Schizophrenia
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
- DSM-5 eliminated subcategories of schizophrenia (paranoid, disorganized, catatonic, etc.).
- System(s) affected: central nervous system (CNS)
Epidemiology
Prevalence
- 0.3–0.7% of the population >18 years old
- Age of onset: typically <30 years, earlier in males (late teens to mid-20s) than females (early 20s to early 30s)
Etiology and Pathophysiology
- A complex interaction between genetic and environmental factors
- Overstimulation of mesolimbic dopamine D2 receptors, deficient prefrontal dopamine, and aberrant prefrontal glutamate (NMDA) activity result in perceptual disturbances, disordered thought process, and cognitive impairments.
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, and inadequate social support.
General Prevention
Educate all patients on the risks around cannabis use, especially those in a potential prodromal period or those with a family history of psychosis.
Commonly Associated Conditions
- Nicotine dependence (>50%) and substance use disorders
- Metabolic syndrome, diabetes mellitus, and obesity
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Citation
Domino, Frank J., et al., editors. "Schizophrenia." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688698/all/Schizophrenia.
Schizophrenia. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688698/all/Schizophrenia. Accessed November 6, 2024.
Schizophrenia. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688698/all/Schizophrenia
Schizophrenia [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 06]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688698/all/Schizophrenia.
* Article titles in AMA citation format should be in sentence-case
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