To identify recent advances in understanding the nature, causes, and treatment of schizophrenia, we searched PubMed for journal articles in English published over the past 5 years with the keywords schizophrenia plus epidemiology, diagnosis, etiology, pathophysiology, neurodevelopmental, onset, course, treatment, pharmacology, psychosocial, rehabilitation, first episode, developing nation, or stigma. This search was supplemented by reading chapters in recently published compilations on
SeminarSchizophrenia
Section snippets
Epidemiology
The annual incidence of schizophrenia is 0·2–0·4 per 1000, with a lifetime prevalence (risk) of about 1%.8 The incidence of schizophrenia is the same across sexes, although women tend to have a later age of onset than men,9 and a more benign course of illness, including fewer hospital admissions and better social functioning.10 The later age of onset in women is associated with higher attainment of social role functioning before illness, which confers a better outcome.11 The mechanism
Diagnosis and clinical description
Modern notions of schizophrenia are based on the work of Kraepelin,15 who focused on the long-term deteriorating course of the illness, and Bleuler,16 who emphasised the core symptoms of the disorder as difficulties in thinking straight (loosening of associations), incongruous or flattened affect, loss of goal-directed behaviour or ambivalence due to conflicting impulses, and retreat into an inner world (autism). The two major diagnostic systems for schizophrenia in common use are the Tenth
Aetiology
Both genetic and environmental factors appear to play a role in the aetiology of schizophrenia.
Onset and course of illness
Schizophrenia typically has its onset between the ages of 16 and 30 years, and infrequently after the age of 45 years.83 The disorder usually has a gradual, insidious onset that takes place over an average of 5 years, beginning with the emergence of negative and depressive symptoms, followed shortly by cognitive and social impairment, which is then followed several years later by the emergence of psychotic symptoms and first psychiatric contact.12, 84 The course of the illness is most strongly
Stress-vulnerability model
The course of schizophrenia can be understood with the stress-vulnerability model.89 According to this model, schizophrenia is caused by an underlying psychobiological vulnerability, determined early in life by genetic and early environmental (eg, perinatal) effects. Once the vulnerability is established, the onset of the illness and its course, including relapses, is determined by the dynamic interplay of biological and psychosocial factors, as illustrated in figure 3. Among the biological
Management
The management of schizophrenia can be divided into pharmacological and psychosocial treatment.
Schizophrenia in developing nations
Since the prevalence of schizophrenia is similar in developing and developed countries, the majority of people in the world with the illness live in developing nations where they face particular challenges.7 First, the detection of schizophrenia may be complicated by the higher presence of infectious, parasitic, and nutritional diseases that result in psychotic symptoms. Second, most people with schizophrenia in developing nations live with family members, but receive no formal treatment,
Stigma
Stigma has long been recognised as a major challenge for people with mental illness,146 with schizophrenia among the most stigmatising disorders.147 Widely held myths about people with schizophrenia and other severe mental illnesses are that they are frequently violent, childlike, or irresponsible,148 with exaggerated beliefs about danger contributing most strongly to negative attitudes.149 People with mental illness are held more responsible for their disorders than people with other
Search strategy
References (161)
The 100-year epidemiology of schizophrenia
Schizophr Res
(1997)- et al.
Trauma, PTSD, and the course of schizophrenia: an interactive model
Schizophr Res
(2002) - et al.
Genetic basis of schizophrenia
Lancet
(1995) - et al.
Genes for schizophrenia: recent findings and their pathophysiological implications
Lancet
(2003) - et al.
Relationship between in utero exposure to influenza epidemics and risk of schizophrenia in Denmark
Biol Psychiatry
(1996) - et al.
The ecogenics of schizophrenia: a review
Schizophr Res
(1998) - et al.
Lack of normal pattern of cerebral asymmetry in familial schizophrenic patients and their relatives: the Maudsley family study
Schizophr Res
(1999) - et al.
Is schizophrenia due to excessive synaptic pruning in the prefrontal cortex? The Feinberg hypothesis revisited
J Psychiatric Res
(1994) Schizophrenia: caused by a fault in programmed synaptic elimination during adolescence?
