Schizophrenia

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Last reviewed: 21 Oct 2024
Last updated: 25 Jun 2024

Summary

Definition

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
  • loss of insight
Full details

Risk factors

  • family history of schizophrenia
  • increasing paternal age
  • obstetric complications
  • cannabis use
  • low IQ
  • motor dysfunction
  • psychological stress
  • childhood adversity
  • migrant status
Full details

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
Full details

Treatment algorithm

ACUTE

acute psychosis

ONGOING

known schizophrenia: long-term management

Contributors

Expert advisers

Stephen Lawrie, MB ChB, MRCPsych, MPhil, MD (Hons), FRCPsych, Hon.FRCP(Edin), FRSE

Professor of Psychiatry and Neuroimaging

University of Edinburgh

Honorary Consultant Psychiatrist

NHS Lothian

Royal Edinburgh Hospital

Edinburgh

UK

Disclosures

SL declares that he has no competing interests.

Acknowledgements

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

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

UK

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

Academic Clinical Lecturer

Institute of Psychiatry, Psychology and Neuroscience

King's College London

UK

Adrian Preda, MD

Professor of Clinical Psychiatry

Department of Psychiatry and Human Behavior

University of California, Irvine School of Medicine

Irvine

CA

Robert G. Bota, MD

Health Sciences Clinical Professor of Psychiatry

University of California

Irvine

CA

Disclosures

​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; has a family member with professional links to Lilly and GSK, including shares; and 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. ​​​​TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka. 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

Sheffield

UK

Disclosures

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.

Editors

Annabel Sidwell

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Susan Mayor

Lead Section Editor, BMJ Best Practice

Disclosures

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

Disclosures

RW declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

  • Differentials

    • Schizoaffective disorder
    • Substance-induced psychotic disorder
    • Dementia with psychosis
    More Differentials
  • Guidelines

    • Psychosis and schizophrenia in adults: prevention and management
    • Management of schizophrenia: a national clinical guideline
    More Guidelines
  • Patient information

    Schizophrenia: what is it?

    Schizophrenia: what treatments work?

    More Patient information
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