Professional Documents
Culture Documents
handbook
H. Lundbeck A/S
9 Ottiliavej
DK - 2500 Valby
Copenhagen, Denmark
Tel: +45 36 30 13 11
Fax: +45 36 43 89 00
www.lundbeck.com
September 2006
This booklet is sponsored by H. Lundbeck A/S – an international pharmaceutical company engaged
in the research and development, production, marketing and sale of drugs for the treatment of
psychiatric and neurological disorders.
Contents
Page
Foreword 1
What is schizophrenia? 3
Index 41
Foreword
Foreword
Even now in the 21st Century, Improved communication between the patient,
mental illnesses, such as family and physician and the active
schizophrenia, remain engagement of families and carers in the
treatment and care model are other issues
misunderstood, poorly diagnosed, which need to be tackled.
and under-treated. Despite the
advances in medical therapies Research is ongoing in all these areas, looking at
available for this disorder over new treatments and healthcare approaches,
recent decades, there are still many whilst maintaining the ultimate aims of
unmet needs in schizophrenia discovering a cause for the disorder and a cure.
In the meantime, education to raise awareness
therapy and we still do not and decrease stigma are other valuable ways to
understand the disorder fully. improve the lives of those with schizophrenia.
The first major advance for patients, families, This booklet has been designed as a short
carers and physicians alike, would be treatments synopsis of schizophrenia to provide you with
with increased effectiveness against all more information on the disorder.
subtypes of symptoms, accompanied by fewer
side effects. These medications would also have
a rapid action with positive effects on the Inger Nilsson,
conditions that frequently occur alongside President of EUFAMI
schizophrenia, such as those involving cognition
and mood. In addition, there is still a significant
group of patients who do not respond to
existing therapies, and we should not give up on
research to find new treatments which may be
effective for these patients.
1
2
What is schizophrenia?
What is schizophrenia?
Schizophrenia is the most common form of Although mental disorders have been
severe mental illness,1 affecting approximately studied and described since medical records
24 million people worldwide.2 It is believed to began, it was the German psychiatrist, Emil
be caused by an imbalance of chemicals in the Kraepelin (1856–1926), who first classified
brain (neurotransmitters), and is characterised mental illness as an actual ‘disease’ with a
by psychotic episodes (delusions, hallucinations, specific onset, course and outcome. As part
disorganised behaviour) interspersed with of this classification, Kraepelin described
periods of blunted emotions, apathy, and the condition ‘dementia praecox’, meaning
withdrawal. However, although the condition is early mental decline.
highly treatable, it is complex and poorly
understood, and the word ‘schizophrenia’ is Dementia praecox was later renamed
associated with notable stigma and is often ‘schizophrenia’ following extensive study of
misused. the symptoms of the disorder by the Swiss
psychiatrist, Eugen Bleuler (1857–1939).
A person with schizophrenia experiences a The name schizophrenia (from the Greek:
condition where their thoughts (cognition), ‘schizo’=split, ‘phrenos’=mind) was chosen
emotion, and behaviour become disturbed and to reflect the poor connection between the
they may find it difficult to judge reality. These thought processes (cognition) of a person
underlying processes produce symptoms that with the disorder, and other functions of
are highly variable, but typically include the mind such as emotion, behaviour, and
hallucinations, delusions, apathy, blunted volition (self-will). It is a common
emotions, odd behaviour, poor personal care, misconception that patients with
and social withdrawal. Consequently, schizophrenia exhibit a ‘split’ or ‘multiple’
schizophrenia affects most aspects of the personality.
human condition, and the resulting symptoms
can appear strange and frightening for both the
patient and those around them.
%
Onset Course Outcome with this
pattern
F other patterns 23
4
Adapted from: Target schizophrenia. The Association of the British Pharmaceutical Industry, London, 2003.1
The onset of symptoms can be sudden, or may problems with planning or abstract thinking,
be preceded by weeks, months or years of and a tendency towards isolation. This period of
gradually increasing symptoms, known as the successful treatment is known as the
prodromal phase. Prodromal signs tend to be maintenance phase.
