia, in large part due to the low abnormal glutamate receptor levels found in postmortem brains of those diagnosed with schizophrenia, and the discovery that glutamate inhibitors such as phencyclidine and ketamine can mimics the symptoms and cognitive problems associated with the condition. Reduced glutamate function is associated with poor performance on tests requiring frontal lobes and hippocampal function, and glutamate can affect dopamine function, both of which have been implicated in schizophrenia; this has demonstrated the important (and possibly causal) mediating role of the glutamate pathway under these conditions. But positive symptoms fail to respond to glutamatergic drugs. Closely related to evidence of glutamic dysfunction in schizophrenia is a change observed in GABAergic transmission. Post-Mortem studies show decreased expression of GAD67, GAT-1 and GABA sub-substituted A sub/sub subtitles in the prefrontal cortex, although this appears to be confined to a specific subset of parvalbumin containing GABAergic neurons. While the in vivo imaging of GABAergic signaling appears to be considerably reduced, this may depend on the stage of treatment and disease.
Diagnosis
Schizophrenia is diagnosed based on criteria both in the fifth edition of the American Psychiatric Association (APA) of the Diagnostic and Statistical Manual of Mental Disorder (DSM 5), or the International Statistical Classification of the World Health Organization and Related Health Issues (ICD-10). This criterion uses the self-reported experience of the person and reports behavioral abnormalities, followed by clinical judgment by mental health professionals. The symptoms associated with schizophrenia occur along the continuum in the population and must reach a certain degree of severity and degree of damage, before the diagnosis is made. In 2013 there is no objective test.
Criteria
In 2013, the American Psychiatric Association released the fifth edition of DSM (DSM-5). To be diagnosed with schizophrenia, two diagnostic criteria must be met for a period of at least one month, with significant impact on social or occupational function for at least six months. The person must suffer from delusions, hallucinations, or irregular speeches. The second symptom can be a negative symptom, or a very irregular or catatonic behavior. The definition of schizophrenia remains essentially the same as that defined by the 2000 DSM version (DSM-IV-TR), but the DSM-5 makes a number of changes.
- The classification subtypes - such as catatonic and paranoid schizophrenia Ã, - are removed. This was retained in the previous revision largely for reasons of tradition, but later proved to be of little value.
- Catatonia is no longer strongly associated with schizophrenia.
- In describing a person's schizophrenia, it is suggested that better distinction be made between the current state of the condition and its historical progress, to achieve a clearer overall characterization.
- Special treatments for Schneider's first rank symptoms are no longer recommended.
- Skizoaffective disorder is better defined by a clearer demarcation of schizophrenia.
- An assessment that includes eight domains of psychopathology - such as whether hallucinations or mania are experienced - is suggested to aid clinical decision making.
ICD-10 criteria are commonly used in European countries, whereas DSM criteria are used in the United States and for various levels worldwide, and apply in research. The ICD-10 criterion places more emphasis on Schneiderian's first rankings. In practice, the agreement between the two systems is high. The current proposal for ICD-11 criteria for schizophrenia recommends adding self-impairment as a symptom.
If signs of the disorder are present for more than a month but less than six months, the diagnosis of schizophrenia disorder is applied. Psychotic symptoms lasting less than a month can be diagnosed as brief psychotic disorders, and various conditions may be classified as unspecified psychotic disorders, while schizoaffective disorder is diagnosed if symptoms of mood disorder are substantially present with psychotic symptoms. If psychotic symptoms are a direct physiological outcome of a general medical condition or a substance, then the diagnosis is one of the secondary psychoses for that condition. Schizophrenia is not diagnosed if symptoms of pervasive developmental disorder are present unless prominent delusions or hallucinations are present.
