Schizophrenia
 

National Institute of Mental Health 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • National Institutes of Health 
Contents 

What is schizophrenia? ........................................................................... 1
 

What are the symptoms of schizophrenia? ........................................... 2
 

Positive symptoms ...............................................................................2
 

Negative symptoms..............................................................................3
 

Cognitive symptoms.............................................................................4
 

When does schizophrenia start and who gets it? ................................. 4
 

Are people with schizophrenia violent? ................................................. 5
 

What about substance abuse? ................................................................ 5
 

What causes schizophrenia? .................................................................. 6
 

How is schizophrenia treated?................................................................ 8
 

Antipsychotic medications .................................................................8
 

Psychosocial treatments ...................................................................11
 

How can you help a person with schizophrenia? .................................14
 

What is the outlook for the future?........................................................15
 

Citations ...................................................................................................16
 

For more information on schizophrenia ................................................18
 
National Institute of Mental Health 

Schizophrenia 

What is schizophrenia? 

Schizophrenia is a chronic, severe, and disabling brain disorder that 

has affected people throughout history. About 1 percent of Americans 

have this illness.1 

People with the disorder may hear voices other people don’t hear. They 

may believe other people are reading their minds, controlling their 

thoughts, or plotting to harm them. This can terrify people with the 

illness and make them withdrawn or extremely agitated. 

People with schizophrenia may not make sense when they talk. They 

may sit for hours without moving or talking. Sometimes people with 

schizophrenia seem perfectly fine until they talk about what they are 

really thinking. 

Families and society are affected by schizophrenia too. Many 

people with schizophrenia have difficulty holding a job or caring for 

themselves, so they rely on others for help. 

Treatment helps relieve many symptoms of schizophrenia, but most 

people who have the disorder cope with symptoms throughout their 

lives. However, many people with schizophrenia can lead rewarding 

and meaningful lives in their communities. Researchers are developing 

more effective medications and using new research tools to understand 

the causes of schizophrenia. In the years to come, this work may help 

prevent and better treat the illness. 
2 NATIONAL INSTITUTE OF MENTAL HEALTH 

What are the symptoms of 

schizophrenia? 

The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive 

symptoms. 

Positive symptoms 

Positive symptoms are psychotic behaviors not seen in 

healthy people. People with positive symptoms often “lose 

touch” with reality. These symptoms can come and go. 

Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving 

treatment. They include the following: 

Hallucinations are things a person sees, hears, smells, or feels 

that no one else can see, hear, smell, or feel. “Voices” are the 

most common type of hallucination in schizophrenia. Many 

people with the disorder hear voices. The voices may talk to 

the person about his or her behavior, order the person to do 

things, or warn the person of danger. Sometimes the voices 

talk to each other. People with schizophrenia may hear voices 

for a long time before family and friends notice the problem. 

Other types of hallucinations include seeing people or objects 

that are not there, smelling odors that no one else detects, and 

feeling things like invisible fingers touching their bodies when 

no one is near. 

Delusions are false beliefs that are not part of the person’s 

culture and do not change. The person believes delusions 

even after other people prove that the beliefs are not true or 

logical. People with schizophrenia can have delusions that 

seem bizarre, such as believing that neighbors can control 

their behavior with magnetic waves. They may also believe 

that people on television are directing special messages to 

them, or that radio stations are broadcasting their thoughts 

aloud to others. Sometimes they believe they are someone 

else, such as a famous historical figure. They may have paranoid delusions and believe that others are trying to harm 

them, such as by cheating, harassing, poisoning, spying on, 

or plotting against them or the people they care about. These 

beliefs are called “delusions of persecution.” 
●	 

●	 

●	 

●	 

SCHIZOPHRENIA 3 

“Voices” 

ARE THE MOST 

COMMON TYPE OF 

HALLUCINATION IN 

SCHIZOPHRENIA. 

Thought disorders are unusual or dysfunctional ways 

of thinking. One form of thought disorder is called “disorganized thinking.” This is when a person has trouble 

organizing his or her thoughts or connecting them logically. 

They may talk in a garbled way that is hard to understand. 

Another form is called “thought blocking.” This is when a 

person stops speaking abruptly in the middle of a thought. 

