Overview
Definition
A severe, chronic, and debilitating mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior.
Epidemiology
Affects ~1% of the population. Onset is typically late teens/early 20s for men, and late 20s for women.
Etiology & Risk Factors
- Dopamine hypothesis: Hyperactivity in the mesolimbic pathway (causes positive symptoms) and hypoactivity in the mesocortical pathway (causes negative symptoms).
- Strong genetic component
- Neurodevelopmental abnormalities (ventricular enlargement, cortical volume loss)
Clinical Symptoms
- Positive Symptoms: Hallucinations (most commonly auditory), Delusions (fixed false beliefs, often paranoid/persecutory or bizarre), Disorganized speech (word salad, derailment)
- Negative Symptoms: Flat affect, Alogia (poverty of speech), Avolition (lack of drive), Anhedonia, Asociality
Clinical Approach
Diagnosis
- DSM-5 Criteria: ≥ 2 active phase symptoms (at least one must be hallucinations, delusions, or disorganized speech) for ≥ 1 month
- Continuous signs of the disturbance must persist for ≥ 6 months
- Must rule out Schizoaffective Disorder, drug-induced psychosis, and medical causes
Management
- Atypical (Second-Generation) Antipsychotics (e.g., Risperidone, Olanzapine, Aripiprazole, Quetiapine) are first-line to block D2 receptors and manage symptoms
- Clozapine: Reserved for treatment-resistant schizophrenia (must monitor for agranulocytosis)
- Psychosocial rehabilitation, family therapy, and supported employment
Complications
- Significant lifelong disability and unemployment
- High rates of substance use disorder (especially nicotine/smoking)
- Decreased life expectancy (due to cardiovascular disease and suicide)