non-specific and can include patterns of social
isolation, neglected personal hygiene, loss of After the first psychotic episode, the course of
interest in work/study, and development of odd the disorder is unpredictable. As many as 15%
behaviour and ideas. of people who experience an acute episode of
schizophrenia will never have another episode
The psychotic episode is characterised by more and recover completely.4 However, more
so-called ‘positive symptoms’, where an commonly, the person will relapse into further
individual may experience delusions, active phases interspersed with residual phases.4
hallucinations, fear/anxiety, and may lose the Complete remission (recovery) is less likely once
perception of reality. a long-term pattern of episodes becomes
established. In addition, 50% of patients with
With treatment or, in some cases, left schizophrenia attempt suicide at some point
untreated, the active phase diminishes, leaving during the course of the disorder, leading to
the person functional again (in remission), or fatality in 10% of cases.1 The overall mortality
with varying severities of negative and/or rate is considerably higher in people with
cognitive symptoms. These symptoms include schizophrenia than in the general population
blunted emotions, lack of drive/interest, (due to coexisting medical problems, as well as
suicide).
5
Who is affected?
6
Figure 2: Relative risk of the onset of schizophrenia versus age
Incidence of schizophrenia
Female
Male
Median Median
25 years 28 years
20 25 30 35 40 45
Age (years)
Adapted from: Target schizophrenia. The Association of the British Pharmaceutical Industry, London, 2003.1
7
The consequences of support to patients with schizophrenia are high
schizophrenia and wide ranging, with only 1% of the cost of
care due to drug treatment. Community follow-
As a diverse and serious condition, schizo- up of hospital treatment is essential for many
phrenia produces complex consequences. reasons, not least because one of the highest
risk periods for patient suicide is in the first 6
The obvious major consequence is to the weeks after discharge from hospital following
patients themselves, who typically experience the initial psychotic episode.
severe anxiety and fear during psychotic
episodes, prompted by hallucinations, delusions All these difficulties, combined with the social
and general loss of reality. While it is distressing stigma of this often misunderstood condition
for the patient to cope with situations that can compound the issues facing people with
they genuinely perceive as ‘real’, it is also schizophrenia and further impair their chances
extremely disturbing for family and friends to of regaining their quality of life.
deal with this often alarming change in
behaviour. For every person with schizophrenia,
around 10 others are affected by its References
consequences.1 This can put a strain on 1. ABPI. Target schizophrenia. May, 2003.
relationships, leading to inevitably difficult 2. World Health Organization (WHO).
decisions about care provision, and adding to Schizophrenia. www.who.int/mental_health/
the general stress of the situation. management/schizophrenia, accessed
March 2006.
Aside from emotional concerns, schizophrenia 3. Marneros A, Deister A, Rohde A. Validity of the
can also impact on an individual’s future in negative/positive dichotomy for schizophrenic
terms of education, employment and resulting disorders under long-term conditions.
financial security. The intermittent and Schizophr Res 1992; 7 (2): 117–123.
unpredictable nature of symptoms makes 4. Watt DC, Katz K, Shepherd M. The natural
steady work and independent living difficult for history of schizophrenia: a 5-year prospective
most individuals. Therefore, information and follow-up of a representative sample of
support are necessary for patients and their schizophrenics by means of a standardized
families to provide adequate patient care and clinical and social assessment. Psychol Med
1983; 13 (3): 663–670.
avoid potential decline into problems such as
family breakdown, drug and alcohol abuse, and 5. NHS National electronic Library for Health.
homelessness. As a result, healthcare costs for www.nelmh.org/home_schizophrenic.asp?c=10,
accessed March 2006.
8
What is the frequency of
schizophrenia?
Frequency
(total number of cases in the population) of worldwide distribution, treatment levels do not.
about 0.5%. That is, schizophrenia affects 1 in The World Health Organization (WHO)
every 200 people worldwide.2 However, the estimates that 90% of people with untreated
prevalence varies with age, increasing until age schizophrenia are in developing countries.3
40, and then declining. The estimate of lifetime
risk is 1% (or 1 in 100 people). This measure is
thought to be a more representative value as it References
takes into account that the most high-risk age 1. ABPI. Target schizophrenia. May, 2003.
group is between 20 and 39 years.2 2. Tsuang MT, Faraone SV. Schizophrenia, the
facts. Second edition. Oxford University Press,
Studies of the number of new cases of 1997.
schizophrenia gave an incidence of 21.8 per
3. World Health Organization (WHO).
100,000 people.2 This gives an incidence rate of Schizophrenia. www.who.int/mental_health/
0.02%. The incidence rate is lower than the management/schizophrenia, accessed
prevalence rate because schizophrenia is a March 2006.
predominantly chronic disorder, and so its
presence in the population is cumulative.3
9
10
What causes schizophrenia?
