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Schizophrenia
Specialty	Psychiatry, clinical psychology

Schizophrenia (Template:Pron-en or /ˌskɪtsɵˈfriːniə/) is a mental disorder characterized by abnormalities in the perception or expression of reality. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Onset of symptoms typically occurs in young adulthood, with around 0.4–0.6% of the population affected. Diagnosis is based on the patient's self-reported experiences and observed behavior. No laboratory test for schizophrenia currently exists.

Studies suggest that genetics, early environment, neurobiology, psychological and social processes are important contributory factors; some recreational and prescription drugs appear to cause or worsen symptoms. Current psychiatric research is focused on the role of neurobiology, but no single organic cause has been found. As a result of the many possible combinations of symptoms, there is debate about whether the diagnosis represents a single disorder or a number of discrete syndromes. Despite the etymology of the term from the Greek roots skhizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-; "mind"), schizophrenia does not imply a "split mind" and it is not the same as dissociative identity disorder (previously known as multiple personality disorder or split personality), a condition with which it is often confused in public perception.

Increased dopamine activity in the mesolimbic pathway of the brain is consistently found in schizophrenic individuals. The mainstay of treatment is antipsychotic medication; this type of drug primarily works by suppressing dopamine activity. Dosages of antipsychotics are generally lower than in the early decades of their use. Psychotherapy, and vocational and social rehabilitation are also important. In more serious cases—where there is risk to self and others—involuntary hospitalization may be necessary, although hospital stays are less frequent and for shorter periods than they were in previous times.

The disorder is thought to mainly affect cognition, but it also usually contributes to chronic problems with behavior and emotion. People with schizophrenia are likely to have additional (comorbid) conditions, including major depression and anxiety disorders; the lifetime occurrence of substance abuse is around 40%. Social problems, such as long-term unemployment, poverty and homelessness, are common. Furthermore, the average life expectancy of people with the disorder is 10 to 12 years less than those without, due to increased physical health problems and a higher suicide rate ( about 5% ).

Signs and symptoms

Depending on the individual, a person diagnosed with schizophrenia may experience hallucinations (most commonly hearing voices), delusions (often bizarre or persecutory in nature), and disorganized thinking and speech. The latter may range from loss of train of thought, to sentences only loosely connected in meaning, to incoherence known as word salad in severe cases. There is often an observable pattern of emotional difficulty, for example lack of responsiveness or motivation. Impairment in social cognition is associated with schizophrenia, as are symptoms of paranoia, and social isolation commonly occurs. In one uncommon subtype, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation; these are signs of catatonia.

Late adolescence and early adulthood are peak years for the onset of schizophrenia. In 40% of men and 23% of women diagnosed with schizophrenia, the condition arose before the age of 19. These are critical periods in a young adult's social and vocational development. To minimize the developmental disruption associated with schizophrenia, much work has recently been done to identify and treat the prodromal (pre-onset) phase of the illness, which has been detected up to 30 months before the onset of symptoms, but may be present longer. Those who go on to develop schizophrenia may experience the non-specific symptoms of social withdrawal, irritability and dysphoria in the prodromal period, and transient or self-limiting psychotic symptoms in the prodromal phase before psychosis becomes apparent.

Schneiderian classification

The psychiatrist Kurt Schneider (1887–1967) listed the forms of psychotic symptoms that he thought distinguished schizophrenia from other psychotic disorders. These are called first-rank symptoms or Schneider's first-rank symptoms, and they include delusions of being controlled by an external force; the belief that thoughts are being inserted into or withdrawn from one's conscious mind; the belief that one's thoughts are being broadcast to other people; and hearing hallucinatory voices that comment on one's thoughts or actions or that have a conversation with other hallucinated voices. Although they have significantly contributed to the current diagnostic criteria, the specificity of first-rank symptoms has been questioned. A review of the diagnostic studies conducted between 1970 and 2005 found that these studies allow neither a reconfirmation nor a rejection of Schneider's claims, and suggested that first-rank symptoms be de-emphasized in future revisions of diagnostic systems.

Positive and negative symptoms

Schizophrenia is often described in terms of positive and negative (or deficit) symptoms. The term positive symptoms refers to symptoms that most individuals do not normally experience but are present in schizophrenia. They include delusions, auditory hallucinations, and thought disorder, and are typically regarded as manifestations of psychosis. Negative symptoms are things that are not present in schizophrenic persons but are normally found in healthy persons, that is, symptoms that reflect the loss or absence of normal traits or abilities. Common negative symptoms include flat or blunted affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), and lack of motivation (avolition). Research suggests that negative symptoms contribute more to poor quality of life, functional disability, and the burden on others than do positive symptoms.

A third symptom grouping, the disorganization syndrome, is sometimes described, and includes chaotic speech, thought, and behavior. There is evidence for a number of other symptom classifications.

Diagnosis

Schizophrenia is diagnosed on the basis of symptom profiles. Neural correlates do not provide sufficiently useful criteria. Diagnosis is based on the self-reported experiences of the person, and abnormalities in behavior reported by family members, friends or co-workers, followed by a clinical assessment by a psychiatrist, social worker, clinical psychologist or other mental health professional. Psychiatric assessment includes a psychiatric history and some form of mental status examination.

Standardized criteria

The most widely used standardized criteria for diagnosing schizophrenia come from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, version DSM-IV-TR, and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, the ICD-10. The latter criteria are typically used in European countries, while the DSM criteria are used in the United States and the rest of the world, as well as prevailing in research studies. The ICD-10 criteria put more emphasis on Schneiderian first-rank symptoms, although, in practice, agreement between the two systems is high.

According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), to be diagnosed with schizophrenia, three diagnostic criteria must be met:

1. Characteristic symptoms: Two or more of the following, each present for much of the time during a one-month period (or less, if symptoms remitted with treatment).
   • Delusions
   • Hallucinations
   • Disorganized speech, which is a manifestation of formal thought disorder
   • Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior
   • Negative symptoms: Blunted affect (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation)

   If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing with each other, only that symptom is required above. The speech disorganization criterion is only met if it is severe enough to substantially impair communication.

2. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset.
3. Duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if symptoms remitted with treatment).

If signs of disturbance are present for more than a month but less than six months, the diagnosis of schizophreniform disorder is applied. Psychotic symptoms lasting less than a month may be diagnosed as brief psychotic disorder, and various conditions may be classed as psychotic disorder not otherwise specified. Schizophrenia cannot be diagnosed if symptoms of mood disorder are substantially present (although schizoaffective disorder could be diagnosed), or if symptoms of pervasive developmental disorder are present unless prominent delusions or hallucinations are also present, or if the symptoms are the direct physiological result of a general medical condition or a substance, such as abuse of a drug or medication.

Confusion with other conditions

There is a spectrum of disorders that share similarities with schizophrenia but which are diagnosed as separate conditions, including schizophreniform disorder, schizoaffective disorder, schizoid personality disorder and schizotypal personality disorder (related to the concept of schizotypy). Paranoid personality disorder is also generally considered to be related.

Psychotic symptoms may be present in several other mental disorders, including bipolar disorder, borderline personality disorder,, drug intoxication and drug-induced psychosis. Delusions ("non-bizarre") are also present in delusional disorder, and social withdrawal in social anxiety disorder or avoidant personality disorder. Schizophrenia is complicated with obsessive-compulsive disorder (OCD) considerably more often than could be explained by pure chance, although it can be difficult to distinguish compulsions that represent OCD from the delusions of schizophrenia.

A more general medical and neurological examination may be needed to rule out medical illnesses which may rarely produce psychotic schizophrenia-like symptoms, such as metabolic disturbance, systemic infection, syphilis, HIV infection, epilepsy, and brain lesions. It may be necessary to rule out a delirium, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, and indicates an underlying medical illness. Investigations are not generally repeated for relapse unless there is a specific medical indication or possible adverse effects from antipsychotic medication.

"Schizophrenia" does not mean dissociative identity disorder—formerly and still widely known as "multiple personalities"—despite the etymology of the word (Greek σχίζω = "I split").

Subtypes

The DSM-IV-TR contains five sub-classifications of schizophrenia (the DSM-5 developers are planning to drop them):

• Paranoid type: Where delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent. (DSM code 295.3/ICD code F20.0)
• Disorganized type: Named hebephrenic schizophrenia in the ICD. Where thought disorder and flat affect are present together. (DSM code 295.1/ICD code F20.1)
• Catatonic type: The subject may be almost immobile or exhibit agitated, purposeless movement. Symptoms can include catatonic stupor and waxy flexibility. (DSM code 295.2/ICD code F20.2)
• Undifferentiated type: Psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types have not been met. (DSM code 295.9/ICD code F20.3)
• Residual type: Where positive symptoms are present at a low intensity only. (DSM code 295.6/ICD code F20.5)

The ICD-10 defines two additional subtypes.

• Post-schizophrenic depression: A depressive episode arising in the aftermath of a schizophrenic illness where some low-level schizophrenic symptoms may still be present. (ICD code F20.4)
• Simple schizophrenia: Insidious and progressive development of prominent negative symptoms with no history of psychotic episodes. (ICD code F20.6)

Controversies and research directions

The scientific validity of schizophrenia, and its defining symptoms such as delusions and hallucinations, have been criticised. In 2006, a group of consumers and mental health professionals from the UK, under the banner of Campaign for Abolition of the Schizophrenia Label, argued for a rejection of the diagnosis of schizophrenia based on its heterogeneity and associated stigma, and called for the adoption of a biopsychosocial model. Other UK psychiatrists opposed the move arguing that the term schizophrenia is a useful, even if provisional concept.

Similarly, there is an argument that the underlying issues would be better addressed as a spectrum of conditions or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill. This approach appears consistent with research on schizotypy, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public. In concordance with this observation, psychologist Edgar Jones, and psychiatrists Tony David and Nassir Ghaemi, surveying the existing literature on delusions, pointed out that the consistency and completeness of the definition of delusion have been found wanting by many; delusions are neither necessarily fixed, nor false, nor involve the presence of incontrovertible evidence.

Nancy Andreasen, a leading figure in schizophrenia research, has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic validity for the sake of artificially improving reliability. She argues that overemphasis on psychosis in the diagnostic criteria, while improving diagnostic reliability, ignores more fundamental cognitive impairments that are harder to assess due to large variations in presentation. This view is supported by other psychiatrists. In the same vein, Ming Tsuang and colleagues argue that psychotic symptoms may be a common end-state in a variety of disorders, including schizophrenia, rather than a reflection of the specific etiology of schizophrenia, and warn that there is little basis for regarding DSM’s operational definition as the "true" construct of schizophrenia. Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes that are alternatives to those that are purely symptom-based. These deficits take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving.

The exclusion of affective components from the criteria for schizophrenia, despite their ubiquity in clinical settings, has also caused contention. This exclusion in the DSM has resulted in a "rather convoluted" separate disorder—schizoaffective disorder. Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity. The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.

An approach broadly known as the anti-psychiatry movement, most active in the 1960s, opposes the orthodox medical view of schizophrenia as an illness. Psychiatrist Thomas Szasz argues that psychiatric patients are individuals with unconventional thoughts and behavior that society diagnoses as a method of social control, and therefore the diagnosis of "schizophrenia" is merely a form of social construction. The Hearing Voices Movement argues that many people diagnosed as psychotic need their experiences to be accepted and valued rather than medicalized.

