Schizophrenia is a topic covered in the 5-Minute Emergency Consult.

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  • A chronic psychotic disorder characterized by delusions, hallucinations, disorganization, negative symptoms, and cognitive deficits:
    • Premorbid phase:
      • Development of negative symptoms with deterioration of personal, social, and intellectual functioning
    • Active phase:
      • Development of active delusions, hallucinations, and bizarre behavior
      • May be precipitated by a stressful event
    • Residual phase:
      • Patients are left with impaired social and cognitive abilities
      • Psychotic symptoms may persist
    • Subtypes: Catatonic, disorganized, paranoid, residual, undifferentiated
  • Onset typically early in adulthood (age <30)
  • Comorbid substance abuse (alcohol, cannabis, tobacco, and stimulants) is common
  • Violence may result from impaired judgment, paranoia, and command hallucinations
  • Life expectancy 12–25 yr less than general population likely because:
    • 41% of patients have metabolic syndrome with increased risk of death due to cardiovascular events
    • 5–10% of patients commit suicide
    • Patients have decreased access to medical care
  • Disorganized thinking, abnormal behavior, and delusions may obscure the detection of medical illness
  • Medication noncompliance is a key reason for psychiatric decompensation and presentation to the ED


  • Pathophysiology unclear but dopamine pathway strongly implicated
  • Genetic component (concordance rate of 50% in monozygotic twins)
  • Specific genes uncertain:
    • Higher risk in patients with DiGeorge syndrome (22q11.2 deletion)
  • Perinatal risk factors:
    • Influenza during 2nd trimester
    • Maternal and postnatal infections
    • Advanced paternal age
  • Use of cannabis may unmask psychosis in predisposed individuals

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