Initially, the disease presents as mild personality changes, slight paranoia and increased moodiness. It may then progress to a decreased emotional range, depression, noticeable personality changes, disorganized or ‘rambling’ speech, sudden mood swings usually without any precipitating factors and auditory hallucinations. Tactile hallucinations are rare but can possibly occur. The patient often gets delusional, with a firm, almost to the point of stubborn, belief that what he perceives is real. He/she may also get unnecessarily hostile and aggressive or closeted and withdrawn, depending upon his mental status.

• Weight Gain

  With regard to weight gain, lack of data is not an issue. [ncbi.nlm.nih.gov]

  […] changes in children treated with olanzapine. 27 Although the findings of a recent study indicated that orally disintegrating olanzapine induces less weight gain in adolescents than standard oral tablets, the weight gain still remained in excess of what [web.archive.org]

  Olanzapine appears to cause the most significant weight gain in patients with EOS, while ziprasidone and aripiprazole seem to cause the least. [doi.org]

  However, the risks of serious weight gain and the development of diabetes are significant. Quetiapine (Seroquel) – risk of weight gain and diabetes, however, the risk is lower than Clozapine or Olanzapine. [medicalnewstoday.com]

• Noncompliance

  Long-term use can develop dependence and put the patient at risk if they are noncompliant. [emedicine.medscape.com]

  Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS) and its relationship to sociodemographic, clinical and psychopathological variables. Schizophr Res. 2009; 107 ( 2-3 ):213–217. [ PubMed ] [ Google Scholar ] 31. [ncbi.nlm.nih.gov]

  Neuroleptic noncompliance in schizophrenia. In: C.A. Tamminga & S.C. Schulz (red.). Advances in neuropsychiatry and psychopharmacology: Schizophrenia Research (pp. 286-296). New York: Raven Press. [directievetherapie.nl]

  Evaluation of noncompliance in schizophrenia patients using electronic monitoring (MEMS) and its relationship to sociodemographic, clinical and psychopathological variables. Schizophr Res. 2009 ;107(2-3): 213 – 217. [doi.org]

• Family History of Suicide

  A family history of suicide, and comorbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment. [ncbi.nlm.nih.gov]

  Family history of suicide among suicide victims. Am. J. Psychiatry 160, 1525 –1526 ( 2003 ).. Genetic association studies on suicide have mainly focused on serotonin-related genes. [oadoi.org]

• Motor Restlessness

  restlessness; not anxiety or agitation Five to 60 days Unknown Reduce dose or change drug; antiparkinsonian agents (benzodiazepines or propranolol [Inderal])† may help Parkinsonism Bradykinesia, rigidity, variable tremor, mask facies, shuffling gait [aafp.org]

  restlessness) Parkinsonian symptoms of stiffness, resting tremor, difficulty with gait, and feeling slowed-down Orthostatic hypotension caused by alpha-adrenergic blockade Dry mouth, fatigue, sedation, visual disturbance, inhibited urination, and sexual [emedicine.medscape.com]

  Depression-related symptoms, such as agitation or motor restlessness, as well as fear of mental disintegration [34] Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: systematic review of risk factors. Br. J. [oadoi.org]

• Delusion

  Corrections for publication bias further reduced the effect sizes to 0.21 for positive symptoms and to 0.03 for delusions. In blinded studies, the corrected effect sizes were 0.22 for positive symptoms and 0.03 for delusions. [ncbi.nlm.nih.gov]

  The quality of the studies was evaluated and the effect size and the moderating variables of MCT on delusion were determined. Results A total of 11 studies on the effect of MCT for delusion were investigated. [doi.org]

  Delusions A delusion is a belief held with complete conviction, even though it's based on a mistaken, strange or unrealistic view. It may affect the way the person behaves. Delusions can begin suddenly, or may develop over weeks or months. [nhs.uk]

• Auditory Hallucination

  He uses the device all day and his auditory hallucinations have subsided. Improvement of schizophrenia symptoms has enabled the patient to reduce his psychiatric medications intake. [ncbi.nlm.nih.gov]

  Temporal course of auditory hallucinations. Br. J. Psychiatry 185, 516–517 (2004). 56. Lennox, B. R., Park, S. B., Medley, I., Morris, P. G. & Jones, P. B. The functional anatomy of auditory hallucinations in schizophrenia. [doi.org]

• Anhedonia

  […] with questionable or no anhedonia ( Figure 3 ). [doi.org]