Subtype
With the publication of DSM-5, APA removed all the subclassifications of schizophrenia. Five sub-classifications included in the DSM-IV-TR are:
- Types of paranoia: Delusions or auditory hallucinations are present, but mind disorder, irregular behavior, or affective alignment do not. Delusions are persecution and/or grandiose, but otherwise, other themes such as jealousy, religiosity, or somatization can also be present. (Code DSM 295.3/ICD code F20.0)
- Unorganized type: Named schizophrenia hebephrenic on ICD. Where mind and flat distractions are present together. (Code DSM 295.1/ICD code F20.1)
- Catatonic Type: The subject may be barely moving or showing restless and purposeless movements. Symptoms can include faint catatonic and waxy flexibility. (Code DSM 295.2/ICD code F20.2)
- Undifferentiated Type: Psychotic symptoms present but criteria for paranoid, unorganized, or catatonic types have not been met. (Code DSM 295.9/ICD code F20.3)
- Residual type: Where positive symptoms are present only with low intensity. (Code DSM 295.6/ICD code F20.5)
ICD-10 defines additional subtypes:
- Post-schizophrenia depression: The episodes of depression that arise after the onset of schizophrenia where some of the symptoms of low-grade schizophrenia may still exist. (ICD Code F20.4)
- Simple schizophrenia: The adverse and progressive development of prominent negative symptoms without a history of psychotic episodes. (ICD Code F20.6)
- Other schizophrenia include schizophrenia cenesthopathic and schizophreniform disorder NOS (ICD code F20.8).
Differential diagnosis
Psychotic symptoms may appear in some other mental disorders, including bipolar disorder, threshold personality disorder, drug toxicity, and drug induced psychosis. Delusions ("non-peculiar") are also present in delusional disorders, and social withdrawal in social anxiety disorders, avoidant personality disorder and schizotypal personality disorder. Schizotypal personality disorders have similar symptoms but are less severe than schizophrenia. Schizophrenia occurs along with obsessive-compulsive disorder (OCD) much more often than can be explained by chance, although it can be difficult to distinguish the obsessions that occur in OCD from schizophrenic delusions. Some people withdraw from benzodiazepines have severe withdrawal syndromes that can last a long time. It may resemble schizophrenia and can be misdiagnosed as such.
More general medical and neurologic examinations may be needed to rule out medical illnesses that may rarely produce symptoms of schizophrenia such as psychotics, such as metabolic disorders, systemic infections, syphilis, AIDS dementia complexes, epilepsy, limbic encephalitis, and brain lesions. Stroke, multiple sclerosis, hyperthyroidism, hypothyroidism, and dementia such as Alzheimer's disease, Huntington's disease, frontotemporal dementia, and Lewy's dementia can also be associated with psychotic symptoms of schizophrenia. It may be necessary to rule out delirium, which can be distinguished by visual hallucinations, acute onset and fluctuating levels of consciousness, and suggests underlying medical illness. Investigations are generally not repeated to relapse unless there is a special medical indication or possible side effects of antipsychotic drugs. In children hallucinations must be separated from typical childhood fantasies.
Prevention
Prevention of schizophrenia is difficult because there is no reliable marker for further development of the disorder. There is transient evidence for the effectiveness of early intervention to prevent schizophrenia. Although there is some evidence that early intervention in those with psychotic episodes may improve short-term outcomes, there is little benefit from this action after five years. Trying to prevent schizophrenia in the prodrom phase is an uncertain benefit and therefore in 2009 is not recommended. Cognitive behavioral therapy can reduce the risk of psychosis in those at high risk after one year and is recommended in this group, by the National Institute for Health and Care Excellence (NICE). Another measure of prevention is to avoid drugs associated with developmental disorders, including marijuana, cocaine, and amphetamines.
Management
The primary treatment of schizophrenia is the antipsychotic drug, often combined with psychological and social support. Hospitalization can occur for severe episodes either voluntarily or (if mental health legislation permits) unconsciously. Long term hospitalization is rare since deinstitutionalization began in the 1950s, although it still occurs. Community support services including drop-in centers, visits by members of the community mental health team, work support and support groups are common. Some evidence suggests that regular exercise has a positive effect on their physical and mental health with schizophrenia.
