Clinical Review

Schizophrenia

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39227.616447.BE (Published 12 July 2007) Cite this as: BMJ 2007;335:91
  1. Marco M Picchioni, clinical lecturer in psychiatry,
  2. Robin M Murray, professor of psychiatry
  1. King's College London, Institute of Psychiatry, Division of Psychological Medicine, London SE5 8AF
  1. Correspondence to: M Picchioni m.picchioni{at}iop.kcl.ac.uk

    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” …

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