Schizophrenia clinically manifests acute episodes associating delirium, hallucinations and behavioural problems, and by a diverse range of chronic symptoms that persist and may lead to handicap. It affects around 0.7% of the world population, thus schizophrenia is not a rare disease. It has been reported worldwide, in all cultures and geographic regions. Symptoms may be difficult to detect before onset of the advanced stages of the disease. However, three fundamental psychopathological dimensions are often identified: delusional transformation or distortion of reality manifesting as episodes of delirium or as hallucinations; emotional decline with decreased expression manifesting as negative symptoms such as abulia, apathy, withdrawal and an absent or diminished ability to modulate thoughts; disorganised thinking with language and ideation problems, and disorganised behaviour. In general the disease is progressive with relapses of acute psychosis during the first few years. After this period, patients tend to stabilise but the severity of the residual symptoms varies. Multiple aetiological factors appear to be implicated in the disease: schizophrenia is a complex hereditary, multifactorial condition that is also influenced by environmental factors. Bipolar disorder may need to be considered in the differential diagnosis of adolescents or young adults. At present, genetic counselling offered to parents of affected children should be approached with care, as schizophrenia is a polygenic multifactorial disease. Antipsychotic drugs (neuroleptics and second-generation antipsychotics) have dramatically altered the disease course for schizophrenia patients by improving clinical status and reducing the number of relapses. Psychosocial management is mandatory and should include rehabilitation programs, family psychoeducation, psychotherapy and help from support groups. Prognosis depends on the disease characteristics, but also on the quality of the psychosocial support provided, access to care and on the degree of compliance with the proposed management approach.
Last update: September 2007