Schizophrenia
Mental disorder with psychotic symptoms / From Wikipedia, the free encyclopedia
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Schizophrenia is a mental disorder[14] characterized by continuous or relapsing episodes of psychosis.[5] Major symptoms include hallucinations (typically hearing voices), delusions and disorganized thinking.[7] Other symptoms include social withdrawal and flat affect.[5] Symptoms typically develop gradually, begin during young adulthood, and in many cases are never resolved.[3][7] There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person.[7] For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months (according to the DSM-5) or one month (according to the ICD-11).[7][15] Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders and obsessive–compulsive disorder.[7]
About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime.[16] In 2017, there were an estimated 1.1 million new cases and in 2022 a total of 24 million cases globally.[2][17] Males are more often affected and on average have an earlier onset than females.[2] The causes of schizophrenia may include genetic and environmental factors.[5] Genetic factors include a variety of common and rare genetic variants.[18] Possible environmental factors include being raised in a city, childhood adversity, cannabis use during adolescence, infections, the age of a person's mother or father, and poor nutrition during pregnancy.[5][19]
About half of those diagnosed with schizophrenia will have a significant improvement over the long term with no further relapses, and a small proportion of these will recover completely.[7][20] The other half will have a lifelong impairment.[21] In severe cases, people may be admitted to hospitals.[20] Social problems such as long-term unemployment, poverty, homelessness, exploitation and victimization are commonly correlated with schizophrenia.[22][23] Compared to the general population, people with schizophrenia have a higher suicide rate (about 5% overall) and more physical health problems,[24][25] leading to an average decrease in life expectancy by 20[10] to 28 years.[11] In 2015, an estimated 17,000 deaths were linked to schizophrenia.[13]
The mainstay of treatment is antipsychotic medication, along with counseling, job training and social rehabilitation.[5] Up to a third of people do not respond to initial antipsychotics, in which case clozapine may be used.[26] In a network comparative meta-analysis of 15 antipsychotic drugs, clozapine was significantly more effective than all other drugs, although clozapine's heavily multimodal action may cause more side effects.[27] In situations where doctors judge that there is a risk of harm to self or others, they may impose short involuntary hospitalization.[28] Long-term hospitalization is used on a small number of people with severe schizophrenia.[29] In some countries where supportive services are limited or unavailable, long-term hospital stays are more common.[30]
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