User:Fr33kman/Schizophrenia

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Schizophrenia
Embroidery art with nonlinear text sewn into it with multiple colors of thread
Cloth embroidered by a person diagnosed with schizophrenia
Pronunciation
SpecialtyPsychiatry
SymptomsHallucinations (usually hearing voices), delusions, social isolation, flat affect, confused thinking[2][3]
ComplicationsSuicide, heart disease, lifestyle diseases[4]
Usual onsetAges 16 to 30[3]
DurationChronic[3]
CausesEnvironmental and genetic factors[5]
Risk factorsFamily history, cannabis use in adolescence, problems during pregnancy, childhood adversity, birth in late winter or early spring, older father, being born or raised in a city[5][6]
Diagnostic methodBased on observed behavior, reported experiences, and reports of others familiar with the person[7]
Differential diagnosisSubstance use disorder, Huntington's disease, mood disorders (bipolar disorder, major depressive disorder), autism,[8] borderline personality disorder,[9] schizophreniform disorder, schizotypal personality disorder, schizoid personality disorder, antisocial personality disorder, psychotic depression, anxiety, disruptive mood dysregulation disorder
ManagementCounseling, life skills training[2][5]
MedicationAntipsychotics[5]
Prognosis20–28 years shorter life expectancy[10][11]
Frequency~0.32% (1 in 300) of the global population is affected.[12]
Deaths~17,000 (2015)[13]

Schizophrenia is a mental disorder[14] that has continuous or relapsing periods of psychosis.[5] Major symptoms include hallucinations (typically hearing voices), delusions and disorganized thinking.[7] Other symptoms include social withdrawal and flat affect.[5] Symptoms typically develop gradually, begin during young adulthood, and in many cases are never ending.[3][7] There is no diagnostic test; diagnosis is based on observed behaviour, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person.[7] For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months (according to the DSM-5) or one month (according to the ICD-11).[7][15] Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders and obsessive–compulsive disorder.[7]

About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime.[16] In 2017, there were an estimated 1.1 million new cases and in 2022 a total of 24 million cases globally.[2][17] Males are more often affected and on average have an earlier beginning than females.[2] The causes of schizophrenia may include genetic and environmental factors.[5] Genetic factors include a variety of common and rare genetic variants.[18] Possible environmental factors include being raised in a city, childhood problems, cannabis use during adolescence, infections, the age of a person's mother or father, and poor nutrition during pregnancy.[5][19]

About half of those diagnosed with schizophrenia will have a significant improvement over the long term with no further occurrences, and a small proportion of these will recover completely.[7][20] The other half will have a lifelong impairment.[21] In severe cases, people may have to be placed in hospitals.[20] Social problems such as long-term unemployment, poverty, homelessness, exploitation and victimization are commonly correlated with schizophrenia.[22][23] Compared to the general population, people with schizophrenia have a higher suicide rate (about 5% overall) and more physical health problems,[24][25] leading to an average decrease in life expectancy by 20[10] to 28 years.[11] In 2015, an estimated 17,000 deaths were linked to schizophrenia.[13]

Treatment is often antipsychotic medication, along with counseling, job training and social rehabilitation.[5] Up to a third of people do not respond to initial antipsychotics, in which case clozapine may be used.[26] In a study of 15 antipsychotic drugs, clozapine was more effective than all other drugs, although clozapine's action may cause more side effects.[27] In situations where doctors judge that there is a risk of harm to self or others, they may impose short involuntary hospitalization.[28] Long-term hospitalization is used on a small number of people with severe schizophrenia.[29] In some countries where supportive services are limited or unavailable, long-term hospital stays are more common.[30]

Signs and symptoms[change | change source]

My Eyes at the Moment of the Apparitions by German artist August Natterer, who had schizophrenia

Schizophrenia is a mental disorder characterized by significant alterations in perception, thoughts, mood and behavior.[31] Symptoms are described in terms of positive, negative and cognitive symptoms.[3][32] The positive symptoms of schizophrenia are the same for any psychosis and are sometimes referred to as psychotic symptoms. These may be present in any of the different psychoses and are often temporary, making early diagnosis of schizophrenia hard. Psychosis noted for the first time in a person who is later diagnosed with schizophrenia is referred to as a first-episode psychosis (FEP).[33][34]

Positive symptoms[change | change source]

