research books on schizophrenia

Advances in Schizophrenia Research 2009

• © 2010
• Wagner F. Gattaz 0 ,
• Geraldo Busatto 1

Fac. Medicina, Universidade de São Paulo, Sao Paulo, Brazil

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Based on the Sixth Symposium on the Search for the Causes of Schizophrenia which started in 1986 to commemorate the 600th anniversary of the University of Heidelberg and is now one of the most respected forums for schizophrenia research

Content stems from the lectures of 35 leading Scizophrenia researchers addressing an audience of 60 world renowned scientists

Includes supplementary material: sn.pub/extras

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Table of contents (26 chapters)

Front matter, epidemiology and risk factors, incidence and outcome of schizophrenia across the globe.

• Paulo R. Menezes

Gene–Environment Interactions for Searchers: Collaboration between Epidemiology and Molecular Genetics

• Jim van Os, Bart P.F. Rutten, Richie Poulton

The Natural History of the Course and Outcome of Schizophrenia

• Judith Allardyce, Jim van Os

Impact of Contextual Environmental Mechanisms on the Incidence of Schizophrenia and Other Psychoses

• James B. Kirkbride

Pathophysiology

Disinhibition of prefrontal cortex neurons in schizophrenia.

• B. Moghaddam, A.L. Pehrson

Brain Anatomical Abnormalities in Schizophrenia: Neurodevelopmental Origins and Patterns of Progression over Time

• Geraldo F. Busatto, Marcus V. Zanetti, Maristela S. Schaufelberger, José A.S. Crippa

The Neuropathology of Schizophrenia: Central Role for the Hippocampus?

• Peter Falkai, Eleni Parlapani, Oliver Gruber, Andrea Schmitt

Molecular Neuroimaging, Pathophysiological Mechanisms, and Drug Discovery

• Philip McGuire

Animal Models of Schizophrenia: Focus on Hippocampal Disruption of Dopamine System Regulation

• Anthony A. Grace

Genetic and Proteomic Studies in Schizophrenia

• Emmanuel Dias-Neto, Daniel Martins-de-Souza, Elida P.B. Ojopi, Wagner F. Gattaz

Neurogenetic Risk Mechanisms of Schizophrenia: An Imaging Genetics Approach

• Andreas Meyer-Lindenberg

Progress in Genetic Studies of Schizophrenia

• Renan P. Souza, Marco A. Romano Silva, James L. Kennedy

Psychopathology, Cognition, Outcome

Prediction of psychosis through the prodromal syndrome.

• Tyrone D. Cannon

Schizophrenia as a Cognitive Disorder: Recent Approaches to Identifying its Core Cognitive Components to Aid Treatment Development

• Keith H. Nuechterlein, Michael F. Green, Robert S. Kern

Cognitive and Social Processes in Psychosis: Recent Developments

• Daniel Freeman
• Antipsychotics
• Community care for schizop
• Genetics of schizophrenia
• Incidence of schizophrenia
• Models of schizophrenia
• Pharmacogenomics in schizophrenia
• Prevalence of schizophrenia
• Schizophrenia
• intervention
• rehabilitation

About this book

Editors and affiliations.

Wagner F. Gattaz, Geraldo Busatto

Bibliographic Information

Book Title : Advances in Schizophrenia Research 2009

Editors : Wagner F. Gattaz, Geraldo Busatto

DOI : https://doi.org/10.1007/978-1-4419-0913-8

Publisher : Springer New York, NY

eBook Packages : Medicine , Medicine (R0)

Copyright Information : Springer-Verlag New York 2010

Hardcover ISBN : 978-1-4419-0912-1 Published: 10 December 2009

Softcover ISBN : 978-1-4899-8321-3 Published: 05 September 2014

eBook ISBN : 978-1-4419-0913-8 Published: 12 November 2009

Edition Number : 1

Number of Pages : XV, 465

Topics : Neurology , Psychiatry , Neuropsychology , Personality and Social Psychology

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Schizophrenia and Psychotic Spectrum Disorders

Professor and Head, Department of Psychiatry

Professor In Residence, UCLA Department of Psychiatry and Biobehavioral Sciences

Assistant Professor of Psychiatry and Program Director, Psychiatry Residency

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Schizophrenia is a complex and heterogeneous disease of the brain, resulting from a complex interaction of innate susceptibility and environmental factors, involving multiple neurotransmitter systems and virtually all brain structures. As research in neurobiology, genetics, and epidemiology continues to progress at an astonishing rate, application of such knowledge may usher in newer and better interventions, ultimately reducing global burden and improving outcomes of schizophrenia. The primary focus of this volume is to present in readable form key topics in schizophrenia and other psychotic disorders, including a detailed review of the scientific literature on the pathophysiology underlying the disorder, symptoms, etiology, diagnostic approach, and treatments. People living with psychotic disorders have long been marginalized or misunderstood. This book is written with the goal of providing individuals in various disciplines, including trainees and established clinicians, a better understanding at multiple levels of one of the least understood psychiatric diagnoses. Improved understanding of the pathophysiology, phenomenology, intervention, and shaping of community and societal attitudes will lead to better outcomes for people with mental illnesses and their families.