When asked why he or she stopped talking, the person may 

say that it felt as if the thought had been taken out of his or 

her head. Finally, a person with a thought disorder might 

make up meaningless words, or “neologisms.” 

Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat 

certain motions over and over. In the other extreme, a 

person may become catatonic. Catatonia is a state in which 

a person does not move and does not respond to others. 

Catatonia is rare today, but it was more common when 

treatment for schizophrenia was not available.2 

Negative symptoms 

Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder 

to recognize as part of the disorder and can be mistaken for 

depression or other conditions. These symptoms include the 

following: 

“Flat affect” (a person’s face does not move or he or she 

talks in a dull or monotonous voice) 

Lack of pleasure in everyday life 

Lack of ability to begin and sustain planned activities 

Speaking little, even when forced to interact. 

People with negative symptoms need help with everyday 

tasks. They often neglect basic personal hygiene. This may 

make them seem lazy or unwilling to help themselves, but 

the problems are symptoms caused by the schizophrenia. 
 

●	 

●	 

●	 

4 NATIONAL INSTITUTE OF MENTAL HEALTH 

Cognitive symptoms 

Cognitive symptoms are subtle. Like negative symptoms, 

cognitive symptoms may be difficult to recognize as part of 

the disorder. Often, they are detected only when other tests 

are performed. Cognitive symptoms include the following: 

Poor “executive functioning” (the ability to understand 

information and use it to make decisions) 

Trouble focusing or paying attention 

Problems with “working memory” (the ability to use 

information immediately after learning it). 

Cognitive symptoms often make it hard to lead a normal life 

and earn a living. They can cause great emotional distress. 

When does schizophrenia start and 

who gets it? 

Schizophrenia affects men and women equally. It occurs 

at similar rates in all ethnic groups around the world. 

Symptoms such as hallucinations and delusions usually start 

between ages 16 and 30. Men tend to experience symptoms 

a little earlier than women. Most of the time, people do not 

get schizophrenia after age 45.3

 Schizophrenia rarely occurs 

in children, but awareness of childhood-onset schizophrenia 

is increasing.4,5 

It can be difficult to diagnose schizophrenia in teens. This is 

because the first signs can include a change of friends, a drop 

in grades, sleep problems, and irritability—behaviors that are 

common among teens. A combination of factors can predict 

schizophrenia in up to 80 percent of youth who are at high 

risk of developing the illness. These factors include isolating 

oneself and withdrawing from others, an increase in unusual 

thoughts and suspicions, and a family history of psychosis.6 

In young people who develop the disease, this stage of the 

disorder is called the “prodromal” period. 
SCHIZOPHRENIA 5 

Are people with schizophrenia 

violent? 

People with schizophrenia are not usually violent. In fact, 

most violent crimes are not committed by people with 

schizophrenia.7

 However, some symptoms are associated 

with violence, such as delusions of persecution. Substance 

abuse may also increase the chance a person will become 

violent.8

 If a person with schizophrenia becomes violent, 

the violence is usually directed at family members and tends 

to take place at home. 

The risk of violence among people with schizophrenia is 

small. But people with the illness attempt suicide much 

more often than others. About 10 percent (especially young 

adult males) die by suicide.9,10 It is hard to predict which 

people with schizophrenia are prone to suicide. If you 

know someone who talks about or attempts suicide, help 

People him or her find professional help right away. WITH
 

SCHIZOPHRENIA
 

ARE NOT USUALLY 

VIOLENT. 

What about substance abuse? 

Some people who abuse drugs show symptoms similar to 

those of schizophrenia. Therefore, people with schizophrenia may be mistaken for people who are affected by drugs. 

Most researchers do not believe that substance abuse causes 

schizophrenia. However, people who have schizophrenia are 

much more likely to have a substance or alcohol abuse problem than the general population.11 

Substance abuse can make treatment for schizophrenia less 

effective. Some drugs, like marijuana and stimulants such 

as amphetamines or cocaine, may make symptoms worse. 

In fact, research has found increasing evidence of a link 

between marijuana and schizophrenia symptoms.12,13 In addition, people who abuse drugs are less likely to follow their 

treatment plan. 

