Schizophrenia Clinical Presentation

  • Author: Frances R Frankenburg, MD; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Dec 22, 2014
 

History

Information about the medical and psychiatric history of the family, details about pregnancy and early childhood, history of travel, and history of medications and substance abuse are all important. This information is helpful in ruling out other causes of psychotic symptoms.

The patient usually had an unexceptional childhood. In retrospect, family members may describe the person with schizophrenia as a physically clumsy and emotionally aloof child. The child may have been anxious and preferred to play by himself or herself. The child may have been late to learn to walk and may have been a bed wetter.[59, 60]

A noticeable change in personality and a decrease in academic, social, and interpersonal functioning often begin during middle-to-late adolescence. Usually, 1-2 years pass between the onset of these vague symptoms and the first visit to a psychiatrist.[61] The first psychotic episode usually occurs between the late teenage years and the mid 30s.

The symptoms of schizophrenia may be divided into the following 4 domains:

  • Positive symptoms - Psychotic symptoms, such as hallucinations, which are usually auditory; delusions; and disorganized speech and behavior
  • Negative symptoms - A decrease in emotional range, poverty of speech, and loss of interests and drive; the person with schizophrenia has tremendous inertia
  • Cognitive symptoms - Neurocognitive deficits (eg, deficits in working memory and attention and in executive functions, such as the ability to organize and abstract); patients also find it difficult to understand nuances and subtleties of interpersonal cues and relationships
  • Mood symptoms - Patients often seem cheerful or sad in a way that is difficult to understand; they often are depressed
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Physical Examination

The findings from a general physical examination are usually noncontributory. This examination is necessary to rule out other illnesses.

It is sometimes helpful to perform a neurologic examination as a baseline before initiating antipsychotic medications, because these drugs themselves can cause some neurological signs. Some patients with schizophrenia have motor disturbances before exposure to antipsychotic agents. Schizophrenia has been associated with left and mixed handedness, minor physical anomalies, and soft neurologic signs.

Mental status examination

On a detailed mental status examination (MSE), the following observations may be made in a severely ill patient with schizophrenia:

  • The patient may be unduly suspicious of the examiner or be socially awkward
  • The patient may express a variety of odd beliefs or delusions
  • The patient often has a flat affect (ie, little range of expressed emotion)
  • The patient may admit to hallucinations or respond to auditory or visual stimuli that are not apparent to the examiner
  • The patient may show thought blocking, in which long pauses occur before he or she answers a question
  • The patient’s speech may be difficult to follow because of the looseness of his or her associations; the sequence of thoughts follows a logic that is clear to the patient but not to the interviewer
  • The patient has difficulty with abstract thinking, demonstrated by inability to understand common proverbs or idiosyncratic interpretation of them
  • The speech may be circumstantial (ie, the patient takes a long time and uses many words in answering a question) or tangential (ie, the patient speaks at length but never actually answers the question)
  • The patient’s thoughts may be disorganized, stereotyped, or perseverative
  • The patient may make odd movements (which may elated to neuroleptic medication)
  • The patient may have little insight into his or her problems (ie, anosognosia)
  • Orientation is usually intact (ie, patients know who and where they are and what time it is)

Persons with schizophrenia may display strange and poorly understood behaviors. These include drinking water to the point of intoxication, staring at themselves in the mirror, performing stereotyped activities, hoarding useless objects, and mutilating themselves. Their wake-sleep cycle may be disturbed.

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Complications

Substance abuse

Alcohol and drug abuse (especially nicotine) are common in schizophrenia, for reasons that are not entirely clear. For some people, these drugs provide relief from symptoms of the illness or the adverse effects of antipsychotic drugs, and the drive for this relief is strong enough to allow even patients who are impoverished and disorganized to find substances to abuse.[62]

Comorbid substance abuse occurs in 20-70% of patients with schizophrenia, particularly younger male patients, and is associated with increased hostility, crime, violence, suicidality, noncompliance with medication, homelessness, poor nutrition, and poverty. Drug use and abuse can also increase symptoms. For example, cannabis use has been shown to be associated with an earlier onset of psychosis and to correlate, in a bidirectional way, with an adverse course of psychotic symptoms in persons with schizophrenia. That is, people with more severe psychotic symptoms are more likely to use cannabis, and cannabis, in turn, seems to worsen psychotic symptoms.[63] However, other research has shown that the use of cannabis is associated with better cognitive functioning.[64]

A register-based study of more than 3000 inpatients from Scotland who experienced substance-induced psychoses showed that episodes of psychosis induced from several types of illicit substances are significantly linked to a later clinical diagnosis of schizophrenia.[65]

Patients who abuse substances may fare better in dual-diagnosis treatment programs, in which principles from the mental health field can be integrated with principles from the chemical dependency field.

Depression

Many patients with schizophrenia report symptoms of depression. It is unclear whether such depression is an independent problem, part of the schizophrenia, a reaction to the schizophrenia, or a complication of treatment. Addressing this issue is important because of the high rate of suicide in patients with schizophrenia.

