Schizophrenia
File(s)
Accepted version
Author(s)
Jauhar, Sameer
Johnstone, Mandy
McKenna, Peter J
Type
Journal Article
Abstract
Schizophrenia, characterised by psychotic symptoms and in many cases social and occupational decline, remains an aetiological and therapeutic challenge. Contrary to popular belief, the disorder is modestly more common in men than in women. Nor is the outcome uniformly poor. A division of symptoms into positive, negative, and disorganisation syndromes is supported by factor analysis. Catatonic symptoms are not specific to schizophrenia and so-called first rank symptoms are no longer considered diagnostically important. Cognitive impairment is now recognised as a further clinical feature of the disorder. Lateral ventricular enlargement and brain volume reductions of around 2% are established findings. Brain functional changes occur in different subregions of the frontal cortex and might ultimately be understandable in terms of disturbed interaction among large-scale brain networks. Neurochemical disturbance, involving dopamine function and glutamatergic N-methyl-D-aspartate receptor function, is supported by indirect and direct evidence. The genetic contribution to schizophrenia is now recognised to be largely polygenic. Birth and early life factors also have an important aetiological role. The mainstay of treatment remains dopamine receptor-blocking drugs; a psychological intervention, cognitive behavioural therapy, has relatively small effects on symptoms. The idea that schizophrenia is better regarded as the extreme end of a continuum of psychotic symptoms is currently influential. Other areas of debate include cannabis and childhood adversity as causative factors, whether there is progressive brain change after onset, and the long-term success of early intervention initiatives.
Date Issued
2022-01-29
Date Acceptance
2022-01-01
Citation
The Lancet, 2022, 399 (10323), pp.473-486
ISSN
0140-6736
Publisher
Elsevier
Start Page
473
End Page
486
Journal / Book Title
The Lancet
Volume
399
Issue
10323
Copyright Statement
Copyright © Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/35093231
PII: S0140-6736(21)01730-X
Subjects
BRAIN VOLUMES
DEFAULT MODE NETWORK
DORSOLATERAL PREFRONTAL CORTEX
DOUBLE-BLIND
General & Internal Medicine
HIGH-RISK
Life Sciences & Biomedicine
Medicine, General & Internal
NEGATIVE SYMPTOMS
POSITIVE SYMPTOMS
QUANTITATIVE METAANALYSIS
REPORTED PSYCHOTIC SYMPTOMS
Science & Technology
TASK-INDUCED DEACTIVATION
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2022-01-28