The exact cause of schizophrenia is not yet Figure 3: Altered brain activity in patients
known, although studies point towards a with schizophrenia
combination of genetic and environmental
factors that influence the function of the brain.
Causes
In addition, brain scans of people with
schizophrenia have shown that fluid-filled areas
of the brain called the ventricles may be
enlarged in some types of schizophrenia, with
the amygdala and hippocampus reduced in size
(Figure 4).2 How these alterations are connected
to the symptoms of schizophrenia is unknown.
11
Figure 4: Areas of the brain – in some types of schizophrenia, the ventricles may be enlarged,
whilst the amygdala and hippocampus may be reduced in size
Lateral ventricles
Third ventricle
Fourth ventricle
Central canal
Amygdala
12
Is the condition inherited? Figure 5: Family patterns of schizophrenia
development
The parents or siblings of a person with
schizophrenia have a 10-fold higher risk of Affected relative
developing the disorder than a person in the
general population, and this rises to a 15-fold None
higher risk for the children of people with
schizophrenia (Figure 5).3 However, studies in
identical and non-identical twins have shown Cousin
that development of the condition is not
entirely explained by genetic inheritance. In
those cases where one identical twin developed Aunt or uncle
schizophrenia, the second identical twin (who
would have inherited exactly the same genes)
developed schizophrenia in only around 50% of
Grandparent
cases.3
Non-identical
twin
Identical twin
0 10 20 30 40 50
Risk of developing
schizophrenia (%)
14
How is schizophrenia diagnosed?
15
Differentiating schizophrenia Schizoaffective disorder
from other disorders
Some patients show equal measures of
Several other conditions may produce symptoms of both mood-based (affective)
symptoms that are very similar to those disorders and schizophrenia. In such cases, a
observed in schizophrenia. For effective schizoaffective disorder may be diagnosed,
management, it is extremely important that although it has not yet been established
schizophrenia is differentiated from these other whether these are entirely separate conditions,
conditions, some of which are described in the or different extremes of the same disorder.3
table opposite.
References
1. World Health Organization. The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria
for research. Geneva, Switzerland. © World Health Organization, 1992.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fourth edition.
Washington, USA © American Psychiatric Association, 1994.
3. Tsuang MT, Faraone SV. Schizophrenia, the facts. Second edition. Oxford University Press, 1997.
16
Table 1: Disorders producing similar symptoms to schizophrenia
Drug-induced Known use of drugs such as LSD, Symptoms subside upon withdrawal
cannabis, amphetamines, cocaine, of the drug/alcohol.
ecstasy.
Note that, long-term abuse of these
Alcohol abuse. substances can lead to permanent
brain changes that may induce
schizophrenia.
Mood-based Manic depression (bipolar disorder), Like schizophrenia, they have no known
(affective) social anxiety disorder, obsessive– defect that can be confirmed by
compulsive disorder, personality and physical examination. Instead, careful
delusional disorders. observation of symptoms is required.
17
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18
Signs & symptoms
What are the signs and symptoms
of schizophrenia?
Positive symptoms
21
Cognitive impairment Assessing symptoms in
schizophrenia
Cognitive impairment can be considered to be a
separate condition from schizophrenia, or is In addition to the classification systems used in
sometimes classed as a third category of diagnosis, clinical scales may be used by
symptom, alongside the positive and negative physicians to follow the progress of a patient’s
signs. Cognition refers to the thought processes symptoms over time. These include the Brief
that allow functions such as learning, memory, Psychiatric Rating Scale (BPRS), the Positive and
attention, speed of thought, problem solving, Negative Syndrome Scale (PANSS), and the
planning, and situation assessment. Cognitive Calgary Depression Scale (CDS).6,7,8
impairment reduces the ability to use logical
thought, and markedly diminishes quality of
life. Cognitive problems are common in patients References
with schizophrenia, with one study showing 1. Hirsch SR, Weinberger DR. Schizophrenia.
that 85% of patients who were almost fully Second edition. Blackwell Publishing, 2005.
recovered from schizophrenia, still experienced 2. Concise Medical Dictionary. Sixth edition.
cognitive difficulties.4 Oxford University Press, 2003.