The research evidence for the use of antidepressant agents in schizophrenic patients is mixed. Further complicating the situation are the findings that antipsychotic agents may have antidepressant properties.[66] One meta-analysis suggested that the addition of antidepressants to antipsychotics might help treat the negative symptoms of chronic schizophrenia, which can be difficult to distinguish from depression.[67]

Suicide attempts are lower in people treated with clozapine than with other antipsychotic agents.[68]

Anxiety

Many patients with schizophrenia report symptoms of anxiety. It is unclear whether such anxiety is an independent problem, part of the schizophrenia, a reaction to the schizophrenia, or a complication of treatment. Some adverse effects of medications, such as akathisia, may be experienced as anxiety. Anxiety may precede the onset of schizophrenia by several years.[69]

Treatment is keyed to the source of the anxiety. Antipsychotics usually relieve anxiety that is part of an acute psychotic episode; only limited data are available on treatment of comorbid anxiety disorders. Following treatment recommendations for primary anxiety disorder would be reasonable in many cases; however, fluvoxamine and other selective serotonin reuptake inhibitors (SSRIs) should be used cautiously in patients receiving clozapine; they can raise clozapine blood levels. Benzodiazepines may be helpful but carry their own risks.[70, 71]

Obsessive-compulsive symptoms

A number of patients with schizophrenia display obsessive-compulsive symptoms, such as the need to check, count, or repeat certain activities. As is similar to anxiety or depression, the connection between these symptoms and schizophrenia is not understood. Obsessive-compulsive symptoms are a known adverse effect of some antipsychotic medications, particularly clozapine. Patients with schizophrenia and obsessive-compulsive symptoms tend to do more poorly. There is no clear consensus on how to treat the obsessive-compulsive symptoms.

Violence

Most people with schizophrenia are not violent. However, a few may act violently, sometimes as a result of command hallucinations or delusions.[67] Because the violent acts carried out by these few patients may be unpredictable and bizarre, they are often highly publicized, and the intense publicity has the unfortunate consequence of exacerbating the stigma of the disease.

Violence may be associated with substance abuse. However, the rate of violence in patients with schizophrenia who do not abuse substances is higher than that in people without schizophrenia.[72, 73] Clozapine is sometimes recommended for treatment of patients with schizophrenia who are violent.

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Contributor Information and Disclosures
Author

Frances R Frankenburg, MD  Professor, Department of Psychiatry, Boston University School of Medicine; Chief of Inpatient Psychiatry and Consulting Psychiatrist, Edith Nourse Rogers Memorial Veterans Administration Medical Center; Associate Psychiatrist, McLean Hospital

Frances R Frankenburg, MD is a member of the following medical societies: Alpha Omega Alpha and American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

Eduardo Dunayevich, MD  Executive Director, Clinical Development, Amgen

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Lilly Research Laboratories Salary Other

Additional Contributors

Ronald C Albucher, MD Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center

Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Cassels, C. Antipsychotic Linked to Potentially Fatal Skin Reaction. Medscape Medical News. Available at http://www.medscape.com/viewarticle/836427. Accessed December 13, 2014.

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Press; 2000.

  3. Wright IC, Rabe-Hesketh S, Woodruff PW, et al. Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry. Jan 2000;157(1):16-25. [Medline].

  4. Tamminga CA, Stan AD, Wagner AD. The hippocampal formation in schizophrenia. Am J Psychiatry. Oct 2010;167(10):1178-93. [Medline].

  5. Mattai A, Hosanagar A, Weisinger B, Greenstein D, Stidd R, Clasen L. Hippocampal volume development in healthy siblings of childhood-onset schizophrenia patients. Am J Psychiatry. Apr 2011;168(4):427-35. [Medline].

  6. Sigmundsson T, Suckling J, Maier M, et al. Structural abnormalities in frontal, temporal, and limbic regions and interconnecting white matter tracts in schizophrenic patients with prominent negative symptoms. Am J Psychiatry. Feb 2001;158(2):234-43. [Medline].

  7. Ellison-Wright I, Bullmore E. Meta-analysis of diffusion tensor imaging studies in schizophrenia. Schizophr Res. Mar 2009;108(1-3):3-10. [Medline].

  8. McIntosh AM, Owens DC, Moorhead WJ, Whalley HC, Stanfield AC, Hall J, et al. Longitudinal volume reductions in people at high genetic risk of schizophrenia as they develop psychosis. Biol Psychiatry. May 15 2011;69(10):953-8. [Medline].

  9. Olabi B, Ellison-Wright I, McIntosh AM, et al. Are there progressive brain changes in schizophrenia? A meta-analysis of structural magnetic resonance imaging studies. Biol Psychiatry. Jul 1 2011;70(1):88-96. [Medline].

  10. Coyle JT. The glutamatergic dysfunction hypothesis for schizophrenia. Harv Rev Psychiatry. Jan-Feb 1996;3(5):241-53. [Medline].