Medication
First-line psychiatric treatment for schizophrenia is an antipsychotic drug, which can reduce the positive symptoms of psychosis in about 7 to 14 days. Antipsychotics, however, fail to significantly improve negative symptoms and cognitive dysfunction. In those taking antipsychotics, continued use reduces the risk of relapse. There is little evidence of the effects of its use beyond two or three years. However, the use of anti-psychotic can lead to hypersensitivity dopamine increases the risk of symptoms if antipsychotics are stopped.
The antipsychotic options used are based on benefits, risks, and costs. It is debatable whether, as a class, typical or atypical antipsychotics are better. Amisulpride, olanzapine, risperidone, and clozapine may be more effective but are associated with larger side effects. Typical antipsychotics have the same drop-out and symptom relapse rates that are atypical when used at low to moderate doses. There is a good response in 40-50%, partial response in 30-40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people. Clozapine is an effective treatment for those who respond poorly to other drugs ("resistant" or "refractory schizophrenia"), but has a serious side effect of agranulocytosis (lowered white blood cell count) in less than 4% of people..
Most people with antipsychotics have side effects. People who have typical antipsychotics tend to have higher extrapyramidal side effects, while some atypically associated with weight gain, diabetes and the risk of metabolic syndrome; this is most evident with olanzapine, while risperidone and quetiapine are also associated with weight gain. Risperidone has an extrapyramidal symptom level similar to haloperidol. It remains unclear whether new antipsychotics reduce the likelihood of developing neuroleptic malignant syndrome or tardive dyskinesia, a rare but serious neurological disorder.
For people who do not or can not take medication regularly, long-term depot preparation of antipsychotics can be used to achieve control. They reduce the risk of relapse to a greater extent than oral medication. When used in combination with psychosocial interventions, they can improve long-term adherence to treatment. The American Psychiatric Association suggests considering stopping antipsychotics in some people if there are no symptoms for more than a year.
A number of psychosocial interventions may be useful in the treatment of schizophrenia including: family therapy, assertive community treatment, supported occupations, cognitive remediation, skills training, token economic intervention, and psychosocial interventions for substance use and weight management. Family therapy or education, which addresses the entire family system of an individual, can reduce relapse and hospitalization. Evidence for the effectiveness of cognitive-behavioral therapy (CBT) either in relieving symptoms or preventing minimal recurrence. Evidence for metacognitive training is mixed with some reviews finding benefits and others not. Art or drama therapy has not been well studied.
Prognosis
Schizophrenia has great human and economic costs. This results in a declining life expectancy of up to 10-25 years. This is mainly because of its association with obesity, poor diet, sedentary lifestyle, and smoking, with an increased rate of suicide playing a lower role. Antipsychotic drugs may also increase the risk. The differences in life expectancy increased between the 1970s and 1990s.
Schizophrenia is a major cause of disability, with active psychosis classified as the most disabling third condition after quadriplegia and dementia and on the eve of paraplegia and blindness. About three-quarters of people with schizophrenia have sustained disability with recurrence and 16.7 million people globally are considered to have moderate or severe defects from the condition. Some people actually recover and others work well in the community. Most people with schizophrenia live independently with community support. About 85% are unemployed. Some evidence suggests that paranoid schizophrenia may have better prospects than other types of schizophrenia for independent living and work functions. In people with the first episode of psychosis, good long-term outcomes occurred at 42%, intermediate outcome at 35% and poor outcome at 27%. The results for schizophrenia appear to be better in developing countries than in developed countries. These conclusions, however, have been questioned.
There is a suicide rate that is higher than the average associated with schizophrenia. This has been cited at 10%, but a more recent analysis revised the estimate to 4.9%, most commonly in the period after the onset or admission of the first hospital. Several times as many (20 to 40%) attempt suicide at least once. There are various risk factors, including male gender, depression, and high intelligence.
Schizophrenia and smoking have shown strong links in studies around the world. The use of cigarettes is very high in individuals diagnosed with schizophrenia, with estimates ranging from 80-90% to regular smokers, compared with 20% of the general population. Those who smoke tend to smoke heavily, and also smoke with a high nicotine content. Among people with schizophrenia use marijuana is also common.