Causes

While the reliability of the diagnosis introduces difficulties in measuring the relative effect of genes and environment (for example, symptoms overlap to some extent with severe bipolar disorder or major depression), evidence suggests that genetic and environmental factors can act in combination to result in schizophrenia. Evidence suggests that the diagnosis of schizophrenia has a significant heritable component but that onset is significantly influenced by environmental factors or stressors. The idea of an inherent vulnerability (or diathesis) in some people, which can be unmasked by biological, psychological or environmental stressors, is known as the stress-diathesis model. An alternative idea that biological, psychological and social factors are all important is known as the "biopsychosocial" model.

Genetic

Twin studies and adoption studies have suggested a high level of heritability (the proportion of variation between individuals in a population that is influenced by genetic factors). It has been suggested that schizophrenia is a condition of complex inheritance, with many different potential genes each of small effect, with different pathways for different individuals. Some have suggested that several genetic and other risk factors need to be present before a person becomes affected but this is still uncertain. Candidate genes linked to an increased risk of schizophrenia and bipolar disorder as found in recent genome wide association studies appear to be partly separate and partly overlapping between the two disorders Metaanalyses of genetic linkage studies have produced evidence of chromosomal regions increasing susceptibility, which interacts directly with the Disrupted in Schizophrenia 1 (DISC1) gene protein more recently the zinc finger protein 804A. has been implicated as well as the chromosome 6 HLA region. However, a large and comprehensive genetic study found no evidence of any significant association with any of 14 previously identified candidate genes. Schizophrenia, in a small minority of cases, has been associated with rare deletions or duplications of tiny DNA sequences (known as copy number variants) disproportionately occurring within genes involved in neuronal signaling and brain development/human cognitive, behavioral, and psychological variation.

Assuming a hereditary genetic basis, one question for evolutionary psychology is why genes that increase the likelihood of the condition evolved, assuming the condition would have been maladaptive from an evolutionary/reproductive point of view. One theory implicates genes involved in the evolution of language and human nature, but so far all theories have been disproved or remain unsubstantiated.

Prenatal

Causal factors are thought to initially come together in early neurodevelopment to increase the risk of later developing schizophrenia. One curious finding is that people diagnosed with schizophrenia are more likely to have been born in winter or spring, (at least in the northern hemisphere). There is now evidence that prenatal exposure to infections increases the risk for developing schizophrenia later in life, providing additional evidence for a link between in utero developmental pathology and risk of developing the condition.

Social

Living in an urban environment has been consistently found to be a risk factor for schizophrenia. Social disadvantage has been found to be a risk factor, including poverty and migration related to social adversity, racial discrimination, family dysfunction, unemployment or poor housing conditions. Childhood experiences of abuse or trauma have also been implicated as risk factors for a diagnosis of schizophrenia later in life. Parenting is not held responsible for schizophrenia but unsupportive dysfunctional relationships may contribute to an increased risk.

Substance Abuse

In a recent study of people with schizophrenia and a substance abuse disorder, over a ten year period, "substantial proportions were above cutoffs selected by dual diagnosis clients as indicators of recovery." Although about half of all patients with schizophrenia use drugs or alcohol, and the vast majority use tobacco, a clear causal connection between drug use and schizophrenia has been difficult to prove. The two most often used explanations for this are "substance use causes schizophrenia" and "substance use is a consequence of schizophrenia", and they both may be correct. A 2007 meta-analysis estimated that cannabis use is statistically associated with a dose-dependent increase in risk of development of psychotic disorders, including schizophrenia, though the authors admit that some uncertainty about causality still remains. Interestingly, cannabis use has increased dramatically in several countries over the past few decades, though the rates of psychosis and schizophrenia have generally not increased. There is little evidence to suggest that other drugs including alcohol cause schizophrenia. Psychotic individuals may also use drugs to cope with unpleasant states such as depression, anxiety, boredom and loneliness, because drugs increase "feel-good" neurotransmitters level, like dopamine and serotonin which level usually goes down during depression. Various studies have shown that amphetamines increases the concentrations of dopamine in the synaptic cleft, thereby heightening the response of the post-synaptic neuron. However, regarding psychosis itself, it is well understood that methamphetamine and cocaine use can result in methamphetamine- or cocaine-induced psychoses that present very similar symptomatology and may persist even when users remain abstinent.

Mechanisms

Psychological

A number of psychological mechanisms have been implicated in the development and maintenance of schizophrenia. Cognitive biases that have been identified in those with a diagnosis or those at risk, especially when under stress or in confusing situations, include excessive attention to potential threats, jumping to conclusions, making external attributions, impaired reasoning about social situations and mental states, difficulty distinguishing inner speech from speech from an external source, and difficulties with early visual processing and maintaining concentration. Some cognitive features may reflect global neurocognitive deficits in memory, attention, problem-solving, executive function or social cognition, while others may be related to particular issues and experiences.

Despite a common appearance of "blunted affect", recent findings indicate that many individuals diagnosed with schizophrenia are emotionally responsive, particularly to stressful or negative stimuli, and that such sensitivity may cause vulnerability to symptoms or to the disorder. Some evidence suggests that the content of delusional beliefs and psychotic experiences can reflect emotional causes of the disorder, and that how a person interprets such experiences can influence symptomatology. The use of "safety behaviors" to avoid imagined threats may contribute to the chronicity of delusions. Further evidence for the role of psychological mechanisms comes from the effects of psychotherapies on symptoms of schizophrenia.

Neural

Studies using neuropsychological tests and brain imaging technologies such as fMRI and PET to examine functional differences in brain activity have shown that differences seem to most commonly occur in the frontal lobes, hippocampus and temporal lobes. These differences have been linked to the neurocognitive deficits often associated with schizophrenia.

Particular focus has been placed upon the function of dopamine in the mesolimbic pathway of the brain. This focus largely resulted from the accidental finding that a drug group which blocks dopamine function, known as the phenothiazines, could reduce psychotic symptoms. It is also supported by the fact that amphetamines, which trigger the release of dopamine, may exacerbate the psychotic symptoms in schizophrenia. An influential theory, known as the Dopamine hypothesis of schizophrenia, proposed that excess activation of D₂ receptors was the cause of (the positive symptoms of) schizophrenia. Although postulated for about 20 years based on the D₂ blockade effect common to all antipsychotics, it was not until the mid-1990s that PET and SPET imaging studies provided supporting evidence. This explanation is now thought to be simplistic, partly because newer antipsychotic medication (called atypical antipsychotic medication) can be equally effective as older medication (called typical antipsychotic medication), but also affects serotonin function and may have slightly less of a dopamine blocking effect.

Interest has also focused on the neurotransmitter glutamate and the reduced function of the NMDA glutamate receptor in schizophrenia. This has largely been suggested by abnormally low levels of glutamate receptors found in postmortem brains of people previously diagnosed with schizophrenia and the discovery that the glutamate blocking drugs such as phencyclidine and ketamine can mimic the symptoms and cognitive problems associated with the condition. The fact that reduced glutamate function is linked to poor performance on tests requiring frontal lobe and hippocampal function and that glutamate can affect dopamine function, all of which have been implicated in schizophrenia, have suggested an important mediating (and possibly causal) role of glutamate pathways in schizophrenia. Positive symptoms fail however to respond to glutamatergic medication.

There have also been findings of differences in the size and structure of certain brain areas in schizophrenia. A 2006 metaanlaysis of MRI studies found that whole brain and hippocampal volume are reduced and that ventricular volume is increased in patients with a first psychotic episode relative to healthy controls. The average volumetric changes in these studies are however close to the limit of detection by MRI methods, so it remains to be determined whether schizophrenia is a neurodegenerative process that begins at about the time of symptom onset, or whether it is better characterised as a neurodevelopmental process that produces abnormal brain volumes at an early age. In first episode psychosis typical antipsychotics like haloperidol were associated with significant reductions in gray matter volume, whereas atypical antipsychotics like olanzapine were not. Studies in non-human primates found gray and white matter reductions for both typical and atypical antipsychotics.

A 2009 meta-analysis of diffusion tensor imaging studies identified two consistent locations of reduced fractional anisotropy (roughly the level of organization of neural connections) in schizophrenia. The authors suggest that two networks of white matter tracts may be affected in schizophrenia, with the potential for "disconnection" of the gray matter regions which they link. During fMRI studies, greater connectivity in the brain's default network and task-positive network has been observed in patients diagnosed with schizophrenia, and may reflect excessive attentional orientation toward introspection and toward extrospection, respectively. The greater anti-correlation between the two networks suggests excessive rivalry between the networks.

Screening and prevention

There are no reliable markers for the later development of schizophrenia although research is being conducted into how well a combination of genetic risk plus non-disabling psychosis-like experience predicts later diagnosis. People who fulfill the 'ultra high-risk mental state' criteria, that include a family history of schizophrenia plus the presence of transient or self-limiting psychotic experiences, have a 20–40% chance of being diagnosed with the condition after one year. The use of psychological treatments and medication has been found effective in reducing the chances of people who fulfill the 'high-risk' criteria from developing full-blown schizophrenia. However, the treatment of people who may never develop schizophrenia is controversial, in light of the side-effects of antipsychotic medication; particularly with respect to the potentially disfiguring tardive dyskinesia and the rare but potentially lethal neuroleptic malignant syndrome. The most widely used form of preventative health care for schizophrenia takes the form of public education campaigns that provide information on risk factors and early symptoms, with the aim to improve detection and provide treatment earlier for those experiencing delays. The new clinical approach early intervention in psychosis is a secondary prevention strategy to prevent further episodes and prevent the long term disability associated with schizophrenia.

Management

The concept of a cure as such remains controversial, as there is no consensus on the definition, although some criteria for the remission of symptoms have recently been suggested. The effectiveness of schizophrenia treatment is often assessed using standardized methods, one of the most common being the Positive and Negative Syndrome Scale (PANSS). Management of symptoms and improving function is thought to be more achievable than a cure. Treatment was revolutionized in the mid-1950s with the development and introduction of chlorpromazine. A recovery model is increasingly adopted, emphasizing hope, empowerment and social inclusion.

Hospitalization may occur with severe episodes of schizophrenia. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur. Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment and patient-led support groups.

In many non-Western societies, schizophrenia may only be treated with more informal, community-led methods. Multiple international surveys by the World Health Organization over several decades have indicated that the outcome for people diagnosed with schizophrenia in non-Western countries is on average better there than for people in the West. Many clinicians and researchers suspect the relative levels of social connectedness and acceptance are the difference, although further cross-cultural studies are seeking to clarify the findings.

Medication

The first line psychiatric treatment for schizophrenia is antipsychotic medication. These can reduce the positive symptoms of psychosis. Most antipsychotics take around 7–14 days to have their main effect. Currently available antipsychotics fail, however, to significantly ameliorate the negative symptoms, and the improvements on cognition may be attributed to the practice effect.

The newer atypical antipsychotic drugs are usually preferred for initial treatment over the older typical antipsychotic, although they are expensive and are more likely to induce weight gain and obesity-related diseases. In 2005–2006, results from a major randomized trial sponsored by the US National Institute of Mental Health (Clinical Antipsychotic Trials of Intervention Effectiveness, or CATIE) found that a representative first-generation antipsychotic, perphenazine, was as effective as and more cost-effective than several newer drugs taken for up to 18 months. The atypical antipsychotic which patients were willing to continue for the longest, olanzapine, was associated with considerable weight gain and risk of metabolic syndrome. Clozapine was most effective for people with a poor response to other drugs, but it had troublesome side effects. Because the trial excluded patients with tardive dyskinesia, its relevance to these people is unclear. Also careful approach need to be taken to antipsychotics that are blocking dopamine function, because excessive blocking of this neurotransmitter responsible for pleasure system, can cause relapses in depression, and this can increase addictive behaviors in patients who may try to compensate dopamine deficiency with drugs or alcohol (since amphetamines are increase the concentrations of dopamine in the synaptic cleft). Perphenazine is a Consumer Reports Best Buy Drug for schizophrenia.