  11. Cioffi CL. Modulation of NMDA receptor function as a treatment for schizophrenia. Bioorg Med Chem Lett. Jul 19 2013;[Medline].

  12. Drexhage RC, Weigelt K, van Beveren N, Cohen D, Versnel MA, Nolen WA, et al. Immune and neuroimmune alterations in mood disorders and schizophrenia. Int Rev Neurobiol. 2011;101:169-201. [Medline].

  13. Fan X, Goff DC, Henderson DC. Inflammation and schizophrenia. Expert Rev Neurother. Jul 2007;7(7):789-96. [Medline].

  14. Selten JP, Cantor-Graae E, Kahn RS. Migration and schizophrenia. Curr Opin Psychiatry. Mar 2007;20(2):111-5. [Medline].

  15. Bourque F, van der Ven E, Malla A. A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychol Med. May 2011;41(5):897-910. [Medline].

  16. Kirkbride J, Coid JW, Morgan C, et al. Translating the epidemiology of psychosis into public mental health: evidence, challenges and future prospects. J Public Ment Health. Jun 2010;9(2):4-14. [Medline].

  17. Kety SS, Wender PH, Jacobsen B, et al. Mental illness in the biological and adoptive relatives of schizophrenic adoptees. Replication of the Copenhagen Study in the rest of Denmark. Arch Gen Psychiatry. Jun 1994;51(6):442-55. [Medline].

  18. Brooks M. New Schizophrenia Genes Identified. Medscape Medical News [serial online]. Jul 22 2014;Accessed Jul 29 2014. Available at http://www.medscape.com/viewarticle/828655.

  19. Biological insights from 108 schizophrenia-associated genetic loci. Nature. Jul 24 2014;511(7510):421-7. [Medline].

  20. Caspi A, Moffitt TE, Cannon M, et al. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry. May 15 2005;57(10):1117-27. [Medline].

  21. Shifman S, Johannesson M, Bronstein M, et al. Genome-wide association identifies a common variant in the reelin gene that increases the risk of schizophrenia only in women. PLoS Genet. Feb 2008;4(2):e28. [Medline].

  22. Wratten NS, Memoli H, Huang Y, Dulencin AM, Matteson PG, Cornacchia MA, et al. Identification of a schizophrenia-associated functional noncoding variant in NOS1AP. Am J Psychiatry. April/2009;166:434-41. [Medline].

  23. O'Brien NL, Way MJ, Kandaswamy R, et al. The functional GRM3 Kozak sequence variant rs148754219 affects the risk of schizophrenia and alcohol dependence as well as bipolar disorder. Psychiatr Genet. Jul 18 2014;[Medline].

  24. Bassett AS, Costain G, Fung WL, Russell KJ, Pierce L, Kapadia R, et al. Clinically detectable copy number variations in a Canadian catchment population of schizophrenia. J Psychiatr Res. Nov 2010;44(15):1005-9. [Medline].

  25. Bassett AS, Scherer SW, Brzustowicz LM. Copy number variations in schizophrenia: critical review and new perspectives on concepts of genetics and disease. Am J Psychiatry. Aug 2010;167(8):899-914. [Medline]. [Full Text].

  26. Owen MJ, O'Donovan MC, Thapar A, Craddock N. Neurodevelopmental hypothesis of schizophrenia. Br J Psychiatry. Mar 2011;198:173-5. [Medline].

  27. Sahoo T, Theisen A, Rosenfeld JA, et al. Copy number variants of schizophrenia susceptibility loci are associated with a spectrum of speech and developmental delays and behavior problems. Genet Med. Oct 2011;13(10):868-80. [Medline].

  28. Corvin AP, Morris DW, McGhee K, Schwaiger S, Scully P, Quinn J, et al. Confirmation and refinement of an 'at-risk' haplotype for schizophrenia suggests the EST cluster, Hs.97362, as a potential susceptibility gene at the Neuregulin-1 locus. Mol Psychiatry. Feb 2004;9(2):208-13. [Medline].

  29. Ekelund J, Hennah W, Hiekkalinna T, Parker A, Meyer J, Lönnqvist J, et al. Replication of 1q42 linkage in Finnish schizophrenia pedigrees. Mol Psychiatry. Nov 2004;9(11):1037-41. [Medline].

  30. Hennah W, Thomson P, McQuillin A, Bass N, Loukola A, Anjorin A, et al. DISC1 association, heterogeneity and interplay in schizophrenia and bipolar disorder. Mol Psychiatry. Sep 2009;14(9):865-73. [Medline].

  31. Huffaker SJ, Chen J, Nicodemus KK, Sambataro F, Yang F, Mattay V, et al. A primate-specific, brain isoform of KCNH2 affects cortical physiology, cognition, neuronal repolarization and risk of schizophrenia. Nat Med. May 2009;15(5):509-18. [Medline]. [Full Text].