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Research articles

Transplantation of gut microbiota derived from patients with schizophrenia induces schizophrenia-like behaviors and dysregulated brain transcript response in mice

• Mingliang Ju

The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study

• Yohannes Gebreegziabhere
• Kassahun Habatmu
• Atalay Alem

Further clarification of cognitive processes of prospective memory in schizophrenia by comparing eye-tracking and ecologically-valid measurements

• Chuan-Yue Wang

Visualizing threat and trustworthiness prior beliefs in face perception in high versus low paranoia

• Antonia Bott
• Hanna C. Steer
• Tania M. Lincoln

Association of homocysteine with white matter dysconnectivity in schizophrenia

• Koichi Tabata
• Shuraku Son
• Makoto Arai

Smoking affects symptom improvement in schizophrenia: a prospective longitudinal study of male patients with first-episode schizophrenia

Exploring functional dysconnectivity in schizophrenia: alterations in eigenvector centrality mapping and insights into related genes from transcriptional profiles

• Mengjing Cai

Mapping the landscape: a bibliometric analysis of resting-state fMRI research on schizophrenia over the past 25 years

• Remilai Aximu

Cortical white matter microstructural alterations underlying the impaired gamma-band auditory steady-state response in schizophrenia

• Daisuke Koshiyama
• Ryoichi Nishimura
• Kiyoto Kasai

Genetic overlap between schizophrenia and cognitive performance

• Jianfei Zhang
• Yanmin Peng

The relationship between visual hallucinations, functioning, and suicidality over the course of illness: a 10-year follow-up study in first-episode psychosis

• Isabel Kreis
• Kristin Fjelnseth Wold
• Ingrid Melle

Reduction of N-acetyl aspartate (NAA) in association with relapse in early-stage psychosis: a 7-Tesla MRS study

• Marina Mihaljevic
• Yu-Ho Chang

Changes in kynurenine metabolites in the gray and white matter of the dorsolateral prefrontal cortex of individuals affected by schizophrenia

• Nico Antenucci
• Giovanna D’Errico
• Giuseppe Battaglia

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The 20 Best Books about Schizophrenia

When I was first diagnosed with schizoaffective disorder bipolar type, I looked for the best books about schizophrenia to help me learn about what my new normal with my new diagnosis would look like. Ever a nerd, I researched the best schizophrenia books that would help me look at my condition from a spectrum of perspectives. This list contains 20 books on schizophrenia that reflect a diverse array of subjects and experiences, including books on understanding schizophrenia for families and loved ones and a multitude of memoirs about schizophrenia. It is my hope that it will be a resource for understanding schizophrenia that patients, family members, and mental health practitioners can use for help, healing, and hope.

You might also be interested in my list of the 20 best books about bipolar disorder …

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And now onto the best books about schizophrenia…

The center cannot hold by elyn r. saks.

Perhaps one of the most important books about schizophrenia, Elyn R. Saks’ The Center Cannot Hold: My Journey through Madness is undeniably a groundbreaking book in breaking the stigma of schizophrenia. Through relating her journey with schizophrenia, law professor Saks championed transparency while penning a riveting autobiography that cracked open the schizophrenia experience for all to see.

How to read it: Purchase The Center Cannot Hold on Amazon

Cognitive therapy of schizophrenia by david g. kingdon and douglas turkington.

When I was 18, I saw a student intern at the Penn Center for Cognitive Therapy for outpatient therapy. I was exhibiting some of the positive symptoms of schizophrenia (in particular, delusions), but they slipped through the cracks as I was treated primarily for depression and anxiety. The result was my cognitive therapy treatment wasn’t tailored to psychosis. Now, however, we have books like David G. Kingdon and Douglas Turkington’s Cognitive Therapy of Schizophrenia . This essential book is one of the best schizophrenia books for patients, allies, and mental health professionals alike. Finally we have a treatment option to alleviate schizophrenia symptoms beyond medication. Through chapters on topics like psychoeducation and normalization, intervening with delusions and hallucinations, and negative symptoms, this comprehensive book about understanding schizophrenia fills the gap in knowledge about how to treat schizophrenia with psychotherapy.

In short, this book gives me something I craved and needed so much when I was younger: hope.

How to read it: Purchase Cognitive Therapy of Schizophrenia on Amazon

The collected schizophrenias by esmé weijun wang.

While there’s plenty of writing about schizophrenia, there’s less out there about schizoaffective disorder, the condition I have. In The Collected Schizophrenias , Esmé Weijun Wang peels back the curtain on this comparably rare diagnosis. With essays spanning topics like fashion to being “high functioning” to specific delusions, like the Capgras delusion that your loved ones have been replaced by an identical imposter, The Collected Schizophrenias is an essential schizophrenia book and one of the best books on schizoaffective disorder.

How to read it: Purchase The Collected Schizophrenias on Amazon

The complete family guide to schizophrenia  by kim t. mueser and susan gingerich.

It can be hard to watch your loved one deal with schizophrenia, and, simultaneously, it’s equally hard to face this illness without the support of your family. Enter The Complete Family Guide to Schizophrenia by Kim T. Mueser, PhD, and Susan Gingerich, MSW. One of the best books for schizophrenia patients, this book covers topics like an overview of the illness, special issues for specific family members (like a patient’s mother, sister, or brother, etc.), preventing relapses, dealing with specific symptoms like delusions and hallucinations, and helping your loved one improve their quality of life. If you’re looking for a comprehensive guide to schizophrenia from a family standpoint, it doesn’t get much better than this book.

How to read it: Purchase The Complete Family Guide to Schizophrenia on Amazon

The day the voices stopped by ken steele.