Positive symptoms are those symptoms that are not normally experienced, but are present in people during a psychotic episode in schizophrenia. They include delusions, hallucinations, and disorganized thoughts and speech, typically regarded as manifestations of psychosis.[33] Hallucinations occur at some point in the lifetimes of 80% of those with schizophrenia[35] and most commonly involve the sense of hearing (most often hearing voices), but can sometimes involve any of the other senses of taste, sight, smell and touch.[36] The frequency of hallucinations involving multiple senses is double the rate of those involving only one sense.[35] They are also typically related to the content of the delusional theme.[37] Delusions are bizarre or persecutory in nature. Distortions of self-experience such as feeling as others can hear one's thoughts to believing that thoughts are being inserted into one's mind, are also common.[38] Thought disorders can include thought blocking and disorganized speech.[3] Positive symptoms generally respond well to medication[5] and become reduced over the course of the illness, perhaps linked to the age-related decline in dopamine activity.[7]

Negative symptoms[change | change source]

Negative symptoms are shortage of normal emotional responses, or of other thought processes. The five recognized areas of negative symptoms are: blunted affect – showing flat expressions (monotone) or little emotion; alogia – a lack of speech; anhedonia – an inability to feel pleasure; asociality – the lack of desire to form relationships, and avolition – a lack of motivation and apathy.[39][40] Lack of interest and sadness are seen as motivational deficits resulting from impaired reward processing.[41][42] Reward is the main driver of motivation and this is mostly mediated by dopamine.[42] It has been suggested that negative symptoms are categorised into two subareas of apathy (lack of interest) or lack of motivation, and a lack of expression (lack of speaking).[39][43] Apathy includes avolition, anhedonia, and social withdrawal; diminished expression includes blunt affect and alogia.[44] Sometimes diminished expression is treated as both verbal and non-verbal.[45]

Apathy (lack of interest) accounts for around 50 percent of the most often found negative symptoms and affects the outcome and quality of life. Apathy is related to disrupted cognitive (thinking) processing affecting memory and planning including goal-directed behaviour.[46] The two subdomains have suggested a need for separate treatment approaches.[47] A lack of distress – relating to a reduced experience of depression and anxiety is another noted negative symptom.[48] A separation is often made between those negative symptoms that are basic to schizophrenia, termed primary; and those that result from positive symptoms, from the side effects of antipsychotics, substance use disorder (drug or alcohol abuse), and social poverty– termed secondary negative symptoms.[49] Negative symptoms are less responsive to medication and the most difficult to treat.[47] However, if properly assessed, secondary negative symptoms are able to be treated.[43]

Cognitive symptoms[change | change source]

See also: Visual processing abnormalities in schizophrenia
Map of deficits in neural tissue throughout the human brain in a patient with schizophrenia. The most deficient areas are magenta, while the least deficient areas are blue.

An estimated 70% of those with schizophrenia have cognitive deficits (thought symptoms), and these are most pronounced in early starting and late-starting illness.[50][51] These are often seen long before the beginning of illness in the prodromal stage, and may be present in childhood or early adolescence.[52][53] They are a core feature but not considered to be core symptoms, as are positive and negative symptoms.[54][55] However, their presence and degree of dysfunction is taken as a better indicator of functionality than the presentation of core symptoms.[52] Cognitive deficits become worse at first episode psychosis but then return to normal, and remain fairly stable over the course of the illness.[56][57]

The shortage in cognition (thinking) are seen to drive the negative psychosocial outcome in schizophrenia, and are claimed to be a possible reduction in IQ from the norm of 100 to 70–85.[58][59] Cognitive deficits may be of neurocognition (nonsocial) or of social cognition.[50] Neurocognition is the ability to receive and remember information, and includes verbal fluency, memory, reasoning, problem solving, speed of processing, and auditory and visual perception.[57] Verbal memory and attention are seen to be the most affected.[59][60] Verbal memory impairment is associated with a decreased level of semantic processing (relating meaning to words).[61] Another memory impairment is that of episodic memory.[62] An impairment in visual perception that is consistently found in schizophrenia is that of visual backward masking.[57] Visual processing impairments include an inability to perceive complex visual illusions.[63] Social cognition is concerned with the mental operations needed to interpret, and understand the self and others in the social world.[57][50] This is also an associated impairment, and facial emotion perception is often found to be difficult.[64][65] Facial perception is critical for ordinary social interaction.[66] Cognitive impairments do not usually respond to antipsychotics, and there are a number of interventions that are used to try to improve them; cognitive remediation therapy is of particular help.[55]