  32. Kirov G, Ivanov D, Williams NM, Preece A, Nikolov I, Milev R, et al. Strong evidence for association between the dystrobrevin binding protein 1 gene (DTNBP1) and schizophrenia in 488 parent-offspring trios from Bulgaria. Biol Psychiatry. May 15 2004;55(10):971-5. [Medline].

  33. Mirnics K, Middleton FA, Stanwood GD, Lewis DA, Levitt P. Disease-specific changes in regulator of G-protein signaling 4 (RGS4) expression in schizophrenia. Mol Psychiatry. May 2001;6(3):293-301. [Medline].

  34. Morris DW, Rodgers A, McGhee KA, Schwaiger S, Scully P, Quinn J, et al. Confirming RGS4 as a susceptibility gene for schizophrenia. Am J Med Genet B Neuropsychiatr Genet. Feb 15 2004;125B(1):50-3. [Medline].

  35. Schindler KM, Pato MT, Dourado A, Macedo A, Azevedo MH, Kennedy JL, et al. Association and linkage disequilibrium between a functional polymorphism of the dopamine-2 receptor gene and schizophrenia in a genetically homogeneous Portuguese population. Mol Psychiatry. 2002;7(9):1002-5. [Medline].

  36. Shifman S, Bronstein M, Sternfeld M, Pisanté-Shalom A, Lev-Lehman E, Weizman A, et al. A highly significant association between a COMT haplotype and schizophrenia. Am J Hum Genet. Dec 2002;71(6):1296-302. [Medline]. [Full Text].

  37. Stefansson H, Sarginson J, Kong A, et al. Association of neuregulin 1 with schizophrenia confirmed in a Scottish population. Am J Hum Genet. Jan 2003;72(1):83-7. [Medline]. [Full Text].

  38. Steinberg S, Mors O, Børglum AD, Gustafsson O, Werge T, Mortensen PB, et al. Expanding the range of ZNF804A variants conferring risk of psychosis. Mol Psychiatry. Jan 2011;16(1):59-66. [Medline]. [Full Text].

  39. Tang JX, Chen WY, He G, Zhou J, Gu NF, Feng GY, et al. Polymorphisms within 5' end of the Neuregulin 1 gene are genetically associated with schizophrenia in the Chinese population. Mol Psychiatry. Jan 2004;9(1):11-2. [Medline].

  40. Williams HJ, Norton N, Dwyer S, Moskvina V, Nikolov I, Carroll L, et al. Fine mapping of ZNF804A and genome-wide significant evidence for its involvement in schizophrenia and bipolar disorder. Mol Psychiatry. Apr 2011;16(4):429-41. [Medline].

  41. Xu B, Roos JL, Dexheimer P, et al. Exome sequencing supports a de novo mutational paradigm for schizophrenia. Nat Genet. Aug 7 2011;43(9):864-8. [Medline].

  42. Girard SL, Gauthier J, Noreau A, et al. Increased exonic de novo mutation rate in individuals with schizophrenia. Nat Genet. Jul 10 2011;43(9):860-3. [Medline].

  43. Brooks M. De Novo Gene Mutations Linked to Schizophrenia. Medscape Medical News. Available at http://www.medscape.com/viewarticle/819742.. Accessed February 4, 2014.

  44. Fromer M, Pocklington AJ, Kavanagh DH, Williams HJ, Dwyer S, Gormley P, et al. De novo mutations in schizophrenia implicate synaptic networks. Nature. Jan 22 2014;[Medline].

  45. Ripke S, O'Dushlaine C, Chambert K, et al. Genome-wide association analysis identifies 13 new risk loci for schizophrenia. Nat Genet. Oct 2013;45(10):1150-9. [Medline]. [Full Text].

  46. Lencz T, Guha S, Liu C, Rosenfeld J, Mukherjee S, Derosse P. Genome-wide association study implicates NDST3 in schizophrenia and bipolar disorder. Nat Commun. Nov 19 2013;4:2739. [Medline].

  47. Sullivan PF, Kendler KS, Neale MC. Schizophrenia as a complex trait: evidence from a meta-analysis of twin studies. Arch Gen Psychiatry. Dec 2003;60(12):1187-92. [Medline].

  48. Brown AS, Derkits EJ. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. Am J Psychiatry. Mar 2010;167(3):261-80. [Medline].

  49. Brown AS, Begg MD, Gravenstein S, Schaefer CA, Wyatt RJ, Bresnahan M, et al. Serologic evidence of prenatal influenza in the etiology of schizophrenia. Arch Gen Psychiatry. Aug 2004;61 (8):774-80. [Medline].

  50. Torrey EF, Bowler AE, Rawlings R, Terrazas A. Seasonality of schizophrenia and stillbirths. Schizophr Bull. 1993;19(3):557-62. [Medline].