Among the many best books on schizophrenias, the memoir The Day the Voices Stop is one of the oldest (published in 2001) and most highly regarded. This harrowing story follows Ken Steele’s lifelong struggle with schizophrenias, in particular command hallucinations and paranoid delusions, and eventual step towards healing with the help of psychiatric medicine. Steele’s vivid prose, written with Claire Berman, brings his nightmare and eventual recovery to life in this memoir that ranks among the best schizophrenia books.

How to read it: Purchase The Day the Voices Stopped on Amazon

Desperate remedies: psychiatry’s turbulent quest to cure mental illness by andrew scull.

There’s no history of schizophrenia without a history of psychiatry. And in Desperate Remedies , narrative medicine scholar Andrew Scull delivers a comprehensive history of the field of psychiatry. The author of the acclaimed history of mental illness, Madness in Civilization , Scull here has written an account of psychiatry that is equal parts readable, educational, rousing, fascinating, and challenging. Anyone who wants to learn more about schizophrenia within the context of the psychiatric field will want to pick this one up.

How to read it: Purchase Desperate Remedies on Amazon

The dialectical behavior therapy skills workbook for psychosis by maggie mullen, lcsw.

As a schizophrenic, I have always wished there were more therapy options for dealing with my illness, especially my psychosis symptoms. Sure, there’s medication, but how do you treat the condition outside meds? Enter The Dialectical Behavior Therapy Skills Workbook for Psychosis . Among the best books for schizophrenia patients, Maggie Mullen’s workbook fills the gap in therapy books about schizophrenia, offering the chance to develop skills of resilience, learn coping skills, and devise methods for dealing with psychosis outside medication. I love that this book is an interactive workbook you can go through at your own pace or with the assistance of a mental health professional. The Dialectical Behavior Therapy Skills Workbook for Psychosis is truly a beacon of hope in the treatment of psychosis.

How to read it: Purchase The Dialectical Behavior Therapy Skills Workbook for Psychosis on Amazon

Divided minds by pamela spiro wagner and carolyn s. spiro, m.d..

Many of the best books about schizophrenia are written by loved ones. That’s certainly the case with Divided Minds . Co-written by twin sisters Pamela Spiro Wagner and Carolyn S. Spiro, Divided Minds details the experience the two had while Pamela developed schizophrenia and Carolyn thrived. As Pamela’s condition deteriorated, Carolyn emerged as a medical student and, ultimately, a psychiatrist, but still the sisters remained close. Together and told in alternating voices, Pamela and Carolyn have written here a crucial book in the literature of memoirs about schizophrenia.

How to read it: Purchase Divided Minds on Amazon

The edge of every day by marin sardy.

If we’re talking about the best books about schizophrenia, Marin Sardy’s The Edge of Every Day definitely deserves a spot on that list. Sardy grew up with a schizophrenic mother in Anchorage, Alaska. Sardy’s mother refused treatment, leading to a challenging childhood for Sardy. Later, Sardy’s brother developed the same condition and ultimately died by suicide. In The Edge of Every Day, at the top of any list of the best schizophrenia books, Sardy collects her essays about the experience of being a loved one who bears witness to this untamable illness. Sardy’s voice is an important contribution to books about schizophrenia from the perspective of a family member.

How to read it: Purchase The Edge of Every Day on Amazon

Hidden valley road by robert kolker.

Robert Kolker’s Hidden Valley Road: Inside the Mind of an American Family was named one of the top five nonfiction books published in 2020 , and it’s not hard to see why. This engrossing read chronicles the devastating history of the Galvin family. Of their twelve children, six of Don and Mimi Galvin’s sons developed schizophrenia. What follows is a fascinating account of how the Galvins contributed to scientific research about the genetic nature of mental illness. The Galvins were among the first families that the National Institute of Mental Health studied. Although their lives were marked by the tragedy and hardship of mental illness, the Galvins persevered, and their history is presented in parallel with the evolving practices of psychiatry, psychotherapy, and psychopharmacology. This is definitely on the list of the best schizophrenia books.

How to read it: Purchase Hidden Valley Road on Amazon

A kind of mirraculas paradise  by sandy allen.

This interesting hybrid memoir deserves a spot on any list of the best books about schizophrenia. Sandy Allen’s eccentric Uncle Bob was allegedly “crazy” and had lived outside society in a series of mental institutions for parts of the ’60s and ’70s. But they didn’t really have a relationship. Until Uncle Bob sends Allen his autobiography in 2009, asking them to help bring it to publication. The result, A Kind of Mirraculas Paradise , is a hybrid memoir that includes Allen’s narrative and Uncle Bob’s autobiography as translated by Allen. This remarkable memoir is one of the most important schizophrenia books because it truly does tell Bob’s story to the world, an important record of narrative medicine about patient experiences.

How to read it: Purchase A Kind of Mirraculas Paradise on Amazon

Like crazy: life with my mother and her invisible friends by dan mathews.

When Dan Mathews watched his eccentric seventy-eight-year-old mother become unable to live independently, he crossed the country to stay with her in Virginia. While doing that, a trip to the emergency room reveals Mathews’ mother had lived her whole adult life as an undiagnosed schizophrenic. Uplifting and hopeful, count Like Crazy stands as ranking among the best memoirs about schizophrenia.

How to read it: Purchase Like Crazy on Amazon

Mind fixers: psychiatry’s troubled search for the biology of mental illness by anne harrington.

One of the ways we understand mental illness is through biology. But even biology has its limit in explaining how mental illness forms and how it gets treated. In Mind Fixers , Harvard history professor Anne Harrington explores the imperfect science of how psychiatry, neurology, and biology all fail to give us easy answers or even answer at all for the diagnosis and treatment of mental illness. Harrington dedicates a whole chapter to the complexities of the science behind schizophrenia. If you want to understand how to think about schizophrenia in biological terms, check out this book.