Because of their reportedly lower risk of side effects that affect mobility, atypical antipsychotics have been first-line treatment for early-onset schizophrenia for many years before certain drugs in this class were approved by the Food and Drug Administration for use in children and teenagers with schizophrenia. This advantage comes at the cost of an increased risk of metabolic syndrome and obesity, which is of concern in the context of long-term use begun at an early age. Especially in the case of children and teenagers who have schizophrenia, medication should be used in combination with individual therapy and family-based interventions.

Recent reviews have refuted the claim that atypical antipsychotics have fewer extrapyramidal side effects than typical antipsychotics, especially when the latter are used in low doses or when low potency antipsychotics are chosen.

Prolactin elevations have been reported in women with schizophrenia taking atypical antipsychotics. It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome, a rare but serious and potentially fatal neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs.

Response of symptoms to medication is variable: treatment-resistant schizophrenia is a term used for the failure of symptoms to respond satisfactorily to at least two different antipsychotics. Patients in this category may be prescribed clozapine, a medication of superior effectiveness but several potentially lethal side effects including agranulocytosis and myocarditis. Clozapine may have the additional benefit of reducing propensity for substance abuse in schizophrenic patients. For other patients who are unwilling or unable to take medication regularly, long-acting depot preparations of antipsychotics may be given every two weeks to achieve control. The United States and Australia are two countries with laws allowing the forced administration of this type of medication on those who refuse but are otherwise stable and living in the community. At least one study suggested that in the longer-term some individuals may do better not taking antipsychotics.

Psychological and social interventions

Psychotherapy is also widely recommended and used in the treatment of schizophrenia, although services may often be confined to pharmacotherapy because of reimbursement problems or lack of training.

Cognitive behavioral therapy (CBT) is used to target specific symptoms and improve related issues such as self-esteem, social functioning, and insight. Although the results of early trials were inconclusive as the therapy advanced from its initial applications in the mid 1990s, more recent reviews clearly show CBT is an effective treatment for the psychotic symptoms of schizophrenia.

Another approach is cognitive remediation, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Based on techniques of neuropsychological rehabilitation, early evidence has shown it to be cognitively effective, with some improvements related to measurable changes in brain activation as measured by fMRI. A similar approach known as cognitive enhancement therapy, which focuses on social cognition as well as neurocognition, has shown efficacy.

Family therapy or education, which addresses the whole family system of an individual with a diagnosis of schizophrenia, has been consistently found to be beneficial, at least if the duration of intervention is longer-term. Aside from therapy, the effect of schizophrenia on families and the burden on carers has been recognized, with the increasing availability of self-help books on the subject. There is also some evidence for benefits from social skills training, although there have also been significant negative findings. Some studies have explored the possible benefits of music therapy and other creative therapies.

The Soteria model is alternative to inpatient hospital treatment using a minimal medication approach. It is described as a milieu-therapeutic recovery method, characterized by its founder as "the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment." Although research evidence is limited, a 2008 systematic review found the programme equally as effective as treatment with medication in people diagnosed with first and second episode schizophrenia.

Other

Electroconvulsive therapy is not considered a first line treatment but may be prescribed in cases where other treatments have failed. It is more effective where symptoms of catatonia are present, and is recommended for use under NICE guidelines in the UK for catatonia if previously effective, though there is no recommendation for use for schizophrenia otherwise. Psychosurgery has now become a rare procedure and is not a recommended treatment.

Service-user led movements have become integral to the recovery process in Europe and the United States; groups such as the Hearing Voices Network and the Paranoia Network have developed a self-help approach that aims to provide support and assistance outside the traditional medical model adopted by mainstream psychiatry. By avoiding framing personal experience in terms of criteria for mental illness or mental health, they aim to destigmatize the experience and encourage individual responsibility and a positive self-image. Partnerships between hospitals and consumer-run groups are becoming more common, with services working toward remediating social withdrawal, building social skills and reducing rehospitalization.

Regular exercise can have healthful effects on both the physical and mental health and well-being of individuals with schizophrenia.

Prognosis

Course

Coordinated by the World Health Organization and published in 2001, The International Study of Schizophrenia (ISoS) was a long-term follow-up study of 1633 individuals diagnosed with schizophrenia around the world. Of the 75% who were available for follow-up, half had a favourable outcome, and 16% had a delayed recovery after an early unremitting course. More usually, the course in the first two years predicted the long-term course. Early social intervention was also related to a better outcome. The findings were held as important in moving patients, carers and clinicians away from the prevalent belief of the chronic nature of the condition. A review of major longitudinal studies in North America noted this variation in outcomes, although outcome was on average worse than for other psychotic and psychiatric disorders. A moderate number of patients with schizophrenia were seen to remit and remain well; the review raised the question that some may not require maintenance medication.

A clinical study using strict recovery criteria (concurrent remission of positive and negative symptoms and adequate social and vocational functioning continuously for two years) found a recovery rate of 14% within the first five years. A 5-year community study found that 62% showed overall improvement on a composite measure of clinical and functional outcomes.

World Health Organization studies have noted that individuals diagnosed with schizophrenia have much better long-term outcomes in developing countries (India, Colombia and Nigeria) than in developed countries (United States, United Kingdom, Ireland, Denmark, Czech Republic, Slovakia, Japan, and Russia), despite antipsychotic drugs not being widely available.

Defining recovery

Rates are not always comparable across studies because exact definitions of remission and recovery have not been widely established. A "Remission in Schizophrenia Working Group" has proposed standardized remission criteria involving "improvements in core signs and symptoms to the extent that any remaining symptoms are of such low intensity that they no longer interfere significantly with behavior and are below the threshold typically utilized in justifying an initial diagnosis of schizophrenia". Standardized recovery criteria have also been proposed by a number of different researchers, with the stated DSM definitions of a "complete return to premorbid levels of functioning” or "complete return to full functioning" seen as inadequate, impossible to measure, incompatible with the variability in how society defines normal psychosocial functioning, and contributing to self-fulfilling pessimism and stigma. Some mental health professionals may have quite different basic perceptions and concepts of recovery than individuals with the diagnosis, including those in the Consumer/Survivor/Ex-Patient Movement. One notable limitation of nearly all the research criteria is failure to address the person's own evaluations and feelings about their life. Schizophrenia and recovery often involve a continuing loss of self-esteem, alienation from friends and family, interruption of school and career, and social stigma, "experiences that cannot just be reversed or forgotten". An increasingly influential model defines recovery as a process, similar to being "in recovery" from drug and alcohol problems, and emphasizes a personal journey involving factors such as hope, choice, empowerment, social inclusion and achievement.

Predictors

Several factors have been associated with a better overall prognosis: Being female, rapid (vs. insidious) onset of symptoms, older age of first episode, predominantly positive (rather than negative) symptoms, presence of mood symptoms, and good pre-illness functioning. The strengths and internal resources of the individual concerned, such as determination or psychological resilience, have also been associated with better prognosis. The attitude and level of support from people in the individual's life can have a significant impact; research framed in terms of the negative aspects of this—the level of critical comments, hostility, and intrusive or controlling attitudes, termed high 'Expressed emotion'—has consistently indicated links to relapse. Most research on predictive factors is correlational in nature, however, and a clear cause-and-effect relationship is often difficult to establish.

Mortality

In a study of over 168,000 Swedish citizens undergoing psychiatric treatment, schizophrenia was associated with an average life expectancy of approximately 80–85% of that of the general population; women were found to have a slightly better life expectancy than men, and a diagnosis of schizophrenia was associated with an overall better life expectancy than substance abuse, personality disorder, heart attack and stroke. Other identified factors include smoking, poor diet, little exercise and the negative health effects of psychiatric drugs.

There is a higher than average suicide rate associated with schizophrenia. This has been cited at 10%, but a more recent analysis of studies and statistics revises the estimate at 4.9%, most often occurring in the period following onset or first hospital admission. Several times more attempt suicide. There are a variety of reasons and risk factors.

Violence

The relationship between violent acts and schizophrenia is a contentious topic. Current research indicates that the percentage of people with schizophrenia who commit violent acts is higher than the percentage of people without any disorder, but lower than is found for disorders such as alcoholism, and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse. Studies have indicated that 5% to 10% of those charged with murder in Western countries have a schizophrenia spectrum disorder.

The occurrence of psychosis in schizophrenia has sometimes been linked to a higher risk of violent acts. Findings on the specific role of delusions or hallucinations have been inconsistent, but have focused on delusional jealousy, perception of threat and command hallucinations. It has been proposed that a certain type of individual with schizophrenia may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to diagnosis.

Individuals with a diagnosis of schizophrenia are often the victims of violent crime—at least 14 times more often than they are perpetrators. Another consistent finding is a link to substance misuse, particularly alcohol, among the minority who commit violent acts. Violence by or against individuals with schizophrenia typically occurs in the context of complex social interactions within a family setting, and is also an issue in clinical services and in the wider community.

Epidemiology

Schizophrenia occurs equally in males and females, although typically appears earlier in men—the peak ages of onset are 20–28 years for males and 26–32 years for females. Onset in childhood is much rarer, as is onset in middle- or old age. The lifetime prevalence of schizophrenia—the proportion of individuals expected to experience the disease at any time in their lives—is commonly given at 1%. However, a 2002 systematic review of many studies found a lifetime prevalence of 0.55%. Despite the received wisdom that schizophrenia occurs at similar rates worldwide, its prevalence varies across the world, within countries, and at the local and neighbourhood level. One particularly stable and replicable finding has been the association between living in an urban environment and schizophrenia diagnosis, even after factors such as drug use, ethnic group and size of social group have been controlled for. Schizophrenia is known to be a major cause of disability. In a 1999 study of 14 countries, active psychosis was ranked the third-most-disabling condition after quadriplegia and dementia and ahead of paraplegia and blindness.

History

Accounts of a schizophrenia-like syndrome are thought to be rare in the historical record before the 1800s, although reports of irrational, unintelligible, or uncontrolled behavior were common. A detailed case report in 1797 concerning James Tilly Matthews, and accounts by Phillipe Pinel published in 1809, are often regarded as the earliest cases of the illness in the medical and psychiatric literature. Schizophrenia was first described as a distinct syndrome affecting teenagers and young adults by Bénédict Morel in 1853, termed démence précoce (literally 'early dementia'). The term dementia praecox was used in 1891 by Arnold Pick to in a case report of a psychotic disorder. In 1893 Emil Kraepelin introduced a broad new distinction in the classification of mental disorders between dementia praecox and mood disorder (termed manic depression and including both unipolar and bipolar depression). Kraepelin believed that dementia praecox was primarily a disease of the brain, and particularly a form of dementia, distinguished from other forms of dementia, such as Alzheimer's disease, which typically occur later in life.

The word schizophrenia—which translates roughly as "splitting of the mind" and comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind")—was coined by Eugen Bleuler in 1908 and was intended to describe the separation of function between personality, thinking, memory, and perception. Bleuler described the main symptoms as 4 A's: flattened Affect, Autism, impaired Association of ideas and Ambivalence. Bleuler realized that the illness was not a dementia as some of his patients improved rather than deteriorated and hence proposed the term schizophrenia instead.

