What is schizophrenia?
Answer
Schizophrenia is a complex, chronic neurodevelopmental psychiatric disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interaction. The DSM-5 groups schizophrenia symptoms into three distinct domains:
Positive symptoms (Excess or distortion of normal function) reflect an excess or loss of contact with reality. Delusions are fixed, false beliefs not grounded in reality or cultural norms (persecutory delusions or grandiosity). Hallucinations are sensory perceptions without an external stimulus. They may be auditory hallucinations (i.e. hearing voices), visual, olfactory, or tactile types. Disorganized thinking/speech manifest as loose associations, derailment, or word salads.
Negative symptoms (deficit or loss of normal function) resulting in a slowing of emotional expression and goal-directed behavior. This often accounts for long-term functional disability. Flat or blunted affect may be noted. Diminished emotional expression in facial movements, voice tone, or eye contact. Avolation which is a severe lack of motivation to begin or sustain goal-directed activities. Alogia which is poverty of speech. Anhedonia or the inability to experience pleasure from previously enjoyed activities. And asocialty or lack of interest in social interactions.
Cognitive impairments are not a core diagnostic criteria, but executive dysfunctions are a core feature of the pathology. Deficits in working memory and processing speed. Impaired executive functions (planning, organizing, or abstract reasoning). There may also be a difficulity in maintaining sustained attention.
Treatment in the form of pharmacotherapy includes first-generation antipsychotics such as haloperidol or chlorpromazine. Second-generation antipsychotics such as risperidone, olanzapine, quetiapine, or aripiprazole. And clozapine is reserved for treatment-resistant schizophrenia (failure of = or >2 adequate antipsychotic trials).