Summary
Definition
History and exam
Key diagnostic factors
- hallucinations
- delusions
- passivity phenomena
- negative symptoms
- disorganised thinking (formal thought disorder)
- catatonia
Other diagnostic factors
- agitation or distress
- suicidal thoughts
- altered cognition
- loss of insight
Risk factors
- family history of schizophrenia
- increasing paternal age
- obstetric complications
- cannabis use
- low IQ
- motor dysfunction
- psychological stress
- childhood adversity
- migrant status
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Treatment algorithm
acute psychosis
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 DifferentialsGuidelines
- Psychosis and schizophrenia in adults: prevention and management
- Management of schizophrenia: a national clinical guideline
More GuidelinesPatient information
Schizophrenia: what is it?
Schizophrenia: what treatments work?
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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