Schizophrenia: A Review

Schizophrenia is a debilitating mental illness that affects 1 percent of the population in all cultures. It affects equal numbers of men and women, but the onset is often later in women than in men.

Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, voices that converse with or about the patient, and delusions that are often paranoid. Negative symptoms include flattened affect, loss of a sense of pleasure, loss of will or drive, and social withdrawal. Both types of symptoms affect patients' families; therefore, it is important for physicians to provide guidance to all persons affected by the disease. Psychosocial and family interventions can improve outcomes.

Medications can control symptoms, but virtually all antipsychotics have neurologic or physical side effects (e.g., weight gain, hypercholesterolemia, diabetes). There is a 10 percent lifetime risk of suicide in patients with schizophrenia.

Schizophrenia is a devastating mental illness that impairs mental and social functioning and often leads to the development of comorbid diseases. These changes disrupt the lives of patients as well as their families and friends. Family physicians can play an important role in the effective treatment of schizophrenia; they are in a position to recognize the early signs of illness, make referrals to appropriate mental health professionals, help patients and their families cope with the devastating effects of schizophrenia, and encourage a multidisciplinary approach to address all dimensions of the illness.

Risk Factors, Etiology, and Pathophysiology

Schizophrenia has a prevalence of 1 percent in all cultures and is equally common in men and women.1 Men typically present with the disease in their late teenage years or early 20s, whereas women generally present in their late 20s or early 30s.

Diagnosis

Schizophrenia is characterized by positive and negative symptoms that can influence a patient's thoughts, perceptions, speech, affect, and behaviors. Positive symptoms include hallucinations, voices that converse with or about the patient, and delusions that are often paranoid. Negative symptoms include flattened affect, loss of a sense of pleasure, loss of will or drive, and social withdrawal.

Schizophrenia is also characterized by disorganized thought, which is manifested in speech and behavior. Disorganized speech may range from loose associations and moving quickly through multiple topics to speech that is so muddled that it resembles schizophasia (commonly referred to as "word salad"). Schizophasia is speech that is confused and repetitive, and that uses words that have no apparent meaning or relationship to one another. Disorganized behavior may lead to difficulties in performing daily living activities, such as preparing a meal or maintaining hygiene. It also can manifest as childlike silliness or outbursts of unpredictable agitation.