Neurological soft signs of clumsiness and loss of fine motor movement are often found in schizophrenia, which may resolve with effective treatment of FEP.[15][67]

Onset[change | change source]

Further information: Basic symptoms of schizophrenia
See also: Childhood schizophrenia and Adolescence § Changes in the brain

Onset typically occurs between the late teens and early 30s, with the peak incidence occurring in males in the early to mid-twenties, and in females in the late twenties.[3][7][15] Onset before the age of 17 is known as early-onset,[68] and before the age of 13, as can sometimes occur, is known as childhood schizophrenia or very early-onset.[7][69] Onset can occur between the ages of 40 and 60, known as late-onset schizophrenia.[50] Onset over the age of 60, which may be difficult to differentiate as schizophrenia, is known as very-late-onset schizophrenia-like psychosis.[50] Late onset has shown that a higher rate of females are affected; they have less severe symptoms and need lower doses of antipsychotics.[50] The tendency for earlier onset in males is later seen to be balanced by a post-menopausal increase in the development in females. Estrogen produced pre-menopause has a dampening effect on dopamine receptors but its protection can be overridden by a genetic overload.[70] There has been a dramatic increase in the numbers of older adults with schizophrenia.[71]

Onset may happen suddenly or may occur after the slow and gradual development of a number of signs and symptoms, a period known as the prodromal stage.[7] Up to 75% of those with schizophrenia go through a prodromal stage.[72] The negative and cognitive symptoms in the prodrome stage can precede FEP (first episode psychosis) by many months and up to five years.[56][73] The period from FEP and treatment is known as the duration of untreated psychosis (DUP) which is seen to be a factor in functional outcome. The prodromal stage is the high-risk stage for the development of psychosis.[57] Since the progression to first episode psychosis is not inevitable, an alternative term is often preferred of at risk mental state.[57] Cognitive dysfunction at an early age impacts a young person's usual cognitive development.[74] Recognition and early intervention at the prodromal stage would minimize the associated disruption to educational and social development and has been the focus of many studies.[56][73]

