Schizophrenia

A recent BMJ article provided an update on schizophrenia. This condition seems to be slowly moving on.
More is known now about its aetiology compared to what was known when I was trained as an undergraduate. Excess dopamine activity in the mesolimbic system is acknowledged to be a key part of the neurochemical changes in schizophrenia, with one theory holding that dopamine has a role in "salience" and that the excesses can increase the salience of mundane things, turning a glance from a stranger to a glare with malevolent thoughts. Lifetime risk of the disease is 1% in the population but 6.5% in those with first degree relatives and 40% in monozygotic twins of affected individuals. Environmental factors play a role, people born following a complicated obstetric history, those of low birth weight, migrants, people who are socially isolated and city dwellers are all more likely to develop the condition. Misuse of cannabis, lsd and amphetamine are all associated with the condition.
Diagnostic criteria seem to me to be similar to what they were in the mid 1980's.

At least one present most of the time for a month:

• Thought echo, insertion or withdrawal, or thought broadcast
• Delusions of control referred to body parts, actions, or sensations
• Delusional perception
• Hallucinatory voices giving a running commentary, discussing the patient, or coming from some part of the patient's body
• Persistent bizarre or culturally inappropriate delusions
  

Or at least two present most of the time for a month

• Persistent daily hallucinations accompanied by delusions
• Incoherent or irrelevant speech
• Catatonic behaviour such as stupor or posturing
• Negative symptoms such as marked apathy, blunted or incongruous mood

Here are some suggested screening questions:

• Do you hear voices when no one is around? What do they say?
• Do you ever think that people are talking or gossiping about you, maybe even thinking about trying to get you?
• Do you ever think that somehow people can pick up on what you are thinking or can manipulate what you are thinking?

Treatments have evolved with an emphasis on early treatment and the use of atypical antipsychotic agents. Clozapine remains a useful option for resistent patients but requires monitoring because of the (<1%)>