Treatment
there are many treatments available to help
control symptoms of the disorder and to Drug treatment for schizophrenia pre-
prevent relapse into psychotic episodes. This dominantly involves the use of antipsychotic
control is extremely valuable, and can help a medications, which help to restore the balance
person with schizophrenia to restore elements of neurotransmitters in the brain.
of normal life. Treatment usually consists of a
combination of medication and psychosocial Antipsychotic medication for schizophrenia was
therapy, with a period in hospital often first used in the 1950s, and was shown to be
necessary for care and monitoring during effective in controlling the positive symptoms
psychotic episodes. of the disorder (hallucinations, delusions, etc.).
Research has since shown that these ‘typical’
Treatment for schizophrenia is long-term over a antipsychotic drugs block the action of the
period of years, and appears to be most neurotransmitter, dopamine, in the brain (see
effective when started early in the course of the Figure 7).
disorder.1 However, despite the treatable nature
of the disorder, approximately one third of
Figure 7: Dopamine in neurotransmission
patients are not improved following standard
treatment.2
Dopamine
terminal
Dopamine
Dopamine (D2) receptor
Chlorpromazine
(typical antipsychotic) –
blocks dopamine binding
to dopamine (D2) receptor,
preventing signal transmission 23
Newer antipsychotics block both dopamine and Table 2: Examples of antipsychotic drugs*
serotonin pathways, although the additional
effects on the serotonin pathway are, as yet, Typical (conventional) Atypical (new)
antipsychotics antipsychotics
not so well understood. The serotonin block is
believed to contribute to the lower levels of Largactil®/Thorazine® Solian®
extrapyramidal symptom (EPS) side effects. (chlorpromazine) (amisulpride)
Increased dopamine in the meso-cortical Modecate®/Moditen® Abilify®
pathway is thought to be the main reason for (fluphenazine) (aripiprazole)
positive symptoms. Amphetamines, which Depixol® Clozaril®
stimulate the dopamine pathway, cause similar (flupentixol) (clozapine)
symptoms which may be indistinguishable from Haldol® Zyprexa®
schizophrenia.2 However, the action of (haloperidol) (olanzapine)
antipsychotics to block this pathway can lead
Loxapac®/Loxitane® Seroquel®
to EPS (see ‘Side effects with antipsychotic (loxapine) (quetiapine)
treatment’).
Fentazin® Risperdal®
(perphenazine) (risperidone)
In recent years, new ‘atypical’ antipsychotics
have been developed. These are at least as Navane® Serdolect®
(thiothixene) (sertindole)
effective on the positive symptoms of
schizophrenia as the typical antipsychotics, as Mellaril® Geodon®/Zeldox®
well as indicating a possibility of being more (thioridazine) (ziprasidone)
effective on the negative symptoms. Atypical
antipsychotics also work by altering *Antipsychotic drugs are marketed under a variety of
brand names – the names given in brackets are the
neurotransmitter (dopamine, serotonin)
generic (non-proprietary) names. Some may also be
function in the brain. Their mechanisms of known under other proprietary names.
action tend to be different from the typical
agents, and this may be related to the atypical
antipsychotics’ tendency to cause fewer severe Side effects with antipsychotic treatment
EPS side effects (see opposite), although they Side effects occur when the antipsychotic drug
are not free of side effects in general. influences systems other than those involved in
schizophrenia. The occurrence of side effects
Drug selection must, therefore, not only take varies from drug to drug, as well as between the
into account the symptoms and needs of the general drug classes. A description of some side
patient, but also balance the risk–benefit in effects associated with antipsychotic drug use
24 terms of effectiveness and side effects. is given in the table opposite.
Table 3: Side effects of antipsychotic drugs
Anticholinergic effects, e.g., dry Effects caused by the antipsychotic acting non-specifically,
mouth, blurred vision, constipation, and blocking the action of the neurotransmitter,
dizziness acetylcholine.