In the early 1970s, the diagnostic criteria for schizophrenia was the subject of a number of controversies which eventually led to the operational criteria used today. It became clear after the 1971 US-UK Diagnostic Study that schizophrenia was diagnosed to a far greater extent in America than in Europe. This was partly due to looser diagnostic criteria in the US, which used the DSM-II manual, contrasting with Europe and its ICD-9. David Rosenhan's 1972 study, published in the journal Science under the title On being sane in insane places, concluded that the diagnosis of schizophrenia in the US was often subjective and unreliable. These were some of the factors in leading to the revision not only of the diagnosis of schizophrenia, but the revision of the whole DSM manual, resulting in the publication of the DSM-III in 1980.{subscription required}

The term schizophrenia is commonly misunderstood to mean that affected persons have a "split personality". Although some people diagnosed with schizophrenia may hear voices and may experience the voices as distinct personalities, schizophrenia does not involve a person changing among distinct multiple personalities. The confusion arises in part due to the literal interpretation of Bleuler's term schizophrenia. The first known misuse of the term to mean "split personality" was in an article by the poet T. S. Eliot in 1933.

Society and culture

Stigma

Social stigma has been identified as a major obstacle in the recovery of patients with schizophrenia. In a large, representative sample from a 1999 study, 12.8% of Americans believed that individuals with schizophrenia were "very likely" to do something violent against others, and 48.1% said that they were "somewhat likely" to. Over 74% said that people with schizophrenia were either "not very able" or "not able at all" to make decisions concerning their treatment, and 70.2% said the same of money management decisions. The perception of individuals with psychosis as violent has more than doubled in prevalence since the 1950s, according to one meta-analysis.

In 2002, the Japanese Society of Psychiatry and Neurology changed the term for schizophrenia from Seishin-Bunretsu-Byo　精神分裂病 (mind-split-disease) to Tōgō-shitchō-shō　統合失調症 (integration disorder) to reduce stigma, The new name was inspired by the biopsychosocial model, and it increased the percentage of cases in which patients were informed of the diagnosis from 36.7% to 69.7% over three years.

Iconic cultural depictions

The book and film A Beautiful Mind chronicled the life of John Forbes Nash, a Nobel Prize-winning mathematician who was diagnosed with schizophrenia. The Marathi film Devrai (featuring Atul Kulkarni) is a presentation of a patient with schizophrenia. The film, set in Western India, shows the behavior, mentality, and struggle of the patient as well as his loved-ones. Other factual books have been written by relatives on family members; Australian journalist Anne Deveson told the story of her son's battle with schizophrenia in Tell me I'm Here, later made into a movie.

In Bulgakov's The Master and Margarita the poet Ivan Bezdomnyj is institutionalized and diagnosed with schizophrenia after witnessing the devil (Woland) predict Berlioz's death. The book The Eden Express by Mark Vonnegut recounts his struggle with schizophrenia and his recovering journey.