  Implications for assessment and treatment are discussed in relation to this new conceptualization of anhedonia. [ncbi.nlm.nih.gov]

• Anxiety Disorder

  Among the anxiety disorders, the evidence at present is most abundant for an association with obsessive-compulsive disorder. [ncbi.nlm.nih.gov]

  Anxiety disorders were the most commonly treated (68.3 %). [doi.org]

• Withdrawn

  Symptoms such as becoming socially withdrawn and unresponsive or changes in sleeping patterns can be mistaken for an adolescent "phase". [nhs.uk]

  They might feel frightened and withdrawn, and could appear to have lost touch with reality. This lifelong disease can’t be cured but can be controlled with proper treatment. [webmd.com]

  For example, becoming socially withdrawn and unresponsive. Or changes in sleeping patterns People often have episodes of schizophrenia when their symptoms are severe. This is acute schizophrenia. [www2.hse.ie]

  Randomised trials of patients with schizophrenia continued on or withdrawn from any antipsychotic drug regimen after stabilisation were eligible. Our primary outcome was relapse between 7 and 12 months. [ncbi.nlm.nih.gov]

• Sexual Dysfunction

  RESULTS: Consensus recommendations included regular monitoring of body mass index, plasma glucose level, lipid profiles, and signs of prolactin elevation or sexual dysfunction. [ajp.psychiatryonline.org]

  […] at higher doses Sexual dysfunction Amisulpiride: Hyperprolactinaemia Insomnia Extrapyramidal effects Quetiapine: Hypotension Dyspepsia Drowsiness Clozapine Sedation Hypersalivation Constipation Reduced seizure threshold Hypotension and hypertension Tachycardia [ncbi.nlm.nih.gov]

  Schizophrenia medication can have very unpleasant—even disabling—side effects such as drowsiness, lack of energy, uncontrollable movements, weight gain, and sexual dysfunction. [helpguide.org]

  dysfunction, which can be adverse reactions to antipsychotic medication or to anticholinergic drugs taken for prophylaxis of dystonia Find out about threats made to others, expressions of suicidal intent, and possession of weapons at home or on the person [emedicine.medscape.com]

• Confusion

  ECT side effects and ongoing controversy In addition to confusion, memory loss and headaches commonly occur immediately following ECT treatment. [schizophrenic.com]

  Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand. [nhs.uk]

  Confused thoughts (thought disorder) People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Psychosis is a symptom of Schizophrenia. [www2.hse.ie]

  In the present paper, the authors review the main methodological issues which have led to the current confusion about the number of dimensions underlying schizophrenic psychopathology. [ncbi.nlm.nih.gov]

  The hallucination is very real to the person experiencing it, and it may be very confusing for a loved one to witness. The voices in the hallucination can be critical or threatening. [nami.org]

• Agitation

  Repeat doses can be administered every 20–30 minutes as needed to control continued severe agitation. The haloperidol dose can be doubled each time up to 20 mg if prior dosing is inadequate for severe agitation. [emedicine.medscape.com]

  Second level analyses isolated the individual symptoms of social inattention, poor overall attention, active social avoidance and agitated/aggressive behavior from PANSS, SANS, and SAPS as predictive of support intensity. [ncbi.nlm.nih.gov]

  People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason. [nhs.uk]

• Catatonia

  Abstract Catatonia is a motor dysregulation syndrome described by Karl Kahlbaum in 1874. He understood catatonia as a disease of its own. [ncbi.nlm.nih.gov]

  Lethal catatonia Special consideration should be given to the syndrome of lethal catatonia. [schizophrenia.com]

  Catatonia According to the APA, the same criteria are used to diagnose catatonia whether the context is a psychotic, bipolar, depressive, or other medical disorder, or an unidentified medical condition: In DSM-IV, two out of five symptom clusters were [pro.psychcentral.com]

• Irritability

  The patient's activity and mood improved within 2 weeks, but in the following 2 weeks the patient reported increased drive, activity, libido, unpleasant inner tension, and irritability. [dx.doi.org]

  The patient’s activity and mood improved within 2 weeks, but in the following 2 weeks the patient reported increased drive, activity, libido, unpleasant inner tension, and irritability. [ncbi.nlm.nih.gov]

  PubMed Central PubMed Google Scholar Crane C, Martin M, Johnston D, Goodwin GM: Does depression influence symptom severity in irritable bowel syndrome? Case study of a patient with irritable bowel syndrome and bipolar disorder. [doi.org]