Raised prolactin levels Elevated levels of the hormone, prolactin, may promote
milk production, suppress ovulation, and reduce sexual
drive in women. In men, higher prolactin levels can lower
sexual drive and may induce impotence.
Neuroleptic malignant syndrome Very rare, but potentially fatal effect that produces
(NMS) problems with breathing and heart rate.
25
The most common side effects of antipsychotic Shortcomings of antipsychotic
drugs are EPS side effects: caused by the effect treatments
of the antipsychotic on the part of the brain
that helps to control movement. There are three Recent evidence suggests that the majority of
basic types of EPS effect: dystonia, akasthisia, patients with schizophrenia (74%) will
and pseudo-parkinsonism. These effects may discontinue their medication before 18 months
occur in up to 40–60% of patients.2 of treatment.3 Patients stop taking their
medication for a number of reasons, including
Other less common side effects include inefficacy and intolerable side effects. Each
sedation, weight gain, and raised prolactin levels patient has a different profile of symptoms, and
(leading to disruption of sexual function) (see each antipsychotic a different profile of side
Table 3), although not all of the side effects effects, thus it might be expected that there is
listed here occur with every drug. There is no simple answer to drug therapy. A good
evidence that some antipsychotics may impair relationship between clinician and patient will
cognitive function, and this has potentially prevent the patient from ceasing medication
confused the classification of this type of before an alternative can be offered, and
schizophrenia symptom. switching medication is common before the
best balance between symptoms control and
side effects is met.
26
Psychosocial and cognitive/ The supportive nature of these therapies can
behavioural therapies also encourage patients to comply with their
drug treatment – a significant concern in this
Psychological, including behavioural therapies, patient population, where approximately 50%
form a key part of schizophrenia treatment and of patients fail to take their medication once
rehabilitation. These therapies cannot generally discharged from hospital.2
help in dealing with acute psychotic phases of
illness, but have been shown to reduce the rate Future therapies
of relapse.4 Used in combination with
medication, they can help a person with Despite innumerable advances in drug
schizophrenia to rebuild their social, functional, treatments over recent decades, there are still
and communication skills. Psychosocial support many unmet needs in schizophrenia therapy.
and psychoeducation can be very helpful for Obvious improvements would be treatments
the families of people with schizophrenia. with increased effectiveness against all types of
symptoms, fewer side effects, and rapid action.
Psychotherapy involves regular meetings In addition, treatments are required for patients
between the patient and a therapist to talk with symptoms that do not respond to existing
about their problems and concerns in general, therapies (i.e., are refractory). Earlier diagnosis
which may or may not be related directly to would also be helpful, along with therapies that
the schizophrenia. The types of psychotherapy offered positive effects on conditions that
differ, and range from dealing with specific day- frequently occur alongside schizophrenia such
to-day problems, to the recall of previous as those involving cognition and mood (see
events to guide the patient to insights in their next section – ‘ What are the co-morbidities of
life.2 Behavioural therapy seeks exclusively to schizophrenia?’).
change the behaviour of the patient, with the
primary aim of addressing the patient’s ability Research is ongoing in all of these areas, looking
to deal with social situations.2 Cognitive at new approaches to treatment, and
behavioural psychotherapy focuses on helping maintaining the ultimate aims of discovering a
the patient to find ways of changing core cause and a cure. In the meantime, education
beliefs and/or thought patterns that cause to raise awareness and decrease stigma are
discomfort, anxiety, depression, or in some way other valuable ways to improve the lives of
interfere with their life situation. those with schizophrenia.
27
References
1. National Alliance for Research on Schizophrenia
and Depression (NARSAD). Understanding
schizophrenia. © NARSAD, 2003. Accessed
online, March 2006.
28
What are the co-morbidities of
schizophrenia?
Co-morbidities
antidepressant. Unfortunately, while
People with schizophrenia and manic addressing certain of his symptoms, this
depression (bipolar disorder) have higher risks therapy increased his weight further,
of certain physical conditions than average:2 potentiating some of his original problems
• 2–4 times the rate of cardiovascular diseases and impacting upon his health and quality
• 2–4 times the rate of respiratory disease of life.
• 5 times the rate of diabetes
• 8 times the rate of Hepatitis C
• 15 times the rate of HIV.
