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Schizophrenia is one of the most serious and frightening of all mental illnesses. No other disorder arouses as much anxiety in the general public, the media, and doctors. Effective treatments are available, yet patients and their families often find it hard to access good care. In the United Kingdom, as in many parts of the world, this is often due to poor service provision, but sometimes it is simply down to misinformation. In this review, we clarify the causes and presentation of schizophrenia, summarise the treatments that are available, and try to clear up a few myths.
Methods
We searched the online electronic databases Web of Knowledge, the Cochrane Library, and the current National Institute for Health and Clinical Excellence (NICE) guidelines for suitable evidence based material.
What is schizophrenia?
The name schizophrenia derives from the early observation that the illness is typified by "the disconnection or splitting of the psychic functions."w1 Unfortunately, this has led to the misconception that the illness is characterised by a "split personality," which it is not. Box 1 lists the common symptoms of schizophrenia.
Box 1 Definitions of symptoms of schizophrenia
Positive symptoms
Lack of insight
Failure to appreciate that symptoms are not real or caused by illness
Hallucination
A perception without a stimulus
Hallucinations can occur in any sense-touch, smell, taste, or vision-but auditory hallucinations are the most common (usually "hearing voices")
Delusions
A fixedly held false belief that is not shared by others from the patient's community
Delusions often develop along personal themes; for example:
Persecution-patients think they are victims of some form of threat or are central to a conspiracy
Passivity-patients think that their thoughts or actions are being controlled by an external force or person
Other-delusions can develop along any theme; for instance grandiose, sexual, or religious
Thought disorder
Manifests as distorted or illogical speech-a failure to use language in a logical and coherent way
Typified by "knight's move" thinking-thoughts proceed in one direction but suddenly go off at right angles, like the knight in chess, with no logical chain of thought
Negative symptoms
These include social withdrawal, self neglect, loss of motivation and initiative, emotional blunting, and paucity of speech
People with schizophrenia typically hear voices (auditory hallucinations), which often criticise or abuse...