Schizophrenia and smoking 

Addiction to nicotine is the most common form of substance abuse in people with schizophrenia. They are 

addicted to nicotine at three times the rate of the general 

population (75 to 90 percent vs. 25 to 30 percent).14 
6 NATIONAL INSTITUTE OF MENTAL HEALTH 

The relationship between smoking and schizophrenia is 

complex. People with schizophrenia seem to be driven to 

smoke, and researchers are exploring whether there is a biological basis for this need. In addition to its known health 

hazards, several studies have found that smoking may make 

antipsychotic drugs less effective. 

Quitting smoking may be very difficult for people with 

schizophrenia because nicotine withdrawal may cause their 

psychotic symptoms to get worse for a while. Quitting 

strategies that include nicotine replacement methods may 

be easier for patients to handle. Doctors who treat people 

with schizophrenia should watch their patients’ response to 

antipsychotic medication carefully if the patient decides to 

start or stop smoking. 

What causes schizophrenia? 

Experts think schizophrenia is caused by several factors. 

Genes and environment. Scientists have long known 

that schizophrenia runs in families. The illness occurs in 

1 percent of the general population, but it occurs in 

10 percent of people who have a first-degree relative with 

the disorder, such as a parent, brother, or sister. People who 

have second-degree relatives (aunts, uncles, grandparents, or 

cousins) with the disease also develop schizophrenia more 

often than the general population. The risk is highest for an 

identical twin of a person with schizophrenia. He or she has 

a 40 to 65 percent chance of developing the disorder.15 

We inherit our genes from both parents. Scientists believe 

several genes are associated with an increased risk of schizophrenia, but that no gene causes the disease by itself.16 In 

fact, recent research has found that people with schizophrenia tend to have higher rates of rare genetic mutations. 

These genetic differences involve hundreds of different 

genes and probably disrupt brain development.17 

Other recent studies suggest that schizophrenia may result 

in part when a certain gene that is key to making important 

brain chemicals malfunctions. This problem may affect the 
 

 

 

 

 

SCHIZOPHRENIA 7 

part of the brain involved in developing higher functioning 

skills.18 Research into this gene is ongoing, so it is not yet 

possible to use the genetic information to predict who will 

develop the disease. 

Scientists ARE 

LEARNING MORE 

ABOUT BRAIN 

CHEMISTRY AND 

ITS LINK TO 

SCHIZOPHRENIA. 

Despite this, tests that scan a person’s genes can be bought 

without a prescription or a health professional’s advice. Ads 

for the tests suggest that with a saliva sample, a company 

can determine if a client is at risk for developing specific 

diseases, including schizophrenia. However, scientists 

don’t yet know all of the gene variations that contribute to 

schizophrenia. Those that are known raise the risk only by 

very small amounts. Therefore, these “genome scans” are 

unlikely to provide a complete picture of a person’s risk for 

developing a mental disorder like schizophrenia. 

In addition, it probably takes more than genes to cause the 

disorder. Scientists think interactions between genes and the 

environment are necessary for schizophrenia to develop. 

Many environmental factors may be involved, such as exposure to viruses or malnutrition before birth, problems during 

birth, and other not yet known psychosocial factors. 

Different brain chemistry and structure. Scientists 

think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters 

dopamine and glutamate, and possibly others, plays a role 

in schizophrenia. Neurotransmitters are substances that 

allow brain cells to communicate with each other. Scientists 

are learning more about brain chemistry and its link to 

schizophrenia. 

Also, in small ways the brains of people with schizophrenia 

look different than those of healthy people. For example, 

fluid-filled cavities at the center of the brain, called ventricles, are larger in some people with schizophrenia. The 

brains of people with the illness also tend to have less gray 

matter, and some areas of the brain may have less or more 

activity. 
 

● 

● 

● 

● 

8 NATIONAL INSTITUTE OF MENTAL HEALTH 

Studies of brain tissue after death also have revealed differences in the brains of people with schizophrenia. Scientists 

found small changes in the distribution or characteristics of 

brain cells that likely occurred before birth.3

 Some experts 

think problems during brain development before birth may 

lead to faulty connections. The problem may not show 

up in a person until puberty. The brain undergoes major 

changes during puberty, and these changes could trigger 

psychotic symptoms. Scientists have learned a lot about 

schizophrenia, but more research is needed to help explain 

how it develops. 

How is schizophrenia treated? 

Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. 

Treatments include antipsychotic medications and various 

psychosocial treatments. 

Antipsychotic medications 

Antipsychotic medications have been available since the 

mid-1950’s. The older types are called conventional or 

“typical” antipsychotics. Some of the more commonly 

used typical medications include: 

Chlorpromazine (Thorazine) 

Haloperidol (Haldol) 

Perphenazine (Etrafon, Trilafon) 

Fluphenazine (Prolixin). 

In the 1990’s, new antipsychotic medications were developed. These new medications are called second generation, 

or “atypical” antipsychotics. 

One of these medications, clozapine (Clozaril) is an effective 

medication that treats psychotic symptoms, hallucinations, 

and breaks with reality. But clozapine can sometimes cause a 

serious problem called agranulocytosis, which is a loss of the 

white blood cells that help a person fight infection. People 

who take clozapine must get their white blood cell counts 

checked every week or two. This problem and the cost of 
 

● 

● 

● 

● 

● 

● 

● 

● 

● 

● 

● 

● 

● 

SCHIZOPHRENIA 9 

blood tests make treatment with clozapine difficult for many 

people. But clozapine is potentially helpful for people who 

do not respond to other antipsychotic medications.19 

Scientists 

HAVE LEARNED 

A LOT ABOUT 

SCHIZOPHRENIA, 

BUT MORE 

RESEARCH IS 

NEEDED TO HELP 

EXPLAIN HOW IT 

DEVELOPS. 

Other atypical antipsychotics were also developed. None 

cause agranulocytosis. Examples include: 

Risperidone (Risperdal) 

Olanzapine (Zyprexa) 

Quetiapine (Seroquel) 

Ziprasidone (Geodon) 

Aripiprazole (Abilify) 

Paliperidone (Invega). 

What are the side effects? 

Some people have side effects when they start taking these 

medications. Most side effects go away after a few days 

and often can be managed successfully. People who are 

taking antipsychotics should not drive until they adjust to 

their new medication. Side effects of many antipsychotics 

include: 

Drowsiness 

Dizziness when changing positions 

Blurred vision 

Rapid heartbeat 

Sensitivity to the sun 

Skin rashes 

Menstrual problems for women. 

Atypical antipsychotic medications can cause major weight 

gain and changes in a person’s metabolism. This may 

increase a person’s risk of getting diabetes and high cholesterol.20 A person’s weight, glucose levels, and lipid levels 

should be monitored regularly by a doctor while taking an 

atypical antipsychotic medication. 
 

● 

● 

● 

● 

10 NATIONAL INSTITUTE OF MENTAL HEALTH 

Typical antipsychotic medications can cause side effects 

related to physical movement, such as: 

Rigidity 

Persistent muscle spasms 

Tremors 

Restlessness. 

Long-term use of typical antipsychotic medications may lead 

to a condition called tardive dyskinesia (TD). TD causes 

muscle movements a person can’t control. The movements 

commonly happen around the mouth. TD can range from 

mild to severe, and in some people the problem cannot be 

cured. Sometimes people with TD recover partially or fully 

after they stop taking the medication. 

TD happens to fewer people who take the atypical 

antipsychotics, but some people may still get TD. People 

who think that they might have TD should check with 

their doctor before stopping their medication. 

How are antipsychotics taken and how do people 

respond to them? 

Antipsychotics are usually in pill or liquid form. Some antipsychotics are shots that are given once or twice a month. 

Symptoms of schizophrenia, such as feeling agitated and having hallucinations, usually go away within days. Symptoms 

like delusions usually go away within a few weeks. After 

about six weeks, many people will see a lot of improvement. 

However, people respond in different ways to antipsychotic 

medications, and no one can tell beforehand how a person 

will respond. Sometimes a person needs to try several medications before finding the right one. Doctors and patients 

can work together to find the best medication or medication 

combination, as well as the right dose. 

Some people may have a relapse—their symptoms come back 

or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes. 
SCHIZOPHRENIA 11 

Some people stop taking the medication because they feel 

better or they may feel they don’t need it anymore. But no 

one should stop taking an antipsychotic medication without 

talking to his or her doctor. When a doctor says it is okay to 

stop taking a medication, it should be gradually tapered off, 

never stopped suddenly. 

