Data from a PET study25 suggests the less the frontal lobes activated (red) during a working memory task, the greater the increase in abnormal dopamine activity in the striatum (green), thought to be related to the neurocognitive deficits in schizophrenia.Actress Clara Bow was diagnosed with schizophrenia in 1949.
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Schizophrenia

Schizophrenia is a severe mental illness characterized by persistent defects in the perception or expression of reality. A person experiencing untreated schizophrenia typically demonstrates grossly disorganized thinking, and may also experience delusions or auditory hallucinations. more...

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Although the illness primarily affects cognition, it can also contribute to chronic problems with behavior or emotions. Due to the many possible combinations of symptoms, it is difficult to say whether it is in fact a single psychiatric disorder; and Eugen Bleuler deliberately called the disease "the schizophrenias" (plural) when he coined the present name.

Diagnosis is based on the self-reported experiences of the patient, in combination with secondary signs observed by a psychiatrist or other competent clinician such as a doctor of psychology. There is no objective biological test for schizophrenia, though studies suggest that genetics and biochemistry are important contributing factors. Current research into the development of the disorder often focuses on the role of neurobiology, although a reliable and identifiable organic cause has not been found. In the absence of objective laboratory tests to confirm the diagnosis, some question the legitimacy of schizophrenia's status as a disease.

The term "schizophrenia" translates roughly as "shattered mind," and comes from the Greek σχίζω (schizo, "to split" or "to divide") and φρήν (phrēn, "mind"). Despite its etymology, schizophrenia is not synonymous with dissociative identity disorder, also known as multiple personality disorder or "split personality"; in popular culture the two are often confused. Although schizophrenia often leads to social or occupational dysfunction, there is little association of the illness with a predisposition toward aggressive behavior.

Overview

Schizophrenia is often described in terms of "positive" and "negative" symptoms. Positive symptoms include delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. Negative symptoms are so named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation. Some models of schizophrenia include formal thought disorder and planning difficulties in a third group, a "disorganization syndrome."

Additionally, neurocognitive deficits may be present. These may take the form of reduced or impaired psychological functions such as memory, attention, problem-solving, executive function or social cognition.

Onset of schizophrenia typically occurs in late adolescence or early adulthood, with males tending to show symptoms earlier than females.

Psychiatrist Emil Kraepelin was the first to draw a distinction between what he termed dementia praecox ("premature dementia") and other psychotic illnesses. In 1911, "dementia praecox" was renamed "schizophrenia" by psychiatrist Eugen Bleuler, who found Kraepelin's term to be misleading, as the disorder is not a form of dementia, premature or otherwise.

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Flu, fetuses, and schizophrenia
From Environmental Health Perspectives, 12/1/04 by Julie Wakefield

Pregnant women who contract the flu may increase the risk that their child will develop schizophrenia later in life, according to a recent addition to a growing body of research along these lines. The study, published in the August 2004 Archives of General Psychiatry, "is not definitive but is the strongest evidence thus far that a prenatal virus may be a risk factor [for schizophrenia]," says lead investigator Ezra Susser, head of epidemiology at Columbia University's Mailman School of Public Health.

"Influenza infection during pregnancy appears to be a risk factor," agrees Johns Hopkins University neurovirologist Robert Yolken, who adds it is probably one of many risk factors for developing schizophrenia. The severe mental illness, which usually revolves delusions, hallucinations, and disordered thinking, affects about 1% of the U.S. population. The Mailman team's work is part of a larger study designed to examine prenatal infection and such factors as father's age and prenatal exposure to chemicals in influencing schizophrenia in adulthood.

The Mailman team looked for influenza antibody in archived blood samples from 64 women whose children developed schizophrenia as adults and a control group of 125 women whose children did not develop the disorder. The samples were collected as part of the Child Health and Development Study, which collected blood samples from more than 12,000 mothers of children born between 1959 and 1967 and followed the children's development into adulthood.

The risk of schizophrenia was tripled when the mother had the flu during the first half of pregnancy and increased sevenfold if exposure occurred in the first trimester. The overall risk is small, however. The findings suggest that about 97% of children born to women who got the flu while pregnant will not develop schizophrenia.

Although researchers do not know the mechanism of action, the Mailman team speculates that antibodies released by the mother's immune system may affect the developing brain. But direct effects from the flu virus are also possible.

Researchers believe schizophrenia may result from a combination of genetic and environmental factors, including complications during delivery and exposure to the herpes simplex virus type 2 and to rubella virus during pregnancy. "It may not be just one virus," Yolken says. "And [the key environmental factor] may vary from population to population, as genetic factors likely play a role." Moreover, different strains of herpes or flu viruses may play greater or lesser roles.

Until more study is completed, the Mailman team still advocates that pregnant women get the flu shot. Susser says, "The very safest thing would be to get vaccinated against the flu virus before becoming pregnant."

COPYRIGHT 2004 National Institute of Environmental Health Sciences
COPYRIGHT 2005 Gale Group

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