Schizophrenia
Schizophrenia is a mental disorder[17] characterized by reoccurring episodes of psychosis that are correlated with a general misperception of reality.[7] Other common signs include hallucinations (typically hearing voices), delusions (i.e., paranoia), disorganized thinking and behavior,[10] social withdrawal, and flat or inappropriate affect.[7] Symptoms develop gradually and typically begin during young adulthood and are never resolved.[3][10] There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person.[10] For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months (according to the DSM-5) or one month (according to the ICD-11).[10][18] Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.[10]
For other uses, see Schizophrenia (disambiguation).Schizophrenia
harm to self or other, social isolation, cognitive issues, heart disease, lifestyle diseases,[4] obesity and type 2 diabetes arising from antipsychotic medication[5][6]
Ages 16 to 30[3]
Chronic[3]
Environmental and genetic factors[7]
Family history, cannabis use in adolescence, consumption of hallucinogens or amphetamines,[8] problems during pregnancy, childhood adversity, birth in late winter or early spring, older father, being born or raised in a city[7][9]
Based on observed behavior, reported experiences, and reports of others familiar with the person[10]
Substance use disorder, Huntington's disease, mood disorders (bipolar disorder, major depressive disorder), autism,[11] borderline personality disorder,[12] schizophreniform disorder, schizotypal personality disorder, schizoid personality disorder, antisocial personality disorder, psychotic depression, anxiety, disruptive mood dysregulation disorder, sleep paralysis
Counseling, life skills training[2][7]
20–28 years shorter life expectancy[13][14]
~0.32% (1 in 300) of the global population is affected.[15]
~17,000 (2015)[16]
About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime.[19] In 2017, there were an estimated 1.1 million new cases and in 2022 a total of 24 million cases globally.[2][20] Males are more often affected and on average have an earlier onset than females.[2] The causes of schizophrenia may include genetic and environmental factors.[7] Genetic factors include a variety of common and rare genetic variants.[21] Possible environmental factors include being raised in a city, childhood adversity, cannabis use during adolescence, infections, the age of a person's mother or father, and poor nutrition during pregnancy.[7][22]
About half of those diagnosed with schizophrenia will have a significant improvement over the long term with no further relapses, and a small proportion of these will recover completely.[10][23] The other half will have a lifelong impairment.[24] In severe cases, people may be admitted to hospitals.[23] Social problems such as long-term unemployment, poverty, homelessness, exploitation and victimization are commonly correlated with schizophrenia.[25][26] Compared to the general population, people with schizophrenia have a higher suicide rate (about 5% overall) and more physical health problems,[27][28] leading to an average decrease in life expectancy by 20[13] to 28 years.[14] In 2015, an estimated 17,000 deaths were linked to schizophrenia.[16]
The mainstay of treatment is antipsychotic medication, including olanzapine and risperidone, along with counseling, job training and social rehabilitation.[7] Up to a third of people do not respond to initial antipsychotics, in which case clozapine gained approval by the US Food and Drug Administration for treatment-resistant cases.[29] In a network comparative meta-analysis of 15 antipsychotic drugs, clozapine was significantly more effective than all other drugs, although clozapine's heavily multimodal action may cause more significant side effects.[30] In situations where doctors judge that there is a risk of harm to self or others, they may impose short involuntary hospitalization.[31] Long-term hospitalization is used on a small number of people with severe schizophrenia.[32] In some countries where supportive services are limited or unavailable, long-term hospital stays are more common.[33]
Prevention
Prevention of schizophrenia is difficult as there are no reliable markers for the later development of the disorder.[177]
Early intervention programs diagnose and treat patients in the prodromal phase of the illness. There is some evidence that these programs reduce symptoms. Patients tend to prefer early treatment programs to ordinary treatment and are less likely to disengage from them. As of 2020, it is unclear whether the benefits of early treatment persist once the treatment is terminated.[178]
Cognitive behavioral therapy may reduce the risk of psychosis in those at high risk after a year[179] and is recommended in this group, by the National Institute for Health and Care Excellence (NICE).[34] Another preventive measure is to avoid drugs that have been associated with development of the disorder, including cannabis, cocaine, and amphetamines.[86]
Antipsychotics are prescribed following a first-episode psychosis, and following remission, a preventive maintenance use is continued to avoid relapse. However, it is recognized that some people do recover following a single episode and that long-term use of antipsychotics will not be needed but there is no way of identifying this group.[180]