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Published by: somebody_ma on Sep 23, 2010
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dementia praecox, auditory hallucinations, impaired information processing
Schizophrenia is a chronic debilitating psychiatric disorder. It is not wellunderstood and probably consists of several separate illnesses. Symptoms includedisturbances in thoughts (or cognitions), affects, and perceptions and difficulties inrelationships with others. The hallmark symptom of schizophrenia is the experience of auditory hallucinations. However, impaired information processing is probably the mostharmful symptom. Patients with schizophrenia have lower rates of employment, marriage,and independent living than other people.
The causes of schizophrenia are not known. However, at least 2groups of risk factors, genetic and perinatal, are widely thought to exist. A genetic factor probably does exist because the risk of schizophrenia is elevated in biological relatives of patients who are schizophrenic but not in adopted relatives. The risk of schizophrenia infirst-degree relatives of people with schizophrenia is 10%. If both parents areschizophrenic, the risk of schizophrenia in their child is 40%. Concordance foschizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins.Much research concerning the association of pregnancy and birth complications withschizophrenia has been conducted. Women who are malnourished or who have certainviral illnesses during their pregnancy may be at greater risk of giving birth to children wholater develop schizophrenia. Children born to Dutch mothers who were malnourishedduring World War II have a high incidence of schizophrenia. The 1957 influenza A2epidemic in Helsinki resulted in an increase in schizophrenia in the offspring of womenwho developed this flu during their second trimester. Obstetric complications may beassociated with a higher incidence of schizophrenia. Children born in the winter monthsmay be at greater risk for developing schizophrenia. These perinatal risk factors suggestthat schizophrenia is a neurodevelopmental disorder, although the exact nature is far fromunderstood. Interest has also focused on the various connections within the brain rather than localization in one part of the brain. Indeed, neuropsychological studies show
impaired information processing in patients with schizophrenia, and MRI studies showanatomic abnormalities in a network of neocortical and limbic regions and interconnectingwhite matter tracts.The prevalence of schizophrenia is approximately 1% worldwide. Reported values rangebetween 0.11 and 0.70 per 1000. The most recent studies indicate that the incidence of schizophrenia may have declined during the past 10-20 years. Problems with samplingand changes in diagnostic criteria may account for the decreased incidence.
In the United States the most recent cost estimated for direct treatment is 17.3billion annually; for indirect treatment, the estimated cost is 15.2 billion annually.
People with schizophrenia have a 10% lifetime risk of suicide.
No known racial differences exist in the prevalence of schizophrenia. Someresearch indicates that schizophrenia is diagnosed more frequently in black people than inwhite people.
The prevalence of schizophrenia is the same in men and women. The onset of schizophrenia is later and the symptomatology is less severe in women than in men. Thismay be because of the antidopaminergic influence of estrogen.
The onset usually occurs in adolescence, and symptoms remit somewhat in older patients. Most of the deterioration that occurs in patients with schizophrenia occurs in thefirst 5-10 years of the illness and is usually followed by decades of relative stability,although a return to baseline is unusual.The patient is usually someone who was unexceptional in his or her childhood who beganto experience a change in personality and a decrease in academic, social, andinterpersonal functioning during mid-to-late adolescence. In retrospect, family membersmay describe the person with schizophrenia as an individual who was physically clumsyand emotionally aloof during childhood. Usually, about a year passes between the onsetof these vague symptoms and the first visit to a psychiatrist.The symptoms of schizophrenia may be divided into the 3 following domains:
Positive symptoms are those that are added to the presentation such as
hallucinations, which are usually auditory; delusions; catatonia, agitation anddisorganized speech and behavior.
Negative symptoms are those patient characteristics that appear missing from thepresentation. They may include a decrease in emotional range, affectiveflattening, apathy, poverty of speech, loss of interests, loss of drive, socialwithdrawal, anhedonia.
Cognitive symptoms include deficits in attention, memory, and executivefunctions such as the ability to organize and abstract.Symptoms usually follow a waxing and waning course.
The patient's pattern of symptoms may change over years.
Positive symptoms respond fairly well to antipsychotic medication, but the other symptoms are quite persistent.
Full recovery is uncommon, especially if the illness has been present for years.The course is usually worse if comorbid substance abuse exists.
Patients who are schizophrenic may show a repertoire of strange poorlyunderstood behaviors that are rarely observed in others. These include water drinking to the point of intoxication, staring at oneself in the mirror, hoardinguseless objects, self-mutilation, and a disturbed wake-sleep cycle.Some patients who are schizophrenic may be violent.
Because the violence may be unpredictable and bizarre, these events are oftenhighly publicized.
Violence may be associated with command hallucinations and is often associatedwith substance abuse.
Most patients who are schizophrenic are not violent and are usually afraid of others rather than threatening to others.Findings on a general physical examination are usually without abnormality and are notcontributory. This examination is necessary to rule out other illnesses. A neurologicalexamination is important to evaluate the patient for movement disorders, particularly thosethat might indicate Wilson disease or Huntington disease, or disorders that are presentbefore the initiation of antipsychotic medications.

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