Frequently Asked Questions

What is the Schizophrenia Library?
The Schizophrenia Library is a resource comprising relevant schizophrenia and psychosis- related research findings, gathered from a variety of sources, and stored in a searchable database. This involves compiling existing systematic reviews and conducting original reviews and meta-analyses, preparing and disseminating summaries of major findings, and forming collaborative links within the population health and epidemiology research community.

The Library aims to serve as a resource to scientists, clinicians, government, consumer and carer groups, and the general public, and to help to inform policy and clinical guideline development. The Library also aims to be a resource that can be used by scientists to identify pertinent research questions and knowledge gaps. The Schizophrenia Library will be updated regularly to ensure access to the latest information.

What do the categories mean?
The Schizophrenia Library is structured around nine key categories which have been identified based on the available information. They cover many topics relevant to schizophrenia including treatments; risk factors; physical features; symptoms; disease course and outcome; co-morbid conditions; epidemiology; family considerations and diagnostic measures.

Where does the information come from?
The information in the library was collected through systematic searches of Medline, Embase, CINAHL, Current Contents, PsycINFO and the Cochrane library, supplemented by hand-searching. Included are systematic reviews with or without meta-analysis, reporting results separately for schizophrenia, schizoaffective disorder, schizophreniform disorder or first episode schizophrenia/psychosis.

How is the information collated and summarised?
All included reviews’ reporting was quality assessed using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, and the quality of the data was assessed using GRADE guidelines for consistency, precision and directness. Data extraction and quality assessment were completed by two reviewers.

The Library consists of two levels of information on each topic. The first is a brief, lay language Factsheet on each topic. This Factsheet provides general information describing the area examined, how it is of potential use to people with schizophrenia and whether it is effective. The second level of information provided is a Technical Commentary Table on each topic that provides extensive information about the area reviewed. This consists of a summary of each review’s topic, aims, method, results and conclusion with a quality assessment included. The evidence in each review is given a high, moderate or low quality rating depending on the consistency and precision of the results. While high quality evidence ensures more confidence in the results, it is reflected in the quality, not quantity of the available research and so further research may change results, as with moderate or low quality evidence. Details about each systematic review examined within a topic are also included. These Technical Commentary Tables are the basis of the Library and are pitched at clinicians and researchers. They form the basis for the Factsheet (see above), which are written in lay terms, and provide simple answers to the many complex questions covered in the Technical Commentary Table.

How do I search for a particular topic or keyword?
There are two ways to use the Schizophrenia Library. The first is to browse through the Library database. This method will allow users to look through all the topic areas, using drop down menus and may be a more useful method for the general public. The second is to search the Library database using a keyword.

Can I save a copy of the information?
The detailed Factsheets and Technical Tables are provided in PDF form for ease of printing or saving for offline access.

How do I cite the Library?
If you wish to cite information gained from this website, please ensure that you include reference to the Schizophrenia Library, Schizophrenia Research Institute, Australia (www.schizophreniaresearch.org.au) plus the date accessed.

Can I access the papers online?
There is a link on each Technical Table to each review’s online abstract, where available. Most full text access is restricted by journal subscriptions.

What are the symptoms of schizophrenia?
Schizophrenia is a highly heterogeneous disorder, and the symptoms experienced vary widely between patients. The symptoms contained in the diagnostic guidelines for schizophrenia are not unique to the disorder, and may occur in other psychiatric disorders. However, a diagnosis of schizophrenia requires the extended presence of a number of different symptom combinations, and consequently many variations of symptoms and subgroups are possible. Factor analysis studies have identified three key clusters of symptoms: positive symptoms, negative symptoms and disorganised symptoms. See below for more detail on each symptom cluster. Broader models of symptoms have proposed the incorporation of cognitive dysfunction (such as deficits in executive function, memory and attention) and affective symptoms (mania, depression), as these are symptoms commonly reported in schizophrenia patients, however this is yet to be incorporated into any diagnostically relevant guidelines.

The symptom clusters which have been identified represent groups of symptoms which commonly resemble one another, occur together, and may be a consequence of similar pathology. The symptoms of schizophrenia have potentially debilitating consequences for sufferers, and each symptom complex may respond differently to distinct treatment approaches.

What are positive symptoms?
Positive symptoms of schizophrenia are a well documented feature of the disorder and are arguably the most recognizable symptoms. ‘Positive symptoms’ suggests an experience additional to what would be considered normal experience, and refers to the psychotic dimensions associated with schizophrenia such as hallucinations and delusions. Delusions are essentially distortions or exaggerations of inferential thinking, often representing a fragmented version of reality which lacks any logical consistency. Delusions in schizophrenia vary widely in content but some examples include persecutory, grandiose, somatic, or religious forms. Hallucinations are perceptual disturbances which can occur in any modality but are most commonly auditory, for example heard as voices speaking in the second or third person. These experiences cause extreme distress for the sufferer.

What are negative symptoms?
Negative symptoms refer to processes featuring an absence of normal function, and have been well defined to include blunted affect, alogia, asociality, avolition and anhedonia . Clinical manifestations of blunted affect include diminished range and intensity of emotional expression such as a scarcity of facial expressions, gestures and voice modulation, and restricted eye contact. Alogia is often manifested as poverty of speech; asociality involves reduced social interaction. Avolition refers to restrictions in the initiation of goal-directed behaviour, often resulting in poor hygiene and reduced motivation, while anhedonia is defined as an inability to experience pleasure, manifesting as scarcity of recreation, inability to experience closeness or reduced interest in any sexual activity.

Negative symptoms have a significant effect on the day to day function of the patient, affecting their ability to manage the disorder and reducing quality of life. Reduced premorbid adjustment and poorer illness outcome are characteristic of patients with negative symptoms. If patients are both cognitively impaired and unemotional, the impact of these symptoms may be unrecognised or understated by the patient.

What are disorganisation symptoms?
The third cluster of symptoms comprises disorganisation. Key features of disorganisation include disorganised speech and behaviour, and flat or inappropriate affect. Severely disorganised speech is almost impossible to follow, while disorganised behaviour includes bizarre or inappropriate behaviours, actions or gestures. A flattened affect entails a lack of emotional responsiveness, while inappropriate affect means exhibiting the incorrect emotional responses in a given context.

Disorganisation symptoms have a significant effect on the day to day function of the patient, affecting their ability to function in society and reducing quality of life.

Are there any recommended readings?
Yes, click on the links to access article abstracts.

Tandon R, Keshavan MS, Nasrallah HA. Schizophrenia, Part 1 – just the facts. What we know in 2008: An overview. Schizophrenia Research 2008; 100(1-3): 4-19.

Tandon R, Keshavan MS, Nasrallah HA. Schizophrenia, Part 2 – just the facts. What we know in 2008: Epidemiology and etiology. Schizophrenia Research 2008: 102(1-3): 1-18.

Keshavan MS et al. Schizophrenia, Part 3 – just the facts. What we know in 2008: Neurobiology. Schizophrenia Research 2008: 106(2-3): 89-107.

Tandon R, Nasrallah HA, Keshavan MS. Schizophrenia, Part 4 – just the facts. Clinical features and conceptualization. Schizophrenia Research 2009: 110(1-3): 1-23.

Tandon R, Nasrallah HA, Keshavan MS. Schizophrenia, Part 5 – just the facts. Treatment and prevention: past, present, and future. Schizophrenia Research 2010: doi:10.1016/j.schres.2010.05.025

MacDonald AW, Schulz SC. What We Know: Findings That Every Theory of Schizophrenia Should Explain. Schizophrenia Bulletin 2009: 35(3): 493-508.

Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions. 2008.