Schizophrenia is a serious and persistent mental illness that has instilled fear, curiosity, and reverence through the ages. This complex condition affects an individual’s grasp on reality, which can severely limit the ability to live and work independently. The impact of the schizophrenia extends beyond the individual to families and communities. Schizophrenia is associated with increased morbidity and mortality, and significant health care costs and resource utilization. The term “schizophrenia” likely encompasses a syndrome with various symptoms and signs that share a common feature of impairment in reality testing. Current research aims to identify mechanisms to explain the diverse phenotypes observed and to identify and understand possible subtypes. Alterations in the mesolimbic dopaminergic pathways as well as changes in the prefrontal cortex are thought to play a role in pathology. Pharmacological treatments targeting these pathways are the primary interventions; however, psychosocial treatments can effectively improve function and quality of life. Advances in neurobiology, brain imaging, and genetics have given us a window of understanding into the complexity of schizophrenia. This article aims to provide an overview of current research into this complex condition.
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• Schizophrenia is a heterogenous clinical syndrome and likely a group of related conditions that share a common set of symptoms involving psychosis and compromised cognition.
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• The etiology of schizophrenia is complex and likely involves genetic, neurodevelopmental, environmental, and psychological triggers.
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• Although positive symptoms such as hallucinations and delusions are most commonly discussed, negative symptoms are equally or potentially more impairing.
Historical note and terminology
Depictions of schizophrenia have been found as far back as the second millennium B.C. Ancient texts from Greek and Roman literature, in addition to the Egyptian “Book of Hearts,” describe thought disturbances pathognomonic of schizophrenia in the ancient world.
Due to lack of understanding of mental illness, schizophrenia patients were often mistreated. It wasn’t until the end of the 18th century that the French physician Philippe Pinel identified individuals with schizophrenia as “mentally ill” and in need of medical care. Still, psychopharmacological treatment was not introduced for another 150 years.
German psychiatrist Emil Kraeplin provided one of the first characterizations of the symptoms, course, and prognosis of schizophrenia in the late 1800s. He coined the term “dementia praecox,” emphasizing the cognitive deficits that occur in the early adolescence of patients with schizophrenia. This 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 used in lay vernacular, “schizophrenia” is not synonymous with multiple personality disorder or split personality.