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\def\citeauthor{~Mohamed~Harsath~J,
              ~Shaik~Ameera~Muskan,
              ~Shaik~Asia~Begum,
              ~Vetti~Anu,
              ~Naga~Bharathi~S}
\def\citetitle{\textbf{A Review of Schizophrenia}}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\def\RunningAuthor{Naga Bharathi S et al.}
\firstPage{27}
\articleType{Review Article}
\receivedDate{15 Jan 2023}
\acceptedDate{03 Feb 2023}
\revisedDate{02 Feb 2023}
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\journalIssue{1}
\journalDoi{ijebr.v2i1.445}
\copyrightYear{2023}
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\title{\textbf{A Review of Schizophrenia}}
\author{Mohamed~Harsath~J\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0009-0009-4817-9744}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Shaik~Ameera~Muskan\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0009-0005-0731-4330}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Shaik~Asia~Begum\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0009-0003-4166-521X}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Vetti~Anu\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0009-0008-5713-0072}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}}, 
            Naga~Bharathi~S\textsuperscript{*}\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Ratnam Institute of Pharmacy, Pidathapolur village and post Muthukur (M), SPSR Nellore District, Pidathapolur, Nellore, Andhra Pradesh, 524346}~\\{\textsuperscript{2}Department of pharmacy practice, Ratnam Institute of Pharmacy, Pidathapolur village and post Muthukur(M), SPSR Nellore district, Pidathapolur, Nellore, Andhra Pradesh - 524346}}

\begin{abstract}
Schizophrenia is a chronic psychiatric disorder. "Eugen Bleuler" first used the phrase "Schizophrenia" in 1908. It mainly affects the person's ability to think clearly and control emotions. Schizophrenia affects 1\% of adults worldwide. Men are more likely to be diagnosed and have an earlier onset than women. The exact cause of Schizophrenia is unknown, and it may be due to genetics, the imbalance between the neurotransmitters, stress, pregnancy, or birth-related factors. Signs and symptoms usually involve positive and negative symptoms. Positive symptoms include hallucinations, delusions, and disorganized speech. Negative symptoms include a lack of ability, interest in everyday activities, and social withdrawal. According to ICD-10, the diagnosis of Schizophrenia, a person must show at least two of the following symptoms for a month such as delusions, hallucinations, disorganized speech, and hyperactive behaviour. Schizophrenia is usually treated with antipsychotics for the symptoms of an acute schizophrenic episode. Other therapies include cognitive behavioural therapy, psychoeducation, and family therapy.


\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Schizophrenia,\newline Neurotransmitters,\newline Hallucinations,\newline ICD-10,\newline Antipsychotics
\end{keywords}
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\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Naga~Bharathi~S~\\ Phone:\ +91 6304 019 191~\\  Email:\ bharathiraj2827@gmail.com
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\section{Introduction}
Schizophrenia is a long-term psychiatric condition with various symptoms, including cognitive, affective, and negative symptoms that cause abnormalities in the brain. Men are more prone to get Schizophrenia than women, which is a frequent psychotic condition. Initially, in 1896 Emil Kraepelin referred to Schizophrenia as dementia praecox, which is Latin for "madness," and in 1908, Eugen Bleuler (1857{\textendash}1939) first used the term "schizophrenia." Schizophrenia patients tend to withdraw from society, act irrationally out of fear or confusion, and are more prone to attempt suicide, especially during psychotic episodes and the first six months of therapy \unskip~\cite{1934209:28039087}.

\textbf{Definition }

Schizophrenia is a persistent mental illness that primarily affects a person's capacity to think clearly and emotions, feelings, and conduct. Continuous or relapsing psychotic episodes are what give it its name.

\textbf{Epidemiology }


  
  \begin{enumerate}
  \item \relax Twenty-two million individuals worldwide are thought to be affected by Schizophrenia, according to the World Health Organization (WHO) in 2000.
  \item \relax The true worth of those who have this condition is difficult to assess \unskip~\cite{1934209:28039085}.
  \item \relax Incidence and prevalence
  \item \relax The prevalence ranges between 0.5\% and 2\%.
  \item \relax Teenage or manhood is the typical onset of symptoms \unskip~\cite{1934209:28039074}.
  \end{enumerate}
  \textbf{Who is impacted?}


  
  \begin{enumerate}
  \item \relax Schizophrenia affects 1.5\% of the population and is most prevalent in those between 25 and 45.
  \item \relax The average lifespan of those who have this form of Schizophrenia is 10{\textendash}12 years.
  \item \relax Schizophrenia is more likely to affect people in Western Europe.
  \item \relax According to several experts, Schizophrenia is accompanied by hostility, depression, and hyperactivity.
  \item \relax Moreover, they cooperate with other psychotic illnesses.\unskip~\cite{1934209:28039071}
  \end{enumerate}
  \textbf{Types}

