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Schizophrenia (from the Greek word σχιζοφρένεια, or shjzofre'neja, meaning "split mind") is a psychiatric diagnosis that describes a mental disorder characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction. A person experiencing schizophrenia is typically characterized as demonstrating disorganized thinking, and as experiencing delusions or hallucinations, in particular auditory hallucinations.
Although the disorder is primarily thought to affect cognition, it can also contribute to chronic problems with behavior, interpersonal relationships, and emotion. Due to the many possible combinations of symptoms, a debate is ongoing about whether the diagnosis necessarily or adequately describes a disorder, or alternatively whether it might represent a number of disorders. For this reason, Eugen Bleuler deliberately called the disease "the schizophrenias" plural, when he coined the present name.
Diagnosis is based on the self-reported experiences of the patient, in combination with secondary signs observed by a psychiatrist, clinical psychologist, Social Worker, or other mental health professional. No laboratory test for schizophrenia exists. Studies suggest that genetics, early environment, neurobiology and psychological and social processes are important contributory factors. Current research into the development of the disorder often focuses on the role of neurobiology, although a reliable and identifiable organic cause has not been found. In the absence of a confirmed specific pathology underlying the diagnosis, some question the legitimacy of schizophrenia's status as a disease. Furthermore, some propose that the perceptions and feelings involved are meaningful and do not necessarily involve impairment.
The term schizophrenia translates roughly as "splitting of the mind", and comes from the Greek σχίζω (or schizo, "to split" or "to divide") and φρήν (or phrēn, "mind"). Despite its etymology, schizophrenia is not synonymous with dissociative identity disorder, also known as multiple personality disorder or "split personality"; in popular culture the two are often confused. People with schizophrenia are generally not more violent or dangerous than other members of the population.
Patients diagnosed with schizophrenia are highly likely to be diagnosed with other disorders. The lifetime prevalence of substance abuse is typically around 40%. Comorbidity is also high with clinical depression, anxiety disorders, and social problems, and a generally decreased life expectancy is also present. Patients diagnosed with schizophrenia typically live ten to twelve years less than those without the disorder, owing to increased physical health problems and a high suicide rate. Unemployment and poverty are common. 
History of the disorder
A nonspecific concept of "madness" has been identified in antiquity, but schizophrenia was only classified as a distinct mental disorder by Kraepelin in 1887. He was the first to make a distinction between schizophrenia and manic depression and named it Dementia praecox .
The term schizophrenia is derived from the Greek words 'schizo' (split) and 'phren' (mind) and was coined by Eugene Bleuler to refer to the lack of interaction between thought processes and perception.He suggested the name schizophrenia, as it was obvious that Kraepelin's name was misleading. The word "praecox" implied precocious or early onset, hence premature dementia, as opposed to senile dementia from old age. Bleuler realized the illness was not a dementia, as it did not lead to mental deterioration. Rather, schizophrenia led to a sharpening of the senses and a greater awareness of memories and experiences.
- Main article: Schizophrenia: History of the disorder
Problems with the concept and the validity of the term schizophrenia
However, there has been an increasing acknowledgement of the methodological weaknesses, poor prognostic power, symptomatic variability and general weaknesses inherent in the diagnostic validity of the term 'Schizophrenia', the psychological literature has increasingly tended to focus on specific or discrete symptoms or aspects associated with it (Bentall, 1990).
- Main article: Schizophrenia - Definition problem
Evolutionary factors in schizophrenia
- Main article: Schizophrenia - Evolutionary factors
- Main article: Schizophrenia - Diagnosis
- Main article: Schizophrenia - Biological factors
- Main article: Schizophrenia - Genetic factors
- Main article: Schizophrenia - Environmental factors
- Main article: Schizophrenia - Children
- Main article: Schizophrenia - Developmental factors
- Main article: Schizophrenia - Cognitive features
- Main article: Schizophrenia - Theoretical approaches
- Main article: Schizophrenia - Course of the condition
- Main article: Schizophrenia - Epidemiology.
- Main article: Schizophrenia - Risk factors.
- Main article: Schizophrenia - Etiology.
