Schizophrenia

Disease Description (Causes and Symptoms)

• Definition and age of onset: A chronic mental disorder that usually begins in the late teens to 20s, characterized by a weakened ability to distinguish reality from unreality. The prevalence is approximately 1%, and is generally similar between men and women, although men tend to develop it somewhat earlier.
• Main pathophysiology (summary): It appears to be a brain disorder in which genetic predisposition and environmental factors interact. Abnormal dopamine regulation (the dopamine hypothesis) has been proposed as a key factor, while abnormalities in other neurotransmitters and neural circuits, such as serotonin, as well as neurodevelopmental and structural changes, are also involved in combination. A family history increases the risk of onset (approximately 1% in the general population → approximately 5–10% when one parent or sibling has the disorder, and it may increase to approximately 40% when both parents have the disorder).
• Main symptoms (positive, negative, and cognitive symptoms)
  • Positive symptoms: Delusions (persecutory, grandiose, referential, religious, and other delusions), sensory and perceptual disturbances such as auditory hallucinations, disorganized thoughts and speech, and abnormal behavior
  • Negative symptoms: Avolition (reduced motivation), blunted affect and lack of facial expression, social withdrawal, and reduced speech
  • Cognitive symptoms: Reduced concentration, memory, planning, and problem-solving abilities
  • Other: Possible increase in inappropriate emotional expression and the risk of self-harm or harm to others
• Diagnostic overview: A psychiatrist takes a medical history and performs a mental status examination (family history and information about pathological changes are important). Blood tests, brain imaging (CT/MRI), EEG, and other tests may be performed to distinguish physical illnesses, medications, and underlying brain disorders.

Treatment Methods

• Pharmacological treatment (basic)
  • Antipsychotics are the main treatment: typical (first-generation: haloperidol, etc.) and atypical (second-generation: risperidone, olanzapine, quetiapine, aripiprazole, etc.). They are effective in suppressing acute hallucinations and delusions and are important for preventing relapse.
  • Long-acting injectable (LAI) medications: Useful for preventing relapse when medication adherence is low.
  • Side-effect management: Extrapyramidal symptoms (movement disorders), tardive problems (tardive dyskinesia), metabolic abnormalities (weight gain, hyperglycemia, and lipid abnormalities), sedation, sexual dysfunction, and others—regular monitoring is necessary.
• Psychosocial treatment
  • Individual psychotherapy (psychoeducation, cognitive behavioral therapy for psychosis (CBTp), etc.), family therapy (reducing relapse rates and strengthening support systems), group therapy, social skills training, vocational rehabilitation, housing support, and others.
  • The goal is functional recovery through community-based rehabilitation (day hospitals, supported employment, housing support, and others).
• Management of acute and severe phases
  • Hospitalization: For confirming the diagnosis, stabilizing medications, preventing self-harm or harm to others, and providing basic living support.
  • Electroconvulsive therapy (ECT): Considered in some situations, such as treatment resistance or catatonia.
• Follow-up and lifestyle management
  • Continue taking medications (to prevent relapse), abstain from alcohol and drugs (especially cannabis, smoking, and sympathomimetic stimulants, which may worsen symptoms), and maintain regular sleep, nutrition, and exercise while managing stress.
  • Regular physical examinations (weight and blood pressure), blood glucose and lipid tests, and, when necessary, monitoring such as electrocardiography.
• Complication management and emergency response
  • Assess and manage suicide risk; adjust or replace medications in cases of severe movement-related side effects; consider additional medication or hospitalization in cases of acute psychosis.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items and information to prepare
  • A list of all medications currently being taken (including prescription drugs, OTC medications, supplements, and alternative therapies), along with dosages and administration times
  • Past medical and surgical history, and family history (whether there is a history of mental illness)
  • Copies of recent hospital test results (blood tests, brain imaging, electrocardiography, and others) or related records
  • A record of symptom changes (when they began, in what situations, and their frequency and intensity), including examples of the content of auditory hallucinations and delusions
  • Sleep patterns, changes in meals and weight, medication adherence, and symptoms suspected to be medication side effects
  • Whether any medications, alcohol, or cannabis have been used recently, and the amounts
• Points to note during an outpatient visit
  • If possible, bring a caregiver or family member: This can help with obtaining an objective medical history
  • Immediately inform the doctor if there are thoughts of self-harm or harming others
• Examples of materials to show the doctor during an outpatient visit
  • A symptom diary (for the past 2–4 weeks), weight and blood glucose measurements (if available), and a list of medications being taken

Examples of General Questions to Ask the Doctor

• What are the main side effects of this medication (or combination)? How should I respond if side effects occur?
• How much does the risk of relapse increase if the medication is stopped? What is the long-term medication plan?
• How should weight, blood glucose, and cholesterol be managed? How often should tests be performed?
• What restrictions, if any, apply to daily activities (driving, employment, and education)?
• Whom should I contact in an emergency (such as severe auditory hallucinations or urges to self-harm)?

Examples of Condition-Specific Questions

• When the content of auditory hallucinations or delusions repeatedly occurs (for example, a specific voice gives commands), should the medication be changed immediately, or should monitoring and other nonpharmacological interventions be tried first?
• Do you recommend a long-acting injectable (LAI) medication to prevent relapse? What are the advantages and disadvantages of an LAI, and what side effects can be expected?

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Note: This summary is intended to provide general clinical information. Individual treatment and diagnosis should be determined through direct consultation with a mental health specialist.