Onset is usually in early adulthood and may be preceded by years of ill-differentiated symptoms, from behavioural changes and delusions to frank psychosis.
Initially, patients are usually referred by family members. As the illness progresses, patients tend to self-refer or are brought in by a case manager or law enforcement officer.
Antipsychotic therapy and psychosocial interventions are effective for most patients, but to varying degrees.
Suicidal tendency is one of the most dangerous complications. The lifetime risk of suicide is around 5%. The risk is highest at the onset of the illness.
Schizophrenia is an illness characterised by a co-occurrence of at least two of the following symptoms: delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, or negative symptoms (e.g., affective flattening, avolition, anhedonia, attention deficit, or impoverishment of speech and language) occurring for a significant period of time during a 1-month period (active phase) and associated with continuous problems over at least a 6-month period. At least one of the symptoms needs to be a positive symptom (i.e., delusions, hallucinations, disorganised speech). The duration of the active phase might be shorter than 1 month if the deficits are successfully treated. For a diagnosis of schizophrenia, symptoms must not only occur concomitantly with substance use or a mood-disorder episode. Affective episodes may occur during the course of illness; however, their total duration must be less than the total duration of the active and continuous phase periods.
History and exam
- bizarre or disorganised/catatonic behaviour
- tangentiality and looseness of association (derailment)
- pressured speech
- distractible speech
- incongruent affect
- word salad
- non-auditory hallucinations
- stilted goal-directed behaviours
- catatonic symptoms
- 'soft' neurological deficits
Professor of Clinical Psychiatry
Department of Psychiatry and Human Behavior
University of California, Irvine School of Medicine
AP declares that he has no competing interests.
Health Sciences Clinical Professor of Psychiatry
University of California
RGB declares that he has no competing interests.
South London and Maudsley NHS Foundation Trust
DT declares that he has no competing interests.
Department of Psychiatry
University of New Mexico School of Medicine
JY declares that he has no competing interests.
Professor of Psychiatry
University of Missouri Kansas City
KS declares that he has no competing interests.
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