- Main article: Schizophrenia - Service planning and care pathways
- Main article: Schizophrenia - Assessment.
- Main article: Schizophrenia - Comorbidity.
- Main article: Schizophrenia - Treatment.
- Main article: Schizophrenia - Relapse prevention
- Main article: Schizophrenia - Prognosis.
- Main article: Schizophrenia - Suicide
- Main article: Schizophrenia - Service user page.
- Main article: Schizophrenia - Carer page.
- Acute schizophrenia
- Catatonic schizophrenia
- Childhood schizophrenia
- Paranoid schizophrenia
- Process schizophrenia
- Schizophrenia (disorganised type)
- Schizophreniform disorder
- Undifferentiated schizophrenia
- Disorganized schizophrenia
- Dopamine hypothesis of schizophrenia
- Expressed emotion
- Formal thought disorder
- Fragmentation (schizophrenia)
- Positive and negative symptoms
- Schizoaffective disorder
- Schizophrenogenic family
- Schizophrenogenic mother
- Schizoid personality
- Schizotypal personality
- Interpretation of Schizophrenia (book)
Further information about schizophrenia and approaches to it, suggested by authors such as R.D. Laing, Emil Kraepelin, Eugene Bleuler, Karl Jaspers and Kurt Schneider, as well as books, can be found within the articles for those authors.
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Note 36: Leucht S, Wahlbeck K, Hamann J, Kissling W. (2003) New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis. Lancet, 361(9369), 1581-9.
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Note 38: Cormac I, Jones C, Campbell C. (2002) Cognitive behaviour therapy for schizophrenia. Cochrane Database of systematic reviews, (1), CD000524.
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Note 40: Wykes T, Brammer M, Mellers J, Bray P, Reeder C, Williams C, Corner J. (2002) Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia. British Journal of Psychiatry, 181, 144-52.
Note 41: Kulhara P. (1994) Outcome of schizophrenia: some transcultural observations with particular reference to developing countries. European Archives of Psychiatry and Clinical Neuroscience, 244(5), 227–35.
Note 42: Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A. (1987) The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144(6), 727–35.
Note 43: Robinson DG, Woerner MG, McMeniman M, Mendelowitz A, Bilder RM (2004) Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry, 161, 473-479.
Note 44: Hopper K, Wanderling J (2000) Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. Schizophrenia Bulletin, 26 (4), 835-46.
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Note 46: Radomsky ED, Haas GL, Mann JJ, Sweeney JA (1999) Suicidal behavior in patients with schizophrenia and other psychotic disorders. American Journal of Psychiatry, 156(10), 1590–5.
Note 47: Caldwell CB, Gottesman II. (1990) Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin, 16(4), 571–89.
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Note 49: "Conditions in Occupational Therapy: effect on occupational performance." ed. Ruth A. Hansen and Ben Atchison (Baltimore: Lippincott Williams & Williams, 2000), 54–74. ISBN 0-683-30417-8
Note 50: Zammit S, Allebeck P, Dalman C, Lundberg I, Hemmingsson T, Lewis (2003) Investigating the association between cigarette smoking and schizophrenia in a cohort study. American Journal of Psychiatry, 160 (12), 2216–21.
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Note 53: Fazel S, Grann M. (2004) Psychiatric morbidity among homicide offenders: a Swedish population study. American Journal of Psychiatry, 161(11), 2129-31.
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- Bentall, R. (2003) Madness explained: Psychosis and Human Nature. London: Penguin Books Ltd. ISBN 0713992492
- Boyle, Mary,(1993), Schizophrenia: A Scientific Delusion, Routledge, ISBN 0415097002 (Amazon Review).
- Green, M.F. (2001) Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton. ISBN 0393703347
- Jones, S. and Hayward, P. (2004) Coping with Schizophrenia: A Guide for Patients, Families and Caregivers. ISBN 1851683445
- Keen, T. M. (1999) Schizophrenia: orthodoxy and heresies. A review of alternative possibilities. Journal of Psychiatric and Mental Health Nursing, 1999, 6, 415-424. PDF. An article reviewing the dominant (orthodox) and alternative (heretical) theories, hypotheses and beliefs about schizophrenia.