See also

• Persecutory delusions
• Catastrophic Schizophrenia
• Schizocaria

References

1. ^ Castle D, Wessely S, Der G, Murray RM (1991). "The incidence of operationally defined schizophrenia in Camberwell, 1965-84". The British Journal of Psychiatry. 159: 790–4. doi:10.1192/bjp.159.6.790. PMID 1790446. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
2. Bhugra D (2005). "The global prevalence of schizophrenia". PLoS Medicine. 2 (5): e151, quiz e175. doi:10.1371/journal.pmed.0020151. PMC 1140960. PMID 15916460. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: unflagged free DOI (link)
3. ^ Goldner EM, Hsu L, Waraich P, Somers JM (2002). "Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature". Canadian Journal of Psychiatry. 47 (9): 833–43. PMID 12500753. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
4. ^ American Psychiatric Association (2000). "Schizophrenia". Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Publishing, Inc. ISBN 0-89042-024-6. {{cite book}}: |access-date= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
5. Rathus, Spencer (1991). Abnormal Psychology. Prentice Hall. p. 228. ISBN 0130052167. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
6. ^ Becker T, Kilian R (2006). "Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?". Acta Psychiatrica Scandinavica Supplement. 429 (429): 9–16. doi:10.1111/j.1600-0447.2005.00711.x. PMID 16445476.
7. Sim K, Chua TH, Chan YH, Mahendran R, Chong SA (2006). "Psychiatric comorbidity in first episode schizophrenia: a 2 year, longitudinal outcome study". Journal of Psychiatric Research. 40 (7): 656–63. doi:10.1016/j.jpsychires.2006.06.008. PMID 16904688. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
8. ^ Brown S, Barraclough B, Inskip H (2000). "Causes of the excess mortality of schizophrenia". British Journal of Psychiatry. 177: 212–7. doi:10.1192/bjp.177.3.212. PMID 11040880.{{cite journal}}: CS1 maint: multiple names: authors list (link)
9. Palmer BA, Pankratz VS, Bostwick JM (2005). "The lifetime risk of suicide in schizophrenia: a reexamination". Archives of General Psychiatry. 62 (3): 247–53. doi:10.1001/archpsyc.62.3.247. PMID 15753237. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
10. ^ Cullen KR, Kumra S, Regan J; et al. (2008). "Atypical Antipsychotics for Treatment of Schizophrenia Spectrum Disorders". Psychiatric Times. 25 (3). {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
11. Addington J (2007). "North American prodrome longitudinal study: a collaborative multisite approach to prodromal schizophrenia research". Schizophrenia Bulletin. 33 (3): 665–72. doi:10.1093/schbul/sbl075. PMC 2526151. PMID 17255119. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
12. Parnas J (1989). "Pre-morbid psychopathology in schizophrenia spectrum". British Journal of Psychiatry. 115: 623–7. PMID 2611591. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
13. Amminger GP (2006). "Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals". Schizophrenia Research. 84 (1): 67–76. doi:10.1016/j.schres.2006.02.018. PMID 16677803. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
14. Schneider, K (1959). Clinical Psychopathology (5 ed.). New York: Grune & Stratton.
15. Nordgaard J, Arnfred SM, Handest P, Parnas J (2008). "The diagnostic status of first-rank symptoms". Schizophrenia Bulletin. 34 (1): 137–54. doi:10.1093/schbul/sbm044. PMC 2632385. PMID 17562695. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
16. Sims A (2002). Symptoms in the mind: an introduction to descriptive psychopathology. Philadelphia: W. B. Saunders. ISBN 0-7020-2627-1.
17. Velligan DI and Alphs LD (March 1, 2008). "Negative Symptoms in Schizophrenia: The Importance of Identification and Treatment". Psychiatric Times. 25 (3).
18. Peralta V (2001). "How many and which are the psychopathological dimensions in schizophrenia? Issues influencing their ascertainment". Schizophrenia Research. 49 (3): 269–85. doi:10.1016/S0920-9964(00)00071-2. PMID 11356588. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
19. Manji, Hk; Gottesman, Ii; Gould, Td (2003). "Signal transduction and genes-to-behaviors pathways in psychiatric diseases". Science's STKE: signal transduction knowledge environment. 2003 (207): pe49. doi:10.1126/stke.2003.207.pe49. PMID 14600293. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
20. Jakobsen KD (2005). "Reliability of clinical ICD-10 schizophrenia diagnoses". Nordic Journal of Psychiatry. 59 (3): 209–12. doi:10.1080/08039480510027698. PMID 16195122. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
21. Bowie, C.R. (2005) Cognitive impairment in schizophrenia spectrum personality Current Psychosis and Therapeutics Reports, Volume 3, Number 4, Pages 147-151 DOI 10.1007/BF02629446
22. Pope HG (1983). "Distinguishing bipolar disorder from schizophrenia in clinical practice: guidelines and case reports" (PDF). Hospital and Community Psychiatry. 34: 322–28. Retrieved 2008-02-24.
23. McGlashan TH (1987). "Testing DSM-III symptom criteria for schizotypal and borderline personality disorders". Archives of General Psychiatry. 44 (2): 143–8. PMID 3813809. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |month= ignored (help)
24. Bottas A (April 15, 2009). "Comorbidity: Schizophrenia With Obsessive-Compulsive Disorder". Psychiatric Times. 26 (4).
25. American Psychiatric Association DSM-5 Work Groups (2010) Proposed Revisions - Schizophrenia and Other Psychotic Disorders Retrieved 17 February 2010
26. Boyle, Mary (2002). Schizophrenia: a scientific delusion?. New York: Routledge. ISBN 0-415-22718-6.
27. Bentall, Richard P.; Read, John E; Mosher, Loren R. (2004). Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. Philadelphia: Brunner-Routledge. ISBN 1-58391-906-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
28. "Schizophrenia term use 'invalid'". United Kingdom: BBC News online. BBC. 9 October 2006. Retrieved 16 May 2007.
29. "CASL Biography". Retrieved 2009-02-01. and "CASL History". Retrieved 2009-02-01.
30. ^ Tsuang MT (2000). "Toward reformulating the diagnosis of schizophrenia". American Journal of Psychiatry. 157 (7): 1041–50. doi:10.1176/appi.ajp.157.7.1041. PMID 10873908. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
31. Peralta V, Cuesta MJ (2007). "A dimensional and categorical architecture for the classification of psychotic disorders". World Psychiatry. 6 (2): 100–1. PMC 2219908. PMID 18235866. {{cite journal}}: Unknown parameter |month= ignored (help)
32. Verdoux H (2002). "Psychotic symptoms in non-clinical populations and the continuum of psychosis". Schizophrenia Research. 54 (1–2): 59–65. doi:10.1016/S0920-9964(01)00352–8. PMID 11853979. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
33. Johns LC (2001). "The continuity of psychotic experiences in the general population". Clinical Psychology Review. 21 (8): 1125–41. doi:10.1016/S0272-7358(01)00103–9. PMID 11702510. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
34. Peters ER (2005). "Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI)". Schizophrenia Bulletin. 30 (4): 1005–22. PMID 15954204. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
35. Edgar Jones (1999). "The Phenomenology of Abnormal Belief: A Philosophical and Psychiatric Inquiry". Philosophy, Psychiatry and Psychology. 6 (1): 1–16. doi:10.1353/ppp.1999.0004. Retrieved 2008-02-24. {{cite journal}}: Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
36. David AS (1999). "On the impossibility of defining delusions". Philosophy, Psychiatry and Psychology. 6 (1): 17–20. doi:10.1353/ppp.1999.0006. Retrieved 2008-02-24. {{cite journal}}: Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
37. S. Nassir Ghaemi (1999). "An Empirical Approach to Understanding Delusions". Philosophy, Psychiatry and Psychology. 6 (1): 21–24. doi:10.1353/ppp.1999.0007. Retrieved 2008-02-24. {{cite journal}}: Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
38. Andreasen NC (2000). "Schizophrenia: the fundamental questions". Brain Res. Brain Res. Rev. 31 (2–3): 106–12. doi:10.1016/S0165-0173(99)00027-2. PMID 10719138. {{cite journal}}: Unknown parameter |month= ignored (help)
39. Andreasen NC (1999). "A unitary model of schizophrenia: Bleuler's "fragmented phrene" as schizencephaly". Arch. Gen. Psychiatry. 56 (9): 781–7. doi:10.1001/archpsyc.56.9.781. PMID 12884883. {{cite journal}}: Unknown parameter |month= ignored (help)
40. ^ Jansson LB, Parnas J (2007). "Competing definitions of schizophrenia: what can be learned from polydiagnostic studies?". Schizophr Bull. 33 (5): 1178–200. doi:10.1093/schbul/sbl065. PMID 17158508. {{cite journal}}: Unknown parameter |month= ignored (help)
41. Green MF, Nuechterlein KH (1999). "Should schizophrenia be treated as a neurocognitive disorder?". Schizophr Bull. 25 (2): 309–19. PMID 10416733.
42. Green, Michael (2001). Schizophrenia revealed: from neurons to social interactions. New York: W.W. Norton. ISBN 0-393-70334-7. {{cite book}}: Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)
43. Lake CR, Hurwitz N (2007). "Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease—there is no schizoaffective disorder". Curr Opin Psychiatry. 20 (4): 365–79. doi:10.1097/YCO.0b013e3281a305ab. PMID 17551352. {{cite journal}}: Unknown parameter |month= ignored (help)
44. Malhi GS, Green M, Fagiolini A, Peselow ED, Kumari V (2008). "Schizoaffective disorder: diagnostic issues and future recommendations". Bipolar Disorders. 10 (1 Pt 2): 215–30. doi:10.1111/j.1399-5618.2007.00564.x. PMID 18199238. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
45. Craddock N, Owen MJ (2005). "The beginning of the end for the Kraepelinian dichotomy". Br J Psychiatry. 186: 364–6. doi:10.1192/bjp.186.5.364. PMID 15863738. {{cite journal}}: Unknown parameter |month= ignored (help)
46. Cooper, David A. (1969). The Dialectics of Liberation (Pelican). London, England: Penguin Books Ltd. ISBN 0-14-021029-6.
47. Szasz, Thomas Stephen (1974). The myth of mental illness: foundations of a theory of personal conduct. San Francisco: Harper & Row. ISBN 0-06-091151-4.
48. ;Meyer-Lindenberg A (2002). "Reduced prefrontal activity predicts exaggerated striatal dopaminergic function in schizophrenia". Nature Neuroscience. 5 (3): 267–71. doi:10.1038/nn804. PMID 11865311. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
49. Harrison PJ (2003). "Genes for schizophrenia? Recent findings and their pathophysiological implications". The Lancet. 361 (9355): 417–19. doi:10.1016/S0140-6736(03)12379–3. PMID 12573388. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
50. Day R (1987). "Stressful life events preceding the acute onset of schizophrenia: a cross-national study from the World Health Organization". Culture, Medicine and Psychiatry. 11 (2): 123–205. doi:10.1007/BF00122563. PMID 3595169. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
51. Corcoran C (2003). "The stress cascade and schizophrenia: etiology and onset". Schizophrenia Bulletin. 29 (4): 671–92. PMID 14989406. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
52. O'Donovan MC (2003). "Recent advances in the genetics of schizophrenia". Human Molecular Genetics. 12 Spec No 2: R125–33. doi:10.1093/hmg/ddg302. PMID 12952866. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
53. Owen MJ (2005). "Schizophrenia: genes at last?". Trends in Genetics. 21 (9): 518–25. doi:10.1016/j.tig.2005.06.011. PMID 16009449. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
54. Craddock N (2006). "Genes for schizophrenia and bipolar disorder? Implications for psychiatric nosology". Schizophrenia Bulletin. 32 (1): 9–16. doi:10.1093/schbul/sbj033. PMC 2632175. PMID 16319375. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
55. Datta, SR.; McQuillin, A.; Rizig, M.; Blaveri, E.; Thirumalai, S.; Kalsi, G.; Lawrence, J.; Bass, NJ.; Puri, V. (2008). "A threonine to isoleucine missense mutation in the pericentriolar material 1 gene is strongly associated with schizophrenia". Mol Psychiatry. doi:10.1038/mp.2008.128. PMID 19048012. {{cite journal}}: Unknown parameter |month= ignored (help)
56. Hennah, W.; Thomson, P.; McQuillin, A.; Bass, N.; Loukola, A.; Anjorin, A.; Blackwood, D.; Curtis, D.; Deary, IJ. (2009). "DISC1 association, heterogeneity and interplay in schizophrenia and bipolar disorder". Mol Psychiatry. 14 (9): 865–73. doi:10.1038/mp.2008.22. PMID 18317464. {{cite journal}}: Unknown parameter |month= ignored (help)
57. O'Donovan MC, Craddock NJ, Owen MJ (2009). "Genetics of psychosis; insights from views across the genome". Hum Genet. 126 (1): 3–12. doi:10.1007/s00439-009-0703-0. PMID 19521722.{{cite journal}}: CS1 maint: multiple names: authors list (link)
58. Purcell, SM.; Wray, NR.; Stone, JL.; Visscher, PM.; O'Donovan, MC.; Sullivan, PF.; Sklar, P.; Purcell, SM.; Wray, NR. (2009). "Common polygenic variation contributes to risk of schizophrenia and bipolar disorder". Nature. 460 (7256): 748–52. doi:10.1038/nature08185. PMID 19571811. {{cite journal}}: Unknown parameter |month= ignored (help)
59. Sanders AR, Duan J, Levinson DF; et al. (2008). "No significant association of 14 candidate genes with schizophrenia in a large European ancestry sample: implications for psychiatric genetics". Am J Psychiatry. 165 (4): 497–506. doi:10.1176/appi.ajp.2007.07101573. PMID 18198266. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
60. Walsh T, McClellan JM, McCarthy SE; et al. (2008). "Rare structural variants disrupt multiple genes in neurodevelopmental pathways in schizophrenia". Science. 320 (5875): 539–43. doi:10.1126/science.1155174. PMID 18369103. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
61. Kirov G, Grozeva D, Norton N; et al. (2009). "Support for the involvement of large CNVs in the pathogenesis of schizophrenia". Hum Mol Genet. 18 (8): 1497. doi:10.1093/hmg/ddp043. PMC 2664144. PMID 19181681. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
62. The International Schizophrenia Consortium (11 September 2008). "Rare chromosomal deletions and duplications increase risk of schizophrenia". Nature. 455 (7210): 237–41. doi:10.1038/nature07239. PMID 18668038.
63. Crow TJ (2008). "The 'big bang' theory of the origin of psychosis and the faculty of language". Schizophr. Res. 102 (1–3): 31–52. doi:10.1016/j.schres.2008.03.010. PMID 18502103. {{cite journal}}: Unknown parameter |month= ignored (help)
64. Mueser KT, Jeste DV (2008). Clinical Handbook of Schizophrenia. New York: Guilford Press. pp. 22–23. ISBN 1593856520.
65. Davies G (2003). "A systematic review and meta-analysis of Northern Hemisphere season of birth studies in schizophrenia". Schizophrenia Bulletin. 29 (3): 587–93. PMID 14609251. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
66. Brown AS (2006). "Prenatal infection as a risk factor for schizophrenia". Schizophrenia Bulletin. 32 (2): 200–2. doi:10.1093/schbul/sbj052. PMC 2632220. PMID 16469941.
67. ^ Van Os J (2004). "Does the urban environment cause psychosis?". British Journal of Psychiatry. 184 (4): 287–288. doi:10.1192/bjp.184.4.287. PMID 15056569.
68. van Os J, Krabbendam L, Myin-Germeys I, Delespaul P (2005). "The schizophrenia envirome". Current Opinion in Psychiatry. 18 (2): 141–5. PMID 16639166. Retrieved 2008-07-06. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
69. Mueser KT, McGurk SR (2004). "Schizophrenia". The Lancet. 363 (9426): 2063–72. doi:10.1016/S0140-6736(04)16458–1. PMID 15207959. {{cite journal}}: Check |doi= value (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
70. Selten JP, Cantor-Graae E, Kahn RS (2007). "Migration and schizophrenia". Current Opinion in Psychiatry. 20 (2): 111–115. doi:10.1097/YCO.0b013e328017f68e. PMID 17278906. Retrieved 2008-07-06. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
71. Schenkel LS (2005). "Histories of childhood maltreatment in schizophrenia: Relationships with premorbid functioning, symptomatology, and cognitive deficits". Schizophrenia Research. 76 (2–3): 273–286. doi:10.1016/j.schres.2005.03.003. PMID 15949659. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
72. Janssen (2004). "Childhood abuse as a risk factor for psychotic experiences". Acta Psychiatrica Scandinavica. 109 (1): 38–45. doi:10.1046/j.0001–690X.2003.00217.x. PMID 14674957. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
73. ^ Bentall RP (2007). "Prospects for a cognitive-developmental account of psychotic experiences". Br J Clin Psychol. 46 (Pt 2): 155–73. doi:10.1348/014466506X123011. PMID 17524210. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
74. Subotnik, KL (2002). "Are Communication Deviance and Expressed Emotion Related to Family History of Psychiatric Disorders in Schizophrenia?". Schizophrenia Bulletin. 28 (4): 719–29. PMID 12795501. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
75. http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/32/3/464
76. Ferdinand RF, Sondeijker F, van der Ende J, Selten JP, Huizink A, Verhulst FC (2005). "Cannabis use predicts future psychotic symptoms, and vice versa". Addiction. 100 (5): 612–8. doi:10.1111/j.1360–0443.2005.01070.x. PMID 15847618. {{cite journal}}: Check |doi= value (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)CS1 maint: multiple names: authors list (link)
