Schizophrenia

Descriptive text is not available for this image BASICS

A severe and persistent mental illness characterized by delusions, hallucinations, disorganization of thought and behavior, cognitive dysfunction, and impairment in reality testing

DESCRIPTION

Major psychiatric disorder with a variable course, typically involving prodromal, active, and residual psychotic symptoms with disturbances in thought, speech, affect, behavior, and perception

EPIDEMIOLOGY

Prevalence

  • Worldwide prevalence 7.2 per 1,000 people
  • Age of onset: typically <30 years, earlier in males (late teens to mid-20s) than females (early 20s to early 30s)

ETIOLOGY AND PATHOPHYSIOLOGY

  • 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.
  • Two genes, SRRM2 and AKAP11, have been discovered to be associated with an increased risk of schizophrenia while the gene PLCO demonstrates a shared increased risk of both schizophrenia and autism.

Genetics

If first-degree biologic relative has schizophrenia, risk is 8–10%.

RISK FACTORS

  • Antenatal risk factors include prenatal infection or malnutrition, obstetric complications leading to hypoxia, winter births, postnatal infections requiring hospitalization, urban birth, and advanced paternal age.
  • Risk factors across the lifespan include adolescent cannabis use, childhood trauma, urban residence, autoimmune disorders, severe and repeated stress, lower socioeconomic status, minority status, being a first- or second-generation immigrant, inadequate social support.

GENERAL PREVENTION

Educate all patients on the risks around marijuana use.

COMMONLY ASSOCIATED CONDITIONS

  • Nicotine dependence (>50%) and substance use disorders
  • Metabolic syndrome, diabetes mellitus

There's more to see -- the rest of this topic is available only to subscribers.