How to read it: Purchase Mind Fixers on Amazon

No one cares about crazy people by ron powers.

New York Times bestselling author Ron Powers delivers a searing indictment of the way the mentally ill are treated in America. The title of this book says it all: “No one cares about crazy people.” Powers has first-hand experience as his two sons both have schizophrenia. One died by suicide while the other lives but still struggles with his illness. While trying to be a good ally, Powers embarked on a journey down the mental health rabbit hole that ultimately lead to his realization of just how badly the system is stacked against the mentally ill and their loved ones. This is a challenging book to read because the results Powers finds are uneasy and unsettling, but this is book is a must have for anyone looking to understand schizophrenia.

How to read it: Purchase No One Cares About Crazy People on Amazon

The perfect other: a memoir of my sister by kyleigh leddy.

A newer title on this list of the best books about schizophrenia, The Perfect Other is a must read. Kait Leddy was overjoyed to have a younger sister, Kyleigh, the author of this memoir. But as Kait grew into an adolescent, cracks began to emerge: she was emotionally and physically volatile, her personality changed, and she began to lose her grip on reality. The result was a diagnosis of schizophrenia. Ultimately, Kyleigh lost her sister to schizophrenia. First, Kait went missing, and then she was seen on security cameras making her way to a bridge off which it’s concluded she jumped, though her body was never recovered. Memoirs about schizophrenia don’t get more raw and real than this.

How to read it: Purchase The Perfect Other on Amazon

The quiet room: a journey out of the torment of madness by lori schiller and amanda bennett.

The Quiet Room is a visceral reading experience as it relates Lori Schiller’s journey of madness. As an adolescent, Schiller had a seemingly perfect life. Six years later, she attempted suicide and then wandered the streets of New York speaking with invisible voices. And so began a lifelong battle with schizophrenia, one that took her through hospitals and half-way houses, while she struggled with co-morbid addiction. The Quiet Room is Schiller’s account of living with schizophrenia in a story that ends on a hopeful and uplifting note.

How to read it: Purchase The Quiet Room on Amazon

A road back from schizophrenia by arnhild lauveng.

Arnhild Lauveng’s captivating memoir A Road Back from Schizophrenia holds no punches and ranks among the best books about schizophrenia. In her autobiography, Lauveng offers a peek inside her experience with the illness, including the months or, in one case, a year inside psychiatric units and psychiatric hospitals, plus more about how it actually feels to have this condition. In zesty prose and unsparing detail, Lauveng offers a candid, honest look at living with schizophrenia.

How to read it: Purchase A Road Back from Schizophrenia on Amazon

Schizophrenia: a very short introduction by christopher frith and eve c. johnstone.

Schizophrenia is as complex as it is complicated. There’s a confusing set of symptoms that often lead to misdiagnosis, a host of conflicting medication and treatment options, and still many mysteries as the fields of medicine and science struggle to understand the origins and outcomes of schizophrenia. For an accessible, informative introduction on the disease, pick up Schizophrenia: A Very Short Introduction by Christopher Frith and Eve C. Johnstone, among the best books about schizophrenia. In barely more than 200 pages in a tiny book, the authors manage to demystify schizophrenia in this simple intro to this devastating mental illness.

How to read it: Purchase Schizophrenia: A Very Short Introduction on Amazon

Surviving schizophrenia: a family manual by e. fuller torrey, m.d..

Now in its seventh edition, Surviving Schizophrenia: A Family Manual remains one of the best books for schizophrenia patients. Understanding schizophrenia is easier when you have this book as your guide. For family members, allies, and loved ones, Surviving Schizophrenia helps those who care for a person with schizophrenia better comprehend the diagnosis, symptoms, and treatment of this oft-misunderstood illness. You’ll find this book covers topics like the causes of schizophrenia, the treatment of schizophrenia with meds and other options, and the onset, course, and prognosis of schizophrenia. Together, this book provides a roadmap through the stormy waters of schizophrenia and earns its stripes one of the great books about schizophrenia.

How to read it: Purchase Surviving Schizophrenia on Amazon

When the sun bursts: the enigma of schizophrenia by christopher bollas.

We’re ending this list of the best books about schizophrenia on a hopeful note. Acclaimed psychoanalyst Christopher Bollas argues that schizophrenia patients can be helped by gentler treatment than psychopharmacology, incarceration, dehumanization, and isolation that characterize so many schizophrenic experiences. Drawing on his fifty-year career, Bollas asserts that psychotherapy and, in particular, psychoanalysis, can help restore schizophrenic patients to stability. Given that this list of the best schizophrenia books has also featured cognitive therapy and dialectical behavioral therapy as treatment options, we have cause for hope that talk therapy and its variants can make a significant difference in the lives of those with schizophrenia and their family and loved ones.

How to read it: Purchase When the Sun Bursts on Amazon

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Schizophrenia: Cognitive Theory, Research, and Therapy 1st Edition

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From Aaron T. Beck and colleagues, this is the definitive work on the cognitive model of schizophrenia and its treatment. The volume integrates cognitive-behavioral and biological knowledge into a comprehensive conceptual framework. It examines the origins, development, and maintenance of key symptom areas: delusions, hallucinations, negative symptoms, and formal thought disorder. Treatment chapters then offer concrete guidance for addressing each type of symptom, complete with case examples and session outlines. Anyone who treats or studies serious mental illness will find a new level of understanding together with theoretically and empirically grounded clinical techniques.