Mood disorders
29
Lundbeck Belgium Art Collection
References
1. Kosten T, Ziedonis D. Substance abuse and schizophrenia: editor’s introduction. Schizophrenia Bulletin 1997;
23: 181–185.
2. www.rethink.org
Social and economic effects form an important poor articulation, and withdrawal, do not often
part of living with, and treating, schizophrenia. fit in with a work environment. Further to this,
Schizophrenia is often a difficult disorder for the stress of having to attend work, as well as
society to accept and deal with, as it influences any stress associated with the work itself, can
behaviour, emotion, communication and make symptoms worse. For these reasons,
functional capacity. To live with these schizophrenia frequently generates a barrier to
symptoms, a person with schizophrenia requires employment.
attentive care, which understandably entails
extensive costs – both personal and financial. Education
It is under some debate whether patients with
Social factors schizophrenia suffer a decline in IQ as a
consequence of their disorder since, in most
Social interaction cases, an IQ test for the patient prior to
A person with schizophrenia often finds it diagnosis is not available for comparison.
difficult to integrate socially. This may be However, a lower IQ is known to be associated
because of fear, anxiety or distressing beliefs, or with a poorer prognosis.1
because of symptoms such as poverty of
speech and withdrawal, which are not Homelessness
32
Economic factors
33
Lundbeck Belgium Art Collection
34
Further information
Index sources
This section includes a selection of websites The NIMH mission is to reduce the burden of
and books that provide further information mental illness and behavioural disorders through
about schizophrenia. research on mind, brain, and behaviour. NIMH
funds research by scientists across the US as
Websites well as in NIMH studies in the internal research
programme. Through its extramural programme,
General information on NIMH supports more than 2,000 research grants
schizophrenia and contracts at universities and other
institutions across the country and overseas.
EUFAMI
www.eufami.org Schizophrenia.com
www.schizophrenia.com
EUFAMI is a European network of family and
carer associations with the mission to achieve a Schizophrenia.com is a US-based non-profit-
continuous improvement throughout Europe in making web community that provides
mental health, and in the quality of care and information, support and education to the
welfare, for people affected by mental illnesses; family members, caregivers and individuals
to campaign continuously for the rights of whose lives have been affected by schizophrenia.
families and carers of people with mental The site contains articles on all aspects of life
illnesses across the whole of Europe; and to with schizophrenia, as well as related news
support and strengthen member organisations items. The site also has discussion and chat
– 48 national and regional voluntary boards on various topics, as well as national
associations in 27 countries – in their fight for discussion groups from across the world.
better health care for those affected by mental
illnesses. Rethink
www.rethink.org
National Institute of Mental Health (NIMH)
www.nimh.nih.gov Rethink is the largest severe mental illness
charity in the UK, and aims to improve the lives
Further information
The National Institute of Mental Health (NIMH) of all those affected by severe mental illness,
is one of 27 components of the National whether as a patient, carer, or healthcare
Institutes of Health (NIH) – the United States worker/professional. Rethink provides a range of
Federal government’s principal biomedical and community services including employment
behavioural research agency. NIH is part of the projects, supported housing, day services,
US Department of Health and Human Services. helplines, residential care, and respite centres. 31
35
National Alliance for Research on Corporate information
Schizophrenia and Depression (NARSAD)
www.narsad.org H. Lundbeck A/S
www.lundbeck.com
NARSAD is a charity organisation that raises
funds for scientific research into the causes, This comprehensive site gives a complete
cures, treatments and prevention of severe overview of Lundbeck, including company
psychiatric brain disorders, such as history, vision, mission, and product pipeline.
schizophrenia and depression. The site contains Corporate information such as share prices,
a brochure on schizophrenia, as well as advice sales figures and other financial tools are also
and case stories from people suffering with the available.
illness.
Books
Lundbeck Institute
www.cnsforum.com Birchwood M, Jackson C. Schizophrenia.
Psychology Press, 2001.
The Lundbeck Institute aims to improve the
quality of life of people affected by central Frith C, Johnstone E. Schizophrenia. A very short
nervous system disorders, through education. introduction. Oxford University Press, 2003.
The site contains a section on schizophrenia
and a ‘brain explorer’ animation, which is a Hirsch SR, Weinberger DR (eds). Schizophrenia.
visual aid describing disorders of the brain. Second edition. Blackwell Science (UK), 2003.