  1. ↑ Jones D (2003) [1917]. Roach P, Hartmann J, Setter J (eds.). English Pronouncing Dictionary. Cambridge University Press. ISBN 978-3-12-539683-8.
  2. ↑ 2.0 2.1 2.2 2.3 "Schizophrenia Fact sheet". World Health Organization. 10 January 2022. Retrieved 23 August 2022.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 "Schizophrenia". Health topics. US National Institute of Mental Health. April 2022. Retrieved 22 August 2022.
  4. ↑ "Medicinal treatment of psychosis/schizophrenia". Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). 21 November 2012. Archived from the original on 29 June 2017. Retrieved 26 June 2017.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 Owen MJ, Sawa A, Mortensen PB (July 2016). "Schizophrenia". The Lancet. 388 (10039): 86–97. doi:10.1016/S0140-6736(15)01121-6. PMC 4940219. PMID 26777917.
  6. ↑ Gruebner O, Rapp MA, Adli M, et al. (February 2017). "Cities and mental health". Deutsches Ärzteblatt International. 114 (8): 121–127. doi:10.3238/arztebl.2017.0121. PMC 5374256. PMID 28302261.
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. 2013. pp. 99–105. ISBN 978-0-89042-555-8.
  8. ↑ Ferri FF (2010). "Chapter S". Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd ed.). Philadelphia: Elsevier/Mosby. ISBN 978-0-323-07699-9.
  9. ↑ Cite error: The named reference Paris2018 was used but no text was provided for refs named (see the help page).
  10. ↑ 10.0 10.1 Laursen TM, Nordentoft M, Mortensen PB (2014). "Excess early mortality in schizophrenia". Annual Review of Clinical Psychology. 10: 425–448. doi:10.1146/annurev-clinpsy-032813-153657. PMID 24313570.
  11. ↑ 11.0 11.1 Cite error: The named reference NIHStat was used but no text was provided for refs named (see the help page).
  12. ↑ "Schizophrenia Fact Sheet and Information". World Health Organization.
  13. ↑ 13.0 13.1 Wang H, Naghavi M, Allen C, et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
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  16. ↑ Javitt DC (June 2014). "Balancing therapeutic safety and efficacy to improve clinical and economic outcomes in schizophrenia: a clinical overview". The American Journal of Managed Care. 20 (8 Suppl): S160-165. PMID 25180705.
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  20. ↑ 20.0 20.1 Vita A, Barlati S (May 2018). "Recovery from schizophrenia: is it possible?". Current Opinion in Psychiatry. 31 (3): 246–255. doi:10.1097/YCO.0000000000000407. PMID 29474266. S2CID 35299996.
  21. ↑ Lawrence RE, First MB, Lieberman JA (2015). "Chapter 48: Schizophrenia and Other Psychoses". In Tasman A, Kay J, Lieberman JA, First MB, Riba MB (eds.). Psychiatry (fourth ed.). John Wiley & Sons, Ltd. pp. 798, 816, 819. doi:10.1002/9781118753378.ch48. ISBN 978-1-118-84547-9.
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  23. ↑ Charlson FJ, Ferrari AJ, Santomauro DF, et al. (17 October 2018). "Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016". Schizophrenia Bulletin. 44 (6): 1195–1203. doi:10.1093/schbul/sby058. PMC 6192504. PMID 29762765.
  24. ↑ van Os J, Kapur S (August 2009). "Schizophrenia" (PDF). Lancet. 374 (9690): 635–645. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006. S2CID 208792724. Archived from the original (PDF) on 23 June 2013. Retrieved 23 December 2011.
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  36. ↑ Császár N, Kapócs G, Bókkon I (27 May 2019). "A possible key role of vision in the development of schizophrenia". Reviews in the Neurosciences. 30 (4): 359–379. doi:10.1515/revneuro-2018-0022. PMID 30244235. S2CID 52813070.
  37. ↑ American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. pp. 299–304. ISBN 978-0-89042-025-6.
  38. ↑ Heinz A, Voss M, Lawrie SM, et al. (September 2016). "Shall we really say goodbye to first rank symptoms?". European Psychiatry. 37: 8–13. doi:10.1016/j.eurpsy.2016.04.010. PMID 27429167. S2CID 13761854.
  39. ↑ 39.0 39.1 Adida M, Azorin JM, Belzeaux R, Fakra E (December 2015). "[Negative Symptoms: Clinical and Psychometric Aspects]". L'Encephale. 41 (6 Suppl 1): 6S15–17. doi:10.1016/S0013-7006(16)30004-5. PMID 26776385.
  40. ↑ Mach C, Dollfus S (April 2016). "[Scale for Assessing Negative Symptoms in Schizophrenia: A Systematic Review]". L'Encephale. 42 (2): 165–171. doi:10.1016/j.encep.2015.12.020. PMID 26923997.
