Schizophrenia

Rohit Shankar MRCPsych (Dr. Shankar of the Cornwall Partnership NHS Foundation Trust has received research funding from Eisai and conference sponsorship funding from UCB and Glaxo-Kline.)
Melvyn WB Zhang MBBS MRCPsych (Dr. Zhang of the National Healthcare Group Singapore has no relevant financial disclosures.)
Victor W Mark MD, editor. (Dr. Mark of the University of Alabama at Birmingham has no relevant financial relationships to disclose.)
Originally released December 28, 2005; last updated February 29, 2016; expires February 28, 2019

Overview

Schizophrenia is a major mental disorder that through centuries has been feared, revered, and misunderstood. It is a disorder of the mind that is complex and has the potential to affect not only individuals but also their families and at times the larger society. There are significant implications in terms of health costs given the chronic and associated life-long morbidity of this disorder. Schizophrenia itself is an umbrella term that encapsulates various symptoms and signs. Over centuries, man has struggled to comprehend mental illness in general and schizophrenia in particular. The mainstay of current treatment is pharmacological, which focuses on modulating the neurotransmitter pathways in the brain, especially the dopaminergic pathways. Psychosocial interventions are considered essential in supplementing the medical model of schizophrenia. Advances in neurobiology, brain imaging, and genetics have given us a window of understanding the complexity of the concept of schizophrenia and will hopefully help further treatment mechanisms in the near future. In this article, the authors provide an understanding of current thought lines.

Key points

 

• Schizophrenia is an umbrella term for a group of disorders that present with a common set of symptoms; subtypes are diverse and reflect varied prognoses and treatment responses.

 

• Development of schizophrenia is governed by a multifactorial model that includes genetic, neurodevelopmental, social, and psychological triggers.

 

• Whether atypical antipsychotics (new generation) are superior to typical ones (old generation) in regard to efficacy and side-effect profiles continues to be debated.

 

• Schizophrenia is more than an illness that affects individuals; it affects families and, at times, communities.

Historical note and terminology

Historically, schizophrenia can be traced back to old Pharaonic Egypt as far as the second millennium before Christ. The Book of Hearts describes in detail thought disturbances pathognomonic of schizophrenia. A study into the ancient Greek and Roman literature showed that although the general population probably had an awareness of psychotic disorders, due to lack of understanding of its etiology, schizophrenic patients had to suffer from inadequate treatment up to the end of the 18th century, when French physician Philippe Pinel achieved a landmark in psychiatric treatment by labeling these patients as being mentally ill individuals who needed proper care and adequate medical treatment. However, it was another 150 years before psychopharmacological treatment was introduced, which was the first specific medical therapy for schizophrenia based on scientific understanding. One of the first descriptions of symptoms, course and prognosis of schizophrenia was provided by the German psychiatrist Emil Kraeplin in 1898. He coined the term “dementia praecox,” emphasizing the cognitive deficits that occur in the early adolescence of patients with schizophrenia. Being slightly misleading--in the sense that schizophrenia is not a neurodegenerative, but rather a neurodevelopmental disorder--the term was replaced in 1911, when Swiss psychiatrist Eugen Bleuler introduced the term “schizophrenia,” stressing the occurrence of schisms between thought, emotion and behavior. Although often misunderstood, schizophrenia is not synonymous with multiple personality disorder or split personality.

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