77. Moore THM, Zammit S, Lingford-Hughes A; et al. (2007). "Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review". Lancet. 370 (9584): 319–328. doi:10.1016/S0140-6736(07)61162-3. PMID 17662880. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
78. Degenhardt L, Hall W, Lynskey M (2001). "Comorbidity between cannabis use and psychosis: Modelling some possible relationships" (PDF). Technical Report No. 121. Sydney: National Drug and Alcohol Research Centre. Retrieved 2006-08-19. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
79. "Understanding Drug Abuse and Addiction".
80. Gregg L, Barrowclough C, Haddock G (2007). "Reasons for increased substance use in psychosis". Clin Psychol Rev. 27 (4): 494–510. doi:10.1016/j.cpr.2006.09.004. PMID 17240501.{{cite journal}}: CS1 maint: multiple names: authors list (link)
81. "The Role of Dopamine and Norepinephrine in Depression".
82. "The Chemistry of Depression".
83. ^ Kuczenski R, Segal DS (1997). "Effects of methylphenidate on extracellular dopamine, serotonin, and norepinephrine: comparison with amphetamine". J. Neurochem. 68 (5): 2032–7. doi:10.1046/j.1471-4159.1997.68052032.x. PMID 9109529. {{cite journal}}: Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help); Unknown parameter |month= ignored (help)
84. Mahoney JJ, Kalechstein AD, De La Garza R, Newton TF (2008). "Presence and persistence of psychotic symptoms in cocaine- versus methamphetamine-dependent participants". The American Journal on Addictions. 17 (2): 83–98. doi:10.1080/10550490701861201. PMID 18393050.{{cite journal}}: CS1 maint: multiple names: authors list (link)
85. Broome MR (2005). "What causes the onset of psychosis?". Schizophrenia Research. 79 (1): 23–34. doi:10.1016/j.schres.2005.02.007. PMID 16198238. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
86. Lewis R (2004). "Should cognitive deficit be a diagnostic criterion for schizophrenia?". Journal of Psychiatry and Neuroscience. 29 (2): 102–113. PMC 383342. PMID 15069464.
87. Brune M (2007). "Mental state attribution, neurocognitive functioning, and psychopathology: What predicts poor social competence in schizophrenia best?". Schizophrenia Research. 92 (1–2): 151–9. doi:10.1016/j.schres.2007.01.006. PMID 17346931. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
88. Sitskoorn MM (2004). "Cognitive deficits in relatives of patients with schizophrenia: a meta-analysis". Schizophrenia Research. 71 (2): 285–295. doi:10.1016/j.schres.2004.03.007. PMID 15474899. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
89. Kurtz MM (2005). "Neurocognitive impairment across the lifespan in schizophrenia: an update". Schizophrenia Research. 74 (1): 15–26. doi:10.1016/j.schres.2004.07.005. PMID 15694750.
90. ^ Cohen AS; Docherty, NM (2004). "Affective reactivity of speech and emotional experience in patients with schizophrenia". Schizophrenia Research. 69 (1): 7–14. doi:10.1016/S0920-9964(03)00069–0. PMID 15145465. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
91. Horan WP (2003). "Emotional responses to psychosocial stress in schizophrenia: the role of individual differences in affective traits and coping". Schizophrenia Research. 60 (2–3): 271–83. doi:10.1016/S0920-9964(02)00227-X. PMID 12591589. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
92. Barrowclough C (2003). "Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology". J Abnorm Psychol. 112 (1): 92–9. doi:10.1037/0021–843X.112.1.92. PMID 12653417. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
93. Birchwood M (2000). "The power and omnipotence of voices: subordination and entrapment by voices and significant others". Psychol Med. 30 (2): 337–44. doi:10.1017/S0033291799001828. PMID 10824654. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
94. Smith B (2006). "Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations". Schizophrenia Research. 86 (1–3): 181–8. doi:10.1016/j.schres.2006.06.018. PMID 16857346. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
95. Beck, AT (2004). "A Cognitive Model of Schizophrenia". Journal of Cognitive Psychotherapy. 18 (3): 281–88. doi:10.1891/jcop.18.3.281.65649.
96. Bell V (2006). "Explaining delusions: a cognitive perspective". Trends in Cognitive Science. 10 (5): 219–26. doi:10.1016/j.tics.2006.03.004. PMID 16600666. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
97. Freeman D (2007). "Acting on persecutory delusions: the importance of safety seeking". Behaviour Research and Therapy. 45 (1): 89–99. doi:10.1016/j.brat.2006.01.014. PMID 16530161. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
98. Kuipers E (2006). "Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms". Schizophrenia Bulletin. 32 (Suppl 1): S24–31. doi:10.1093/schbul/sbl014. PMC 2632539. PMID 16885206. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
99. Kircher, Tilo (2006). "Functional brain imaging of symptoms and cognition in schizophrenia". The Boundaries of Consciousness. Amsterdam: Elsevier. p. 302. ISBN 0444528768. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
100. Green MF (2006). "Cognitive impairment and functional outcome in schizophrenia and bipolar disorder". Journal of Clinical Psychiatry. 67 (Suppl 9): 3–8. PMID 16965182.
101. Laruelle M (1996). "Single photon emission computerized tomography imaging of amphetamine-induced dopamine release in drug-free schizophrenic subjects". Proceedings of the National Academy of Sciences of the USA. 93 (17): 9235–40. doi:10.1073/pnas.93.17.9235. PMC 38625. PMID 8799184. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
102. Jones HM (2002). "Dopamine and antipsychotic drug action revisited". British Journal of Psychiatry. 181: 271–275. doi:10.1192/bjp.181.4.271. PMID 12356650. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
103. Konradi C (2003). "Molecular aspects of glutamate dysregulation: implications for schizophrenia and its treatment". Pharmacology and Therapeutics. 97 (2): 153–79. doi:10.1016/S0163-7258(02)00328–5. PMID 12559388. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
104. Lahti AC (2001). "Effects of ketamine in normal and schizophrenic volunteers". Neuropsychopharmacology. 25 (4): 455–67. doi:10.1016/S0893-133X(01)00243–3. PMID 11557159. {{cite journal}}: Check |doi= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
105. Coyle JT (2003). "Converging evidence of NMDA receptor hypofunction in the pathophysiology of schizophrenia". Annals of the New York Academy of Sciences. 1003: 318–27. doi:10.1196/annals.1300.020. PMID 14684455. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
106. Tuominen HJ (2005). "Glutamatergic drugs for schizophrenia: a systematic review and meta-analysis". Schizophrenia Research. 72 (2–3): 225–34. doi:10.1016/j.schres.2004.05.005. PMID 15560967. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
107. Steen RG, Mull C, McClure R, Hamer RM, Lieberman JA (2006). "Brain volume in first-episode schizophrenia: systematic review and meta-analysis of magnetic resonance imaging studies". Br J Psychiatry. 188: 510–8. doi:10.1192/bjp.188.6.510. PMID 16738340. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
108. Lieberman JA, Bymaster FP, Meltzer HY, Deutch AY, Duncan GE, Marx CE, Aprille JR, Dwyer DS, Li XM, Mahadik SP, Duman RS, Porter JH, Modica-Napolitano JS, Newton SS, Csernansky JG (2008). "Antipsychotic drugs: comparison in animal models of efficacy, neurotransmitter regulation, and neuroprotection". Pharmacol. Rev. 60 (3): 358–403. doi:10.1124/pr.107.00107. PMID 18922967. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
109. DeLisi LE (2008). "The concept of progressive brain change in schizophrenia: implications for understanding schizophrenia". Schizophr Bull. 34 (2): 312–21. doi:10.1093/schbul/sbm164. PMC 2632405. PMID 18263882. {{cite journal}}: Unknown parameter |month= ignored (help)
110. Ellison-Wright I, Bullmore E (2009). "Meta-analysis of diffusion tensor imaging studies in schizophrenia". Schizophr. Res. 108 (1–3): 3–10. doi:10.1016/j.schres.2008.11.021. PMID 19128945. {{cite journal}}: Unknown parameter |month= ignored (help)
111. Broyd SJ, Demanuele C, Debener S, Helps SK, James CJ, Sonuga-Barke EJS (2008). "Default-mode brain dysfunction in mental disorders: a systematic review". Neurosci Biobehav Rev. 33 (3): 279. doi:10.1016/j.neubiorev.2008.09.002. PMID 18824195.{{cite journal}}: CS1 maint: multiple names: authors list (link)
112. Cannon TD, Cornblatt B, McGorry P (2007). "The empirical status of the ultra high-risk (prodromal) research paradigm". Schizophrenia Bulletin. 33 (3): 661–4. doi:10.1093/schbul/sbm031. PMC 2526144. PMID 17470445. Retrieved 2008-07-06. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
113. Drake RJ, Lewis SW (2005). "Early detection of schizophrenia". Current Opinion in Psychiatry. 18 (2): 147–50. doi:10.1097/00001504-200503000-00007. PMID 16639167. Retrieved 2008-07-06. {{cite journal}}: Unknown parameter |month= ignored (help)
114. Van Os J, Delespaul P (2005). "Toward a world consensus on prevention of schizophrenia". Dialogues Clin Neurosci. 7 (1): 53–67. PMID 16060596.
115. McGorry, PD.; Yung, A.; Phillips, L. (2001). "Ethics and early intervention in psychosis: keeping up the pace and staying in step". Schizophr Res. 51 (1): 17–29. doi:10.1016/S0920-9964(01)00235-3. PMID 11479062. {{cite journal}}: Unknown parameter |month= ignored (help)
116. Haroun N, Dunn L, Haroun A, Cadenhead KS (2006). "Risk and protection in prodromal schizophrenia: ethical implications for clinical practice and future research". Schizophrenia Bulletin. 32 (1): 166–78. doi:10.1093/schbul/sbj007. PMC 2632176. PMID 16207892. Retrieved 2008-07-06. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
117. Häfner H, Maurer K, Ruhrmann S; et al. (2004). "Early detection and secondary prevention of psychosis: facts and visions". European Archives of Psychiatry and Clinical Neuroscience. 254 (2): 117–28. doi:10.1007/s00406-004-0508-z. PMID 15146341. {{cite journal}}: |access-date= requires |url= (help); Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
118. van Os, J.; Burns, T.; Cavallaro, R.; Leucht, S.; Peuskens, J.; Helldin, L.; Bernardo, M.; Arango, C.; Fleischhacker, W. (2006). "Standardized remission criteria in schizophrenia". Acta Psychiatr Scand. 113 (2): 91–5. doi:10.1111/j.1600-0447.2005.00659.x. PMID 16423159. {{cite journal}}: Unknown parameter |month= ignored (help)
119. Kay, SR.; Fiszbein, A.; Opler, LA. (1987). "The positive and negative syndrome scale (PANSS) for schizophrenia". Schizophr Bull. 13 (2): 261–76. PMID 3616518.
120. Turner T. (2007). "Unlocking psychosis". Brit J Med. 334 (suppl): s7. doi:10.1136/bmj.39034.609074.94. PMID 17204765.
121. ^ Bellack AS (2006). "Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications". Schizophrenia Bulletin. 32 (3): 432–42. doi:10.1093/schbul/sbj044. PMC 2632241. PMID 16461575. {{cite journal}}: Unknown parameter |month= ignored (help)
122. McGurk, SR.; Mueser, KT.; Feldman, K.; Wolfe, R.; Pascaris, A. (2007). "Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial". Am J Psychiatry. 164 (3): 437–41. doi:10.1176/appi.ajp.164.3.437. PMID 17329468. {{cite journal}}: Unknown parameter |month= ignored (help)
123. Kulhara, P. (1994). "Outcome of schizophrenia: some transcultural observations with particular reference to developing countries". Eur Arch Psychiatry Clin Neurosci. 244 (5): 227–35. doi:10.1007/BF02190374. PMID 7893767.
124. Shankar Vedantam (27 June 2005). "Social Network's Healing Power Is Borne Out in Poorer Nations". USA: Washington Post.
125. National Collaborating Centre for Mental Health (2009-03-25). "Schizophrenia: Full national clinical guideline on core interventions in primary and secondary care" (PDF). Gaskell and the British Psychological Society. Retrieved 2009-11-25.
126. Murphy BP, Chung YC, Park TW, McGorry PD (2006). "Pharmacological treatment of primary negative symptoms in schizophrenia: a systematic review". Schizophr. Res. 88 (1–3): 5–25. doi:10.1016/j.schres.2006.07.002. PMID 16930948. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
127. Gray JA, Roth BL (2007). "The pipeline and future of drug development in schizophrenia". Mol. Psychiatry. 12 (10): 904–22. doi:10.1038/sj.mp.4002062. PMID 17667958. {{cite journal}}: Unknown parameter |month= ignored (help)
128. Jarskog LF, Miyamoto S, Lieberman JA (2007). "Schizophrenia: new pathological insights and therapies". Annu. Rev. Med. 58: 49–61. doi:10.1146/annurev.med.58.060904.084114. PMID 16903799.{{cite journal}}: CS1 maint: multiple names: authors list (link)
129. Tandon R, Keshavan MS, Nasrallah HA (2008). "Schizophrenia, "Just the Facts": what we know in 2008 part 1: overview". Schizophr. Res. 100 (1–3): 4–19. doi:10.1016/j.schres.2008.01.022. PMID 18291627. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
130. Lieberman JA, Stroup TS, McEvoy JP; et al. (2005). "Effectiveness of antipsychotic drugs in patients with chronic schizophrenia". New England Journal of Medicine. 353 (12): 1209–23. doi:10.1056/NEJMoa051688. PMID 16172203. Retrieved 2008-07-04. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
131. "Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)". National Institute of Mental Health. Retrieved June 16, 2010.
132. Swartz MS, Stroup TS; et al. (2008). "What CATIE Found: Results From the Schizophrenia Trial". Psychiatr Serv. 59 (5): 500–506. doi:10.1176/appi.ps.59.5.500. PMID 18451005. {{cite journal}}: Explicit use of et al. in: |author= (help)
133. "Dopamine".
134. "Perphenazine". Consumers Union (consumerreports.org/health). Last Revised January 11, 2008. Retrieved June 14, 2010. {{cite web}}: Check date values in: |date= (help)
135. 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): 1581–89. doi:10.1016/S0140-6736(03)13306-5. PMID 12747876. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
136. Dickson RA, Dalby JT, Williams R, Edwards AL (1995). "Risperidone-induced prolactin elevations in premenopausal women with schizophrenia". American Journal of Psychiatry. 152 (7): 1102–03. PMID 7540803. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
137. Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T (2004). "Neuroleptic malignant syndrome and atypical antipsychotic drugs". Journal of Clinical Psychiatry. 65 (4): 464–70. doi:10.4088/JCP.v65n0403. PMID 15119907. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
138. Meltzer HY (1997). "Treatment-resistant schizophrenia—the role of clozapine". Current Medical Research and Opinion. 14 (1): 1–20. doi:10.1185/03007999709113338. PMID 9524789. {{cite journal}}: Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)
139. Wahlbeck K, Cheine MV, Essali A (2007). "Clozapine versus typical neuroleptic medication for schizophrenia". The Cochrane Database of Systematic Reviews (2). John Wiley and Sons, Ltd.: CD000059. doi:10.1002/14651858.CD000059. PMID 10796289.{{cite journal}}: CS1 maint: multiple names: authors list (link)
140. Haas SJ, Hill R, Krum H (2007). "Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993–2003". Drug Safety. 30 (1): 47–57. doi:10.2165/00002018-200730010-00005. PMID 17194170.{{cite journal}}: CS1 maint: multiple names: authors list (link)
141. Lee M, Dickson RA, Campbell M, Oliphant J, Gretton H, Dalby JT. (1998). "Clozapine and substance abuse in patients with schizophrenia". Canadian Journal of Psychiatry. 43: 855–856.{{cite journal}}: CS1 maint: multiple names: authors list (link)
142. Harrow M, Jobe TH (2007). "Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study". Journal of Nervous and Mental Disease. 195 (5): 406–414. doi:10.1097/01.nmd.0000253783.32338.6e. PMID 17502806. {{cite journal}}: Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help); Unknown parameter |month= ignored (help)
143. Moran, M (18 November 2005). "Psychosocial Treatment Often Missing From Schizophrenia Regimens". Psychiatric News. 40 (22). USA: Psychiatry Online: 24. Retrieved 17 May 2007.
144. Sensky T, Turkington D, Kingdon D, Scott JL, Scott J, Siddle R, O'Carroll M, Barnes TR (2000). "A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication". Arch. Gen. Psychiatry. 57 (2): 165–72. doi:10.1001/archpsyc.57.2.165. PMID 10665619. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
145. Kuipers E, Garety P, Fowler D, Dunn G, Bebbington P, Freeman D, Hadley C (1997). "London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. I: effects of the treatment phase". Br J Psychiatry. 171: 319–27. doi:10.1192/bjp.171.4.319. PMID 9373419. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
146. Lewis S, Tarrier N, Haddock G, Bentall R, Kinderman P, Kingdon D, Siddle R, Drake R, Everitt J, Leadley K, Benn A, Grazebrook K, Haley C, Akhtar S, Davies L, Palmer S, Faragher B, Dunn G (2002). "Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes". Br J Psychiatry Suppl. 43: s91–7. PMID 12271807. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
147. Cormac I, Jones C, Campbell C (2002). "Cognitive behaviour therapy for schizophrenia". Cochrane Database of systematic reviews (1): CD000524. doi:10.1002/14651858.CD000524. PMID 11869579. {{cite journal}}: |access-date= requires |url= (help)CS1 maint: multiple names: authors list (link)
