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Schizophrenia - Highlights

Description

An in-depth report on the causes, diagnosis, and treatment of schizophrenia

Highlights:

Causes of Schizophrenia

The causes of schizophrenia are unknown. Multiple factors may play a role such as genetics and brain chemistry.

Risk Factors for Schizophrenia

Risk factors for schizophrenia include:

Age. Schizophrenia can occur at any age, but it tends to first develop (or at least become evident) between adolescence and young adulthood.
Gender. Schizophrenia affects both men and women, although males tend to develop it at a slightly younger age (teens and 20s) than females (20s and 30s).
Family History. Schizophrenia often runs in families. Older paternal age is also being investigated as a risk factor for schizophrenia.

Complications of Schizophrenia

Schizophrenia can have a devastating impact on patients and their families. Patients with schizophrenia have increased risk for self-destructive behaviors and suicide. The antipsychotic drugs used to treat schizophrenia can have severe side effects, including increasing the risk of obesity and diabetes.

Medications

Schizophrenia is a chronic condition, which is usually treated with antipsychotic medication. There are two main classes of these drugs:

Typical antipsychotics include haloperidol (Haldol), chlorpromazine (Thorazine), perphenazine (Trilafon), thioridazine (Mellaril), mesoridazine (Serentil), trifluoperazine (Stelazine), and fluphenazine (Prolixin). Side effects involving the nerves and muscle movement and coordination occur in up to 70% of patients. Typical antipsychotics are sometimes referred to as “first-generation” to distinguish them from newer “second-generation” atypical antipsychotics.
Atypical antipsychotics include clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and palperidone (Invega). These newer drugs may produce fewer unpleasant symptoms than the older antipsychotics but new research shows they pose a similar risk of adverse effects on the heart, which may include sudden death. In addition, recent research indicates that these drugs are no more effective than typical antipsychotics in treating some types of schizophrenia.

Resources

www.nimh.nih.gov -- National Institute of Mental Health
www.mentalhealth.samhsa.gov -- National Mental Health Information Center
www.nami.org -- National Alliance on Mental Illness
www.nmha.org -- Mental Health America
www.narsad.org -- National Alliance for Research on Schizophrenia and Depression
www.psych.org -- American Psychiatric Association
www.aacap.org -- American Academy of Child and Adolescent Psychiatry
www.world-schizophrenia.org -- World Fellowship for Schizophrenia and Allied Disorders
www.schizophrenia.com -- Information resources and research news

References

Aleman A, Sommer IE, Kahn RS. Efficacy of slow repetitive transcranial magnetic stimulation in the treatment of resistant auditory hallucinations in schizophrenia: a meta-analysis. J Clin Psychiatry. 2007 Mar;68(3):416-21.

Bhattacharjee J, El-Sayeh HG. Aripiprazole versus typicals for schizophrenia. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD006617.

Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 2008 Mar 29;371(9618):1085-97.

Leucht C, Kitzmantel M, Chua L, Kane J, Leucht S. Haloperidol versus chlorpromazine for schizophrenia. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004278.

Lieberman JA. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia: efficacy, safety and cost outcomes of CATIE and other trials. J Clin Psychiatry. 2007 Feb;68(2):e04.

Marder SR, West B, Lau GS, et al. Aripiprazole effects in patients with acute schizophrenia experiencing higher or lower agitation: a post hoc analysis of 4 randomized, placebo-controlled clinical trials. J Clin Psychiatry. 2007 May;68(5):662-8.

Mathews M, Muzina DJ. Atypical antipsychotics: new drugs, new challenges. Cleve Clin J Med. 2007 Aug;74(8):597-606.

McEvoy JP, Lieberman JA, Perkins DO, et al. Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind 52-week comparison. Am J Psychiatry. 2007 Jul;164(7):1050-60.

Morrens M, Hulstijn W, Sabbe B. Psychomotor slowing in schizophrenia. Schizophr Bull. 2007 Jul;33(4):1038-53. Epub 2006 Nov 8.

Newcomer JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry. 2007;68 Suppl 1:20-7.

Nussbaum A, Stroup TS. Paliperidone for schizophrenia. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006369.

Schultz SH, North SW, Shields CG. Schizophrenia: a review. Am Fam Physician. 2007 Jun 15;75(12):1821-9.

Sikich L, Frazier JA, McClellan J, Findling RL, Vitiello B, Ritz L, et al. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry. 2008 Nov;165(11):1420-31. Epub 2008 Sep 15.

Swartz MS, Perkins DO, Stroup TS, et al. Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. Am J Psychiatry. 2007 Mar;164(3):428-36.

Torrey EF, Bartko JJ, Lun ZR, Yolken RH. Antibodies to Toxoplasma gondii in patients with schizophrenia: a meta-analysis. Schizophr Bull. 2007 May;33(3):729-36. Epub 2006 Nov 3.

Reviewed last on: 1/22/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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