Epidemiology
Schizophrenia affects about 0.3-0.7% of people at some point in their life, or 24 million people worldwide in 2011. It occurs 1.4 times more often in men than women and usually appears earlier on male - the peak age of onset is 25 years for men and 27 years for women. Onset in childhood is much less frequent, as is the onset in middle or old age.
Despite the previous belief that schizophrenia occurs at the same level worldwide, the frequency varies worldwide, within the state, and at the local and environmental levels. This variation is estimated to be fivefold. This accounts for about one percent of the years of disability life adjusted worldwide and resulted in 20,000 deaths in 2010. The rate of schizophrenia varies by up to threefold depending on how it is defined.
In 2000, the World Health Organization found the percentage of people affected and the number of new cases growing each year almost the same worldwide, with the prevalence of age standards per 100,000 ranging from 343 in Africa to 544 in Japan and Oceania for men. , and from 378 in Africa to 527 in southeast Europe for women. About 1.1% of adults experience schizophrenia in the United States.
History
At the beginning of the 20th century, psychiatrist Kurt Schneider listed the forms of psychotic symptoms that he thought were different schizophrenia from other psychotic disorders. This is called first rank symptom or Schneider's first rank symptom. They include delusions controlled by external forces, the belief that the mind is being inserted into or withdrawn from one's conscious mind, the belief that one's mind is being broadcast to another, and hearing a hallucinatory voice commenting on a person's thoughts or actions or who has a conversation with voices other hallucinations. Although they significantly contribute to current diagnostic criteria, the specificity of first-rank symptoms has been questioned. A review of diagnostic studies conducted between 1970 and 2005 found that they did not allow for re-confirmation or rejection of Schneider's claims, and suggested that first-rank symptoms should not be emphasized in future revision of the diagnostic system. Absence of first-rank symptoms should increase suspicion of a medical disorder.
The history of schizophrenia is complex and not easily lent to linear narratives. Schizophrenia-like syndrome accounts are considered rare in historical records before the 19th century, although reports of irrational, incomprehensible, or uncontrollable behavior are common. A detailed case report in 1797 on James Tilly Matthews, and a report by Philippe Pinel published in 1809, is often regarded as the case of the earliest illness in medical literature and psychiatry. The Latin term dementia praecox was first used by the German alienis Heinrich Schule in 1886 and later in 1891 by Arnold Pick in a case report of psychotic disorders (hebephrenia). In 1893 Emil Kraepelin borrowed the terms from Schule and Pick and in 1899 introduced a wide new difference in the classification of mental disorders between dementia praecox and mood disorders (called manic depression and included unipolar and bipolar depression). Kraepelin believes that dementia praecox may be caused by a long-term, systemic systemic or "whole body" system of disease affecting many organs and peripheral nerves in the body but which affect the brain after puberty at the end of a decisive cascade. The use of the term "praecox" distinguishes it from other forms of dementia such as Alzheimer's disease which usually occurs later in life. It is sometimes argued that the use of the term dÃÆ' Â © mence prÃÆ' Â © coce in 1852 by French physician BÃÆ'Ã… © nÃÆ'Ã… © dict Morel was a medical discovery of schizophrenia. However, this account ignores the fact that there is little to link the descriptive use of Morel terms and independent development of the concept of praecox dementia at the end of the nineteenth century.
The word schizophrenia - which is roughly translated as "mind-breaking" and derived from the Greek root schizein (???????, "to split") and phr? n , phren - (????, ???? -, "mind") - was created by Eugen Bleuler in 1908 and is intended to describe the separation of functions between personality, thought, memory, and perception. The American and British interpretations of Bleuler led to the claim that he described his primary symptoms as four A ' s: flattened affects , autism , corrupt association ideas, and ambivalence . Bleuler realizes that his illness is not dementia, because some of his patients are improving rather than worsening, and therefore propose schizophrenia instead. Treatment was revolutionized in the mid-1950s with the development and introduction of chlorpromazine.