148. Wykes T, Steel C, Everitt B, Tarrier N (2008). "Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor". Schizophr Bull. 34 (3): 523–37. doi:10.1093/schbul/sbm114. PMC 2632426. PMID 17962231. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
149. Zimmermann G, Favrod J, Trieu VH, Pomini V (2005). "The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis". Schizophrenia Research. 77 (1): 1–9. doi:10.1016/j.schres.2005.02.018. PMID 16005380. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
150. Wykes T, Brammer M, Mellers J; et al. (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. doi:10.1192/bjp.181.2.144. PMID 12151286. Retrieved 2008-07-03. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
151. Medalia A (2009). "Cognitive Remediation for Psychiatric Patients: Improving Functional Outcomes for Patients With Schizophrenia". Psychiatric Times. 26 (3).
152. Hogarty GE, Flesher S, Ulrich R; et al. (2004). "Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior". Arch. Gen. Psychiatry. 61 (9): 866–76. doi:10.1001/archpsyc.61.9.866. PMID 15351765. Retrieved 2008-07-03. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
153. McFarlane WR, Dixon L, Lukens E, Lucksted A (2003). "Family psychoeducation and schizophrenia: a review of the literature". J Marital Fam Ther. 29 (2): 223–45. doi:10.1111/j.1752–0606.2003.tb01202.x. PMID 12728780. {{cite journal}}: Check |doi= value (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
154. Glynn SM, Cohen AN, Niv N (2007). "New challenges in family interventions for schizophrenia". Expert Review of Neurotherapeutics. 7 (1): 33–43. doi:10.1586/14737175.7.1.33. PMID 17187495. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
155. Pharoah, F.; Mari, J.; Rathbone, J.; Wong, W.; Pharoah, Fiona (2006). "Family intervention for schizophrenia". Cochrane Database Syst Rev (4): CD000088. doi:10.1002/14651858.CD000088.pub2. PMID 17054127.
156. Jones S, Hayward P (2004). Coping with Schizophrenia: A Guide for Patients, Families and Caregivers. Oxford, England: Oneworld Pub. ISBN 1-85168-344-5.
157. Torrey EF (2006). Surviving Schizophrenia: A Manual for Families, Consumers, and Providers (5th ed.). HarperCollins. ISBN 0-06-084259-8.
158. Kopelowicz A, Liberman RP, Zarate R (2006). "Recent advances in social skills training for schizophrenia". Schizophrenia Bulletin. 32 Suppl 1: S12–23. doi:10.1093/schbul/sbl023. PMC 2632540. PMID 16885207. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
159. American Psychiatric Association (2004). "Practice Guideline for the Treatment of Patients With Schizophrenia. Second Edition". USA: National Guideline Clearinghouse. {{cite web}}: Unknown parameter |month= ignored (help)
160. Talwar N, Crawford MJ, Maratos A, Nur U, McDermott O, Procter S (2006). "Music therapy for in-patients with schizophrenia: exploratory randomised controlled trial". The British Journal of Psychiatry. 189: 405–9. doi:10.1192/bjp.bp.105.015073. PMID 17077429. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
161. Ruddy, R.; Milnes, D.; Ruddy, Rachel (2005). "Art therapy for schizophrenia or schizophrenia-like illnesses". Cochrane Database Syst Rev (4): CD003728. doi:10.1002/14651858.CD003728.pub2. PMID 16235338.
162. Ruddy, RA.; Dent-Brown, K.; Ruddy, Rachel (2007). "Drama therapy for schizophrenia or schizophrenia-like illnesses". Cochrane Database Syst Rev (1): CD005378. doi:10.1002/14651858.CD005378.pub2. PMID 17253555.
163. Mosher LR (1999). "Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review". Journal of Nervous and Mental Disease. 187 (3): 142–9. doi:10.1097/00005053-199903000-00003. PMID 10086470. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help)
164. Calton T, Ferriter M, Huband N, Spandler H (2008). "A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia". Schizophrenia Bulletin. 34 (1): 181–92. doi:10.1093/schbul/sbm047. PMC 2632384. PMID 17573357. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
165. Greenhalgh J, Knight C, Hind D, Beverley C, Walters S (2005). "Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies". Health Technol Assess. 9 (9): 1–156. PMID 15774232. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
166. "The clinical effectiveness and cost effectiveness of electroconvulsive Therapy (ECT) for depressive illness, schizophrenia, catatonia and mania". National Institute for Health and Clinical Excellence. 2003. Retrieved 2007-06-17. {{cite web}}: Unknown parameter |month= ignored (help)
167. Mashour GA, Walker EE, Martuza RL (2005). "Psychosurgery: past, present, and future". Brain Res. Brain Res. Rev. 48 (3): 409–19. doi:10.1016/j.brainresrev.2004.09.002. PMID 15914249. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
168. Goering P, Durbin J, Sheldon CT, Ochocka J, Nelson G, Krupa T (2006). "Who uses consumer-run self-help organizations?". American Journal of Orthopsychiatry. 76 (3): 367–73. doi:10.1037/0002-9432.76.3.367. PMID 16981815. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
169. Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1002/14651858.CD004412.pub2, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1002/14651858.CD004412.pub2 instead.
170. Harrison G, Hopper K, Craig T; et al. (2001). "Recovery from psychotic illness: a 15- and 25-year international follow-up study". British Journal of Psychiatry. 178: 506–17. doi:10.1192/bjp.178.6.506. PMID 11388966. Retrieved 2008-07-04. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
171. ^ Jobe TH, Harrow M (2005). "Long-term outcome of patients with schizophrenia: a review" (PDF). Canadian Journal of Psychiatry. 50 (14): 892–900. PMID 16494258. Retrieved 2008-07-05. {{cite journal}}: Unknown parameter |month= ignored (help)
172. 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 (3): 473–9. doi:10.1176/appi.ajp.161.3.473. PMID 14992973. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
173. Harvey CA, Jeffreys SE, McNaught AS, Blizard RA, King MB (2007). "The Camden Schizophrenia Surveys III: Five-Year Outcome of a Sample of Individuals From a Prevalence Survey and the Importance of Social Relationships". International Journal of Social Psychiatry. 53 (4): 340–356. doi:10.1177/0020764006074529. PMID 17703650. Retrieved 2008-07-04.{{cite journal}}: CS1 maint: multiple names: authors list (link)
174. Hopper K, Wanderling J (1 January 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. PMID 11087016. Retrieved 2008-07-04.
175. Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR (2005). "Remission in schizophrenia: proposed criteria and rationale for consensus". The American Journal of Psychiatry. 162 (3): 441–9. doi:10.1176/appi.ajp.162.3.441. PMID 15741458. Retrieved 2008-07-07. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
176. Liberman RP, Kopelowicz A (2005). "Recovery From Schizophrenia: A Concept in Search of Research". Psychiatric Services. 56 (6): 735–742. doi:10.1176/appi.ps.56.6.735. PMID 15939952. Retrieved 2008-07-07. {{cite journal}}: Unknown parameter |month= ignored (help)
177. Davidson L, Schmutte T, Dinzeo T, Andres-Hyman R (2008). "Remission and recovery in schizophrenia: practitioner and patient perspectives". Schizophrenia Bulletin. 34 (1): 5–8. doi:10.1093/schbul/sbm122. PMC 2632379. PMID 17984297. Retrieved 2008-07-07. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
178. Davidson L, McGlashan TH (1997). "The varied outcomes of schizophrenia". Canadian Journal of Psychiatry. 42 (1): 34–43. PMID 9040921. {{cite journal}}: Unknown parameter |month= ignored (help)
179. Lieberman JA, Koreen AR, Chakos M; et al. (1996). "Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia". Journal of Clinical Psychiatry. 57 Suppl 9: 5–9. PMID 8823344. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
180. Bebbington P, Kuipers L (1994). "The predictive utility of expressed emotion in schizophrenia: an aggregate analysis". Psychological Medicine. 24 (3): 707–18. doi:10.1017/S0033291700027860. PMID 7991753. {{cite journal}}: Unknown parameter |month= ignored (help)
181. Hannerz H, Borgå P, Borritz M (2001). "Life expectancies for individuals with psychiatric diagnoses". Public Health. 115 (5): 328–37. doi:10.1038/sj.ph.1900785. PMID 11593442. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
182. Evins AE (March 1, 2008). "Nicotine Dependence in Schizophrenia: Prevalence, Mechanisms, and Implications for Treatment". Psychiatric Times. 25 (3).
183. Palmer, BA.; Pankratz, VS.; Bostwick, JM. (2005). "The lifetime risk of suicide in schizophrenia: a reexamination". Arch Gen Psychiatry. 62 (3): 247–53. doi:10.1001/archpsyc.62.3.247. PMID 15753237. {{cite journal}}: Unknown parameter |month= ignored (help)
184. Radomsky ED, Haas GL, Mann JJ, Sweeney JA (1 October 1999). "Suicidal behavior in patients with schizophrenia and other psychotic disorders". American Journal of Psychiatry. 156 (10): 1590–5. PMID 10518171. Retrieved 2008-07-04.{{cite journal}}: CS1 maint: multiple names: authors list (link)
185. Caldwell CB, Gottesman II (1990). "Schizophrenics kill themselves too: a review of risk factors for suicide". Schizophr Bull. 16 (4): 571–89. PMID 2077636.
186. Dalby JT, Williams RJ (1989). Depression in schizophrenics. New York: Plenum Press. ISBN 0-306-43240-4.
187. Violence and schizophrenia:
     • Walsh E, Buchanan A, Fahy T (2002). "Violence and schizophrenia: examining the evidence". British Journal of Psychiatry. 180: 490–5. doi:10.1192/bjp.180.6.490. PMID 12042226. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
     • Stuart H (2003). "Violence and mental illness: an overview". World Psychiatry. 2 (2): 121–24. PMC 1525086. PMID 16946914. {{cite journal}}: Unknown parameter |month= ignored (help)
     • Steadman HJ, Mulvey EP, Monahan J; et al. (1998). "Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods". Archives of General Psychiatry. 55 (5): 393–401. doi:10.1001/archpsyc.55.5.393. PMID 9596041. Retrieved 2008-07-04. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
     • Swanson JW, Swartz MS, Van Dorn RA; et al. (2006). "A national study of violent behavior in persons with schizophrenia". Archives of General Psychiatry. 63 (5): 490–9. doi:10.1001/archpsyc.63.5.490. PMID 16651506. Retrieved 2008-07-04. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
     • Swanson JW, Holzer CE, Ganju VK, Jono RT (1990). "Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys". Hospital and Community Psychiatry. 41 (7): 761–70. PMID 2142118. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
188. ^ Mullen PE (2006). "Schizophrenia and violence: from correlations to preventive strategies". Advances in Psychiatric Treatment. 12: 239–248. doi:10.1192/apt.12.4.239. Retrieved 2008-07-04.
189. Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J (2004). "Homicide and mental illness in New Zealand, 1970–2000". British Journal of Psychiatry. 185: 394–8. doi:10.1192/bjp.185.5.394. PMID 15516547. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
190. Fazel S, Grann M (2004). "Psychiatric morbidity among homicide offenders: a Swedish population study". American Journal of Psychiatry. 161 (11): 2129–31. doi:10.1176/appi.ajp.161.11.2129. PMID 15514419. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)
191. Brekke JS, Prindle C, Bae SW, Long JD (2001). "Risks for individuals with schizophrenia who are living in the community". Psychiatr Serv. 52 (10): 1358–66. doi:10.1176/appi.ps.52.10.1358. PMID 11585953. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
192. Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J (2005). "Victimization of patients with schizophrenia and related disorders". The Australian and New Zealand Journal of Psychiatry. 39 (3): 169–74. doi:10.1111/j.1440-1614.2005.01539.x. PMID 15701066. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
193. Walsh E, Gilvarry C, Samele C; et al. (2004). "Predicting violence in schizophrenia: a prospective study". Schizophrenia Research. 67 (2–3): 247–52. doi:10.1016/S0920-9964(03)00091-4. PMID 14984884. Retrieved 2008-07-04. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
194. Solomon PL, Cavanaugh MM, Gelles RJ (2005). "Family violence among adults with severe mental illness: a neglected area of research". Trauma Violence Abuse. 6 (1): 40–54. doi:10.1177/1524838004272464. PMID 15574672. Retrieved 2008-07-04. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link){subscription required)
195. Chou KR, Lu RB, Chang M (2001). "Assaultive behavior by psychiatric in-patients and its related factors". J Nurs Res. 9 (5): 139–51. PMID 11779087. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
196. Lögdberg B, Nilsson LL, Levander MT, Levander S (2004). "Schizophrenia, neighbourhood, and crime". Acta Psychiatrica Scandinavica. 110 (2): 92–7. doi:10.1111/j.1600-0047.2004.00322.x. PMID 15233709. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
197. Kumra S (2001). "Childhood-onset schizophrenia: research update". Canadian Journal of Psychiatry. 46 (10): 923–30. PMID 11816313. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
198. Hassett, Anne, et al. (eds) (2005). Psychosis in the Elderly. London: Taylor and Francis. p. 6. ISBN 1841843946. {{cite book}}: |first= has generic name (help)CS1 maint: multiple names: authors list (link)
199. Jablensky A (1992). "Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study". Psychological Medicine Monograph Supplement. 20: 1–97. doi:10.1017/S0264180100000904. PMID 1565705. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
200. Kirkbride JB (2006). "Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings From the 3-center ÆSOP study". Archives of General Psychiatry. 63 (3): 250–58. doi:10.1001/archpsyc.63.3.250. PMID 16520429. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
201. Kirkbride JB (2007). "Neighbourhood variation in the incidence of psychotic disorders in Southeast London". Social Psychiatry and Psychiatric Epidemiology. 42 (6): 438–45. doi:10.1007/s00127-007-0193-0. PMID 17473901. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
202. Ustun TB (1999). "Multiple-informant ranking of the disabling effects of different health conditions in 14 countries". The Lancet. 354 (9173): 111–15. doi:10.1016/S0140-6736(98)07507-2. PMID 10408486. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
203. Heinrichs RW (2003). "Historical origins of schizophrenia: two early madmen and their illness". J Hist Behav Sci. 39 (4): 349–63. doi:10.1002/jhbs.10152. PMID 14601041.
204. Kraepelin, E. (1907). Text book of psychiatry. Diefendorf A.R. (7 ed.). London: Macmillan.
205. Hansen RA, Atchison B (2000). Conditions in occupational therapy: effect on occupational performance. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-683-30417-8.
206. Kuhn R; (2004). "Eugen Bleuler's concepts of psychopathology". Hist Psychiatry. 15 (3). tr. Cahn CH: 361–6. doi:10.1177/0957154X04044603. PMID 15386868.{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
207. Stotz-Ingenlath G (2000). "Epistemological aspects of Eugen Bleuler's conception of schizophrenia in 1911" (PDF). Medicine, Health Care and Philosophy. 3 (2): 153–9. doi:10.1023/A:1009919309015. PMID 11079343. Retrieved 2008-07-03.
208. Wing JK (1971). "International comparisons in the study of the functional psychoses". British Medical Bulletin. 27 (1): 77–81. PMID 4926366. {{cite journal}}: Unknown parameter |month= ignored (help)
209. Rosenhan D (1973). "On being sane in insane places". Science. 179 (70): 250–8. doi:10.1126/science.179.4070.250. PMID 4683124.
210. Wilson M (1993). "DSM-III and the transformation of American psychiatry: a history". American Journal of Psychiatry. 150 (3): 399–410. PMID 8434655. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help){subscription required}
211. Porter, Roy; Berrios, G. E. (1995). A history of clinical psychiatry: the origin and history of psychiatric disorders. London: Athlone Press. ISBN 0-485-24211-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
212. Maj, Mario; Sartorius, N. (15 September 1999). Schizophrenia. Chichester: Wiley. p. 292. ISBN 978-0-471-99906-5.
213. Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999). "The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems". American Journal of Public Health. 89 (9): 1339–45. doi:10.2105/AJPH.89.9.1339. PMC 1508769. PMID 10474550. Retrieved 2008-07-03. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
214. Phelan JC, Link BG, Stueve A, Pescosolido BA (2000). "Public Conceptions of Mental Illness in 1950 and 1996: What Is Mental Illness and Is It to be Feared?". Journal of Health and Social Behavior. 41 (2): 188–207. doi:10.2307/2676305. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
215. Kim, Y.; Berrios, GE. (2001). "Impact of the term schizophrenia on the culture of ideograph: the Japanese experience". Schizophr Bull. 27 (2): 181–5. PMID 11354585.
216. Sato M (2004). "Renaming schizophrenia: a Japanese perspective". World Psychiatry. 5 (1): 53–55. PMC 1472254. PMID 16757998.
217. Deveson A (1991). Tell Me I'm Here. Penguin. ISBN 0-14-027257-7.

Further reading

• Bentall, Richard (2003). Madness explained: psychosis and human nature. London: Allen Lane. ISBN 0-7139-9249-2.
• Dalby, J. Thomas (1996). Mental disease in history: a selection of translated readings. Bern: Peter Lang. ISBN 0-8204-3056-0.
• Fallon, James H. (2003). "The Neuroanatomy of Schizophrenia: Circuitry and Neurotransmitter Systems". Clinical Neuroscience Research. 3: 77–107. doi:10.1016/S1566-2772(03)00022-7. {{cite journal}}: |access-date= requires |url= (help)
• Fleck, Stephen (1985). Schizophrenia and the family. New York: International Universities Press. ISBN 0-8236-6001-X. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Keen TM (1999). "Schizophrenia: orthodoxy and heresies. A review of alternative possibilities". Journal of Psychiatric and Mental Health Nursing. 6 (6): 415–24. doi:10.1046/j.1365-2850.1999.00237.x. PMID 10818864. {{cite journal}}: Unknown parameter |month= ignored (help)
• Laing, Ronald D. (1990). The divided self: an existential study in sanity and madness. New York: Penguin Books. ISBN 0-14-013537-5.
• Noll, Richard (2006). The Encyclopedia of Schizophrenia And Other Psychotic Disorders (Facts on File Library of Health and Living). New York: Facts on File. ISBN 0-8160-6405-9.
• Roazen, Paul (1991). Sexuality, war, and schizophrenia: collected psychoanalytic papers. New Brunswick, N.J., U.S.A: Transaction Publishers. ISBN 0-88738-365-3. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help) (On the Origin of the 'Influencing Machine' in Schizophrenia.)
• Shaner A, Miller G, Mintz J (2004). "Schizophrenia as one extreme of a sexually selected fitness indicator" (PDF). Schizophr. Res. 70 (1): 101–9. doi:10.1016/j.schres.2003.09.014. PMID 15246469. Retrieved 2008-07-07. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Szasz, Thomas Stephen (1976). Schizophrenia: the sacred symbol of psychiatry. New York: Basic Books. ISBN 0-465-07222-4.
• Walker Elaine; et al. (2004). "Schizophrenia: Etiology and Course". Annual Review of Psychology. 55: 401–30. doi:10.1146/annurev.psych.55.090902.141950. {{cite journal}}: Explicit use of et al. in: |author= (help)

External links

• Template:Dmoz
• NPR: the sight and sounds of schizophrenia
• The current World Health Organisation definition of Schizophrenia
• Symptoms in Schizophrenia Film made in 1940 showing some of the symptoms of Schizophrenia.

Template:Link GA Template:Link GA Template:Link GA Template:Link GA Template:Link FA Template:Link FA

• Schizophrenia
• Disability
• Greek loanwords
• Mental illness diagnosis by DSM and ICD
• Psychosis