Three main symptom clusters have been identified:

Positive symptoms

Positive symptoms are a well-documented feature of schizophrenia and are arguably the most recognisable and conspicuous, and can cause extreme distress to the individual. They include hallucinations, which are defined as a perceptual experience that occurs in the absence of any external sensory input, and are most commonly auditory, although they can occur in any modality. Delusions are also positive symptoms, and involve distortions or exaggerations of inferential thinking, which lack any logical consistency, are not explained by cultural beliefs, and persist regardless of contradictory evidence. Persecutory delusions involve the belief that people are “out to get” the individual, resulting in a lack of trust in others. Delusions of reference refers to the belief that neutral events are directed specifically towards the individual. Somatic delusions involve the belief that the individual has a physical ailment contrary to medical advice. Delusions of grandeur are characterised by an exaggerated belief that the individual has power, ability, or fame.

Negative symptoms

Negative symptoms refer to an absence of normal functions. These include a scarcity of facial expressions of emotion, reduced frequency and range of gestures and voice modulation, restricted eye contact, poverty of speech, reduced social interaction, reduced motivation, poor hygiene, and reduced experience of pleasure manifesting as scarcity of recreation, inability to experience closeness, and reduced interest in sexual activity. Negative symptoms have a significant effect on the day to day functioning of the patient, affecting their ability to manage the disorder and reducing their quality of life.

Disorganisation symptoms

Key features of the symptoms of disorganisation include disorganised speech and behaviour and inappropriate affect. Severely disorganised speech is difficult to follow and may be deprived of content. Disorganised behaviour includes bizarre or inappropriate behaviour, actions or gestures. Inappropriate affect includes exhibiting incorrect emotional responses for a given context. Symptoms of disorganisation have been identified as risk factors for poor illness outcome, and have a significant negative effect on a person’s day-to-day functioning and quality of life.

Diagnosis:

As some of these symptoms occur with other psychiatric disorders such as major depression, bipolar disorder and post-traumatic stress disorder, a combination of symptoms must be present for a diagnosis of schizophrenia.

Using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), at least two of the above symptoms need to have been present for at least six months and for a significant portion of time over a one-month period. At least one symptom of delusions, hallucinations or disorganised speech needs to be present, and there also needs to be significant social or occupational dysfunction.

Using the International Statistical Classification of Diseases and Related Health Problems (ICD-10), either at least one symptom of delusions, hallucinations, or thought symptoms (thought echo, insertion, withdrawal, or broadcasting) needs to be present, or at least two symptoms of hallucinations, negative symptoms, catatonic behaviour, or incoherent/irrelevant speech needs to be present for most of the time for at least one month.

April 2019

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We have not included detailed information on genetic risk factors in the Library due to the availability of these details on a website specifically about genetics in schizophrenia (see; www.szgene.org).

Several environmental risk factors have been identified as increasing the risk for schizophrenia, these include:

• Recreational cannabis use, particularly in childhood or adolescence.
• Exposure to obstetric complications in utero or at birth, including maternal diabetes, emergency caesarean section, congenital malformations, or low birth weight <2000g.
• Exposure to severe childhood adversities, and poor family relationships.
• Being an immigrant, either first or second generation, particularly from a developing country coming to a developed country and living in an area with low ethnic minority density.
• Exposure to childhood central nervous system viral infections.
• Having an older father (over 50) at birth.

April 2019

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There is also evidence that therapy in combination with antipsychotic medication is effective for symptoms, particularly in the early stages of the disorder.

Other treatment options include adjunctive, or medication from other drug classes that are taken in addition to antipsychotics. There are also other physical, non-pharmaceutical treatments that may be effective when pharmaceutical options are not working as well as desired, although these options are mostly still experimental.

Your clinician, usually a psychiatrist, is the best person to guide you through these treatment options.

April 2019

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Family members often have difficulty recognising that an illness is developing in their relative and that the person is in need of help, resulting in delays in timing and type of help sought. Getting the right treatment early on in the disease process is crucial to better outcomes. Predominant barriers to seeking help by relatives are the perceived stigma of having a mental illness and reluctance of the ill relative to participate in the help-seeking process. The individuals’ wider social context and informal networks may also inhibit help-seeking. Crises, or overt psychotic symptoms are the main promoters of active help-seeking and facilitators to accessing services. Relatives’ informal networks often serve to assist in this process.

Family therapy is effective for improving symptoms in patients and provides a greater understanding of the disorder for both patients and their families.

April 2019

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Common co-occurring mental disorders include anxiety, depression, and substance use disorders.

Common co-occurring physical disorders include diabetes, metabolic syndrome, and cardiovascular disease.

Your clinician will take these co-occurring conditions into consideration when organising your treatment regime.

April 2019

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