When a doctor 

SAYS IT IS OKAY
 

TO STOP TAKING
 

A MEDICATION, 

IT SHOULD BE 

GRADUALLY 

TAPERED OFF, 

NEVER STOPPED 

SUDDENLY. 

How do antipsychotics interact with other 

medications? 

Antipsychotics can produce unpleasant or dangerous side 

effects when taken with certain medications. For this reason, all doctors treating a patient need to be aware of all the 

medications that person is taking. Doctors need to know 

about prescription and over-the-counter medicine, vitamins, 

minerals, and herbal supplements. People also need to discuss 

any alcohol or other drug use with their doctor. 

To find out more about how antipsychotics work, the 

National Institute of Mental Health (NIMH) funded a study 

called CATIE (Clinical Antipsychotic Trials of Intervention 

Effectiveness). This study compared the effectiveness and 

side effects of five antipsychotics used to treat people with 

schizophrenia. In general, the study found that the older 

typical antipsychotic perphenazine (Trilafon) worked as 

well as the newer, atypical medications. But because people 

respond differently to different medications, it is important 

that treatments be designed carefully for each person. More 

information about CATIE is on the NIMH Web site at 

http://www.nimh.nih.gov/health/trials/practical/catie/ 

index.shtml. 

Psychosocial treatments 

Psychosocial treatments can help people with schizophrenia who are already stabilized on antipsychotic medication. 

Psychosocial treatments help these patients deal with the 

everyday challenges of the illness, such as difficulty with 

communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to 

address these problems allow people with schizophrenia to 

socialize and attend school and work. 
12 NATIONAL INSTITUTE OF MENTAL HEALTH 

Patients who receive regular psychosocial treatment also 

are more likely to keep taking their medication, and they 

are less likely to have relapses or be hospitalized. A therapist can help patients better understand and adjust to living 

with schizophrenia. The therapist can provide education 

about the disorder, common symptoms or problems patients 

may experience, and the importance of staying on medications. For more information on psychosocial treatments, 

see the psychotherapies section on the NIMH Web site 

at http://www.nimh.nih.gov/health/topics/psychotherapies/ 

index.shtml. 

Illness management skills. People with schizophrenia 

can take an active role in managing their own illness. Once 

patients learn basic facts about schizophrenia and its treatment, they can make informed decisions about their care. 

If they know how to watch for the early warning signs of 

relapse and make a plan to respond, patients can learn to 

prevent relapses. Patients can also use coping skills to deal 

with persistent symptoms. 

Integrated treatment for co-occurring substance 

abuse. Substance abuse is the most common co-occurring 

disorder in people with schizophrenia. But ordinary substance abuse treatment programs usually do not address this 

population’s special needs. When schizophrenia treatment 

programs and drug treatment programs are used together, 

patients get better results. 

Rehabilitation. Rehabilitation emphasizes social and vocational training to help people with schizophrenia function 

better in their communities. Because schizophrenia usually 

develops in people during the critical career-forming years 

of life (ages 18 to 35), and because the disease makes normal thinking and functioning difficult, most patients do not 

receive training in the skills needed for a job. 

Rehabilitation programs can include job counseling and 

training, money management counseling, help in learning to 

use public transportation, and opportunities to practice communication skills. Rehabilitation programs work well when 
SCHIZOPHRENIA 13 

they include both job training and specific therapy designed 

to improve cognitive or thinking skills. Programs like this 

help patients hold jobs, remember important details, and 

improve their functioning.21,22,23 

Once patients 

LEARN BASIC 

FACTS ABOUT 

SCHIZOPHRENIA 

AND ITS 

TREATMENT, 

THEY CAN MAKE 

INFORMED 

DECISIONS ABOUT 

THEIR CARE. 

Family education. People with schizophrenia are often 

discharged from the hospital into the care of their families. 

So it is important that family members know as much as 

possible about the disease. With the help of a therapist, family members can learn coping strategies and problem-solving 

skills. In this way the family can help make sure their loved 

one sticks with treatment and stays on his or her medication. Families should learn where to find outpatient and 

family services. 