\textbf{Paranoid Schizophrenia}


  
  \begin{enumerate}
  \item \relax Delusions or recurrent auditory hallucinations characterize it and are frequently observed in most patients with Schizophrenia and other psychotic diseases.
  \item \relax Other signs of paranoid Schizophrenia include disorganized speech, a face without emotion, a state of confusion, or unusual behaviour like smiling, laughing, or talking to oneself.
  \item \relax Speech and emotional impairment are every day in this form of Schizophrenia.
  \item \relax Anger and anxiety are common in those with the paranoid type.\unskip~\cite{1934209:28039068}
  \end{enumerate}
  \textbf{Catatonic Schizophrenia}


  
  \begin{enumerate}
  \item \relax This illness results in bizarre physical movements, behaviours, and social withdrawal.
  \item \relax Furthermore, bipolar disorder and mood disorder, this sort of Schizophrenia.
  \item \relax It is an uncommon kind of Schizophrenia that only occasionally affects people.
  \item \relax A person with a catatonic type may be rigid, repetitive, and immobile. They may also make odd postural and grimacing motions on their own.
  \end{enumerate}
  \textbf{Disorganized Schizophrenia}


  
  \begin{enumerate}
  \item \relax It is also known as hebephrenic Schizophrenia and is most frequently observed in people between 15 and 25.
  \item \relax Its defining characteristics are disorganized speech, strange conduct, and ideas accompanied by momentary hallucinations and delusions.
  \item \relax Some symptoms of Schizophrenia include a lack of facial expression, a low voice tone, difficulty interacting with people, memory lapses, and mood swings.
  \end{enumerate}
  \textbf{Undifferentiated Schizophrenia}


  
  \begin{enumerate}
  \item \relax This type of Schizophrenia is reserved for those who do not fit any of the three categories listed above. 
  \item \relax Severe delusions, hallucinations, and disorganized speech mark it. 
  \item \relax A person with this type of Schizophrenia will also experience paranoid and catatonic Schizophrenia.
  \end{enumerate}
  \textbf{Residual Schizophrenia}


  
  \begin{enumerate}
  \item \relax Residual Schizophrenia is characterized by undesirable symptoms such as apathy, poor memory, loss of attention, and poor hygiene.
  \item \relax The person with this type of Schizophrenia has a history of psychotic episodes but is not now suffering hallucinations or delusions.
  \item \relax Symptoms include weariness, lack of emotion, speaking less, and lack of motivation.
  \end{enumerate}
  \textbf{Aetiology}

No one knows the cause of Schizophrenia. It may be due to the following:


  
  \begin{enumerate}
  \item \relax Genetic factors
  \item \relax Chemical imbalances
  \item \relax Physiological factors
  \item \relax Environmental factors
  \end{enumerate}
  \textbf{Genetic factors}


  
  \begin{enumerate}
  \item \relax Schizophrenia frequently runs in families, according to genetic causes.
  \item \relax There isn't a single gene that causes Schizophrenia.
  \item \relax If both patients have been diagnosed with Schizophrenia, there is a 50\% probability that the patient will also develop Schizophrenia.
  \item \relax 40{\textendash}60\% chance if an identical twin has been given a schizophrenia diagnosis.
  \end{enumerate}
  \textbf{Chemical imbalances}

An imbalance in the levels of two neurotransmitters may contribute to Schizophrenia. They are as follows:

1. Dopamine

2. Serotonin


  
  \begin{enumerate}
  \item \relax The symptoms of Schizophrenia are caused by abnormal dopamine levels in the mesolimbic and prefrontal regions.
  \item \relax Schizophrenia's adverse symptoms are caused by low dopamine activity in the prefrontal brain region.
  \item \relax Reduced levels of serotonin may cause depression and memory loss. Excessive dopamine activity in the mesolimbic area is what produces the symptoms of Schizophrenia.
  \end{enumerate}
  \textbf{Physiological factors}

The main physiological factors of Schizophrenia such as:


  
  \begin{enumerate}
  \item \relax Emotional
  \item \relax Sexual abuse
  \item \relax Losing job
  \item \relax End of relationship
  \item \relax Losing someone important to us
  \end{enumerate}
  \textbf{Environmental factors}

Environmental factors such as:


  
  \begin{enumerate}
  \item \relax Pregnancy and birth complications
  \item \relax Childhood trauma
  \item \relax Social isolation
  \item \relax Substance abuse
  \end{enumerate}
  \textbf{Pregnancy and birth complications}

Those who develop Schizophrenia are more likely to have birth or prenatal difficulties like


  
  \begin{enumerate}
  \item \relax Low birth weight
  \item \relax Asphyxia 
  \item \relax Early delivery
  \end{enumerate}
  \textbf{Childhood trauma}

Childhood trauma is a severe form of stress that contributes to the development of Schizophrenia and is linked to memory loss, difficulty acquiring verbal language, and concentration deficits. Depressive and positive symptoms are primarily brought on by childhood trauma.