• ISBN-10 1606230182
• ISBN-13 978-1606230183
• Edition 1st
• Publisher The Guilford Press
• Publication date October 29, 2008
• Language English
• Dimensions 6.5 x 1 x 9.25 inches
• Print length 418 pages
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Editorial Reviews

"This book represents a major advance in the application of cognitive theory and therapy. It is fitting that the founder of cognitive therapy is now pioneering its use with people with schizophrenia, who were once thought to be virtually untreatable. The authors provide a groundbreaking integration of neurobiological and cognitive-behavioral approaches to understanding the disorder and improving patients' lives. Unique contributions of the book include the descriptions of cognitive distortions and cognitive triads specific to schizophrenia and the development of cognitive models of thought disorder and negative symptoms, which have been neglected until now."--Tony Morrison, ClinPsyD, Professor of Clinical Psychology and Associate Director of Early Intervention, University of Manchester, UK

About the Author

Neal Stolar, MD-PhD, is a Medical Director and Director of the Cognitive Therapy for the Treatment of Psychosis Special Project at Project Transition in the Philadelphia area; a psychiatric consultant for Creative Health Services and Penn Behavioral Health; a researcher at the University of Pennsylvania’s Psychopathology Research Unit and Schizophrenia Research Center; and in private practice. Dr. Stolar is a Founding Fellow of the Academy of Cognitive and Behavioral Therapies. He has lectured internationally on cognitive therapy of schizophrenia.

Paul Grant, PhD, is Director of Schizophrenia Research and a Fellow in the Psychopathology Research Unit, Department of Psychiatry, University of Pennsylvania. Dr. Grant’s research interests include cognitive psychopathological models of positive and negative symptoms as well as cognitive therapy of schizophrenia. He is the author of several journal articles and book chapters.

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• Publisher ‏ : ‎ The Guilford Press; 1st edition (October 29, 2008)
• Language ‏ : ‎ English
• Hardcover ‏ : ‎ 418 pages
• ISBN-10 ‏ : ‎ 1606230182
• ISBN-13 ‏ : ‎ 978-1606230183
• Item Weight ‏ : ‎ 1.54 pounds
• Dimensions ‏ : ‎ 6.5 x 1 x 9.25 inches
• #791 in Schizophrenia (Books)
• #4,964 in Medical Psychology Pathologies
• #5,810 in Medical Clinical Psychology

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Aaron t. beck.

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Paul Grant, Ph.D., is the Director of Research, Innovation, and Practice at the Beck Institute Center for Recovery-Oriented Cognitive Therapy. He is the co-developer of CT-R, and has been given awards by The National Alliance on Mental Health and the University of Medicine and Dentistry, New Jersey. Grant is the lead author on the basic scientific studies supporting the theoretical framework of CT-R, as well as having developed and validated useful measures of motivation, apathy-interest, self-concept, and uncertainty tolerance. His ongoing studies investigate positive beliefs as the key mechanisms of change in CT-R, looking particularly at psychological and biological correlates of “best self” moments in people with serious mental health conditions. Grant is lead author on papers from a clinical trial validating CT-R and elucidating its mechanisms of change. With colleagues, he has created group, family, and milieu CT-R approaches. He is an investigator on funded studies to use group CT-R to produce improved supported employment outcomes and adding CT-R to acting training for ultra high-risk youth and first episode psychosis. Grant directs large projects implementing this evidence-based practice (CT-R) — in Philadelphia, Pennsylvania, New York, New Jersey, Georgia, Vermont, and Montana — across the continuity of care that involves all mental health disciplines. Training sites include long-term and short-term psychiatric hospitals (state civil and forensic facilities, extended-acute, acute, crisis center), programmatic residences (locked and unlocked, civil and forensic), community teams (fidelity and non-fidelity, mobile crisis, jail diversion), and individual plus group therapy providers (community and VA). He has developed innovative implementation tools, including a peer CT-R competency scale and service-wide fidelity scale, and is involved in measuring team-wide culture change as a mediator of successful CT-R outcomes. He is a coauthor of Guilford’s Schizophrenia: Cognitive Theory, Research and Therapy.

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New book helps citizen scientists navigate complexities of infectious disease outbreaks

by Georgetown University Medical Center

Citizen scientists have long contributed to the collection and observation of natural events—from weather watchers to wildlife trackers—with thousands of organized community projects spanning decades. Beginning in 2020, the COVID-19 pandemic gave rise to an explosion of novice infectious disease detectives, adding to the collection of science enthusiasts.

To give these new disease detectives more tools for their craft, a new book written by two Georgetown University global health researchers, "Outbreak Atlas," helps translate the complex interconnectedness of outbreak responses used by professionals across different fields, presenting accessible information that ensures a shared understanding of the essential activities to control an outbreak.

"We know there are thousands of people who have taken a keen interest in tracking outbreaks after living through the COVID-19 pandemic," explains co-author Rebecca Katz, Ph.D., MPH, director of the Georgetown University Center for Global Health Science and Security (GHSS). "We hope our book helps lift the curtain on what goes on behind the scenes in the management of an outbreak including topics such as preparedness, response and recovery."

The book translates the work of the Georgetown Outbreak Activity Library (GOAL), an interactive online tool for global health practitioners that Katz and Moore developed, that outlines what needs to be done, when, and by whom, throughout all phases of an outbreak—including preparedness, response, and recovery.