  51. Clarke MC, Tanskanen A, Huttunen M, Whittaker JC, Cannon M. Evidence for an interaction between familial liability and prenatal exposure to infection in the causation of schizophrenia. Am J Psychiatry. Sep 2009;166(9):1025-30. [Medline].

  52. Anderson P. Teen Marijuana Use Linked to Earlier Psychosis Onset. Medscape Medical News [serial online]. May 14 2014;Accessed May 20 2014. Available at http://www.medscape.com/viewarticle/825131.

  53. Bhugra D. The global prevalence of schizophrenia. PLoS Med. May 2005;2(5):e151; quiz e175. [Medline]. [Full Text].

  54. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. May 2005;2(5):e141. [Medline]. [Full Text].

  55. Haro JM, Novick D, Bertsch J, et al. Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. Br J Psychiatry. Sep 2011;199:194-201. [Medline].

  56. Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. Nov 2010;24(4 Suppl):81-90. [Medline]. [Full Text].

  57. Hoang U, Stewart R, Goldacre MJ. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006. BMJ. Sep 13 2011;343:d5422. [Medline]. [Full Text].

  58. Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev. Jun 15 2011;CD002831. [Medline].

  59. Hyde TM, Deep-Soboslay A, Iglesias B, et al. Enuresis as a premorbid developmental marker of schizophrenia. Brain. Sep 2008;131:2489-98. [Medline]. [Full Text].

  60. Jones P, Rodgers B, Murray R, Marmot M. Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet. Nov 19 1994;344(8934):1398-402. [Medline].

  61. Ho BC, Andreasen NC. Long delays in seeking treatment for schizophrenia. Lancet. Mar 24 2001;357(9260):898-900. [Medline].

  62. Green AI, Drake RE, Brunette MF, Noordsy DL. Schizophrenia and co-occurring substance use disorder. Am J Psychiatry. Mar 2007;164(3):402-8. [Medline].

  63. Foti DJ, Kotov R, Guey LT, Bromet EJ. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry. Aug 2010;167(8):987-93. [Medline].

  64. Yücel M, Bora E, Lubman DI, et al. The impact of cannabis use on cognitive functioning in patients with schizophrenia: a meta-analysis of existing findings and new data in a first-episode sample. Schizophr Bull. Mar 2012;38(2):316-30. [Medline]. [Full Text].

  65. Brauser D. Cannabis Not the Only Illicit Drug Linked to Schizophrenia. Medscape Medical News. Available at http://www.medscape.com/viewarticle/807520. Accessed July 17, 2013.

  66. Robertson MM, Trimble MR. Major tranquillisers used as antidepressants. A review. J Affect Disord. Sep 1982;4(3):173-93. [Medline].

  67. Singh SP, Singh V, Kar N, Chan K. Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia: meta-analysis. Br J Psychiatry. Sep 2010;197(3):174-9. [Medline].

  68. Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. Jan 2003;60(1):82-91. [Medline].

  69. Shioiri T, Shinada K, Kuwabara H, Someya T. Early prodromal symptoms and diagnoses before first psychotic episode in 219 inpatients with schizophrenia. Psychiatry Clin Neurosci. Aug 2007;61(4):348-54. [Medline].

  70. Kripke DF, Langer RD, Kline LE. Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2(1):e000850. [Medline]. [Full Text].

  71. Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Arch Gen Psychiatry. May 2012;69(5):476-83. [Medline].

  72. Bennett DJ, Ogloff JR, Mullen PE, et al. Schizophrenia disorders, substance abuse and prior offending in a sequential series of 435 homicides. Acta Psychiatr Scand. Sep 2011;124(3):226-33. [Medline].

  73. Fazel S, Långström N, Hjern A, Grann M, Lichtenstein P. Schizophrenia, substance abuse, and violent crime. JAMA. May 20 2009;301(19):2016-23. [Medline].

  74. Cummings JL, Gosenfeld LF, Houlihan JP, McCaffrey T. Neuropsychiatric disturbances associated with idiopathic calcification of the basal ganglia. Biol Psychiatry. May 1983;18(5):591-601. [Medline].

  75. Rosebush PI, MacQueen GM, Clarke JT, et al. Late-onset Tay-Sachs disease presenting as catatonic schizophrenia: diagnostic and treatment issues. J Clin Psychiatry. Aug 1995;56(8):347-53. [Medline].

  76. Pope HG Jr, Katz DL. Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes. Arch Gen Psychiatry. May 1994;51(5):375-82. [Medline].

  77. Reuler JB, Girard DE, Cooney TG. Current concepts. Wernicke's encephalopathy. N Engl J Med. Apr 18 1985;312(16):1035-9. [Medline].

  78. Salokangas RK. Medical problems in schizophrenia patients living in the community (alternative facilities). Curr Opin Psychiatry. Jul 2007;20(4):402-5. [Medline].

  79. Brauser D. Long-term Injectable Drug Effective for Schizophrenia. Medscape Medical News [serial online]. May 11 2012;Accessed Apr 5 2013. Available at http://www.medscape.com/viewarticle/763689.

