Schizophrenia is a serious and disabling mental disorder, affecting just under 1% of the population. While its etiological bases remain obscure and consequently its nosological boundaries are uncertain, the condition classically has its clinical onset in childhood or early adolescence following brain alterations that take place early in development (Van Os J, Kapur S, Schizophrenia. Lancet 374:635-645, 2009). It is characterized by (1) “positive” psychotic symptoms like delusions (fixed false ideas that are held with unshakable conviction), hallucinations (perceptions apparently without a relevant stimulus), and thought disorder (difficulty in assembling a coherent stream of speech), (2) “negative” symptoms including lack of motivation and pleasure, inability of expressing the full range of emotions, diminished speech output, and disinterest in life events, and (3) disorganized, abnormal motor behavior ranging from unpredictable agitation to limited motor and verbal responses to environment. Associated features are cognitive impairment (memory and attention difficulties), mood disturbance, particularly depression and anxiety, sleep disturbance, and lack of insight about the disorder, leading to treatment non-adherence and poor prognosis (The Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing, 2022). All of these attributes, persistent over time, culminate in a decline in social and occupational performance. Approximately 20% of patients attempt and about 5–6% of patients with schizophrenia die by suicide (The Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing, 2022). Additionally, patients with schizophrenia frequently have comorbid substance use disorders, anxiety disorders, obsessive compulsive disorder, as well as other medical conditions like diabetes and cardiovascular and pulmonary disorders, which all contribute to poor outcomes (The Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing, 2022). Schizophrenia is also poorly understood by the public, and it is often highly stigmatizing (Pescosolido BA, Medina TR, Martin JK, Long JS, Am J Public Health 103:853–860, 2013).

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Schizophrenia

  • Adriana Foster,
  • Jordanne King

摘要

Schizophrenia is a serious and disabling mental disorder, affecting just under 1% of the population. While its etiological bases remain obscure and consequently its nosological boundaries are uncertain, the condition classically has its clinical onset in childhood or early adolescence following brain alterations that take place early in development (Van Os J, Kapur S, Schizophrenia. Lancet 374:635-645, 2009). It is characterized by (1) “positive” psychotic symptoms like delusions (fixed false ideas that are held with unshakable conviction), hallucinations (perceptions apparently without a relevant stimulus), and thought disorder (difficulty in assembling a coherent stream of speech), (2) “negative” symptoms including lack of motivation and pleasure, inability of expressing the full range of emotions, diminished speech output, and disinterest in life events, and (3) disorganized, abnormal motor behavior ranging from unpredictable agitation to limited motor and verbal responses to environment. Associated features are cognitive impairment (memory and attention difficulties), mood disturbance, particularly depression and anxiety, sleep disturbance, and lack of insight about the disorder, leading to treatment non-adherence and poor prognosis (The Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing, 2022). All of these attributes, persistent over time, culminate in a decline in social and occupational performance. Approximately 20% of patients attempt and about 5–6% of patients with schizophrenia die by suicide (The Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing, 2022). Additionally, patients with schizophrenia frequently have comorbid substance use disorders, anxiety disorders, obsessive compulsive disorder, as well as other medical conditions like diabetes and cardiovascular and pulmonary disorders, which all contribute to poor outcomes (The Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing, 2022). Schizophrenia is also poorly understood by the public, and it is often highly stigmatizing (Pescosolido BA, Medina TR, Martin JK, Long JS, Am J Public Health 103:853–860, 2013).