J Psychiatric Res
(1982)- et al.
Measuring costs of schizophrenia: implications for the post-institutional era in the US
Pharmacoeconomics
(1995)
An historical perspective on the role of state hospitals viewed from the “revolving door”
Am J Psychiatry
Economic burden of mental disorders in the United States
Economics Neuroscience
Costs of schizophrenia
Br J Psychiatry
The economic burden of schizophrenia in Canada
Can J Psychiatry
Neurological, psychiatric, and developmental disorders: meeting the challenges in the developing world
Predictors of outcome in schizophrenia
J Clin Psychopharmacol
Gender and the course of schizophrenia: differences in treated outcome
Schizophr Bull
Onset and early course as determinants of the further course of schizophrenia
Acta Psychiatrica Scandinavica
Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia
Acta Psychiatrica Scandinavica
Schizophrenia: manifestations, incidence, and course in different cultures—a World Health Organization ten-country study
Psychol Med Monograph Suppl
Schizophrenia: an international follow-up study
Dementia praecox and paraphrenia
Dementia praecox or the group of schizophrenias
The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines
Diagnostic and statistical manual of mental disorders (DSM-IV)
The nosology of psychotic disorders: a comparison among competing classification systems
Schizophr Bull
Course and outcome of schizophrenia
The symptoms of chronic schizophrenia: a re-examination of the positive-negative dichotomy
Br J Psychiatry
Natural history of schizophrenia subtypes: II positive and negative symptoms and long term course
Arch Gen Psychiatry
Factor structure and construct validity of the scale for the assessment of negative symptoms
Psychol Assess
Expressed emotion, attitudes, and schizophrenic symptom dimensions
J Abnorm Psychol
Neuropsychological deficits in schizophrenics: relationship to age, chronicity, and dementia
Arch Gen Psychiatry
Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”?
Schizophr Bull
Comorbidity of mental disorders with alcohol and other drug abuse: results from the epidemiologic catchment area (ECA) study
JAMA
Prevalence of HIV, hepatitis B and hepatitis C in people with severe mental illness
Am J Public Health
Prevalence of violent victimisation in severe mental illness
Br J Psychiatry
Psychiatric problems in homeless men: lifetime psychosis, substance use, and current distress in new arrivals at New York City shelters
Arch Gen Psychiatry
Schizophrenia and smoking: an epidemiological survey at a state hospital
Am J Psychiatry
Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor
J Nerv Ment Dis
Depression in people with first-episode schizophrenia
Br J Psychiatry
Characteristic hostility in schizophrenic outpatients
Schizophr Bull
Lifetime risk of suicide for alcoholism, affective disorder and schizophrenia
Br J Psychiatry
Excess mortality of schizophrenia: a meta-analysis
Br J Psychiatry
Heritability estimates for psychotic disorders: the Maudsley twin psychosis series
Arch Gen Psychiatry
Advances in schizophrenia
Nat Med
Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944–1945
Arch Gen Psychiatry
Obstetric complications and risk of schizophrenia: effect of gender, age at diagnosis and maternal history of psychosis
Br J Psychiatry
Obstetric complications and schizophrenia: historical and meta-analytic review
Am J Psychiatry
A prospective cohort study of genetic and perinatal influences in the etiology of schizophrenia
Schizophr Bull
Cited by (808)
Incidence, prevalence, and mortality of schizophrenia from 2016 to 2020 in Shandong, China
2024, Psychiatry ResearchCardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life
2023, Schizophrenia ResearchInfluence of the dose of ketamine used on schizophrenia-like symptoms in mice: A correlation study with TH, GAD<inf>67</inf>, and PPAR-γ
2023, Pharmacology Biochemistry and BehaviorConvergence of Brain Transcriptomic and Neuroimaging Patterns in Schizophrenia, Bipolar Disorder, Autism Spectrum Disorder, and Major Depressive Disorder
2023, Biological Psychiatry: Cognitive Neuroscience and NeuroimagingComputer-aided diagnosis of schizophrenia based on node2vec and Transformer
2023, Journal of Neuroscience Methods