[schizo- + -phrenia]
A thought disorder affecting about 0.4% to 1.2% of the population, marked by delusions, hallucinations, and disorganized speech and behavior (the positive symptoms) and by flat affect, social withdrawal, and absence of volition (the negative symptoms). Schizophrenia involves dysfunction in one or more areas such as interpersonal relations, work or education, or self-care. Associated features include inappropriate affect, anhedonia, dysphoric mood, abnormal psychomotor activity, cognitive dysfunction, confusion, lack of insight, and depersonalization. Abnormal neurological findings may show a broad range of dysfunction including slow reaction time, poor coordination, abnormalities in eye tracking, and impaired sensory gating. Some individuals drink excessive amounts of water (water intoxication) and develop abnormalities in urine specific gravity or electrolyte imbalance. Because none of the clinical features are diagnostic, schizophrenia remains a diagnosis of exclusion. It is important to exclude psychoses with known organic causes such as temporal lobe epilepsy, metabolic disturbances, toxic substances, or psychoactive drugs. The onset of schizophrenia typically occurs between the late teens and the mid-30s; onset before adolescence is rare. Gender differences suggest that women are more likely to have a later onset, more prominent mood symptoms, and a better prognosis. Hospital-based studies show a higher rate of schizophrenia in men; community-based studies suggest an equal sex ratio.
The cause of schizophrenia is unknown.
Medications to control schizophrenia include antipsychotic drugs that act on dopamine receptors in the brain, e.g., chlorpromazine, fluphenazine, haloperidol, clozapine, and risperidone. Each of these may be associated with significant side effects; therefore, drug treatment with any of them requires careful monitoring. Supportive psychotherapy or cognitive behavioral therapy may be helpful for the patient and family.
After initial diagnosis, about one in five patients have well-controlled disease. Eighty percent of those affected suffer frequent relapses that may result in periodic hospitalizations, intensive treatment, or crisis management.
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