  80. Cassels C. FDA Approves Once-Monthly Treatment for Schizophrenia. Medscape Medical News [serial online]. Mar 1 2013;Accessed Apr 5 2013. Available at http://www.medscape.com/viewarticle/780106.

  81. Kane JM, Sanchez R, Perry PP, et al. Aripiprazole intramuscular depot as maintenance treatment in patients with schizophrenia: a 52-week, multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. May 2012;73(5):617-24. [Medline]. [Full Text].

  82. Citrome L. New second-generation long-acting injectable antipsychotics for the treatment of schizophrenia. Expert Rev Neurother. Jul 2013;13(7):767-83. [Medline].

  83. Lieberman JA, Stroup TS. The NIMH-CATIE Schizophrenia Study: what did we learn?. Am J Psychiatry. Aug 2011;168(8):770-5. [Medline].

  84. Jones PB, Barnes TR, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry. Oct 2006;63(10):1079-87. [Medline].

  85. 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. Mar 29 2008;371(9618):1085-97. [Medline].

  86. McEvoy JP, Lieberman JA, Perkins DO, Hamer RM, Gu H, Lazarus A, 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. Jul 2007;164(7):1050-60. [Medline].

  87. [Guideline] Buchanan RW, Kreyenbuhl J, Kelly DL, Noel JM, Boggs DL, Fischer BA, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull. Jan 2010;36(1):71-93. [Medline]. [Full Text].

  88. Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry. Sep 2013;70(9):913-20. [Medline].

  89. Lieberman JA, Phillips M, Gu H, Stroup S, Zhang P, Kong L, et al. Atypical and conventional antipsychotic drugs in treatment-naive first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazine. Neuropsychopharmacology. May 2003;28(5):995-1003. [Medline].

  90. Woerner MG, Robinson DG, Alvir JM, Sheitman BB, Lieberman JA, Kane JM. Clozapine as a first treatment for schizophrenia. Am J Psychiatry. Aug 2003;160(8):1514-6. [Medline].

  91. Moore TA, Buchanan RW, Buckley PF, Chiles JA, Conley RR, Crismon ML, et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2006 update. J Clin Psychiatry. Nov 2007;68(11):1751-62. [Medline].

  92. Agid O, Arenovich T, Sajeev G, Zipursky RB, Kapur S, Foussias G, et al. An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. J Clin Psychiatry. Nov 2011;72(11):1439-44. [Medline].

  93. Essock SM, Schooler NR, Stroup TS, McEvoy JP, Rojas I, Jackson C, et al. Effectiveness of switching from antipsychotic polypharmacy to monotherapy. Am J Psychiatry. Jul 2011;168(7):702-8. [Medline].

  94. Correll CU, Rummel-Kluge C, Corves C, Kane JM, Leucht S. Antipsychotic combinations vs monotherapy in schizophrenia: a meta-analysis of randomized controlled trials. Schizophr Bull. Mar 2009;35(2):443-57. [Medline]. [Full Text].

  95. Honer WG, MacEwan GW, Gendron A, Stip E, Labelle A, Williams R, et al. A randomized, double-blind, placebo-controlled study of the safety and tolerability of high-dose quetiapine in patients with persistent symptoms of schizophrenia or schizoaffective disorder. J Clin Psychiatry. Jan 2012;73(1):13-20. [Medline].

  96. Asmal L, Flegar SJ, Wang J, Rummel-Kluge C, Komossa K, Leucht S. Quetiapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. Nov 18 2013;11:CD006625. [Medline].

  97. Rosenheck RA, Krystal JH, Lew R, Barnett PG, Fiore L, Valley D, et al. Long-acting risperidone and oral antipsychotics in unstable schizophrenia. N Engl J Med. Mar 3 2011;364(9):842-51. [Medline].

  98. Kishimoto T, Robenzadeh A, Leucht C, Leucht S, Watanabe K, Mimura M, et al. Long-Acting Injectable vs Oral Antipsychotics for Relapse Prevention in Schizophrenia: A Meta-Analysis of Randomized Trials. Schizophr Bull. Jan 2 2013;[Medline].

  99. Subotnik KL, Nuechterlein KH, Ventura J, et al. Risperidone nonadherence and return of positive symptoms in the early course of schizophrenia. Am J Psychiatry. Mar 2011;168(3):286-92. [Medline].

  100. Takeuchi H, Suzuki T, Remington G, et al. Effects of risperidone and olanzapine dose reduction on cognitive function in stable patients with schizophrenia: an open-label, randomized, controlled, pilot study. Schizophr Bull. Sep 2013;39(5):993-8. [Medline]. [Full Text].

  101. Glassman AH, Bigger JT Jr. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry. Nov 2001;158(11):1774-82. [Medline].

