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Schizophrenia

Definition
Schizophrenia is a severe psychiatric disorder characterised by a breakdown of thought processes and
by impaired emotional responses. It has a lifetime risk of approx. 1% with more prevalent in males
than females.
Symptoms
Schizophrenia is characterised by heterogeneous clinical symptoms. Schizophrenia is described in
terms of negative and positive symptoms. Schizophrenia affects an individuals thoughts (delusions),
perception (hallucinations), emotions (anxiety and depression), behaviour (sleep disturbed, impulsive,
OCD and mutism) and interpersonal skills.
Positive symptoms Negative symptoms
Hallucinations Poor motivation
Delusions Poor cognition
Poor social interactions
Disorganised speech
Disorganised behaviour

Diagnosis
Schizophrenia is diagnosed using the DSM-IV and the OCD-10 diagnostic scale. In order for an
individual to be diagnosed with schizophrenia, the following criteria must be met, with the symptoms
needing to be present for at least a month.
Delusions, hallucinations/disorganised speech
An impact on social function for at least six months
Experiencing negative symptoms
Subtle cognitive and behavioural signs are present from early childhood, but the characteristic
features are generally have their onset in the late teens and the early twenties.
Types
Schizophrenia, paranoid type:feeling victimized, delusions, hallucinations, and
occasionally, aggressive behavior.
Schizophrenia, disorganized type: flat affect, loose associations, and extremely
disorganized behavior.
Schizophrenia, catatonic type:psychomotor disturbance, either motionless or excessive
motor activity.
Schizophrenia, undifferentiated type:mixed schizophrenic symptoms (of other types) along
with disturbances of thought, affect, and behavior.
Schizophrenia, residual type: is characterized by at least one previous, though not a current,
episode, social withdrawal, flat affect and looseness of associations.
Causes:
Genetic predisposition
Dopamine dysfunction hypothesis
Neurodevelopmental hypothesis
Psychological
Treatments
Medications
CBT
Psychological treatments: reducing sensory input, teaching techniques that ensures coping
with voices, increasing physical activity, modulating social interactions and learning stress
management.
Causes of schizophrenia: More details
Perinatal and early childhood factors
Prospective studies have shown that some factors in foetal lifeincluding hypoxia, maternal
infection, maternal stress, and maternal malnutritionmight account for a small proportion of
incidence of schizophrenia.
Environmental factors
Numerous studies have argued that the rate of schizophrenia and is affected by some environmental
factors.
Increase risk in children from urban cultures
Certain immigrant ethnic groups also have a higher risk of developing psychotic disorders
Cannabis use is associated with increased risk of developing psychotic disorders and
symptoms


















Genes: Lecture 1
Family studies
Many studies on the genetic epidemiology of schizophrenia provides compelling support for the
genetic factors in its aetiology. Family studies show that the risk of schizophrenia is increased in the
relatives of those with the disorder. The lifetime risk of schizophrenia is around 1%. This contrasts
with the averaged risk of siblings of 9% and to offspring of affected of 13%.
Adoption studies
These can provide evidence of an increased risk of schizophrenia in biological first-degree relatives.
For example, an adoption study carried out by Kendler et al. 1994.
Numerous family, twin and adoption studies have shown that vulnerability for schizophrenia risk is
partly genetic as the illness is known to be increased among relatives of affected individuals.
Twin studies suggest that the syndrome has heritability estimates of around 80%. However,
concordance in mono-zygotic twins is typically 50%, pointing to the importance of
environmental factors.
The high heritability values set high expectations for the linkage and association studies that
were carried out in schizophrenia.
Schizophrenia candidate genes: neuregulin 1 9NRG1), dysbindin (DTNBP1), D-amino-acid
oxidase activator (DAOA): these genes only provided subtle evidence of associated with
disease risk and involvement in the aetiology of the disorder.
The development and availability of new genotypic technologies has made genome-wide
association studies (GWAS) possible, a method investigating single nucleotide
polymorphisms (SNPs) within the genome.
These GWAS studies have identified both common and rare variants that show consistent
associations with schizophrenia.
Common variants (SNPs) in schizophrenia:

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