37
Co-morbidity Hypothalamus
A term used to refer to a disease or disorder A region of the forebrain, linked with the
that is not directly caused by another disorder thalamus and pituitary gland. It contains
but occurs at the same time. centres controlling body temperature, thirst,
hunger, water balance, and sexual function. It is
Delusion also closely connected with emotional activity.
False or unrealistic belief.
Limbic system
Dopamine A complex system of nerve pathways and
One of many chemicals (neurotransmitters) networks in the brain that is involved in the
that send messages between nerve cells. expression of instinct and mood. It includes the
activities of the amygdala, hippocampus and
Dystonia hypothalamus.
A dysfunction of the muscles, characterised by
spasms or abnormal muscle contraction. MRI scan
Magnetic resonance imaging (MRI) is a type of
Extrapyramidal symptoms (EPS) scan that uses radio waves to generate an
A set of movement-related side effects image of body tissues. It is especially useful for
common with antipsychotics, e.g., tremor, examining the nervous system, muscles, and
stiffness, cramps, involuntary movements, and bones.
restlessness.
Negative symptoms
Hallucination Symptoms which represent the absence of
Symptom that can be produced by a disease or some usual trait, such as blunted emotions,
medications, which makes a person believe they apathy, or social withdrawal.
are seeing, hearing, or feeling things that are
not really there. Neuroleptic malignant syndrome (NMS)
A very rare, but potentially fatal side effect of
Hippocampus some antipsychotics.
An area of the floor of the lateral ventricle of
the brain. It contains complex foldings of
cortical tissue and is involved in the limbic
system.
38
Neurological Positive symptoms
Describing any condition or symptom that Symptoms considered to be added effects of
affects the nervous system. the disorder, such as hallucinations, delusions,
and disorganised speech.
Neurotransmitter
Type of chemical that is present in the nervous Prolactin
system to carry messages between different A hormone that stimulates milk production
nerve cells. Examples of neurotransmitters after childbirth and also stimulates production
include dopamine, acetylcholine, and of the ‘male’ hormone progesterone. Excessive
noradrenaline. secretion of prolactin can give rise to abnormal
production of milk in both sexes.
PET scan
Positron emission tomography (PET) is a type of Substantia nigra
scan that can detect chemicals in the brain. It is Area of the brain where dopamine is produced.
sometimes used to produce pictures (scans)
showing the arrangement of dopamine-
producing nerve cells.
39
40
Index
Index
Acute 4, 5, 27 Clinical scales 22
Age of onset 6, 7, 9 Clozapine 24
Alcohol abuse 8, 14, 31, 32 Clozaril® (clozapine) 24
Alogia 20 Cognitive impairment 3, 22, 26
American Psychiatric Association (APA) 15 Cognitive symptoms 4, 5, 22
Amisulpride 24 Co-morbidities 5, 27, 29
Amygdala 11, 12, 37, 38 - cardiovascular disease 29
- respiratory disease 29
Anhedonia 20, 37
- diabetes 29
Antidepressant 29 - hepatitis C 29
Antipsychotic drugs 21, 23 - HIV 29
- atypical 24 Core symptoms 15
- discontinuation 26, 27
Course 4, 5
- side effects 24, 25, 26
- switching 26 Definitions 37–39
- typical 23 Delusions 3, 5, 15, 17, 19–20, 21, 23, 38
Anxiety 5, 8, 21, 29 Dementia praecox 3
Apathy 3, 20, 31, 38 Depixal® (flupentixol) 24
Aripiprazole 24 Depression 17, 26, 27, 29
Avolition 20, 29, 37 Development 4, 5, 6, 13