  41. ↑ Waltz JA, Gold JM (2016). "Motivational Deficits in Schizophrenia and the Representation of Expected Value". Current Topics in Behavioral Neurosciences. 27: 375–410. doi:10.1007/7854_2015_385. ISBN 978-3-319-26933-7. PMC 4792780. PMID 26370946.
  42. ↑ 42.0 42.1 Husain M, Roiser JP (August 2018). "Neuroscience of apathy and anhedonia: a transdiagnostic approach". Nature Reviews. Neuroscience. 19 (8): 470–484. doi:10.1038/s41583-018-0029-9. PMID 29946157. S2CID 49428707.
  43. ↑ 43.0 43.1 Galderisi S, Mucci A, Buchanan RW, Arango C (August 2018). "Negative symptoms of schizophrenia: new developments and unanswered research questions". The Lancet. Psychiatry. 5 (8): 664–677. doi:10.1016/S2215-0366(18)30050-6. PMID 29602739. S2CID 4483198.
  44. ↑ Klaus F, Dorsaz O, Kaiser S (19 September 2018). "[Negative symptoms in schizophrenia – overview and practical implications]". Revue médicale suisse. 14 (619): 1660–1664. doi:10.53738/REVMED.2018.14.619.1660. PMID 30230774. S2CID 246764656.
  45. ↑ Batinic B (June 2019). "Cognitive Models of Positive and Negative Symptoms of Schizophrenia and Implications for Treatment". Psychiatria Danubina. 31 (Suppl 2): 181–184. PMID 31158119.
  46. ↑ Bortolon C, Macgregor A, Capdevielle D, Raffard S (September 2018). "Apathy in schizophrenia: A review of neuropsychological and neuroanatomical studies". Neuropsychologia. 118 (Pt B): 22–33. doi:10.1016/j.neuropsychologia.2017.09.033. PMID 28966139. S2CID 13411386.
  47. ↑ 47.0 47.1 Marder SR, Kirkpatrick B (May 2014). "Defining and measuring negative symptoms of schizophrenia in clinical trials". European Neuropsychopharmacology. 24 (5): 737–743. doi:10.1016/j.euroneuro.2013.10.016. PMID 24275698. S2CID 5172022.
  48. ↑ Tatsumi K, Kirkpatrick B, Strauss GP, Opler M (April 2020). "The brief negative symptom scale in translation: A review of psychometric properties and beyond". European Neuropsychopharmacology. 33: 36–44. doi:10.1016/j.euroneuro.2020.01.018. PMID 32081498. S2CID 211141678.
  49. ↑ Klaus F, Kaiser S, Kirschner M (June 2018). "[Negative Symptoms in Schizophrenia – an Overview]". Therapeutische Umschau. 75 (1): 51–56. doi:10.1024/0040-5930/a000966. PMID 29909762. S2CID 196502392.
  50. ↑ 50.0 50.1 50.2 50.3 50.4 50.5 Murante T, Cohen CI (January 2017). "Cognitive Functioning in Older Adults With Schizophrenia". Focus (American Psychiatric Publishing). 15 (1): 26–34. doi:10.1176/appi.focus.20160032. PMC 6519630. PMID 31975837.
  51. ↑ Kar SK, Jain M (July 2016). "Current understandings about cognition and the neurobiological correlates in schizophrenia". Journal of Neurosciences in Rural Practice. 7 (3): 412–418. doi:10.4103/0976-3147.176185. PMC 4898111. PMID 27365960.
  52. ↑ 52.0 52.1 Bozikas VP, Andreou C (February 2011). "Longitudinal studies of cognition in first episode psychosis: a systematic review of the literature". The Australian and New Zealand Journal of Psychiatry. 45 (2): 93–108. doi:10.3109/00048674.2010.541418. PMID 21320033. S2CID 26135485.
  53. ↑ Shah JN, Qureshi SU, Jawaid A, Schulz PE (June 2012). "Is there evidence for late cognitive decline in chronic schizophrenia?". The Psychiatric Quarterly. 83 (2): 127–144. doi:10.1007/s11126-011-9189-8. PMID 21863346. S2CID 10970088.
  54. ↑ Biedermann F, Fleischhacker WW (August 2016). "Psychotic disorders in DSM-5 and ICD-11". CNS Spectrums. 21 (4): 349–354. doi:10.1017/S1092852916000316. PMID 27418328. S2CID 24728447.
  55. ↑ 55.0 55.1 Cite error: The named reference Vidailhet2013 was used but no text was provided for refs named (see the help page).
  56. ↑ 56.0 56.1 56.2 Hashimoto K (5 July 2019). "Recent Advances in the Early Intervention in Schizophrenia: Future Direction from Preclinical Findings". Current Psychiatry Reports. 21 (8): 75. doi:10.1007/s11920-019-1063-7. PMID 31278495. S2CID 195814019.
  57. ↑ 57.0 57.1 57.2 57.3 57.4 57.5 Green MF, Horan WP, Lee J (June 2019). "Nonsocial and social cognition in schizophrenia: current evidence and future directions". World Psychiatry. 18 (2): 146–161. doi:10.1002/wps.20624. PMC 6502429. PMID 31059632.
  58. ↑ Javitt DC, Sweet RA (September 2015). "Auditory dysfunction in schizophrenia: integrating clinical and basic features". Nature Reviews. Neuroscience. 16 (9): 535–550. doi:10.1038/nrn4002. PMC 4692466. PMID 26289573.