Cognitive behavioral therapy. Cognitive behavioral 

therapy (CBT) is a type of psychotherapy that focuses on 

thinking and behavior. CBT helps patients with symptoms 

that do not go away even when they take medication. The 

therapist teaches people with schizophrenia how to test 

the reality of their thoughts and perceptions, how to “not 

listen” to their voices, and how to manage their symptoms 

overall. CBT can help reduce the severity of symptoms and 

reduce the risk of relapse. 

Self-help groups. Self-help groups for people with schizophrenia and their families are becoming more common. 

Professional therapists usually are not involved, but group 

members support and comfort each other. People in selfhelp groups know that others are facing the same problems, 

which can help everyone feel less isolated. The networking 

that takes place in self-help groups can also prompt families 

to work together to advocate for research and more hospital 

and community treatment programs. Also, groups may be 

able to draw public attention to the discrimination many 

people with mental illnesses face. 
14 NATIONAL INSTITUTE OF MENTAL HEALTH 

How can you help a person with 

schizophrenia? 

People with schizophrenia can get help from professional 

case managers and caregivers at residential or day programs. 

However, family members usually are a patient’s primary 

caregivers. 

People with schizophrenia often resist treatment. They may 

not think they need help because they believe their delusions or hallucinations are real. In these cases, family and 

friends may need to take action to keep their loved one safe. 

Laws vary from state to state, and it can be difficult to force 

a person with a mental disorder into treatment or hospitalization. But when a person becomes dangerous to himself or 

herself, or to others, family members or friends may have to 

call the police to take their loved one to the hospital. 

Treatment at the hospital. In the emergency room, a 

mental health professional will assess the patient and determine whether a voluntary or involuntary admission is 

needed. For a person to be admitted involuntarily, the law 

states that the professional must witness psychotic behavior 

and hear the person voice delusional thoughts. Family and 

friends can provide needed information to help a mental 

health professional make a decision. 

After a loved one leaves the hospital. Family and 

friends can help their loved ones get treatment and take their 

medication once they go home. If patients stop taking their 

medication or stop going to follow-up appointments, their 

symptoms likely will return. Sometimes symptoms become 

severe for people who stop their medication and treatment. 

This is dangerous, since they may become unable to care 

for themselves. Some people end up on the street or in jail, 

where they rarely receive the kind of help they need. 
SCHIZOPHRENIA 15 

People with 

SCHIZOPHRENIA 

CAN GET 

HELP FROM 

PROFESSIONAL 

CASE MANAGERS 

AND CAREGIVERS 

AT RESIDENTIAL 

OR DAY 

PROGRAMS. 

Family and friends can also help patients set realistic goals 

and learn to function in the world. Each step toward these 

goals should be small and taken one at a time. The patient 

will need support during this time. When people with a 

mental illness are pressured and criticized, they usually do 

not get well. Often, their symptoms may get worse. Telling 

them when they are doing something right is the best way 

to help them move forward. 

It can be difficult to know how to respond to someone 

with schizophrenia who makes strange or clearly false statements. Remember that these beliefs or hallucinations seem 

very real to the person. It is not helpful to say they are 

wrong or imaginary. But going along with the delusions is 

not helpful, either. Instead, calmly say that you see things 

differently. Tell them that you acknowledge that everyone 

has the right to see things his or her own way. In addition, 

it is important to understand that schizophrenia is a biological illness. Being respectful, supportive, and kind without 

tolerating dangerous or inappropriate behavior is the best 

way to approach people with this disorder. 

What is the outlook for the future? 

The outlook for people with schizophrenia continues to 

improve. Although there is no cure, treatments that work 

well are available. Many people with schizophrenia improve 

enough to lead independent, satisfying lives. 

Continued research and understanding in genetics, neuroscience, and behavioral science will help scientists and 

health professionals understand the causes of the disorder 

and how it may be predicted and prevented. This work will 

help experts develop better treatments to help people with 

schizophrenia achieve their full potential. Families and individuals who are living with schizophrenia are encouraged to 

participate in clinical research. For up-to-date information 

about the latest NIMH-funded research in schizophrenia, 

see the NIMH Web site at http://www.nimh.nih.gov. 
16 NATIONAL INSTITUTE OF MENTAL HEALTH 

Citations 

1. 	 Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto 

US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year 

prevalence rates of disorders and services. Archives of General Psychiatry. 1993 Feb;50(2):85-94. 