Bipolar disorder 17, 29 Diagnosis 9, 15
Bleuler, Eugen 3 Disease course 4
Blunted emotions 3, 5, 20 Disease development 4, 5, 6, 13
Brain tumour 15, 17 Disorganised (hebephrenic) schizophrenia 21
Brief Psychiatric Rating Scale (BPRS) 22, 37 Dopamine 11, 23, 24, 38
Calgary Depression Scale (CDS) 22 Drug abuse 8, 14, 15, 29, 31, 32
Catatonic 20, 21, 37 DSM-IV 15
Cause(s) 11–14 Dystonia 38
- genetic 11, 13 Economic factors 8, 32, 33
- environmental 11, 14 - hospitalisation 33
41
Epilepsy 15, 17 Magnetic resonance imaging (MRI) 19, 38
European Federation of Associations of Families of Maintenance phase 5
People with Mental Illness (EUFAMI) 35 Medication 23
Exclusion criteria 15 Mellaril® (thioridazine) 24
Extrapyramidal symptom side (EPS) effects 24, 25, 38 Meso-cortical pathway 24
- dystonia 26
Modecate® (fluphenazine) 24
- akasthisia 26
- pseudo-parkinsonism 26 Moditen® (fluphenazine) 24
Fentazin® (perphenazine) 24 Mood disorder 15, 29
Flupentixol 24 Mortality 5, 32
Fluphenazine 24 MRI See Magnetic resonance imaging
Frequency 3, 9 National Alliance for Research on Schizophrenia and
Depression (NARSAD) 36
Gender 6, 7, 9, 14
National Institute of Mental Health (NIMH) 35
Genetic 11, 13
National Institutes of Health (NIH) 35
Geodon® (ziprasidone) 24
Navane® (thiothixene) 24
H. Lundbeck A/S 36
Negative symptoms 4, 5, 11, 19, 20, 24, 38
Haldol® (haloperidol) 24
Neuroleptic malignant syndrome (NMS) 25, 38
Hallucinations 3, 5, 11, 15, 19, 21, 23, 38
Neurotransmitters 3, 11, 23, 24, 39
Haloperidol 24
Obsessive–compulsive disorder 17
Hebephrenic see Disorganised (hebephrenic)
schizophrenia 21 Olanzapine 24
Hippocampus 11, 12, 38 Paranoid 21, 31
Hypothalamus 38 Perphenazine 24
ICD-10 15 Personality disorder 17
Imaging 11, 17 PET See Positron Emission Tomography
Incidence 7, 9 Positive and Negative Syndrome Scale (PANSS) 22, 39
Kraepelin, Emil 3 Positive symptoms 5, 19–20, 23, 24, 39
Largactil® (chlorpromazine) 24 Positron Emission Tomography (PET) 11, 19, 39
Loxapac® (loxapine) 24 Prevalence 9
- geographical 9
Loxapine 24
Prodomal phase 5
Loxitane® (loxapine) 24
Psychiatrist 3, 5, 15
Lundbeck Institute 36
Psychosocial therapy 23, 27
42
Psychotic episode 3, 4, 5, 8, 23, 33 Stigma 3, 8, 27, 32
Quality of life 8, 29 Suicide 5, 8, 29, 32
Quetiapine 24 Symptoms 3, 4
Relative risk 7 - core 15
- cognitive 4, 5, 22
Remission 5
- negative 4, 5, 11, 19, 20, 21, 23, 24, 37, 38, 39
Risperidol® (risperidone) 24 - positive 5, 19–20, 22, 23, 24, 31, 37, 39
Risperidone 24 Thioridazine 24
Schizoaffective disorder 16 Thiothixene 24
schizophrenia.com 35 Thorazine® (chloropromazine) 24
Schizophrenia Treatment and Evaluation Programme Treatment 23 See antipsychotic drugs; psychosocial
(STEP) 36 therapy
Self-care 3, 5, 15, 21 - costs 8, 31, 33
Serdolect® (sertindole) 24 Unmet needs 27
Seroquel® (quetiapine) 24 Ventricles 11, 12
Serotonin 24 Viral infection 14, 17
Sertindole 24 Winter birth 14
Side effects 24, 25, 26 World Health Organization (WHO) 9, 15
- anticholinergic effects 25 Zeldox® (ziprasidone) 24
- extrapyramidal symptoms (EPS) 24, 25, 38
Ziprasidone 24
- sedation 25
- seizures 25 Zyprexa® (olanzapine) 24
- weight gain 25, 29
- prolactin 25, 26, 39
- neuroleptic malignant syndrome 25, 38
- sexual 20, 25, 26, 38
Social anxiety disorder 17
Social factors 8, 31
- social interaction 31
- employment 8, 31
- education 8, 31
- homelessness 8, 31
- drugs, alcohol and violence 31–32
- suicide and mortality 32
Social withdrawal 3, 20
Solian® (amisulpride) 24