- NICE (2003) Schizophrenia: full national clinical guidelines on core interventions in primary and secondary care, NICE, London.
- Read, J., Mosher, L.R., Bentall, R. (2004) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. ISBN 1583919066. A critical approach to biological and genetic theories, and a review of social influences on schizophrenia.
- Szasz, T. (1976) Schizophrenia: The Sacred Symbol of Psychiatry. New York: Basic Books. ISBN 0465072224
- Torey, E.F., M.D. (2001) Surviving Schizophrenia: A Manual for Families, Consumers, and Providers (4th Edition). Quill (HarperCollins Publishers) ISBN 0060959193
- Vonnegut, M. The Eden Express. ISBN 0553027557. A personal account of schizophrenia.
- Achimovich, L. (2005). Review of Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia: ANZJFT Australian and New Zealand Journal of Family Therapy Vol 26(2) Jun 2005, 108-110.
- Bowen, M. (1960) A family concept of schizophrenia. In: D.D. Jackson (ed.) The Etiology of Schizophrenia, New York: Basic Books.
- Clark, R.E. (1948) The relationship of schizophrenia to occupational income and occupational prestige, American Sociological Review 13: 325-30.
- Clausen, J.A. and Kohn, M.L. (1959) Relation of schizophrenia to the social structure of a small city. In: B. Pasamanick (ed.) Epidemiology of Mental Disorder, Washington, DC: American Association for the Advancement of Science.
- Leff, J. (1992) Over the edge: stress and schizophrenia, New Scientist 4 January.
- Read J, Mosher L, Bentall R, eds. (2002) Models of madness: psychological, social and biological approaches to schizophrenia.
- Strauss, J. and Carpenter, W. (1981) Schizophrenia, New York: Plenum Press.
Schizophrenia - Academic support materials
- Schizophrenia - Lecture slides
- Schizophrenia - Lecture notes
- Schizophrenia - Lecture handouts
- Schizophrenia - Multimedia materials
- Schizophrenia - Other academic support materials
- Schizophrenia - Anonymous fictional case studies for training
Critical approaches to schizophrenia
- The fraud of "schizophrenia" from controversial Scientology based anti-psychiatry group CCHR.
- Successfulschizophrenia.org A website critical of Schizophrenia as a disorder, with many links and resources, by Al Siebert, psychologist Ph.D.
- Schizophrenia: A Nonexsistent Disease by Lawrence Stevens, J.D
Critical approaches to schizophrenia (from non-Scientologist sources)
- Loren Mosher, M.D. (Chief of the Center for Studies of Schizophrenia at the U.S. National Institute of Mental Health 1969-1980) Still Crazy After All These Years
- Bola, John R., Ph.D.; & Mosher, Loren R., M.D. (2003). Treatment of Acute Psychosis Without Neuroleptics: Two-Year Outcomes From the Soteria Project. The Journal of Nervous and Mental Disease, (191: 219-229). Available as PDF.
- Jonathan Leo, Ph.D. Schizophrenia: Medical students are taught it's all in the genes, but are they hearing the whole story?
News, information and further description
- Understanding Schizophrenia - A factsheet from the mental health charity Mind.
- DSM-IV-TR Full diagnostic criteria for schizophrenia
- World Health Organisation data on schizophrenia from 'The World Health Report 2001. Mental Health: New Understanding, New Hope'
- Schizophrenia in history
- National Institute of Mental Health (USA) Schizophrenia information
- UCLA Laboratory of Neuro Imaging definition
- The current World Health Organisation definition of Schizophrenia
- A directory of free full-text articles on diagnosis and management of schizophrenia
- Symptoms in Schizophrenia Film made in 1940 showing some of the symptoms of Schizophrenia.
- Schizophrenia.com A non-profit making information site (pharmaceutical company sponsored)
- Schizophrenia and chronic mental illness overview from MayoClinic.com (pharmaceutical company sponsored).
- Schizophrenia by WebMD (pharmaceutical company sponsored).
- Open The Doors - information on global programme to fight stigma and discrimination because of Schizophrenia. The World Psychiatric Association (WPA)
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