Schizophrenia

About Schizophrenia

Schizophrenia is a serious mental disorder affecting somewhat less than one percent of people over their lifetime, typically emerging in late adolescence or early adulthood, often somewhat earlier in men. It involves positive symptoms such as hallucinations, usually auditory, delusions, often persecutory, and disorganized speech and behavior; negative symptoms such as blunted emotional expression, reduced speech, lack of motivation and social withdrawal; and cognitive difficulties with attention, working memory and planning. The dopamine hypothesis links positive symptoms to excess dopamine activity in certain brain pathways, and neurodevelopmental theories point to early brain development, with imaging studies showing on average reduced gray matter and enlarged ventricles. Genetic factors contribute substantially, but many genes each add a small amount of risk, and environmental factors such as heavy cannabis use and urban upbringing also play a role. First generation antipsychotics such as haloperidol and chlorpromazine block dopamine D2 receptors and can cause movement side effects, while second generation antipsychotics carry a greater risk of weight gain and metabolic effects. Clozapine is the most effective option for treatment resistant schizophrenia but requires regular blood count monitoring because of a risk of agranulocytosis. Coordinated specialty care for first episode psychosis, combining medication, therapy, family support and supported employment, improves outcomes.