Schizophrenia and Other Psychotic Disorders

Schizophrenia is a chronic, debilitating psychotic disorder that affects 1% of adults. Symptoms of the illness are highly variable from person to person but typically include “positive” symptoms (delusions, hallucinations, thought disorganization), “negative” symptoms (blunted affect, social dysfunction, lack of motivation), cognitive impairments, and mood disturbance. Recurrence of active psychosis, progression of symptoms, and deterioration in all areas of life function are the rule. Given the combination of onset in early adulthood and persistent dysfunction, schizophrenia incurs enormous financial and personal costs. The biological basis of the disorder is not clear but is known to include genetic, environmental, and developmental factors. Recent research findings underscore the importance of dopamine systems and maturational changes in the brain. Treatment includes psychosocial interventions to address social deficits, family issues, and functional impairments and medication treatment to control symptoms. Atypical antipsychotic medications are used as first-line pharmacotherapy; clozapine is used for patients with treatment-refractory illness, and depot conventional antipsychotics are used for responsive but noncompliant patients. Optimal treatment is provided in community-based centers with expertise in the disorder. Ensuring adequate support for such treatment, however, is a continuing challenge.