"GOAL helps guide professionals to be prepared for an outbreak and our book translates that information for a lay audience so they are empowered to be a part of this important work too," Katz says.

"More than 100 case studies and the visuals we've included in the book give real world examples of outbreak management," says co-author Mackenzie S. Moore, M.Sc., a scientist and global health researcher, a member of GHSS. "Outbreak Atlas contributes to the larger goal of increasing public health literacy in the general public. Successful outbreak response relies heavily on public support and community engagement , and we hope to equip citizen scientists with information that empowers them to make informed decisions that protect themselves, their friends, and their families.."

The book will be available for purchase at online retailers beginning April 15.

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Schizophrenia.

Manassa Hany ; Baryiah Rehman ; Yusra Azhar ; Jennifer Chapman .

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Last Update: March 20, 2023 .

• Continuing Education Activity

Schizophrenia is a psychotic disorder characterized by hallucinations, delusions, and disturbances in thought, perception, and behavior. Traditionally, schizophrenia may involve positive symptoms, such as hallucinations, delusions, formal thought disorders, and negative symptoms, such as paucity of speech, anhedonia, and lack of motivation. This activity outlines the evaluation of schizophrenia and explains the role of the interprofessional team in improving care for patients with this condition.

• Review the epidemiology of schizophrenia.
• Explain the characteristic features of schizophrenia.
• Review the management of schizophrenia.
• Summarize the importance of improving care coordination among the interprofessional team members to detect the positive and negative symptoms of the condition, which will enhance the delivery of care for those with schizophrenia.
• Introduction

Derived from the Greek 'schizo' (splitting) and 'phren' (mind) with the term first coined by Eugen Bleuler in 1908, schizophrenia is a functional psychotic disorder characterized by the presence of delusional beliefs, hallucinations, and disturbances in thought, perception, and behavior. Traditionally, symptoms have been divided into two main categories: positive symptoms, which include hallucinations, delusions, and formal thought disorders, and negative symptoms such as anhedonia, poverty of speech, and lack of motivation. The diagnosis of schizophrenia is clinical, made exclusively after obtaining a full psychiatric history and excluding other causes of psychosis. Risk factors include birthing complications, the season of birth, severe maternal malnutrition, maternal influenza in pregnancy, family history, childhood trauma, social isolation, cannabis use, minority ethnicity, and urbanization. [1] [2]  Due to its relative complexity and heterogeneity, the etiology and pathophysiological mechanisms are not fully understood. Despite a low prevalence, schizophrenia's global burden of disease is immense. Over half of the patients have significant co-morbidities, both psychiatric and medical, making it one of the leading causes of disability worldwide. [3]  The diagnosis correlates with a 20% reduction in life expectancy, with up to 40% of deaths attributed to suicide. [4]

Several studies postulate that the development of schizophrenia results from abnormalities in multiple neurotransmitters, such as dopaminergic, serotonergic, and alpha-adrenergic hyperactivity or glutaminergic and GABA hypoactivity. Genetics also plays a fundamental role - there is a 46% concordance rate in monozygotic twins and a 40% risk of developing schizophrenia if both parents are affected. The gene neuregulin (NGR1), which is involved in glutamate signaling and brain development, has been implicated, alongside dysbindin (DTNBP1), which helps glutamate release, and catecholamine O-methyl transferase (COMT) polymorphism, which regulates dopamine function.

As aforementioned, there are also several environmental factors associated with an enhanced risk of developing the disease:

• Abnormal fetal development and low birth weight
• Gestational diabetes
• Preeclampsia
• Emergency cesarean section and other birthing complications
• Maternal malnutrition and vitamin D deficiency
• Winter births - associated with a 10% higher relative risk
• Urban residence - increases the risk of developing schizophrenia by 2 to 4%

The incidence is also up to ten times greater in children of African and Caribbean migrants compared to whites, according to a study conducted in Britain. [1]  The association between cannabis use and psychosis has been widely studied, with recent longitudinal studies suggesting a 40% increased risk, while also suggesting a dose-effect relationship between the use of the drug and the risk of developing schizophrenia. [2]

• Epidemiology

Though the prevalence of the disease varies globally, estimates are that schizophrenia affects approximately 1% of adults, whereas prevalence in the United States is 0.6 to 1.9% [5] . Men are slightly more likely to be diagnosed and have an earlier onset than women, while African-Caribbean migrants and their descendants also have a higher incidence. [6]

• Pathophysiology

There are three main hypotheses regarding the development of schizophrenia. The neurochemical abnormality hypothesis argues that an imbalance of dopamine, serotonin, glutamate, and GABA results in the psychiatric manifestations of the disease. It postulates that four main dopaminergic pathways are involved in the development of schizophrenia. This dopamine hypothesis attributes the positive symptoms of the illness to excessive activation of D2 receptors via the mesolimbic pathway, while low levels of dopamine in the nigrostriatal pathway are theorized to cause motor symptoms through their effect on the extrapyramidal system. Low mesocortical dopamine levels resulting from the mesocortical pathway are thought to elicit the negative symptoms of the disease. Other symptoms such as amenorrhea and decreased libido may be caused by elevated prolactin levels due to decreased availability of tuberoinfundibular dopamine as a result of blockage of the tuberoinfundibular pathway. Evidence showing exacerbation of positive and negative symptoms in schizophrenia by NMDA receptor antagonists insinuates the potential role of glutaminergic hypoactivity while serotonergic hyperactivity has also been shown to play a role in schizophrenia development. [5]  

There are also arguments that schizophrenia is a neurodevelopmental disorder based on abnormalities present in the cerebral structure, an absence of gliosis suggesting in utero changes, and the observation that motor and cognitive impairments in patients precede the illness onset.