2. 	 World Health Organization (WHO). Catatonic Schizophrenia. The ICD-10 Classification of Mental 

and Behavioural Disorders: Clinical descriptions and diagnostic guidelines.1992.Geneva, Switzerland: 

World Health Organization. 

3. 	 Mueser KT and McGurk SR. Schizophrenia. Lancet. 2004 Jun 19;363(9426):2063-2072. 

4. 	 Nicolson R, Lenane M, Hamburger SD, Fernandez T, Bedwell J, Rapoport JL. Lessons from childhood-onset schizophrenia. Brain Research Review. 2000;31(2-3):147-156. 

5. 	 Masi G, Mucci M, Pari C. Children with schizophrenia: clinical picture and pharmacological treatment. CNS Drugs. 2006;20(10):841-866. 

6. 	 Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins 

D, Tsuang M, McGlashan T, Heinssen R. Prediction of psychosis in high-risk youth: A Multi-site 

longitudinal study in North America. Archives of General Psychiatry. 2008 Jan;65(1):28-37. 

7. 	 Walsh E, Buchanan A, Fahy T. Violence and schizophrenia: examining the evidence. British Journal 

of Psychiatry. 2002 Jun;180:490-495. 

8. 	 Swanson JW, Swartz MS, Van Dorn RA, Elbogen E, Wager HR, Rosenheck RA, Stroup S, 

McEvoy JP, Lieberman JA. A national study of violent behavior in persons with schizophrenia. 

Archives of General Psychiatry. 2006 May;63(5):490-499. 

9. 	 Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, Bourgeois M, Chouinard G, 

Islam MZ, Kane J, Krishnan R, Lindenmayer JP, Potkin S, International Suicide Prevention Trial 

Study Group. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention 

Trial (InterSePT). Archives of General Psychiatry. 2003 Jan;60(1):82-91. 

10. 	 Meltzer HY and Baldessarini RJ. Reducing the risk for suicide in schizophrenia and affective disorders. Journal of Clinical Psychiatry. 2003 Sep;64(9):1122-1129. 

11. 	 Blanchard JJ, Brown SA, Horan WP, Sherwood AR. Substance use disorders in schizophrenia: 

Reviews, integration and a proposed model. Clinical Psychological Review. 2000;20:207-234. 

12. 	 Zullino DF, Waber L, Khazaal Y. Cannabis and the course of schizophrenia. American Journal of 

Psychiatry. 2008;165(10):1357-1358. 

13. 	 Muller-Vahl KR and Emrich HM. Cannabis and schizophrenia: towards a cannabinoid hypothesis of 

schizophrenia. Expert Review of Neurotherapeutics. 2008;8(7):1037-1048. 

14. 	 Jones RT and Benowitz NL. Therapeutics for Nicotine Addiction. In Davis KL, Charney D, Coyle 

JT & Nemeroff C (Eds.), Neuropsychopharmacology: The Fifth Generation of Progress (pp1533­

1544). 2002. Nashville, TN:American College of Neuropsychopharmacology. 

15. 	 Cardno AG and Gottesman II. Twin studies of schizophrenia: from bow-and-arrow concordances to 

star wars Mx and functional genomics. American Journal of Medical Genetics. 2000 Spring;97(1):12-17. 
SCHIZOPHRENIA 17 

16. 	 Harrison PJ and Weinberger DR. Schizophrenia genes, gene expression, and neuropathology: on 

the matter of their convergence. Molecular Psychiatry. 2005;10(1):40-68. 

17. 	 Walsh T, McClellan JM, McCarthy SE, Addington AM, Pierce SB, Cooper GM, Nord AS, 

Kusenda M, Malhotra D, Bhandari A, Stray SM, Rippey CF, Roccanova P, Makarov V, Lakshmi 

B, Findling RL, Sikich L, Stromberg T, Merriman B, Gogtay N, Butler P, Eckstrand K, Noory L, 

Gochman P, Long R, Chen Z, Davis S, Baker C, Eichler EE, Meltzer PS, Nelson SF, Singleton 

AB, Lee MK, Rapoport JL, King MC, Sebat J. Rare structural variants disrupt multiple genes in 

neurodevelopmental pathways in schizophrenia. Science. 2008 Apr 25;320(5875):539-543. 