\textbf{Social isolation}

Most of the research has found that a person's risk of getting Schizophrenia, depression, and anxiety rises when socially isolated.

\textbf{Substance abuse}

In vulnerable patients, certain drugs like cocaine, LSD, amphetamines, and cannabis can cause schizophrenia symptoms to appear.

\textbf{Risk Factors}


  
  \begin{enumerate}
  \item \relax Social isolation
  \item \relax Age 
  \item \relax Sex
  \item \relax Neonatal hypoxia
  \item \relax Using drugs such as cannabis, LSD
  \item \relax Exposure to infections
  \item \relax Birth complications
  \item \relax Malnutrition
  \item \relax Family history
  \item \relax Childhood trauma Figure~\ref{f-9010ff27d5f3}.
  \end{enumerate}
  
\bgroup
\fixFloatSize{images/a898d8f1-5a57-42e4-8180-681133cefb29-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/a898d8f1-5a57-42e4-8180-681133cefb29-upicture1.png}{\includegraphics{images/a898d8f1-5a57-42e4-8180-681133cefb29-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Pathophysiology of Schizophrenia}}
\label{f-9010ff27d5f3}
\end{figure}
\egroup

\begin{table*}[!htbp]
\caption{\boldmath {Positive, Negative \& Cognitive Symptoms of Schizophrenia} }
\label{tw-9492ee315e3e}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3433\linewidth-2\tabcolsep}p{\dimexpr.31340000000000003\linewidth-2\tabcolsep}p{\dimexpr.3433\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Positive symptoms & Negative symptoms & Cognitive Symptoms\\
\tblmidrule 
Hallucinations &
  Alogia &
  Disorganized thinking\\
Delusions &
  Social withdrawal &
  Poor concentration\\
Thought disorders &
  Anhedonia &
  Poor memory\\
Movement disorders &
  A motivation &
  Difficulty in expressing ideas\\
combativeness &
  apathy &
  Difficulty in integrating thoughts and feelings\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {First-line and second-line medications} }
\label{tw-6ce392108317}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1357\linewidth-2\tabcolsep}p{\dimexpr.1666\linewidth-2\tabcolsep}p{\dimexpr.1489\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.1888\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}S.NO & DRUG NAME & DOSE & FREQ \mbox{}\protect\newline AGENCY & MECHANISM OF ACTION & SIDE EFFECTS\\
\tblmidrule 
1. &
  Chlorpromazine &
  200-800mg &
  OD &
  Blocks postsynaptic mesolimbic dopaminergic receptors. &
  Blurred vision\\
2. &
  Loxapine &
  10-50mg &
  BD &
  blocks post synaptic mesolimbic D1 and D2 receptors. &
  Agitation and ECG changes\\
3. &
  Haloperidol &
  0.5-2mg &
  BD &
  Blocks postsynaptic dopaminergic D2 receptors  &
  Dystonia, parkinsonism\\
4. &
  Clozapine  &
  12.5mg &
  OD/BD &
  Antagonism of D2 and 5HT-2A receptors &
  Drowsiness, convulsions\\
5. &
  Risperidone  &
  2-3 mg &
  BD/OD &
  5HT-2 and D2 receptor antagonist &
  EPS, hyperprolactinemia\\
6. &
  olanzapine &
  5-10 mg &
  OD &
  Antagonism of 5HT-2A and C, D1 receptors &
  Weight gain\\
7. &
  Quetiapine  &
  25 -50 mg &
  BD &
  Antagonism of D2 and 5HT-2 &
  Agitation, xerostomia\\
8. &
  Amisulpride &
  400-800 mg &
  OD &
  Blocks dopamine receptors in the limbic system. &
  Insomnia and weight gain\\
9. &
  Aripiprazole  &
  10-15 mg &
  OD &
  Agonist of D2 and 5HT-1A receptors and antagonist of 5HT-2A receptors. &
  Akathisia, headache\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Dopaminergic Activity}