Conversely, the disconnect hypothesis focuses on the neuroanatomical changes seen in PET and fMRI scans. There is a reduction in grey matter volume in schizophrenia, present not only in the temporal lobe but in the parietal lobes as well. Differences in the frontal lobes and hippocampus are also seen, potentially contributing to a range of cognitive and memory impairments associated with the disease. 

• History and Physical

There are slight variations in the diagnostic criteria of schizophrenia depending on the classification system used.

Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5)  

Two or more of the following symptoms must be present for a significant portion of time during a one-month period:

• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms. 

There must also be social/occupational dysfunction, while signs of disturbance must persist for at least six months, including at least one month of symptoms.

International Classification of Diseases (ICD-10)

The patient must exhibit at least one of the following, for a period greater than or equal to a month:

• Thought insertion, echo, broadcast, or withdrawal
• Delusions of control, influence, or passivity
• Hallucinatory voices providing a running commentary of the patient
• Persistent delusions that are culturally inappropriate or implausible

Or, at least two of the following symptoms must be observed, for a period greater than or equal to a month [7] :

• Persistent hallucinations in any modality when accompanied by fleeting delusions
• Breaks of interpolations in thought resulting in incoherence or neologisms
• Catatonic behavior
• Negative symptoms
• Significant and consistent transformation in the overall quality of behavior manifesting as anhedonia and social withdrawal

Unlike DSM-5, ICD-10 further subcategories schizophrenia based on the key presenting symptoms as either paranoid schizophrenia, hebephrenic schizophrenia, catatonic schizophrenia, undifferentiated schizophrenia, post-schizophrenic depression, residual schizophrenia, and simple schizophrenia.  

 In addition to asking about these symptoms, it is also important to elicit:

• Past medical history, drug history, and family history
• Social history, including the use of recreational drugs and alcohol
• Any recent neurological impairments such as altered consciousness or memory problems, head injury, stroke, seizures, faints, dizzy spells, visual impairment, marked tremor, or muscle stiffness
• Potential organic causes of psychosis such as Parkinson's disease, multiple sclerosis, syphilis, AIDS, brain lesions, heavy metal toxicity, delirium, metabolic/endocrine disorders, and dementias including Alzheimer's disease, frontotemporal dementia, and Lewy body dementias

A thorough risk assessment must also be undertaken to determine the risk of harm to self and others. The first schizophrenic episode usually occurs during early adulthood or late adolescence. Individuals often lack insight at this stage; therefore, few will present directly to seek help for their psychotic symptoms. Common presentations include a relative noticing social withdrawal, personality changes, or uncharacteristic behavior; deliberate self-harm or suicide attempts; calling the police to report their delusional symptoms, or referral via the criminal justice system. The use of screening tools such as COPS (Criteria of Prodromal Syndromes), SIPS (Structured Interview for Prodromal Syndromes), and PACE (Personal Assessment and Crisis Evaluation Clinic) has been shown to increase the detection rate of schizophrenia in premorbid states although there is controversy surrounding indicating treatment at this stage.

After conducting a full psychiatric history, it is imperative to conduct a thorough systems review and a mental state examination where appearance, behavior, mood, speech, cognition, and insight need to be assessed, alongside determining evidence of perceptual delusions or formal thought disorders. Though schizophrenia is primarily a clinical diagnosis, specific laboratory and radiographic investigations are useful to exclude other potential causes:

• Urea and electrolytes - an electrolyte imbalance can cause delirium
• Serum calcium - hypoparathyroidism or hyperparathyroidism can, on occasion, have psychiatric manifestations
• Blood glucose - hypoglycemia can produce confusion which can be mistaken for psychosis
• Thyroid function tests - depression is associated with hypothyroidism and may present with psychotic features - severe hyperthyroidism also correlates with changes in mental state
• 24-hour cortisol collection - both hypercortisolism (Cushing syndrome) and adrenocortical insufficiency (Addison disease) can present with psychiatric symptoms
• 24 hour catecholamine/5-HIAA collection - in cases of suspected phaeochromocytoma/carcinoid syndrome
• Urinary toxicology screen - detection of recreational drugs such as cannabis
• CT head/MRI - in cases of significant neurological impairment or suspected neurological abnormality
• HIV/syphilis serology - both infections can cause psychiatric symptoms
• Treatment / Management

For the initial treatment of acute psychosis, it is recommended to start an oral second-generation antipsychotic (SGA) such as aripiprazole, olanzapine, risperidone, quetiapine, asenapine, lurasidone, sertindole, ziprasidone, brexpiprazole, molindone, iloperidone, etc. Sometimes, if clinically needed, alongside a benzodiazepine such as diazepam, clonazepam, or lorazepam to control behavioral disturbances and non-acute anxiety. First-generation antipsychotics (FGA) like trifluoperazine, fluphenazine, haloperidol, pimozide, sulpiride, flupentixol, chlorpromazine, etc., are not commonly used as the first line but can be used.

Once the acute phase is controlled, switching to a depot preparation like aripiprazole, paliperidone, zuclopenthixol, fluphenazine, haloperidol, pipotiazine, or risperidone is recommended as it increases medication adherence and compliance, improving outcomes and decreasing relapses.