  102. Strom BL, Eng SM, Faich G, Reynolds RF, D'Agostino RB, Ruskin J, et al. Comparative mortality associated with ziprasidone and olanzapine in real-world use among 18,154 patients with schizophrenia: The Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC). Am J Psychiatry. Feb 2011;168(2):193-201. [Medline].

  103. Vieweg WV. New Generation Antipsychotic Drugs and QTc Interval Prolongation. Prim Care Companion J Clin Psychiatry. Oct 2003;5(5):205-215. [Medline]. [Full Text].

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

  105. [Best Evidence] Kessing LV, Thomsen AF, Mogensen UB, Andersen PK. Treatment with antipsychotics and the risk of diabetes in clinical practice. Br J Psychiatry. Oct 2010;197(4):266-71. [Medline].

  106. Stroup TS, McEvoy JP, Ring KD, Hamer RH, LaVange LM, Swartz MS, et al. A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP). Am J Psychiatry. Sep 2011;168(9):947-56. [Medline].

  107. Wang M, Tong JH, Zhu G, Liang GM, Yan HF, Wang XZ. Metformin for treatment of antipsychotic-induced weight gain: a randomized, placebo-controlled study. Schizophr Res. Jun 2012;138(1):54-7. [Medline].

  108. Hägg S, Spigset O, Söderström TG. Association of venous thromboembolism and clozapine. Lancet. Apr 1 2000;355(9210):1155-6. [Medline].

  109. Thomassen R, Vandenbroucke JP, Rosendaal FR. Antipsychotic drugs and venous thromboembolism. Lancet. Jul 15 2000;356(9225):252. [Medline].

  110. Lowry F. Psychotropic Drugs Can Reduce Bone Mass in Kids. Medscape Medical News [serial online]. Jun 24 2014;Accessed Jul 2 2014. Available at http://www.medscape.com/viewarticle/827275.

  111. Ho BC, Andreasen NC, Ziebell S, Pierson R, Magnotta V. Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia. Arch Gen Psychiatry. Feb 2011;68(2):128-37. [Medline].

  112. Kern RS, Glynn SM, Horan WP, Marder SR. Psychosocial treatments to promote functional recovery in schizophrenia. Schizophr Bull. Mar 2009;35(2):347-61. [Medline]. [Full Text].

  113. [Guideline] Dixon LB, Dickerson F, Bellack AS, Bennett M, Dickinson D, Goldberg RW, et al. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull. Jan 2010;36(1):48-70. [Medline]. [Full Text].

  114. Guo X, Zhai J, Liu Z, Fang M, Wang B, Wang C, et al. Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Arch Gen Psychiatry. Sep 2010;67(9):895-904. [Medline].

  115. Wexler BE, Bell MD. Cognitive remediation and vocational rehabilitation for schizophrenia. Schizophr Bull. Oct 2005;31(4):931-41. [Medline].

  116. Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. May 2011;168(5):472-85. [Medline].

  117. Grant PM, Huh GA, Perivoliotis D, Stolar NM, Beck AT. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry. Feb 2012;69(2):121-7. [Medline].

  118. Puig O, Penadés R, Baeza I, De la Serna E, Sánchez-Gistau V, Bernardo M, et al. Cognitive remediation therapy in adolescents with early-onset schizophrenia: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. Aug 2014;53(8):859-68. [Medline].

  119. Brooks, M. Cognitive Therapy a Viable Monotherapy for Schizophrenia?. Medscape Medical News. Available at http://www.medscape.com/viewarticle/820258. Accessed February 19, 2014.

  120. Morrison, Anthony P., Turkington, D., Pyle, M., et al. Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet. February 2014;[Full Text].

  121. Bond GR, Drake RE. Making the Case for IPS Supported Employment. Adm Policy Ment Health. Nov 17 2012;[Medline].

  122. McHugo GJ, Drake RE, Xie H, Bond GR. A 10-year study of steady employment and non-vocational outcomes among people with serious mental illness and co-occurring substance use disorders. Schizophr Res. Jul 2012;138(2-3):233-9. [Medline].

  123. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. Dec 8 2010;CD000088. [Medline].

  124. Hegelstad WT, Larsen TK, Auestad B, Evensen J, Haahr U, Joa I, et al. Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. Am J Psychiatry. Apr 2012;169(4):374-80. [Medline].

  125. Weiser M. Early intervention for schizophrenia: the risk-benefit ratio of antipsychotic treatment in the prodromal phase. Am J Psychiatry. Aug 2011;168(8):761-3. [Medline].

  126. Bechdolf A, Wagner M, Ruhrmann S, Harrigan S, Putzfeld V, Pukrop R, et al. Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry. Jan 2012;200(1):22-9. [Medline].

  127. Rosenberg O, Gersner R, Klein LD, Kotler M, Zangen A, Dannon P. Deep transcranial magnetic stimulation add-on for the treatment of auditory hallucinations: a double-blind study. Ann Gen Psychiatry. May 6 2012;11:13. [Medline]. [Full Text].