In the early 1970s, diagnostic criteria for schizophrenia were the subject of a number of controversies that eventually led to operational criteria used today. It became clear after the US-British Diagnostic Study in 1971 that schizophrenia was diagnosed at a much greater rate in America than in Europe. This is partly due to the more loose diagnostic criteria in the US, which use the DSM-II manual, in contrast to Europe and ICD-9. David Rosenhan's 1972 study, published in the journal Science, under the title "On being sane in crazy places", concludes that the diagnosis of schizophrenia in the US is often subjective and unreliable. These are some of the factors leading to a revision not only the diagnosis of schizophrenia, but the revision of the entire DSM manual, resulting in the publication of DSM-III in 1980.
The term schizophrenia is often misconceived that the affected person has a "multiple personality". Although some people diagnosed with schizophrenia may hear a voice and may experience sound as a distinct personality, schizophrenia does not involve a person who changes between different multiple personalities; confusion arose in part because of the literal interpretation of the term Bleuler "schizophrenia" (Bleuler initially related schizophrenia with dissociation, and included multiple personalities in the category of schizophrenia). Dissociative identity disorder (having "multiple personality") is also often misdiagnosed as schizophrenia based on the loose criteria in DSM-II. The misuse of the term first known by the term "multiple personality" was in an article by poet T. S. Eliot in 1933. Other scholars have traced the previous roots. Rather, the term means "separation of mental function", reflecting the presentation of the disease.
Society and culture
In 2002, the term for schizophrenia in Japan was changed from seishin-bunretsu-by? ( ????? , lit. "mind-split disease") to t? g? -shitch? -sh? ( ????? , lit. "integration interruptions") to reduce stigma. The new name is inspired by the biopsychosocial model; it increases the percentage of people who are told about a diagnosis of 37-70% for three years. Similar changes occur in South Korea in 2012. A psychiatric professor, Jim van Os, has proposed changing the English term to "psychosis spectrum syndrome".
In the United States, the cost of schizophrenia - including direct costs (outpatient, inpatient, medicine, and long-term care) and non-health care costs (law enforcement, reduced workplace productivity and unemployment) - is estimated to be $ 62 , 7 billion in 2002. Books and movies A Beautiful Mind tells the life of John Forbes Nash, a mathematician who won the Nobel Prize for Economics and was diagnosed with schizophrenia.
Violence
Individuals with severe mental illness, including schizophrenia, are at a much greater risk of becoming victims of both violent and nonviolent crimes. Schizophrenia has been associated with higher levels of violent acts, but most seem to be related to substance abuse. The murder rate associated with psychosis is similar to that associated with substance abuse, and aligns the overall rate in a region. What is the role of schizophrenia against violence free from drug abuse remains controversial, but certain aspects of individual history or mental state can be a factor. About 11% of people in prison for murder have schizophrenia while 21% have mood disorders. Another study found about 8-10% of people with schizophrenia had committed acts of violence last year compared to 2% of the general population.
Media coverage related to acts of violence by individuals with schizophrenia reinforces public perception of the relationship between schizophrenia and violence. In a large and representative sample of a 1999 study, 12.8% of Americans believed that individuals with schizophrenia were "very likely" to commit violence against others, and 48.1% said they were "somewhat likely" to. Over 74% say that people with schizophrenia "are not very capable" or "not able at all" to make decisions about their care, and 70.2% say the same money management decisions. The perception of individuals with psychosis as violence has more than doubled in prevalence since the 1950s, according to one meta-analysis.
Direction of research
Research has found tentative benefits in using minocycline to treat schizophrenia. Nidotherapy or attempts to change the environment of people with schizophrenia to improve their ability to function, are also being studied; However, there is not enough evidence to make a conclusion about its effectiveness. Negative symptoms have proven to be a challenge to treat, since they are generally not made better with drugs. Various agents have been explored for possible benefits in this field. There are trials on drugs with anti-inflammatory activity, based on the premise that inflammation may play a role in the pathology of schizophrenia.
References
External links
- Media related to Schizophrenia on Wikimedia Commons
- Schizophrenia in Curlie (based on DMOZ)
Source of the article : Wikipedia
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