Schizophrenia

A general term for a group of psychotic illnesses that are characterized by disturbances in thinking, emotional reaction, and behaviour. Onset can be at any age but is most common in late adolescence and the early 20s, and may be triggered by stress. No causes have been identified, but many have been implicated. It is likely that inheritance plays a role. Disruption of the activity of some neurotransmitters in the brain is a possible mechanism. Brain imaging techniques have revealed abnormalities of structure and function in people with schizophrenia. Schizophrenia may begin insidiously, with the individual becoming slowly more withdrawn and losing motivation. In other cases, the illness comes on more suddenly, often in response to external stress. The main symptoms are various forms of delusions such as those of persecution (which are typical of paranoid schizophrenia); hallucinations, which are usually auditory (hearing voices), but which may also be visual or tactile; and thought disorder, leading to impaired concentration and thought processes. Disordered thinking is often reflected in muddled and disjointed speech. Behaviour is eccentric, and selfneglect common. In a rare form of schizophrenia, catatonia may occur, in which rigid postures are adopted for prolonged periods, or there are outbursts of repeated movement. Diagnosis of schizophrenia may take some time and, in some cases, it may be difficult to make a diagnosis at all. Treatment is mainly with antipsychotic drugs, such as phenothiazine drugs, and new atypical antipsychotic drugs such as risperidone. In some cases, the drugs are given as monthly depot injections. Once the symptoms are controlled, community care, vocational opportunities, and family counselling can help to prevent a relapse. Some people may make a complete recovery. However, the majority have relapses punctuated with partial or full recovery. A small proportion have a severe life-long disability.