TABLE OF CONTENTS

1.1 Definition
1.2 Causes and Risk Factors
1.3 Signs and Symptoms
1.3.1 Positive Symptoms
1.3.2 Negative Symptoms
1.4 Investigations
1.5 Treatment
1.6 Complications and When Should You See a Doctor
1.7 Prognosis and Prevention
1.8 References

SCHIZOPHRENIA

1.1 Definition
Schizophrenia is a severe mental disorder that affects the thinking process, emotions, and
behavior and causes a person to lose contact with reality. The person may feel, see, or hear things
that are not present. Schizophrenia and psychotic disorders have a lifetime prevalence of 1.4% in
India.

1.2 Causes and Risk Factors

The exact cause of schizophrenia is not known. It is believed that genes play a major role in
schizophrenia. Having someone in the family increases the risk of schizophrenia. The risk is 10% if
one of the parents has schizophrenia and 40% if the both the parents have the condition. The risk
increases to 50% if an identical twin has the condition.

Environmental factors that may increase the risk of schizophrenia include problems during birth,
such as:
1. Low birth weight
2. Malnutrition
3. Iron deficiency in mother
4. Low folate with increased homocysteine levels during the third trimester of pregnancy
5. Extreme stress such as hunger and famine
6. Gestational diabetes
7. Infections

Other risk factors include:

1. Drug abuse -- cannabis
2. Childhood abuse

Schizophrenia usually occurs during the early 20s or late 30s. However, it may also occur in
children or after the age of 45 years. In children, it occurs between 13 years and 18 years of age
and is more severe.

1.3 Signs and Symptoms

People with schizophrenia may hear voices that are not there. They may think other people are
trying to hurt them. Sometimes they do not make sense when they talk. Symptoms of
schizophrenia are divided into positive, negative, and cognitive types.

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1.3.1 Positive Symptoms
Positive symptoms of schizophrenia include:
1. Seeing or hearing things, not present (hallucinations)
2. Strong false beliefs (delusions)
3. Disorganized thought
4. Abnormal movements of hands and legs
5. Schizophrenia causes a person to lose touch with reality (psychosis).

1.3.2 Negative Symptoms

Negative symptoms include:
1. Problems with emotional expression
2. Lack of motivation or interest
3. Difficulty in interacting with others
4. Reduced speech
5. Inability to feel pleasure in any activity

Cognitive symptoms include:

1. Inability to concentrate or pay attention
2. Difficulty in understanding and processing information
3. Problems with memory
4. Problems with language

Schizophrenia affects work and relationships. The person may not be able to take care of himself.

1.4 Investigations
The diagnosis of schizophrenia depends primarily on the patient’s symptomatic history. The
doctor will ask questions to the patient and family members or friends of the patient.
Schizophrenia is confirmed if at least two or more symptoms are present for more than a month
with some disturbances over a 6-month period. The doctor may conduct a physical examination
and order blood and urine tests to rule out other diseases. Imaging tests such as MRI (Magnetic
Resonance Imaging) or EEG (Electroencephalography) may be done to rule out epilepsy. Blood
test for metabolic screening may be done in children to rule out certain serious disorders that
cause an abnormal reaction in the body.

1.5 Treatment
Schizophrenia does not have a cure. The patient may need a long-term treatment that involves
management of the symptoms using medications and helping a patient lead a normal life through
social support and training.

The doctor may prescribe the following antipsychotic medicines. These are available as the first
generation and second-generation antipsychotics.
• The first-generation antipsychotics include Loxapine and Haloperidol.
• Second generation antipsychotics include Clozapine, Olanzapine, and Risperidone.

The doctor may prescribe different medicines to see which works the best for you. It is important
to take all the medications and as long as recommended by the doctor. Other medicines that may
be prescribed include:
1. Sedatives
2. Antidepressants to treat depression or anxiety
3. Anticholinergics to treat extrapyramidal symptoms (EPS) such as restlessness or
movement disorder
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Other strategies for helping a schizophrenic patient involve:
1. Psychotherapy
2. Involvement of family and friends in the treatment
3. Family education
4. Vocational rehabilitation
5. Social skills training

1.6 Complications and When Should You See a Doctor

Schizophrenia affects a patient’s work, relationships, and ability to lead a normal life. The
antipsychotic medicines used to treat hallucinations and delusions may also have side effects such
as:
1. Instability of the posture
2. Slowness of movement
3. Muscle spasms or tremor
4. Weight gain
5. Sleepiness
6. Cardiovascular diseases
7. Type 2 diabetes

1.7 Prognosis and Prevention

Prognosis depends on the adherence of treatment. Smoking, poor health habits, and not
following the treatment regime may increase the risk of complications including:
1. Hospitalization
2. Relapse
3. Violent behavior
4. Suicide and death

Schizophrenia cannot be prevented. Early treatment, taking the medicines regularly, therapy and
friends, and family support and may help to control the symptoms and help a patient lead a
normal life.

1.8 References
1. Berges AA. Schizophrenia. In: Ferri FF, ed. Ferri’s Clinical Advisor 2018. Philadelphia, PA:
Elsevier; 2018:1144-1145.e1.
2. Bope ET, Kellerman RD. Psychiatric disorders. In: Bope ET, Kellerman RD, eds. Conn's
Current Therapy 2017. Philadelphia, PA: Elsevier; 2017: Chap 10.
3. Gururaj G, Varghese M, Benegal V, et al. and NMHS collaborators group. National Mental
Health Survey of India, 2015-16: Prevalence, patterns and outcomes. Bengaluru, National
Institute of Mental Health and Neuro Sciences, NIMHANS Publication No. 129, 2016.
4. National Institute of Mental Health. National Institute of Health. Updated February 2016.
https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. Accessed July 3,
2017.