Cognitive behavioral therapy (CBT) and the use of art and drama therapies help counteract the negative symptoms of the disease, improve insight, and assist relapse prevention.

Clozapine is used in case of treatment resistance - if there has been a poor response to at least two different antipsychotics, and require initial weekly blood tests for six months, biweekly for six months, and then every four weeks to monitor white blood cell count due to the risk of agranulocytosis.

Other options in treatment resistance include combining antipsychotics, adding lamotrigine, mirtazapine, donepezil, D-alanine, D-serine, estradiol, memantine, or allopurinol to an antipsychotic. The role of electroconvulsive therapy (ECT) is limited but has been used.

During the maintenance phase, prophylaxis and rehabilitation back into the community are vital priorities - and establishing the minimum necessary effective dose of antipsychotics should also take place during this period. Post-schizophrenic depression occurs in up to 30% of patients: if a dysphoric mood is evident, consider reducing the antipsychotic dose, treating with antidepressants or anxiolytics, or switching to a second-generation antipsychotic. There is significant substance abuse amongst patients with schizophrenia which can exacerbate both positive and negative symptoms; therefore, psychosocial and pharma therapeutic approaches should be used to treat the misuse. Clozapine may be given in patients with extensive, persisting substance misuse. 

The treatment of those identified as at risk of developing a psychotic disorder is controversial. Treatment of co-existing disorders and with individual CBT and family intervention is advocated, although no long-term evidence exists regarding its efficacy in preventing a psychotic episode or reducing its severity.

• Differential Diagnosis

As psychotic features can manifest in various other mental disorders, there are wide-ranging differentials for schizophrenia, including but not limited to:

• Substance-induced psychotic disorder
• Mood disorders with psychotic features
• Sleep-related disorders
• Delusional disorder
• Paranoid personality disorder
• Schizotypal personality disorder
• Pervasive developmental disorder
• Psychosis secondary to organic causes
• Toxicity and Adverse Effect Management

Antipsychotic side effects subdivide into five categories.

Extrapyramidal

• Tardive dyskinesia: though symptoms are irreversible, vitamin E has been shown to prevent further deterioration
• Parkinsonism: bradykinesia, tremors, and rigidity can occur a week after administration - can be managed via a reduction in dose or the use of an antimuscarinic such as oral benztropine 
• Akathisia: can occur after a month of antipsychotic use and treated using propranolol and benzodiazepines
• Acute dystonia: managed via a parenteral muscarinic such as benztropine administered intravenously or intramuscularly 

Anticholinergic

• Dry mouth; urinary retention; blurred vision; glaucoma; constipation

Anti-adrenergic

• Sexual dysfunction; tachycardia; postural hypotension

Antihistaminic

• Weight gain, sedation; All patients should be advised to increase their physical activity and monitor their dietary intake.

Idiosyncratic

• Altered glucose tolerance, skin photosensitivity, cholestatic jaundice, hypersensitivity reactions, yellow pigmentation of the skin, neuroleptic malignant syndrome; The neuroleptic malignant syndrome may be fatal and is characterized by increasing rigidity, pyrexia, and fluctuating consciousness - the patient should receive immediate medical care.

Recent efficacy studies such as Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and European First-Episode Schizophrenia Trials (EUFEST) found no significant difference between the first-generation antipsychotics such as haloperidol and newer second-generation antipsychotics such as olanzapine and risperidone. [8]  However, SGAs have far fewer extrapyramidal side effects than their FGA counterparts; therefore, they may be preferentially used.

In schizophrenia, the prognosis is dependent on several factors. Insidious onset, childhood or adolescent onset, poor premorbid adjustment, and cognitive impairment are indicative of a poor prognostic outcome, whereas acute onset, female sex, and living in a developed country signal comparatively better prognostic factors. However, suicide is the most common cause of premature death in schizophrenia, with two-thirds of patients reporting at least one episode of suicidal ideation. [9]

• Complications

Treatment-resistant schizophrenia is when the condition fails to respond to at least two antipsychotic medications for at least six weeks; up to 30% of patients with schizophrenia respond poorly to antipsychotics, and around 7% show no response. Clozapine is the therapeutic option in such instances.

• Deterrence and Patient Education

A significant percentage of patients with schizophrenia die from cardiovascular disease. [10] Educating patients on the importance of modifying risk factors such as increasing exercise, healthier diets, and smoking cessation will decrease their risk of cardiovascular problems and reduce the mortality rate. Moreover, cognitive behavioral therapy has been shown to improve patient compliance and decrease future hospital admissions.

• Enhancing Healthcare Team Outcomes

Alongside educating patients about the importance of making healthy lifestyle choices, it is also imperative that the physicians, nurses, and other allied health professionals work together as an interprofessional team in diligently monitoring patients while admitted. Patients on clozapine need to have their WBC measured regularly as they are at risk of agranulocytosis, while a risk assessment should be carried out on all new patients to evaluate their risk of harm to self or others. Outside of the hospital setting, community psychiatric nurses and family physicians can also educate the patient and provide further information while also monitoring for early signs of relapse. 

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Disclosure: Manassa Hany declares no relevant financial relationships with ineligible companies.

Disclosure: Baryiah Rehman declares no relevant financial relationships with ineligible companies.

Disclosure: Yusra Azhar declares no relevant financial relationships with ineligible companies.

Disclosure: Jennifer Chapman declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Hany M, Rehman B, Azhar Y, et al. Schizophrenia. [Updated 2023 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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