Last reviewed: 27 Dec 2022
Last updated: 14 Jan 2021



History and exam

Key diagnostic factors

  • hallucinations
  • delusions
  • passivity phenomena
  • negative symptoms
  • disorganised thinking (formal thought disorder)
  • catatonia
Full details

Other diagnostic factors

  • agitation or distress
  • suicidal thoughts
  • altered cognition
Full details

Risk factors

  • family history of schizophrenia
  • increasing paternal age
  • obstetric complications
  • cannabis use
  • low IQ
  • motor dysfunction
  • psychological stress
  • childhood abuse
  • birth in late winter/early spring season
  • cooler climate
  • migrant status
Full details

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
Full details

Treatment algorithm


acute psychosis


known schizophrenia: long-term management


Expert advisers

Fiona Gaughran, MB BCh, BAO (Hons), MRCPI, MD NUI, FRCP, FRCPI, FRCP Edin, FRCPsych, FHEA

Lead Consultant Psychiatrist

National Psychosis Service

Director of Research and Development

South London and Maudsley NHS Foundation Trust

Reader in Psychopharmacology and Physical Health

Institute of Psychiatry, Psychology and Neuroscience

Kings College London



FG has received support or honoraria for CME, advisory work, and lectures from Lundbeck, Otsuka, and Sunovion; collaborated with a research group supported by NHS Innovations and Janssen; and has a family member with professional links to Lilly and GSK, including shares. FG is in part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity and the Stanley Medical Research Institute. Any views expressed in her work are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

Toby Pillinger, MA(Oxon), BM, BCh, MRCP, PhD

Academic Clinical Fellow

Institute of Psychiatry, Psychology and Neuroscience

King's College London



TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka.


BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

Adrian Preda, MD

Professor of Clinical Psychiatry

Department of Psychiatry and Human Behavior

University of California, Irvine School of Medicine



Robert G. Bota, MD

Health Sciences Clinical Professor of Psychiatry

University of California




AP declares that he has no competing interests. RGB declares that he has no competing interests.

Peer reviewers

Jonathan Mitchell, MBChB, MRCPsych

Consultant Psychiatrist

Sheffield Health and Social Care NHS Foundation Trust




JM has been involved in production of National Institute for Health and Care Excellence (NICE) guidance on this topic and is a member of the expert advisors panel for the NICE centre for guidelines. He was involved in an NIHR-funded research project on the physical health of people with schizophrenia.


Annabel Sidwell

Section Editor, BMJ Best Practice


AS declares that she has no competing interests.

Susan Mayor

Lead Section Editor, BMJ Best Practice


SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Rachel Wheeler

Lead Section Editor, BMJ Best Practice


RW declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice


JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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