
Contents
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Introduction Introduction
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Clinical features Clinical features
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The acute syndrome The acute syndrome
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The chronic syndrome The chronic syndrome
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Subtypes of schizophrenia Subtypes of schizophrenia
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Type I and type II schizophrenia Type I and type II schizophrenia
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Three clinical sub-syndromes Three clinical sub-syndromes
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Other aspects of the clinical syndrome Other aspects of the clinical syndrome
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Cognitive features Cognitive features
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Depressive symptoms Depressive symptoms
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Neurological signs Neurological signs
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Olfactory dysfunction Olfactory dysfunction
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Water intoxication Water intoxication
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Pain insensitivity Pain insensitivity
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Factors that modify the clinical features Factors that modify the clinical features
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The prodrome of schizophrenia The prodrome of schizophrenia
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Diagnosis and classification Diagnosis and classification
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Historical development of ideas about schizophrenia Historical development of ideas about schizophrenia
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Classification of schizophrenia in DSM-IV and ICD-10 Classification of schizophrenia in DSM-IV and ICD-10
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DSM-IV DSM-IV
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ICD-10 ICD-10
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Summary of the differences between DSM-IV and ICD-10 Summary of the differences between DSM-IV and ICD-10
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Schizophrenia-like disorders Schizophrenia-like disorders
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Brief disorders Brief disorders
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Schizophrenia-like disorders with prominent affective symptoms Schizophrenia-like disorders with prominent affective symptoms
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Persistent disorders without all of the required symptoms for schizophrenia Persistent disorders without all of the required symptoms for schizophrenia
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Comorbidity Comorbidity
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Differential diagnosis Differential diagnosis
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Epidemiology Epidemiology
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Aetiology Aetiology
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Genetics Genetics
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Family studies Family studies
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Twin studies Twin studies
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Adoption studies Adoption studies
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The mode of inheritance The mode of inheritance
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What is heritable? What is heritable?
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Schizophrenia susceptibility genes Schizophrenia susceptibility genes
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Crow's lateralization hypothesis Crow's lateralization hypothesis
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The biology of schizophrenia genes The biology of schizophrenia genes
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Environmental risk factors Environmental risk factors
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Obstetric complications Obstetric complications
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Maternal influenza and other infections Maternal influenza and other infections
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Maternal malnutrition Maternal malnutrition
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Winter birth Winter birth
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Paternal age Paternal age
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Child development Child development
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Substance use Substance use
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Other risk factors Other risk factors
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Neurobiology Neurobiology
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Structural brain changes Structural brain changes
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Structural imaging Structural imaging
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Neuropathology Neuropathology
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Functional brain imaging Functional brain imaging
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Cerebral blood flow Cerebral blood flow
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BOLD signal on fMRI BOLD signal on fMRI
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Neurophysiological findings Neurophysiological findings
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Electroencephalography Electroencephalography
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Sensory evoked potentials: P300 and P50 Sensory evoked potentials: P300 and P50
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Eye tracking Eye tracking
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Neurochemical findings Neurochemical findings
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Dopamine Dopamine
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Glutamate Glutamate
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Gamma-aminobutyric acid (GABA) Gamma-aminobutyric acid (GABA)
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Serotonin (5-HT) Serotonin (5-HT)
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Social and psychosocial factors Social and psychosocial factors
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Psychological factors Psychological factors
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Current aetiological hypotheses about schizophrenia Current aetiological hypotheses about schizophrenia
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Course and prognosis Course and prognosis
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Treatment Treatment
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Pharmacological treatments Pharmacological treatments
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Acute schizophrenia Acute schizophrenia
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Treatment after the acute phase Treatment after the acute phase
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Differences between antipsychotic drugs Differences between antipsychotic drugs
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Treatment-resistant schizophrenia Treatment-resistant schizophrenia
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Antidepressants and mood stabilizers Antidepressants and mood stabilizers
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Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT)
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Psychosocial approaches Psychosocial approaches
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Family therapy Family therapy
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Cognitive–behaviour therapy Cognitive–behaviour therapy
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Social skills training and illness self-management Social skills training and illness self-management
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Treatment of cognitive impairments Treatment of cognitive impairments
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Dynamic psychotherapy Dynamic psychotherapy
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Interaction of drug and psychosocial treatments Interaction of drug and psychosocial treatments
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Management Management
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Other aspects of management Other aspects of management
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Care plans and the Care Programme Approach Care plans and the Care Programme Approach
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Early intervention Early intervention
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Substance misuse Substance misuse
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The violent patient The violent patient
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Suicide risk Suicide risk
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Discussing schizophrenia with patients and their carers Discussing schizophrenia with patients and their carers
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Further reading Further reading
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Cite
Abstract
Chapter 11 discusses how, of all the major psychiatric syndromes, schizophrenia is the most difficult to define and describe. This partly reflects the fact that, over the past 100 years, widely divergent concepts have been held in different countries and by different psychiatrists. Although there is now a greater consensus, substantial uncertainties remain. Indeed, schizophrenia remains the best example of the fundamental issues with which psychiatry continues to grapple—concepts of disease, classification, and aetiology. Having noted the complexities, we start with an introduction to acute schizophrenia and chronic schizophrenia. The reader should bear in mind that these will be idealized descriptions and comparisons, but it is useful to oversimplify at first before introducing the controversial issues.
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