18. 	 Huang HS, Matevossian A, Whittle C, Kim SY, Schumacher A, Baker SP, Akbarian S. Prefrontal 

dysfunction in schizophrenia involves missed-lineage leukemia 1-regulated histone methylation at 

GABAergic gene promoters. Journal of Neuroscience. 2007 Oct 17;27(42):11254-11262. 

19. 	 Gogtay N and Rapoport J. Clozapine use in children and adolescents. Expert Opinion on 

Pharmacotherapy. 2008;9(3):459-465. 

20. 	 Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis 

SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK, Clinical Antipsychotic Trials of Intervention 

Effectiveness (CATIE). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. 

New England Journal of Medicine. 2005 Sep 22;353(12):1209-1223. 

21. 	 Greig TC, Zito W, Wexler BE, Fiszdon J, Bell MD. Improved cognitive function in schizophrenia 

after one year of cognitive training and vocational services. Schizophrenia Research. 2007 Nov;96(1­

3):156-161. 

22. 	 Bell M, Fiszon J, Greig T, Wexler B, Bryson G. Neurocognitive enhancement therapy with 

work therapy in schizophrenia: 6-month follow-up of neuropsychological performance. Journal of 

Rehabilitation Research and Development. 2007;44(5):761-770. 

23. 	 Hogarty GE, Flesher S, Ulrich R, Carter M, Greenwald D, Poque-Geile M, Kechavan M, Cooley 

S, DiBarry AL, Garrett A, Parepally H, Zoretich R. Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Archives of General Psychiatry. 

2004 Sep;61(9):866-876. 
18 NATIONAL INSTITUTE OF MENTAL HEALTH 

For more information on schizophrenia 

Visit the National Library of Medicine’s MedlinePlus 

http://medlineplus.gov


 En Español, http://medlineplus.gov/spanish
 

For information on clinical trials for schizophrenia 

http://www.nimh.nih.gov/health/trials/index.shtml 

National Library of Medicine Clinical Trials Database 

http://www.clinicaltrials.gov 

Clinical trials at NIMH in Bethesda, MD 

http://patientinfo.nimh.nih.gov or call 1-888-674-6464 

Information from NIMH is available in multiple formats. You can browse 

online, download documents in PDF, and order paper brochures through the 

mail. If you would like to have NIMH publications, you can order them online 

at http://www.nimh.nih.gov. If you do not have Internet access and wish to 

have information that supplements this publication, please contact the NIMH 

Information Resource Center at the numbers listed below. 

National Institute of Mental Health 

Science Writing, Press & Dissemination Branch 

6001 Executive Boulevard 

Room 8184, MSC 9663 

Bethesda, MD 20892-9663 

Phone: 301-443-4513 or 

1-866-615-NIMH (6464) toll-free 

TTY: 301-443-8431 or 

1-866-415-8051 toll-free 

FAX: 301-443-4279 

E-mail: nimhinfo@nih.gov 

Web site: http://www.nimh.nih.gov 
• 	

• 	

• 	

• 	

Reprints 

NIMH publications are in the public domain and may be reproduced or 

copied without permission from the National Institute of Mental Health. NIMH 

encourages you to reproduce them and use them in your efforts to improve 

public health. Citation of the National Institute of Mental Health as a source is 

appreciated. However, using government materials inappropriately can raise 

legal or ethical concerns, so we ask you to use these guidelines: 

NIMH does not endorse or recommend any commercial products, processes, 

or services, and publications may not be used for advertising or endorsement 

purposes. 

NIMH does not provide specific medical advice or treatment 

recommendations or referrals; these materials may not be used in a manner 

that has the appearance of such information. 

NIMH requests that non-Federal organizations not alter publications in a way 

that will jeopardize the integrity and “brand” when using publications. 

Addition of non-Federal Government logos and Web site links may not have 

the appearance of NIMH endorsement of any specific commercial products 

or services or medical treatments or services. 

If you have questions regarding these guidelines and use of NIMH publications, 

please contact the NIMH Information Resource Center at 1-866-615-6464 or 

e-mail at nimhinfo@nih.gov. 
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

National Institutes of Health 

National Institute of Mental Health 

NIH Publication No. 09-3517 

Revised 2009