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INTRODUCTION

Schizophrenia is one of the most serious of psychiatric disorders which according to the World Health Organization (WHO) is ranked among the top ten illnesses contributing to the global burden of disease.

  • Diagnosis is based on a standardized psychiatric interview and the use of diagnostic criteria, as specified below. Note that these criteria allow the diagnosis in absence of prominent hallucinations or delusions (e.g., there is instead some combination of negative symptoms, disorganized speech, and/or disorganized or catatonic behavior).

  • Duration of active psychotic symptoms for at least 1 month, or for a shorter duration if successfully treated.

  • Total duration of illness for at least 6 months, including prodrome, acute phase, and residual symptoms.

  • Cognitive impairment and disorganization characterized by disorganized, illogical, loosely associated or bizarre speech, or by inappropriate or bizarre behaviors.

  • The above symptoms are idiopathic in nature—that is, they are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

  • Dysfunction in one or more life domains as a result of the above signs or symptoms.

Other common features:

  • Lack of insight that symptoms and difficulties that stem from them are products of a mental illness that requires treatment.

  • Deterioration in personal appearance and hygiene.

  • Depression and anxiety symptoms, including suicidal thinking.

  • Abnormal motor activity, including rocking, pacing, grimacing, maintaining uncomfortable postures, stereotypies, and odd mannerisms.

  • Poor adherence with treatment.

  • Comorbid drug (including nicotine) and alcohol use disorders, and chronic physical health problems.

GENERAL CONSIDERATIONS

Schizophrenia is a heterogenous clinical syndrome characterized by a constellation of symptoms that have been broadly classified into three domains: positive, negative, and cognitive dysfunction. It typically has a chronic and relapsing course with incomplete remissions and is associated with significant impairment in most domains of functioning. Schizophrenia is one of the top 10 leading causes of disability worldwide. The annual costs for schizophrenia in the US have been estimated to range from US$94 million to US$102 billion with indirect costs (in terms of reduced productivity and cost that care-givers bear by contributing time and service), disability accounting for 50%–85% of the total costs associated with schizophrenia. The economic burden of schizophrenia was estimated to range from 0.02% to 1.65% of the gross domestic product.

The positive symptoms of schizophrenia, often referred to as psychotic symptoms, include hallucinations and other perceptual alterations, delusions, disorganized thinking and speech, and disorganized behavior (including catatonia). The negative symptoms of schizophrenia include amotivation, blunted affect, social withdrawal, avolition (diminished interests, sense of purpose, and social drive), diminished emotional expression, alogia (diminished quantity of speech and amount of spontaneous elaboration), and anhedonia (diminished capacity to experience pleasure or interest). The cognitive symptoms of schizophrenia include deficits in memory, attention, reasoning and problem solving, processing speed, social cognition, and intelligence quotient (IQ). ...

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