Clinical Features: Symptoms are categorized into positive, negative, behavioural disorganization, and cognitive. Negative symptoms are often summarized as the ‘four As’: alogia, avolition, affective flattening, and anhedonia.
Schneider’s First-Rank Symptoms: High diagnostic specificity. Includes thought echo/insertion/withdrawal/broadcasting, third-person auditory hallucinations, passivity phenomena, and delusional perception.
Genetics: High heritability (80%). Lifetime risk: 1% baseline, 9% sibling, 17% dizygotic twin, 48% monozygotic twin, 46% if both parents affected.
Neurobiology: 30% increase in lateral/third ventricular volume; 2.6% decrease in brain volume. Dopamine hypothesis (striatal excess) and Glutamate hypothesis (NMDA hypofunction).
Prognosis: Roughly 1/3 have good outcomes; 14-16% achieve full recovery. Poor prognosis associated with insidious onset, male sex, younger age, and negative symptoms.
Treatment: Antipsychotics are the mainstay. Clozapine is the only proven drug for treatment-resistant cases. CBT and family therapy (targeting Expressed Emotion) are key psychosocial interventions.
Mortality: 3-fold increase in mortality; 15-20 years shorter life expectancy, primarily due to cardiovascular disease and suicide (5% lifetime risk).
⚠️ EXAM DETAIL: The ‘mortality gap’ is increasing; patients die 15-20 years earlier than the general population.
⚠️ EXAM DETAIL: 22q11 deletion (Velocardiofacial syndrome) is the best-known CNV associated with schizophrenia.
⚠️ EXAM DETAIL: Rapid neuroleptization (loading doses) is NOT recommended; use benzodiazepines if sedation is needed.
⚠️ EXAM DETAIL: The Calgary Depression Scale for Schizophrenia is used to distinguish depressive symptoms from negative symptoms and extrapyramidal side effects.