Schizophrenia

Abstract

Schizophrenia has a long history of misunderstanding that continues to challenge clinicians and researchers today. This devastating disease is surprisingly common, affecting approximately half to 1% of the world's population. Schizophrenia is a chronic psychiatric syndrome characterised by psychotic symptoms (e.g., delusions and hallucinations), emotional dysregulation, and deficits in attention and short‐term memory. This syndrome results from a complex interplay between environmental factors and genetic susceptibility, and is typically treated with antipsychotic medications and psychosocial therapies. Substantial evidence suggests that schizophrenia is a disorder of neurodevelopment and that psychotic symptoms may actually represent a late stage of the illness process, not the onset.

Key Concepts:

  • Schizophrenia is a chronic psychiatric syndrome characterised by delusions and hallucinations, emotional dysregulation and cognitive dysfunction.

  • Schizophrenia is caused by a complex interplay of environmental factors and inherited genetic susceptibility.

  • Schizophrenia is now considered to be a neurodevelopmental disorder in which psychosis represents a late, and potentially preventable, outcome of the illness.

  • The neurobiological basis of schizophrenia includes widespread impairments in cortical and subcortical neural circuits including the prefrontal cortex and alterations in a variety of neurotransmitter systems.

  • Schizophrenia is mainly treated with antipsychotic medications and psychosocial therapies.

Keywords: schizophrenia; psychosis; antipsychotic medications; neurobiology; neurotransmitter; development; prefrontal cortex; working memory; cognition

Figure 1.

Proposed developmental course of schizophrenia. This model illustrates that from gestation to late adolescence/young adulthood, a number of genetic liabilities and adverse environmental events (blue bars) increase the risk of developing schizophrenia. A number of neurodevelopmental processes appear to be disrupted in schizophrenia (green bars). Recent evidence shows that working memory performance improves at a slower rate during postnatal development in people who will eventually develop schizophrenia (dashed orange curve) relative to healthy comparison subjects (solid orange curve). In this neurodevelopmental model, psychosis onset (magenta bar) represents a late and potentially preventable outcome of earlier pathological processes.

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Further Reading

Cooper JR, Bloom FE and Roth RH (2002) The Biochemical Basis of Neuropharmacology, 8th edn. New York: Oxford University Press.

Goff DC and Coyle JT (2001) The emerging role of glutamate in the pathophysiology and treatment of schizophrenia. American Journal of Psychiatry 158: 1367–1377.

Lewis DA and Gonzalez‐Burgos G (2006) Pathophysiologically based treatment interventions in schizophrenia. Nature Medicine 12: 1016–1022.

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Hoftman, Gil D, and Lewis, David A(Oct 2013) Schizophrenia. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0000062.pub3]