  128. Levkovitz Y, Rabany L, Harel EV, Zangen A. Deep transcranial magnetic stimulation add-on for treatment of negative symptoms and cognitive deficits of schizophrenia: a feasibility study. Int J Neuropsychopharmacol. Aug 2011;14(7):991-6. [Medline].

  129. Baldessarini RJ, Frankenburg FR. Clozapine. A novel antipsychotic agent. N Engl J Med. Mar 14 1991;324(11):746-54. [Medline].

  130. Brauser D. Psychosocial Interventions May Help Nip Psychosis in the Bud. Medscape Medical News. Available at http://www.medscape.com/viewarticle/829526. Accessed August 9, 2014.

  131. Correll CU, Robinson DG, Schooler NR, et al. Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders: Baseline Results From the RAISE-ETP Study. JAMA Psychiatry. Oct 8 2014.

  132. [Best Evidence] Essali A, Al-Haj Haasan N, Li C, Rathbone J. Clozapine versus typical neuroleptic medication for schizophrenia. Cochrane Database Syst Rev. Jan 21 2009;CD000059. [Medline].

  133. Kane JM, Peters-Strickland T, Baker RA, Hertel P, Eramo A, Jin N, et al. Aripiprazole once-monthly in the acute treatment of schizophrenia: findings from a 12-week, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. Nov 2014;75(11):1254-60. [Medline]. [Full Text].

  134. Kane JM, Peters-Strickland T, Baker RA, Hertel P, Eramo A, Jin N, et al. Aripiprazole once-monthly in the acute treatment of schizophrenia: findings from a 12-week, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. Nov 2014;75(11):1254-60. [Medline].

  135. Keller DM. Parkinsonism a major mortality risk factor in schizophrenia. Medscape Medical News [serial online]. March 5, 2014;Accessed March 7, 2014. Available at http://www.medscape.com/viewarticle/821492.

  136. Kwentus J, Riesenberg RA, Marandi M, Manning RA, Allen MH, Fishman RS, et al. Rapid acute treatment of agitation in patients with bipolar I disorder: a multicenter, randomized, placebo-controlled clinical trial with inhaled loxapine. Bipolar Disord. Feb 2012;14(1):31-40. [Medline].

  137. Lesem MD, Tran-Johnson TK, Riesenberg RA, Feifel D, Allen MH, Fishman R, et al. Rapid acute treatment of agitation in individuals with schizophrenia: multicentre, randomised, placebo-controlled study of inhaled loxapine. Br J Psychiatry. Jan 2011;198(1):51-8. [Medline]. [Full Text].

  138. Lowry F. Rapid Rise in Cardiometabolic Risk in Early Schizophrenia. Medscape Medical News [serial online]. Oct 14 2014;Accessed Oct 15 2014. Available at http://www.medscape.com/viewarticle/833223.

  139. Miklowitz DJ, O'Brien MP, Schlosser DA, Addington J, Candan KA, Marshall C, et al. Family-focused treatment for adolescents and young adults at high risk for psychosis: results of a randomized trial. J Am Acad Child Adolesc Psychiatry. Aug 2014;53(8):848-58. [Medline]. [Full Text].

  140. Schoepf D, Uppal H, Potluri R, Heun R. Physical comorbidity and its relevance on mortality in schizophrenia: a naturalistic 12-year follow-up in general hospital admissions. Presented at: The 22nd European Congress of Psychiatry (EPA); March 3, 2014; Munich, Germany. Abstract FC07. Eur Arch Psychiatry Clin Neurosci. Feb 2014;264(1):3-28. [Medline]. [Full Text].

 
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Cortical activation patterns during verbal working memory maintenance. Healthy controls (A), patients with schizophrenia (B), and significantly different activation between groups (subtraction of SZ-CO) (C) are shown. The time series plots in the middle column show activation associated with true memory maintenance (red lines) relative to the baseline activities (blue line). Bright parts in the middle of each plot represent 1-volume (1.5 s) after onset, and offset of the maintenance phase (4.5 secs). All p-values are corrected with false discovery rate of q< 0.005. Image courtesy of Kim J, Matthews NL, and Park S. An event-related fMRI study of phonological verbal working memory in schizophrenia. PLoS One. 2010; 5(8): e12068.
Cortical activation patterns during false memory trials. (A) False memory, baseline in controls (CO). (B) False memory, baseline in schizophrenia (SZ). (C) SZ – CO. All p-values are corrected with a false discovery rate of q< 0.005. The time course plots show false memory-related activities (yellow) and true memory-related activities (red) relative to the baseline (blue). Image courtesy of Kim J, Matthews NL, and Park S. An event-related fMRI study of phonological verbal working memory in schizophrenia. PLoS One. 2010; 5(8): e12068.
Magnetic resonance imaging showing differences in brain ventricle size in twins. The twin on the right has schizophrenia, whereas the twin on the left does not. Image courtesy of Dr. Daniel Weinberger, Clinical Brain Disorders Branch, National Institutes of Health.
 
 
 
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