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Schizophrenia is a topic covered in the 5-Minute Clinical Consult.

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Schizophrenia is a persistent and severe psychiatric condition characterized by neurocognitive decline and impairment in reality testing.


  • Major psychiatric disorder characterized by prodrome, active, and residual psychotic symptoms involving disturbances in appearance, speech, behavior, perception, and thought that last for at least 6 months
  • DSM-5 eliminated subcategories of schizophrenia (1).
  • System(s) affected: central nervous system (CNS)


  • 7.7 to 43/100,000
  • Predominant sex: male-to-female ratio = 1.4:1.0
  • Age of onset: typically <30 years, earlier in males (early to mid-20s) than females (late 20s), with a smaller peak that occurs in women >45 years

  • Lifetime (1%): highest prevalence in lower socioeconomic classes and urban settings (2-fold higher risk)
  • 1.1% of the population >18 years old; similar rates in all countries

Etiology and Pathophysiology

  • Stems from a complex interaction between genetic and environmental factors; higher incidence if prenatal infection or hypoxia, winter births, first-generation immigrants, advanced paternal age, drug use, and genetic (velocardiofacial) syndromes
  • Overstimulation of mesolimbic dopamine D2 receptors, deficient prefrontal dopamine, and aberrant prefrontal glutamate (NMDA) activity results in perceptual disturbances, disordered thought process, and cognitive impairments

If first-degree biologic relative has schizophrenia, risk is 8–10% (a 10-fold increase).

General Prevention

  • Currently, no known preventive measures decrease the incidence of schizophrenia.
  • Interventions to improve long-term outcome and associated comorbid conditions are employed during management.

Commonly Associated Conditions

  • Nicotine dependence (>50%) (1) and substance use disorders are common and lead to significant long-term medical and social complications.
  • Metabolic syndrome, diabetes mellitus, obesity, and certain infectious diseases, including HIV, hepatitis B, and hepatitis C all occur in higher-than-expected rates in individuals with schizophrenia.

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Stephens, Mark B., et al., editors. "Schizophrenia." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116546/all/Schizophrenia.
Schizophrenia. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116546/all/Schizophrenia. Accessed April 26, 2019.
Schizophrenia. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116546/all/Schizophrenia
Schizophrenia [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116546/all/Schizophrenia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Schizophrenia ID - 116546 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116546/all/Schizophrenia PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -