|Classification and external resources|
A painting often used to help explain what a person with schizophrenia experiences.
The word schizophrenia comes from two Greek words that mean to split and mind because there is a 'split' between what's going on in their minds and what's happening in reality. “Schizophrenia” is commonly misunderstood to mean that an affected persons has a "split personality". A person with schizophrenia may hear voices which sound as if they are coming from different people, the person with schizophrenia however does not change between different personalities. they have only one.
Schizophrenia has many different symptoms and not everyone with schizophrenia has all of them. For this reason, some scientists think that schizophrenia is actually many separate diseases that have some of the same symptoms.
There are many risk factors that might cause a person to develop schizophrenia. They include genetics; the disorder is known to run in families, and environmental factors which affect a developing fetus, such as viruses, oxygen deprivation and poor nutrition.
People with schizophrenia might also have other mental health disorders, including depression, anxiety and drug abuse. They often have problems functioning in society, and have difficulty maintaining stable employment. However there are people with schizophrenia that are able to manage their symptoms and have earned college degrees and professional careers such as Elyn. R. Saks, a law professor at the University of Southern California and a published author.
Treatment of schizophrenia may include medication to help treat the the symptoms, different types of psychotherapy, such as cognitive-behavioral therapy and various cognitive rehabilitation therapies such as Cognitive Remediation Therapy to help with the cognitive deficits associated with the disorder, which can be severe.
|Phases of Schizophrenia|
|Phase I||Phase II||Phase III||Phase IV|
|Premorbid||Pre-psychotic Prodrome||Acute Psychosis||Chronic Illness|
|Features||Genetic vulnerability, Environmental Exposure||Cognitive, behavioral, social deficits; seeking help||Loss of insight, abnormal thought and behavior, remitting-relapsing course||Loss of function, medical complications,|
|Diagnosis||Genetic sequence, family history||SIPS*, cognitive assessment, neuroimaging||Clinical interview,||Clinical interview,|
|Disability||None, mild cognitive deficit||Change in school and social function||Acute loss of function, acute family distress||Chronic disability, unemployment, homelessness, incarceration|
|Intervention||Unknown||Cognitive training? PUFA?*, Family support?||Medication, Psychosocial interventions||Medication, psychosocial interventions, rehabilitation services|
|SIPS = Structured Interview for Prodromal Syndromes
PUFA = polyunsaturated fatty acids. Levels are reduced in people with schizophrenia.
The symptoms of schizophrenia fall into three main categories: positive symptoms, negative symptoms, and cognitive symptoms.
- Positive symptoms
- Positive symptoms are thoughts, behaviors, or sensory perceptions - like hearing voices that are not really there - that a person with a mental disorder has but healthy people do not have. They are called 'positive' not because they are good but because they are "added on". The symbol for add is the plus sign +; it is also the sign for the word "positive". These symptoms may include having strange thoughts that do not make sense (delusions),disorganized thoughts and speech, and feeling, hearing, seeing, smelling, or tasting things that do not exist (hallucinations). Positive symptoms usually respond to drug treatment.
- Negative symptoms
- Negative symptoms are thoughts, behaviors or emotions normally present in a healthy person that a person with a mental disorder has less of or may not have at all, they are 'minus' these. The sign for minus is -; it is also the sign for the word "negative". Negative symptoms includes a 'flat affect'; having a blank inexpressive look on the face and/or a monosyllabic speech spoken in a slow monotone, few gestures, lack of interest in anything including other people, inabilty to act spontaneously or feel pleasure.
- Cognitive symptoms (or cognitive deficits)
- Cognitive symptoms are problems with attention, certain types of memory, concept of time, and the ability to plan and organize. Cognitive deficits caused by schizophrenia can also be difficult to recognize as part of the disorder. They are the most disabling of the symptoms because cognitive problems affect everyday functioning.
Around 40 percent of men and 23 percent of women who have schizophrenia had "pre-onset" signs of schizophrenia before they were 19 years old.This "pre-onset" phase can occur as long as 30 months before symptoms begin. During the pre-onset phase, people who go on to develop schizophrenia might have brief or self-limiting serious or violent symptoms, as well as the non-specific symptoms of social withdrawal, annoyance, a general feeling of extreme unhappiness, and clumsiness.
Violent behavior A minority of people with schizophrenia have an increased risk for aggressive behavior. The risk for aggressive behavior increases with comorbid alcohol abuse, substance abuse, antisocial personality, or neurological impairment. Individuals with severe mental illness such as schizophrenia have a greater risk of being victims of violence.
A combination of a person’s genes and environment plays a role in the development of schizophrenia. People who have a family history of schizophrenia and who experienced a brief period of psychotic symptoms have a 20- to 40-percent chance of being diagnosed one year later.
Estimates of whether schizophrenia is inherited vary because separating the effects of a person’s genes and environment is difficult. The greatest risk (6.5 percent) for developing schizophrenia is having a first-degree relative with the condition. When a person with schizophrenia has an identical twin, that twin also has the condition in more than 40 percent of the cases. Many genes are probably involved, each to a small degree.In the largest study of it's kind, it was found that schizophrenia, autism, major depression, and bipolar disorder and ADHD, are genetically linked. They have the same differences in four regions of the DNA.
Environmental factors that are risk factors for schizophrenia are drug use, stress before birth and in some cases exposure to infectious disease. Living in an urban environment during childhood or as an adult has consistently been found to increase the risk of schizophrenia by a factor of two. This is true even after taking into account drug use, ethnicity, and the size of one’s social group. Other factors that play an important role include whether the person feels socially isolated, as well as social adversity, racial discrimination, failures in family functioning, unemployment, and poor housing conditions. There is evidence that childhood experiences of abuse or trauma are risk factors for developing schizophrenia later in life.
An electrical impulse called an action potential travels down the axon of a neuron. At the end of the neuron the action potential causes the release of different chemicals called neurotransmitters, into the space - called the synapse - between that axon, and the axon or dendrite of the next neuron.
Substance abuse Several drugs have been linked with the development of schizophrenia and the abuse of certain drugs and can cause symptoms like those of schizophrenia. About half of those people who have schizophrenia use drugs or alcohol excessively possibly as coping mechanisms to deal with depression, anxiety, boredom, or loneliness.Frequent marijuana use has been linked to twice the risk of serious mental illness and schizophrenia.
More people with schizophrenia smoke than the general population; it is estimated that at least 60% to as much as 90% of people with schizophrenia smoke. Recent research suggests that cigarette smoking may be a risk factor for developing schizophrenia.
Factors such as oxygen deprivation, infection, or stress and lack of healthy foods in one’s mother during pregnancy, might result in a slight increase in the risk of schizophrenia later in life. People who have schizophrenia are more likely to have been born in winter or spring (at least in the northern half of the world). This might relate to increased rates of exposures to viruses before birth. This difference is about 5 to 8 percent.
People who have schizophrenia have differences in their brain structure compared to those who do not have the disorder. These differences are often in the parts of the brain that manage memory, organization, emotions, the control of impulsive behavior, and language.Among these structural differences, are a reduction in brain volume in the frontal cortex and temporal lobes, and problems within the corpus callosum, the band of nerve fibers which connects the left side and the right side of the brain. People with schizophrenia also tend to have enlarged lateral and third ventricles. The ventricles are spaces within the brain filled with cerebrospinal fluid.
- Brain wiring
The human brain has 100 billion neurons, each one of these neurons are connected to many other neurons. One neuron may have as many as 20,000 connections; there is between 100 trillion and 500 trillion neural connections in the adult human brain. There are many different parts or 'regions' of the brain. To complete a task -like recalling a memory - usually more than one region of the brain is involved, and they are connected by neural networks which is like the brain's wiring. It is believed that there are problems with the brain's wiring in schizophrenia.
The DSM-IV-TR or the ICD-10 criteria are used to determine whether a person has schizophrenia. These criteria use the self-reported experiences of the person and reported abnormalities in the behavior of the person, followed by a clinical assessment. A person can be determined to have the disease only if the symptoms are severe.
|Criteria for diagnosis|
DSM diagnostic criteria is divided into three categories:
The ICD-10 defines two additional subtypes:
Differential diagnosis [change]
There are various medical conditions, other psychiatric conditions and drug abuse related reactions that may mimic the symptoms of schizophrenia. For example delirium can cause visual hallucinations, or an unpredictable changing levels of consciousness. Schizophrenia occurs along with obsessive-compulsive disorder (OCD), a disorder in which a person becomes onsessed with certain ideas or actions. However, separating the obsessions of OCD from the delusions of schizophrenia can be difficult.
There is no clear evidence that treating schizophrenia early is effective. There is some evidence which shows that early treatment improves short term outcomes for people who have a serious episode of mental illness. These measures show little benefit five years later. Attempting to prevent schizophrenia in the pre-onset phase is of uncertain benefit and so is not recommended (as of 2009). Prevention is difficult because there are no reliable markers for the later development of the condition.
The treatment of schizophrenia is based upon the phase of the illness the person is in. There are three treatment phases.
- Acute Phase
The goals of treatment during the acute phase of treatment, defined by an acute psychotic episode, are to prevent harm, control disturbed behavior, reduce the severity of psychosis and associated symptoms (e.g., agitation, aggression, negative symptoms, affective symptoms), determine and address the factors that led to the occurrence of the acute episode, effect a rapid return to the best level of functioning, develop an alliance with the patient and family, formulate short- and long-term treatment plans, and connect the patient with appropriate aftercare in the community
- Stabilization Phase
During the stabilization phase, the goals of treatment are to reduce stress on the patient and provide support to minimize the likelihood of relapse, enhance the patient’s adaptation to life in the community, facilitate continued reduction in symptoms and consolidation of remission, and promote the process of recovery. If the patient has improved with a particular medication regimen, continuation of that regimen and monitoring are recommended for at least 6 months.
- Stable Phase
The goals of treatment during the stable phase are to ensure that symptom remission or control is sustained, that the patient is maintaining or improving his or her level of functioning and quality of life, that increases in symptoms or relapses are effectively treated, and that monitoring for adverse treatment effects continues. Regular monitoring for adverse effects is recommended. For most persons with schizophrenia in the stable phase, psychosocial interventions are recommended as a useful adjunctive treatment to pharmacological treatment and may improve outcomes [I]. Antipsychotic medications substantially reduce the risk of relapse in the stable phase of illness and are strongly recommended
The first-line psychiatric treatment for schizophrenia is antipsychotic medication, which can reduce the positive symptoms in about 7 to 14 days. However, medication fails to improve negative symptoms or problems in thinking significantly.
About 40 to 50 percent of people have a good response to medication, 30 to 40 percent have a partial response, and 20 percent have an unsatisfactory response (after 6 weeks on two or three different drugs). A drug called clozapine is an effective treatment for people who respond poorly to other drugs, but clozapine can lower the white blood cell count in 1 to 4 percent of people who take it. This is a serious side effect.
For people who are unwilling or unable to take drugs regularly, injectable long-acting preparations of antipsychotics can be used. When used in combination with mental and social interventions, such preparations can help people to continue their treatment.
Numerous mental and social interventions can be useful in treating schizophrenia. Such interventions include various types of therapy, community-based treatments, supported employment, skills training, token economic interventions, and mental interventions for drug or alcohol use and weight management. Family therapy or education, which addresses the whole family system of an individual, might reduce a return of symptoms or the need for hospitalizations. The evidence for the effectiveness of cognitive behavioral therapy (also known as “talk therapy”) in reducing symptoms or preventing their return is minimal.
Schizophrenia has great human and economic costs. The condition results in a decreased life expectancy of 12 to 15 years, primarily because of its association with being overweight, not exercising, and smoking cigarettes. An increased rate of suicide plays a lesser role. These differences in life expectancy increased between the 1970s and 1990s.
Schizophrenia is a major cause of disability, with active psychosis ranked as the third-most-disabling. Approximately three-fourths of people with schizophrenia have ongoing disability with symptoms that keep coming back. Some people do recover completely and others function well in society. Most people with schizophrenia live independently, with community support. In people with a first episode of serious mental symptoms, 42 percent have a good long-term outcome. Thirty-five percent of the people have an intermediate outcome. Twenty-seven percent of the people have a poor outcome. Outcomes for schizophrenia appear better in the developing world than in the developed world, although that conclusion has been questioned.
The suicide rate of people who have schizophrenia is estimated to be about 4.9 percent, most often occurring in the period following the first appearance of symptoms or the first hospital admission. 20 to 40 percent try to kill themselves at least once.
Schizophrenia and smoking have shown a strong association in studies worldwide. Use of cigarettes is especially high in individuals who have schizophrenia, with estimates ranging from 80 to 90 percent of these people being regular smokers, as compared to 20 percent of the general population. Those individuals who smoke tend to smoke heavily and smoke cigarettes with a high nicotine content.
As of 2011, schizophrenia affects around 0.3% to 0.7% of people, or 24 million people worldwide, at some point in their lives. More men are affected than women: the number of males with the disorder is 1.4 times greater than that of females. Schizophrenia usually appears earlier in men. For males the symptoms usually start from 20 to 28 years of age, and in females it is 26 to 32 years of age. Symptoms that start in childhood, middle or old age are much rarer. Despite the received wisdom that schizophrenia occurs at similar rates worldwide, its rate of likelihood varies across the world, within countries, and at the local level. The disorder causes approximately 1% of worldwide disability adjusted life years (in other words, years spent with a disability). The rate of schizophrenia varies depending on how it is defined.
Accounts of a schizophrenia-like syndrome are rare before the 19th century. Detailed case reports from 1797 and 1809, are regarded as the earliest cases of the disorder. 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 in a case report of a psychotic disorder. In 1893 Emil Kraepelin introduced a 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 a form of dementia, different from other forms of dementia such as Alzheimer's disease which usually happen later in life.
Eugen Bleuler coined the term ”schizophrenia”, which translates roughly as "split mind", in 1908. The word was intended to describe the separation of functioning between personality, thinking, memory, and perception. Bleuler realized that the illness was not a dementia because some of his patients improved rather than got worse.
In the early 1970s, the criteria for determining schizophrenia were the subject of numerous controversies. Schizophrenia was diagnosed far more often in the United States than in Europe. This difference was partly the result of looser criteria for determining whether someone had the condition in the United States, where the DSM-II manual was used. In Europe, the ICD-9 manual was used. A 1972 study, published in the journal Science, concluded that the diagnosis of schizophrenia in the United States was often unreliable. These factors resulted in the publication of the DSM-III in 1980 with a stricter and more defined criteria for the diagnosis.
Society and culture [change]
Negative social judgement has been identified as a major obstacle in the recovery of people who have schizophrenia.
In 2002, the term for schizophrenia in Japan was changed from “Seishin-Bunretsu-Byō” 精神分裂病 (“mind-split-disease”) to “Tōgō-shitchō-shō” 統合失調症 (“integration disorder”), in an attempt to reduce feelings of shame or embarrassment. The idea that the disease is caused by multiple factors (not just one mental cause) inspired the new name. The change increased the percentage of people who were informed of the diagnosis from 37 percent to 70 percent over three years.
In the United States in 2002, the cost of schizophrenia, including direct costs (people who were not hospitalized, people who were hospitalized, medicines, and long-term care) and non-healthcare costs (law enforcement, reduced workplace productivity, and unemployment), was estimated to be $62.7 billion.
The book “A Beautiful Mind” and the film of the same name are about the life of John Forbes Nash, an American mathematician and Nobel Prize winner who has schizophrenia. The movie The Soloist is based on the life of Nathaniel Ayers, a gifted musician who dropped out of the prestigious Julliard School, in New York City after the symptoms of schizophrenia began. He later became homeless in Los Angeles, California, in the notorious Skid Row section.
- "Schizophrenia" Concise Medical Dictionary. Oxford University Press, 2010. Oxford Reference Online. Maastricht University Library. 29 June 2010prepaid subscription only
- Berrios, G. E.; Porter, Roy (1995). A history of clinical psychiatry: the origin and history of psychiatric disorders. London: Athlone Press. ISBN 0-485-24211-7.
- Buckley PF, Miller BJ, Lehrer DS, Castle DJ (March 2009). "Psychiatric comorbidities and schizophrenia". Schizophr Bull 35 (2): 383–402. doi:10.1093/schbul/sbn135. PMC 2659306. PMID 19011234.
- National Institute of Mental Health: Rethinking schizophrenia: Stages of schizophrenia
- Face Recognition: New Research. Ed. Katherine B. Leeland Nova Publishers (2008) p.49 ISBN: 9781604564662
- David Sue, Derald Wing Sue, Stanley Sue. Understanding Abnormal Behavior Wadsworth Publishing; 9 edition (2008) p.361 ISBN 0547154410
- Kneisl C. and Trigoboff E.(2009). Contemporary Psychiatric- Mental Health Nursing. 2nd edition. London: Pearson Prentice Ltd. p. 371
- American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. ISBN 9780890420256. p. 299
- Cullen KR, Kumra S, Regan J et al. (2008). "Atypical Antipsychotics for Treatment of Schizophrenia Spectrum Disorders". Psychiatric Times 25 (3). http://www.psychiatrictimes.com/schizophrenia/article/10168/1147536.
- Addington J, Cadenhead KS, Cannon TD, et al. (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.
- Amminger GP, Leicester S, Yung AR, et al. (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.
- Parnas J, Jorgensen A (1989). "Pre-morbid psychopathology in schizophrenia spectrum". British Journal of Psychiatry 115: 623–7. PMID 2611591.
- Coyle, Joseph (2006). "Chapter 54: The Neurochemistry of Schizophrenia". In Siegal, George J; Albers, R. Wayne; Brady, Scott T et al. (Textbook). Basic Neurochemistry: Molecular, Cellular and Medical Aspects (7th ed.). Burlington, MA: Elsevier Academic Press. p. 876. ISBN 0-12-088397-X.
- Maniglio, R (2009 Mar). "Severe mental illness and criminal victimization: a systematic review". Acta psychiatrica Scandinavica 119 (3): 180–91. doi:10.1111/j.1600-0447.2008.01300.x. PMID 19016668.
- van Os J, Kapur S. Schizophrenia. Lancet. 2009;374(9690):635–45. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006.
- Picchioni MM, Murray RM (July 2007). "Schizophrenia". BMJ 335 (7610): 91–5. doi:10.1136/bmj.39227.616447.BE. PMC 1914490. PMID 17626963.
- Drake RJ, Lewis SW (March 2005). "Early detection of schizophrenia". Current Opinion in Psychiatry 18 (2): 147–50. doi:10.1097/00001504-200503000-00007. PMID 16639167.
- O'Donovan MC, Williams NM, Owen MJ (October 2003). "Recent advances in the genetics of schizophrenia". Hum. Mol. Genet. 12 Spec No 2: R125–33. doi:10.1093/hmg/ddg302. PMID 12952866.
- 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.
- Selten JP, Cantor-Graae E, Kahn RS (March 2007). "Migration and schizophrenia". Current Opinion in Psychiatry 20 (2): 111–115. doi:10.1097/YCO.0b013e328017f68e. PMID 17278906.
- Larkin W, Read J (2008). "Childhood trauma and psychosis: evidence, pathways, and implications". J Postgrad Med 54: 287-293. PMID 18953148. http://www.jpgmonline.com/text.asp?2008/54/4/287/41437.
- Larson, Michael (2006-03-30). "Alcohol-Related Psychosis". eMedicine. WebMD. http://www.emedicine.com/med/topic3113.htm. Retrieved September 27, 2006.
- 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.
- Leweke FM, Koethe D (June 2008). "Cannabis and psychiatric disorders: it is not only addiction". Addict Biol 13 (2): 264–75. doi:10.1111/j.1369-1600.2008.00106.x. PMID 18482435.
- Yolken R. (Jun 2004). "Viruses and schizophrenia: a focus on herpes simplex virus.". Herpes 11 (Suppl 2): 83A–88A. PMID 15319094. http://www.stanleylab.org/publications/VIRUSES.asp.
- Kircher, Tilo and Renate Thienel (2006). "Functional brain imaging of symptoms and cognition in schizophrenia". The Boundaries of Consciousness. Amsterdam: Elsevier. p. 302. ISBN 0444528768. http://books.google.com/?id=YHGacGKyVbYC&pg=PA302.
- Green MF (2006). "Cognitive impairment and functional outcome in schizophrenia and bipolar disorder". Journal of Clinical Psychiatry 67 (Suppl 9): 3–8. PMID 16965182.
- Jakobsen KD, Frederiksen JN, Hansen T, et al. (2005). "Reliability of clinical ICD-10 schizophrenia diagnoses". Nordic Journal of Psychiatry 59 (3): 209–12. doi:10.1080/08039480510027698. PMID 16195122.
- American Psychiatric Association DSM-5 Work Groups (2010)Proposed Revisions – Schizophrenia and Other Psychotic Disorders. Retrieved 17 February 2010.
- "The ICD-10 Classification of Mental and Behavioural Disorders" (pdf). World Health Organization. p. 26. http://www.who.int/classifications/icd/en/GRNBOOK.pdf.
- Bottas A (April 15, 2009). "Comorbidity: Schizophrenia With Obsessive-Compulsive Disorder". Psychiatric Times 26 (4). http://www.psychiatrictimes.com/display/article/10168/1402540.
- Marshall M, Rathbone J (2006). "Early intervention for psychosis". Cochrane Database Syst Rev (4): CD004718. doi:10.1002/14651858.CD004718.pub2. PMID 17054213.
- de Koning MB, Bloemen OJ, van Amelsvoort TA, et al. (June 2009). "Early intervention in patients at ultra high risk of psychosis: benefits and risks". Acta Psychiatr Scand 119 (6): 426–42. doi:10.1111/j.1600-0447.2009.01372.x. PMID 19392813.
- Cannon TD, Cornblatt B, McGorry P (May 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.
- National Collaborating Centre for Mental Health (2009-03-25). "Schizophrenia: Full national clinical guideline on core interventions in primary and secondary care" (PDF). http://www.nice.org.uk/nicemedia/pdf/CG82FullGuideline.pdf. Retrieved 2009-11-25.
- Smith T, Weston C, Lieberman J (August 2010). "Schizophrenia (maintenance treatment)". Am Fam Physician 82 (4): 338–9. PMID 20704164.
- Tandon R, Keshavan MS, Nasrallah HA (March 2008). "Schizophrenia, "Just the Facts": what we know in 2008 part 1: overview". Schizophrenia Research 100 (1–3): 4–19. doi:10.1016/j.schres.2008.01.022. PMID 18291627. http://download.journals.elsevierhealth.com/pdfs/journals/0920-9964/PIIS0920996408000716.pdf.
- Wahlbeck K, Cheine MV, Essali A (2007). "Clozapine versus typical neuroleptic medication for schizophrenia". The Cochrane Database of Systematic Reviews (John Wiley and Sons, Ltd.) (2): CD000059. doi:10.1002/14651858.CD000059. PMID 10796289.
- McEvoy JP (2006). "Risks versus benefits of different types of long-acting injectable antipsychotics". J Clin Psychiatry 67 Suppl 5: 15–8. PMID 16822092.
- Pharoah F, Mari J, Rathbone J, Wong W (2010). "Family intervention for schizophrenia". Cochrane Database Syst Rev 12: CD000088. doi:10.1002/14651858.CD000088.pub3. PMID 21154340.
- Dixon LB, Dickerson F, Bellack AS, et al. (January 2010). "The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements". Schizophr Bull 36 (1): 48–70. doi:10.1093/schbul/sbp115. PMID 19955389.
- Lynch D, Laws KR, McKenna PJ (January 2010). "Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials". Psychol Med 40 (1): 9–24. doi:10.1017/S003329170900590X. PMID 19476688.
- Jones C, Cormac I, Silveira da Mota Neto JI, Campbell C (2004). "Cognitive behaviour therapy for schizophrenia". Cochrane Database Syst Rev (4): CD000524. doi:10.1002/14651858.CD000524.pub2. PMID 15495000.
- Saha S, Chant D, McGrath J (October 2007). "A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?". Arch. Gen. Psychiatry 64 (10): 1123–31. doi:10.1001/archpsyc.64.10.1123. PMID 17909124.
- Ustun TB; Rehm J, Chatterji S, Saxena S, Trotter R, Room R, Bickenbach J, and the WHO/NIH Joint Project CAR Study Group (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.
- Warner R (July 2009). "Recovery from schizophrenia and the recovery model". Curr Opin Psychiatry 22 (4): 374–80. doi:10.1097/YCO.0b013e32832c920b. PMID 19417668.
- Menezes NM, Arenovich T, Zipursky RB (October 2006). "A systematic review of longitudinal outcome studies of first-episode psychosis". Psychol Med 36 (10): 1349–62. doi:10.1017/S0033291706007951. PMID 16756689.
- Isaac M, Chand P, Murthy P (August 2007). "Schizophrenia outcome measures in the wider international community". Br J Psychiatry Suppl 50: s71–7. PMID 18019048.
- Cohen A, Patel V, Thara R, Gureje O (March 2008). "Questioning an axiom: better prognosis for schizophrenia in the developing world?". Schizophr Bull 34 (2): 229–44. doi:10.1093/schbul/sbm105. PMC 2632419. PMID 17905787.
- Burns J (August 2009). "Dispelling a myth: developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia". Afr J Psychiatry (Johannesbg) 12 (3): 200–5. PMID 19894340.
- Palmer BA, Pankratz VS, Bostwick JM (March 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.
- Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström P. Suicide in schizophrenia. Expert Rev Neurother. 2010;10(7):1153–64. doi:10.1586/ern.10.82. PMID 20586695.
- American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. ISBN 9780890420256. p. 304
- De Leon J, Diaz FJ (2005). "A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors". Schizophrenia research 76 (2-3): 135–57. doi:10.1016/j.schres.2005.02.010. PMID 15949648.
- Keltner NL, Grant JS (2006). "Smoke, Smoke, Smoke That Cigarette". Perspectives in Psychiatric Care 42 (4): 256. doi:10.1111/j.1744-6163.2006.00085.x. PMID 17107571.
- "Schizophrenia". World Health Organization. 2011. http://www.who.int/mental_health/management/schizophrenia/en/. Retrieved February 27, 2011.
- Castle D, Wessely S, Der G, Murray RM (December 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.
- Kumra S, Shaw M, Merka P, Nakayama E, Augustin R (2001). "Childhood-onset schizophrenia: research update". Canadian Journal of Psychiatry 46 (10): 923–30. PMID 11816313.
- Hassett Anne, et al. (eds) (2005). Psychosis in the Elderly. London: Taylor and Francis.. p. 6. ISBN 1841843946. http://books.google.com/?id=eLaMOJ9oj28C&printsec=frontcover&dq=Psychosis+in+the+Elderly.
- Jablensky A, Sartorius N, Ernberg G, et al. (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.
- Kirkbride JB, Fearon P, Morgan C, et al. (March 2006). "Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study". Archives of General Psychiatry 63 (3): 250–8. doi:10.1001/archpsyc.63.3.250. PMID 16520429.
- Kirkbride JB, Fearon P, Morgan C, et al. (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.
- Thomas Bewle. Madness to Mental Illness: A History of the Royal College of Psychiatrists RCPsych Publications; 1 edition (2008) p.52 ISBN 1904671357
- Heinrichs RW (2003). "Historical origins of schizophrenia: two early madmen and their illness". Journal of the History of the Behavioral Sciences 39 (4): 349–63. doi:10.1002/jhbs.10152. PMID 14601041.
- Kraepelin E, Diefendorf AR (1907). Text book of psychiatry (7 ed.). London: Macmillan.
- Hansen RA, Atchison B (2000). Conditions in occupational therapy: effect on occupational performance. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-683-30417-8.
- Kuhn R (2004). tr. Cahn CH. "Eugen Bleuler's concepts of psychopathology". History of Psychiatry 15 (3): 361–6. doi:10.1177/0957154X04044603. PMID 15386868.
- 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. http://www.kluweronline.com/art.pdf?issn=1386-7423&volume=3&page=153.
- Wing JK (January 1971). "International comparisons in the study of the functional psychoses". British Medical Bulletin 27 (1): 77–81. PMID 4926366.
- Rosenhan D (1973). "On being sane in insane places". Science 179 (4070): 250–8. doi:10.1126/science.179.4070.250. PMID 4683124.
- Wilson M (March 1993). "DSM-III and the transformation of American psychiatry: a history". American Journal of Psychiatry 150 (3): 399–410. PMID 8434655.
- Maj, Mario and Sartorius N. (15 September 1999). Schizophrenia. Chichester: Wiley. p. 292. ISBN 978-0-471-99906-5.
- 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.
- Sato M (2004). "Renaming schizophrenia: a Japanese perspective". World Psychiatry 5 (1): 53–55. PMC 1472254. PMID 16757998.
- Wu EQ (2005). "The economic burden of schizophrenia in the United States in 2002". J Clin Psychiatry 66 (9): 1122–9. PMID 16187769.