Dysfunction in dopaminergic activity in the mesocortical and mesolimbic pathways leads to 


  
  \begin{enumerate}
  \item \relax An increase in dopaminergic activity in the mesolimbic path leads to positive symptoms.
  \item \relax Decreased dopaminergic activity in mesocortical ways leads to negative and cognitive symptoms.
  \end{enumerate}
  \textbf{Anatomical Abnormalities}

Most of the studies show that schizophrenia patients may have the following:-


  
  \begin{enumerate}
  \item \relax Decreased whole brain volume.
  \item \relax Increased ventricular volume Table~\ref{tw-9492ee315e3e}.
  \end{enumerate}
  \textbf{Positive symptoms}

Positive symptoms mainly affect behaviour or thoughts.


  
  \begin{enumerate}
  \item \relax Hallucinations
  \item \relax Delusions
  \item \relax Disorganized speech
  \item \relax Difficulty in concentration
  \end{enumerate}
  \textbf{Hallucinations}

Hallucination is a misbelief of objects involving senses such as sight, sound, smell, taste, and touch.\unskip~\cite{1934209:28039073}

Different types of hallucinations include below.


  
  \begin{enumerate}
  \item \relax Auditory: A most common type of hallucination. Although people may think they hear voices, music, or nature sounds, these sounds are unnatural.
  \item \relax Visual Hallucinations:  They will see objects, people, or lights that are not real.
  \item \relax Tactile Hallucinations: They experience a sense of touch or movement on their skin.
  \item \relax Olfactory Halluciantions: A person smells something that is not real.
  \item \relax Gustatory Hallucinations: This type of hallucination cause unpleasant tastes.
  \end{enumerate}
  \textbf{Delusions}

Delusions are beliefs that are not true.

\textbf{Types of Delusions}


  
  \begin{enumerate}
  \item \relax Delusion of Persecution: The individual may think they are a target of an individual or group of individuals.
  \item \relax Delusion of Grandeur: People may believe they have more power and talent.
  \item \relax Delusion of Love: The person may believe they are in love with them.
  \end{enumerate}
  \textbf{Negative Symptoms}


  
  \begin{enumerate}
  \item \relax Alogia (inability to speak)
  \item \relax Violation (lack of motivation)
  \item \relax Asociality (reduced social interaction)
  \item \relax Anhedonia (inability to experience pleasure)
  \item \relax Flat affect
  \item \relax Extreme isolation.\unskip~\cite{1934209:28039073}
  \end{enumerate}
  \textbf{Cognitive Symptoms}


  
  \begin{enumerate}
  \item \relax Memory issues
  \item \relax Impaired sensory perception
  \end{enumerate}
  \textbf{Complications}


  
  \begin{enumerate}
  \item \relax Anxiety disorders
  \item \relax Obsessive-compulsive disorder
  \item \relax Depression 
  \item \relax Social isolation
  \item \relax Aggressive behaviour
  \item \relax Financial problems
  \item \relax History of medical problems
  \item \relax Suicidal attempts [20]
  \end{enumerate}
  \textbf{Diagnosis}

The DSM-V states that Schizophrenia must exhibit at least two of five symptoms to be diagnosed.

1. Delusions

2. Disorganized speech 

3. Hallucinations 

4. Unusual movements

5. Negative symptoms 

\textbf{Other Tests}

\textbf{Test and Screenings}


  
  \begin{enumerate}
  \item \relax Complete blood picture
  \item \relax Imaging studies such as MRI \& CT scans.
  \end{enumerate}
  \textbf{Physiological Evolutions}

A psychiatrist will observe the event, assess the patient's mental state, and enquire about their mood, thoughts, hallucinations, and drug use.\unskip~\cite{1934209:28039072}

\textbf{Treatment}

\textbf{Non-Pharmacological Treatment}
  
  \begin{enumerate}
  \item \relax Cognitive behavioural therapy
  \item \relax Psychoeducation
  \item \relax Family therapy
  \item \relax Social skills training \unskip~\cite{1934209:28039079}Table~\ref{tw-6ce392108317}.
  \end{enumerate}
  
    
\section{CONCLUSION}
Our research leads us to conclude that etiological variables, primarily present in the 30- to 45-year-old age range, are the leading causes of Schizophrenia. Newer antipsychotics can treat this, as listed above.
    
\section{ACKNOWLEDGEMENT}
We thank our principal, Dr. M. Srinivasulu Reddy, for supporting and guiding us in writing the review article.

\textbf{Conflict of interest}

The author declares no conflict of interest.

\textbf{Funding support}

The author declares that they have no budget for the study.
    
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