1. Schizophrenia Although schizophrenia is discussed as if it is a single disease, it probably comprises a group of disorders with heterogeneous etiologies, and it includes patients whose clinical presentations, treat- ment response, and courses of illness vary. Signs and symptoms are variable a...
Kaplan & Sadocks: Synopsis of Psychiatry -- Chapter
Seven
1. Schizophrenia Although schizophrenia is discussed as if it is a
single
disease, it probably comprises a group of
disorders with heterogeneous etiologies, and
it includes patients whose clinical
presentations, treat- ment response, and
courses of illness vary. Signs and symptoms
are variable and
include changes in perception, emotion,
cognition, think- ing, and behavior.
2. Diagnosis, See Image
Signs, and
Symptoms
3. Typical Age The disorder usually begins before age 25 years,
of persist- sthroughout life, and affects persons of
Schizophrenic all social classes.
onset?
4. The Four As of Autism, Affect, Associations, Ambivalence
Schizophrenia
5. Reproductive First-degree biological relatives of persons with
Factors schizo- phrenia
have a ten times greater risk for developing the
disease than the general population.
1/
, Kaplan & Sadocks: Synopsis of Psychiatry -- Chapter
Seven
6. Medical Illness- Several studies have shown that up to 80
es: Schizophre- percent of all schizophrenia patients have
nia significant con- current medical illnesses and
that up to 50 percent of these conditions may be
undiagnosed.
7. Infection and
Birth Season Season-specic risk factors, such as a virus or a
seasonal change in diet, may be operative.
Another hypothesis is that persons
with a genetic predisposition for schizophrenia
have a de- creased biological advantage to
survive season-specific insults.
8. Nicotine Up to 90 percent of schizophrenia patients may
be depen- dent on nicotine. Apart from smoking-
associated mortali- ty, nicotine
decreases the blood concentrations of some
antipsy- chotics. There are suggestions that the
increased preva- lence in smoking is due, at least
in
part, to brain abnormalities in nicotinic receptors
9. Population The effect of
Den- sity population density is consistent with the
observation that the incidence of schizophrenia
in children of either one or two parents with
schizophrenia is twice as high in cities as in rural
commu- nities. These observations suggest that
2/
, Kaplan & Sadocks: Synopsis of Psychiatry -- Chapter
Seven
social stressors may aect
in urban settings the development of schizophrenia in persons at
risk.
3/
, Kaplan & Sadocks: Synopsis of Psychiatry -- Chapter
Seven
10. Socioeconomic Because schizophrenia begins early in life;
and Cultural causes sig- nificant and long-lasting
Factors: impairments; makes heavy de- mands for
Schizophrenia hospital care; and requires ongoing clinical
care, reha- bilitation, and support services, the
financial cost of the illness in the United States
is
estimated to exceed that of all cancers
combined. Pa- tients with a diagnosis of
schizophrenia are reported to account for 15 to
45 percent of
homeless Americans.
11. Hospitalization The probability of readmission within 2 years after
dis-
charge from the first hospitalization is about 40
to 60 percent. Patients with schizophrenia
occupy about 50 percent of all mental hospital
beds and account for about 16 percent of all
psychiatric patients who receive any treatment.
12. ETIOLOGY schizophrenia and schizophrenia-related
Genetic disorders (e.g., schizotypal personality
Factors: disorder) occur at an increased rate among the
Schizophrenia biological relatives of patients with
schizophrenia. The likelihood of a person having
schizophrenia is correlated with the closeness of
the rela- tionship to an aected relative (e.g., rst-
or second-degree relative). In the case of
monozygotic twins who have identical genetic
endow- ment, there is an approximately 50
percent concordance rate for schizophrenia
4/
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