  They can be pleasant, but are often rude, critical, abusive or just plain irritating. How do people react to them? You may try to ignore them, talk back to them – or even shout back at them if they are particularly loud or irritating. [rcpsych.ac.uk]

• Stupor

  In a monograph titled Benign Stupors, August Hoch described 25 psychiatric patients in stupor. [ncbi.nlm.nih.gov]

  This is a life-threatening condition, characterized by stupor or excitement, hyperthermia, clouded consciousness and autonomic dysregulation.....The literature on this syndrome, which consists solely of case series, suggests that neuroleptic treatment [schizophrenia.com]

  Stupor revisited, Compr Psychiatry, 1981, vol. 22 (pg. 466 - 478 ) 4., The History of Mental Symptoms, 1996 Cambridge, UK Cambridge University Press 5. [doi.org]

  In the International Pilot Study of Schizophrenia [ 10 ] and the Determinants of Outcome of Severe Mental Disorders study [ 12 ], catatonia (a form of schizophrenia characterized by a tendency to remain in a fixed stuporous state for long periods) was [dx.doi.org]

  […] psychotic disorders characterized by distortions of reality and disturbances of thought and language and withdrawal from social contact Synonyms: gespletenheid Types: catatonie a form of schizophrenia characterized by a tendency to remain in a fixed stuporous [vocabulary.com]

Laboratory tests

The main purpose of laboratory tests is to exclude any systemic or metabolic disease.

• Complete blood count
• Thyroid function tests
• Liver and kidney function tests
• Urinalysis to check substance abuse, heavy metal poisoning and pregnancy

Imaging 

CT scan and MRI of the brain to check for structural abnormalities, signs of trauma and tumors can be conducted.

Test results

Once any sign of preexisting disease has been ruled out and if the history and clinical signs point towards a mental disorder, a tentative diagnosis of schizophrenia can be made. It is confirmed by psychoanalysis.

• Base Deficit

  Despite these differences, what is most notable in the comparisons across studies is the substantial degree of similarity in the schizophrenia-based deficits in endophenotype performance between COGS-1 and COGS-2 schizophrenia participants. [ncbi.nlm.nih.gov]

Pharmacological treatment

Antipsychotic medication is the mainstay of pharmacological treatment. Randomized trials have shown that antipsychotics reduce positive symptoms of schizophrenia, such as hallucinations, delusions, and suspiciousness, compared to placebo [8]. They include drugs like clozapine, amisulpride and risperidone. All antipsychotics have a wide range of adverse effects and close monitoring is generally indicated.

Non-pharmacological treatment

It includes cognitive-behavioral therapy (CBT) and emotional support by family and/or friends. Cognitive training involves structured exercises prescribed and undertaken with the intention of enhancing cognitive abilities such as attention, memory, and problem solving. Thus, cognitive training represents a potentially promising intervention for enhancing cognitive abilities in schizophrenia [9]. Participation in support groups also helps in reducing depression and anxiety of the patient.

Schizophrenia is a chronic, progressive disease with a negative prognosis. Life expectancy is reduced by as much as 10-25 years [7]. Social as well as personal life is severely compromised and the patient becomes a victim of depression. Not surprisingly, patients are estimated to have a 5% increased chance of committing suicide. Early identification and diagnosis followed by adequate treatment can help reduce the severity of symptoms, decrease mortality rate and increase the quality of life.

Various genetic and environmental factors work together to develop this disease. A number of risk factors have been associated with the development of schizophrenia, including living in an urban area [2], immigration, obstetrical complications [3] and advanced paternal age at conception. Childhood trauma or being a victim of bullying, substance abuse and severe emotional trauma can all set the ground work of this disease.

The tendency of schizophrenia to run in families is a clear indicator of genetic involvement. Several likely candidates have been implicated like NOTCH4, zinc finger protein 804A and the histone protein loci. The likelihood of a child having schizophrenia when one parent already suffers from this disease is 13%, and as high as 50% if both parents do.

Incidence

Approximately 1% of the population will be affected by this disease worldwide in its lifetime.

Age

The onset of this disease occurs typically between late teens and mid thirties. Schizophrenia is extremely rare in children.

Sex

Slightly more men are diagnosed with schizophrenia than women (on the order of 1.4:1) [4]. Also, the onset of this disease is later in females than in males, possibly due to the antidopaminergic effect of estrogen in females.

