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Schizophrenia

Prognosis

One important prognostic sign is the patient's age at onset of psychotic symptoms. Patients with early onset of schizophrenia are more often male, have a lower level of functioning prior to onset, a higher rate of brain abnormalities, more noticeable negative symptoms, and worse outcomes. Patients with later onset are more likely to be female, with fewer brain abnormalities and thought impairment, and more hopeful prognoses.

The average course and outcome for schizophrenics are less favorable than those for most other mental disorders, although as many as 30% of patients diagnosed with schizophrenia recover completely and the majority experience some improvement. Two factors that influence outcomes are stressful life events and a hostile or emotionally intense family environment. Schizophrenics with a high number of stressful changes in their lives, or who have frequent contacts with critical or emotionally over-involved family members, are more likely to relapse. Overall, the most important component of long-term care of schizophrenic patients is complying with their regimen of antipsychotic medications.

Resources

Books

Diagnostic and Statistical Manual of Mental Disorders: DSM IV-TR. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000.

Maj, M. Schizophrenia WPA Series. John Wiley & Sons, 2002.

Periodicals

Clark, R. Barkley. "Psychosocial Aspects of Pediatrics & Psychiatric Disorders." In Current Pediatric Diagnosis & Treatment, edited by William W. Hay Jr., et al. Stamford, CT: Appleton & Lange, 1997.

Day, Max, and Elvin V. Semrad. "Schizophrenia: Comprehensive Psychotherapy." In The Encyclopedia of Psychiatry, Psychology, and Psychoanalysis, edited by Benjamin B. Wolman. New York: Henry Holt and Company, 1996.

Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis & Treatment 1998, edited by Lawrence M. Tierney Jr., et al. Stamford, CT: Appleton & Lange, 1997.

Krausz M. "Efficacy Review of Antipsychotics." Curr Med Res Opin 2002;18 Suppl 3:s8-12.

Marder, Stephen R. "Schizophrenia." In Conn's Current Therapy, edited by Robert E. Rakel. Philadelphia: W. B. Saunders Company, 1998.

Nestor, P. G. "Mental Disorder and Violence: Personality Dimensions and Clinical Features." Amer Journal of Psychiatry 2002 Dec;159(12):1973-8.

Quraishi S, Frangou S. "Neuropsychology of Bipolar Disorder: a Review." Journal of Affective Disorders 2002 Dec: 72(3): 209-26.

Rebecca J. Frey

KEY TERMS

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Affective flattening: —A loss or lack of emotional expressiveness. It is sometimes called blunted or restricted affect.
Akathisia: —Agitated or restless movement, usually affecting the legs and accompanied by a sense of discomfort. It is a common side effect of neuroleptic medications.
Catatonic behavior: —Behavior characterized by muscular tightness or rigidity and lack of response to the environment. In some patients rigidity alternates with excited or hyperactive behavior.
Delusion: —A fixed, false belief that is resistant to reason or factual disproof.
Depot dosage: —A form of medication that can be stored in the patient's body tissues for several days or weeks, thus minimizing the risks of the patient's forgetting daily doses. Haloperidol and fluphenazine can be given in depot form.
Dopamine receptor antagonists (DAs): —The older class of antipsychotic medications, also called neuroleptics. These primarily block the site on nerve cells that normally receives the brain chemical dopamine.
Dystonia: —Painful involuntary muscle cramps or spasms. Dystonia is one of the extrapyramidal side effects associated with antipsychotic medications.
Extrapyramidal symptoms (EPS): —A group of side effects associated with antipsychotic medications. EPS include Parkinsonism, akathisia, dystonia, and tardive dyskinesia.
First-rank symptoms: —A set of symptoms designated by Kurt Schneider in 1959 as the most important diagnostic indicators of schizophrenia. These symptoms include delusions, hallucinations, thought insertion or removal, and thought broadcasting. First-rank symptoms are sometimes referred to as Schneiderian symptoms.
Hallucination: —A sensory experience of something that does not exist outside the mind. A person can experience a hallucination in any of the five senses. Auditory hallucinations are a common symptom of schizophrenia.
Huntington's chorea: —A hereditary disease that typically appears in midlife, marked by gradual loss of brain function and voluntary movement. Some of its symptoms resemble those of schizophrenia.
Negative symptoms: —Symptoms of schizophrenia that are characterized by the absence or elimination of certain behaviors. DSM-IV and DSM-IV-TR specify three negative symptoms: affective flattening, poverty of speech, and loss of will or initiative.
Neuroleptic: —Another name for the older type of antipsychotic medications given to schizophrenic patients.
Parkinsonism: —A set of symptoms originally associated with Parkinson disease that can occur as side effects of neuroleptic medications. The symptoms include trembling of the fingers or hands, a shuffling gait, and tight or rigid muscles.
Positive symptoms: —Symptoms of schizophrenia that are characterized by the production or presence of behaviors that are grossly abnormal or excessive, including hallucinations and thought-process disorder. DSM-IV and the DSM-IV-TR subdivide positive symptoms into psychotic and disorganized.
Poverty of speech: —A negative symptom of schizophrenia, characterized by brief and empty replies to questions. It should not be confused with shyness or reluctance to talk.
Psychotic disorder: —A mental disorder characterized by delusions, hallucinations, or other symptoms of lack of contact with reality. The schizophrenias are psychotic disorders.
Serotonin dopamine antagonists (SDAs): —The newer second-generation antipsychotic drugs, also called atypical antipsychotics. SDAs include clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa).
Wilson's disease: —A rare hereditary disease marked by high levels of copper deposits in the brain and liver. It can cause psychiatric symptoms resembling schizophrenia.
Word salad: —Speech that is so disorganized that it makes no linguistic or grammatical sense.

Additional topics

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