  59. ↑ 59.0 59.1 Megreya AM (2016). "Face perception in schizophrenia: a specific deficit". Cognitive Neuropsychiatry. 21 (1): 60–72. doi:10.1080/13546805.2015.1133407. PMID 26816133. S2CID 26125559.
  60. ↑ Eack SM (July 2012). "Cognitive remediation: a new generation of psychosocial interventions for people with schizophrenia". Social Work. 57 (3): 235–246. doi:10.1093/sw/sws008. PMC 3683242. PMID 23252315.
  61. ↑ Pomarol-Clotet E, Oh M, Laws KR, McKenna PJ (February 2008). "Semantic priming in schizophrenia: systematic review and meta-analysis". The British Journal of Psychiatry. 192 (2): 92–97. doi:10.1192/bjp.bp.106.032102. hdl:2299/2735. PMID 18245021.
  62. ↑ Goldberg TE, Keefe RS, Goldman RS, Robinson DG, Harvey PD (April 2010). "Circumstances under which practice does not make perfect: a review of the practice effect literature in schizophrenia and its relevance to clinical treatment studies". Neuropsychopharmacology. 35 (5): 1053–1062. doi:10.1038/npp.2009.211. PMC 3055399. PMID 20090669.
  63. ↑ King DJ, Hodgekins J, Chouinard PA, Chouinard VA, Sperandio I (June 2017). "A review of abnormalities in the perception of visual illusions in schizophrenia". Psychonomic Bulletin and Review. 24 (3): 734–751. doi:10.3758/s13423-016-1168-5. PMC 5486866. PMID 27730532.
  64. ↑ Kohler CG, Walker JB, Martin EA, Healey KM, Moberg PJ (September 2010). "Facial emotion perception in schizophrenia: a meta-analytic review". Schizophrenia Bulletin. 36 (5): 1009–1019. doi:10.1093/schbul/sbn192. PMC 2930336. PMID 19329561.
  65. ↑ Le Gall E, Iakimova G (December 2018). "[Social cognition in schizophrenia and autism spectrum disorder: Points of convergence and functional differences]". L'Encéphale. 44 (6): 523–537. doi:10.1016/j.encep.2018.03.004. PMID 30122298. S2CID 150099236.
  66. ↑ Grill-Spector K, Weiner KS, Kay K, Gomez J (September 2017). "The Functional Neuroanatomy of Human Face Perception". Annual Review of Vision Science. 3: 167–196. doi:10.1146/annurev-vision-102016-061214. PMC 6345578. PMID 28715955.
  67. ↑ Fountoulakis KN, Panagiotidis P, Kimiskidis V, Nimatoudis I, Gonda X (February 2019). "Neurological soft signs in familial and sporadic schizophrenia". Psychiatry Research. 272: 222–229. doi:10.1016/j.psychres.2018.12.105. PMID 30590276. S2CID 56476015.
  68. ↑ Bourgou Gaha S, Halayem Dhouib S, Amado I, Bouden A (June 2015). "[Neurological soft signs in early onset schizophrenia]". L'Encephale. 41 (3): 209–214. doi:10.1016/j.encep.2014.01.005. PMID 24854724.
  69. ↑ Da Fonseca D, Fourneret P (December 2018). "[Very early onset schizophrenia]". L'Encephale. 44 (6S): S8–S11. doi:10.1016/S0013-7006(19)30071-5. PMID 30935493. S2CID 150798223.
  70. ↑ Häfner H (2019). "From Onset and Prodromal Stage to a Life-Long Course of Schizophrenia and Its Symptom Dimensions: How Sex, Age, and Other Risk Factors Influence Incidence and Course of Illness". Psychiatry Journal. 2019: 9804836. doi:10.1155/2019/9804836. PMC 6500669. PMID 31139639.
  71. ↑ Cohen CI, Freeman K, Ghoneim D, et al. (March 2018). "Advances in the Conceptualization and Study of Schizophrenia in Later Life". The Psychiatric Clinics of North America. 41 (1): 39–53. doi:10.1016/j.psc.2017.10.004. PMID 29412847.
  72. ↑ George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS (October 2017). "Understanding the schizophrenia prodrome". Indian Journal of Psychiatry. 59 (4): 505–509. doi:10.4103/psychiatry.IndianJPsychiatry_464_17 (inactive 31 January 2024). PMC 5806335. PMID 29497198.{{cite journal}}: CS1 maint: DOI inactive as of January 2024 (link)
  73. ↑ 73.0 73.1 Conroy S, Francis M, Hulvershorn LA (March 2018). "Identifying and treating the prodromal phases of bipolar disorder and schizophrenia". Current Treatment Options in Psychiatry. 5 (1): 113–128. doi:10.1007/s40501-018-0138-0. PMC 6196741. PMID 30364516.
  74. ↑ Lecardeur L, Meunier-Cussac S, Dollfus S (May 2013). "[Cognitive deficits in first episode psychosis patients and people at risk for psychosis: from diagnosis to treatment]". L'Encephale. 39 (Suppl 1): S64-71. doi:10.1016/j.encep.2012.10.011. PMID 23528322.
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