Schizophrenia is a result of several pathways that together act to create the disease. The pathogenesis comprises three main mechanisms.

The first is anatomical abnormalities. A meta-analysis of studies using diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white matter tracts are reduced in schizophrenia [5]. The abnormalities identified included loss of whole-brain volume in both gray and white matter and increases in lateral ventricular volume [6]. The exact cause of these structural anomalies is unclear.

The second is abnormally working dopaminergic pathways. It is known that schizophrenics suffer from a hypodopaminergic state which leads to a decrease in mental capabilities and degeneration of involved neurons.

The third mechanism is a defective or disturbed immune system. Schizophrenia is not a strictly autoimmune condition but due to an infection or some other illness, overactivation of the immune system may occur. This would lead to overproduction of cytokines and other inflammatory mediators that could easily penetrate the blood brain barrier and damage the neurons. This excessive inflammation could be both a direct association to schizophrenia or secondary to metabolic diseases like diabetes.

Cognitive behaviour therapy (CBT) is the primary modality for preventing the onset, and mainly, the progression of schizophrenia. The use of a psychological interventional approach that involved CBT and counselling of family members along with group skills training of the patient delayed the onset of psychosis for at least 2 years, as shown by a German study [10]. Avoiding drugs like cocaine and amphetamines can also help prevent this disease.

Schizophrenia is a mental disorder characterized by a myriad of personality changes, most striking of which are extreme paranoia, auditory and sometimes even tactile hallucinations and delusions. It is among the most disabling and economically catastrophic medical disorders, ranked by the World Health Organization as one of the top ten illnesses contributing to the global burden of disease [1]. Schizophrenia tends to run in families, indicating a genetic predisposition. It mainly affects the ability of a person to think and rationalize, but it is also associated with a number of other conditions and comorbidities.

Definition

Schizophrenia is a mental disorder characterized by personality changes, paranoia and hallucinations. It is a common psychological disorder and tends to run in families.

Cause

Schizophrenia is not due to a specific cause; rather it is a combination of various factors that precipitate the disease. They include genetic factors, environmental factors like severe stress, change in living place, physiological changes like pregnancy, pathological conditions like chronic diseases and emotional and/or physical trauma. 

Signs and symptoms

It begins with mild personality changes and mood swings and is followed by hallucinations, paranoia and delusions. The patient may have disorganized speech, wild ideas and the inability to differentiate between what is real and what is not.

Diagnosis

Diagnosis is made first by excluding any underlying disease and then performing a thorough physical and psychological examination. Input from family and close friends or colleagues can also help pinpoint the changes in behaviour, making the diagnosis somewhat easier.

Treatment

Schizophrenia does not have a cure but it can be appropriately managed with the help of antipsychotic drugs and cognitive behaviour therapy. Regular sessions with a psychiatrist and participating in support groups can also help.

1. Murray CJL, Lopez AD. The Global Burden of Disease, Harvard University Press, Cambridge, MA 1996. p.21 
2. Pedersen CB, Mortensen PB. Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiatry 2001; 58:1039.
3. Clarke MC, Harley M, Cannon M. The role of obstetric events in schizophrenia. Schizophr Bull 2006; 32:3.
4. Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry 2010; 22:417.
5. Ellison-Wright I, Bullmore E. Meta-analysis of diffusion tensor imaging studies in schizophrenia. Schizophr Res. Mar 2009;108(1-3):3-10.
6. Olabi B, Ellison-Wright I, McIntosh AM, et al. Are there progressive brain changes in schizophrenia? A meta-analysis of structural magnetic resonance imaging studies. Biol Psychiatry. Jul 1 2011;70(1):88-96. 
7. Laursen TM, Munk-Olsen T, Vestergaard M. "Life expectancy and cardiovascular mortality in persons with schizophrenia". Current opinion in psychiatry. Mar 2012, 25 (2): 83–8. 
8. Buchanan RW, Kreyenbuhl J, Kelly DL, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 2010; 36:71.
9. Lawlor-Savage L, Goghari VM. Working memory training in schizophrenia and healthy populations. Behav Sci (Basel). 2014 Sep 3;4(3):301-19. 
10. Bechdolf A, Wagner M, Ruhrmann S, Harrigan S, Putzfeld V, Pukrop R, et al. Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry. Jan 2012;200(1):22-9