Schizophrenia

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A severe and persistent mental illness characterized by delusions, hallucinations, disorganization of thought and behavior, and cognitive dysfunction

Description

Major psychiatric disorder with a variable course, typically involving prodromal, active, and residual psychotic symptoms with disturbances in thought, speech, affect, behavior, and perception

Epidemiology

Prevalence

  • Worldwide prevalence 7.2 per 1,000 people
  • Age of onset: typically <30 years, earlier in males (late teens to mid-20s) than females (early 20s to early 30s)

Etiology and Pathophysiology

  • Overstimulation of mesolimbic dopamine D2 receptors, deficient prefrontal dopamine, and aberrant prefrontal glutamate (NMDA) activity results in perceptual disturbances, disordered thought process, and cognitive impairments
  • Two genes, SRRM2 and AKAP11, associated with increased risk of schizophrenia; gene PLCO demonstrates a shared increased risk of both schizophrenia and autism.

Genetics

If first-degree relative has schizophrenia, risk is 8–10%.

Risk Factors

  • Antenatal risk factors include prenatal infection or malnutrition, obstetric complications leading to hypoxia, winter births, postnatal infections requiring hospitalization, urban birth, and advanced paternal age.
  • Additional risk factors: adolescent cannabis use, childhood trauma, urban residence, autoimmune disorders, severe and repeated stress, lower socioeconomic status, minority status, being an immigrant, inadequate social support

General Prevention

Educate all patients on the risks of marijuana use.

Commonly Associated Conditions

  • Nicotine dependence (>50%) and substance use disorders
  • Metabolic syndrome, diabetes mellitus

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