SchizophreniaSchizophrenia

Lyudmyla T. Snovyda Lyudmyla T. Snovyda

Schizophrenia -Schizophrenia - from the Greek roots from the Greek roots schizeinschizein ( "to split") and ( "to split") and

phrenphren, phren- ("mind"), is a psychiatric diagnosis , phren- ("mind"), is a psychiatric diagnosis that describes a mental illness characterized by that describes a mental illness characterized by impairments in the perception or expression of impairments in the perception or expression of reality, most commonly manifesting as auditory reality, most commonly manifesting as auditory hallucinations, paranoid or bizarre delusions or hallucinations, paranoid or bizarre delusions or disorganized speech and thinking in the context of disorganized speech and thinking in the context of significant social or occupational dysfunction. significant social or occupational dysfunction. Onset of symptoms typically occurs in young Onset of symptoms typically occurs in young adulthood.Diagnosis is based on the patient's self-adulthood.Diagnosis is based on the patient's self-reported experiences and observed behavior. No reported experiences and observed behavior. No laboratory test for schizophrenia exists.laboratory test for schizophrenia exists.

Schizophrenia -Schizophrenia -Descriptions of schizophrenia-like symptoms date back to circa 2000 BC in the Book of Hearts—part of the ancient Egyptian Ebers Papyrus. However, study of the ancient Greek and Roman literature shows that although the general population probably had an awareness of psychotic disorders, there was no recorded condition that would meet the modern criteria for schizophrenia.Symptoms resembling schizophrenia were, however, reported in Arabic medical and psychological literature during the Middle Ages. In The Canon of Medicine, for example, Avicenna described a condition somewhat resembling schizophrenia which he called Junun Mufrit (severe madness), which he distinguished from other forms of madness (Junun) such as mania, rabies and manic depressive psychosis.

Schizophrenia -Schizophrenia - Although a broad concept of madness has existed for Although a broad concept of madness has existed for

thousands of years, schizophrenia was only classified as a thousands of years, schizophrenia was only classified as a distinct mental disorder by Emil Kraepelin in 1893. He was the distinct mental disorder by Emil Kraepelin in 1893. He was the first to make a distinction in the psychotic disorders between first to make a distinction in the psychotic disorders between what he called what he called dementia praecoxdementia praecox (early dementia—a term (early dementia—a term first used by psychiatrist Benedict Morel [1809–1873]) and first used by psychiatrist Benedict Morel [1809–1873]) and manic depression. Kraepelin believed that dementia praecox manic depression. Kraepelin believed that dementia praecox was primarily a disease of the brain, and particularly a form of was primarily a disease of the brain, and particularly a form of dementia, distinguished from other forms of dementia, such dementia, distinguished from other forms of dementia, such as Alzheimer's disease, which typically occur later in life.as Alzheimer's disease, which typically occur later in life.

Bleuler described the main symptoms as 4 A's: flattened Bleuler described the main symptoms as 4 A's: flattened AffectAffect, , AutismAutism, impaired , impaired AssociationAssociation of ideas and of ideas and AmbivalenceAmbivalence. Bleuler realized that the illness was not a . Bleuler realized that the illness was not a dementia as some of his patients improved rather than dementia as some of his patients improved rather than deteriorated and hence proposed the term schizophrenia deteriorated and hence proposed the term schizophrenia instead.instead.

Schneiderian classificationSchneiderian classification The psychiatrist Kurt Schneider (1887–1967) listed the The psychiatrist Kurt Schneider (1887–1967) listed the

forms of psychotic symptoms that he thought forms of psychotic symptoms that he thought distinguished schizophrenia from other psychotic distinguished schizophrenia from other psychotic disorders. These are called first-rank symptoms or disorders. These are called first-rank symptoms or Schneider's first-rank symptoms, and they include:Schneider's first-rank symptoms, and they include:

delusions of being controlled by an external force; delusions of being controlled by an external force; the belief that thoughts are being inserted into or the belief that thoughts are being inserted into or

withdrawn from one's conscious mind; withdrawn from one's conscious mind; the belief that one's thoughts are being broadcast to the belief that one's thoughts are being broadcast to

other people; other people; and hearing hallucinatory voices that comment on one's and hearing hallucinatory voices that comment on one's

thoughts or actions or that have a conversation with thoughts or actions or that have a conversation with other hallucinated voices.other hallucinated voices.

Positive and negative Positive and negative symptomssymptoms

Schizophrenia is often described in terms of positive (or Schizophrenia is often described in terms of positive (or productive) and negative (or deficit) symptoms. productive) and negative (or deficit) symptoms.

Positive symptoms include:Positive symptoms include: delusions, delusions, auditory hallucinations, auditory hallucinations, and thought disorder, and are typically regarded as and thought disorder, and are typically regarded as

manifestations of psychosis. manifestations of psychosis.

Positive and negative Positive and negative symptomssymptoms

Negative symptomsNegative symptoms are so-named because they are are so-named because they are considered to be the loss or absence of normal traits considered to be the loss or absence of normal traits or abilities, and include features such:or abilities, and include features such:

as flat or blunted affect and emotion, as flat or blunted affect and emotion, poverty of speech (alogia), poverty of speech (alogia), anhedonia, anhedonia, and lack of motivation (avolition). Despite the and lack of motivation (avolition). Despite the

appearance of blunted affect, recent studies indicate appearance of blunted affect, recent studies indicate that there is often a normal or even heightened level that there is often a normal or even heightened level of emotionality in Schizophrenia especially in of emotionality in Schizophrenia especially in response to stressful or negative events.response to stressful or negative events.

Positive and negative Positive and negative symptomssymptoms

A third symptom grouping, the disorganization A third symptom grouping, the disorganization syndrome, is commonly described, and syndrome, is commonly described, and includes chaotic speech, thought, and includes chaotic speech, thought, and behaviour. There is evidence for a number of behaviour. There is evidence for a number of other symptom classifications.other symptom classifications.

Dissociation or splitting of psychic processes at Dissociation or splitting of psychic processes at schizophrenia could be on 3 levelsschizophrenia could be on 3 levels : :

I level - splitting between personality and surrounding;I level - splitting between personality and surrounding; II level - splitting between 2 psychic spheres;II level - splitting between 2 psychic spheres; III level - splitting of psychic processes in sphere of III level - splitting of psychic processes in sphere of

psyche.psyche.

Subtypes, forms:Subtypes, forms:

Historically, schizophrenia in the West was Historically, schizophrenia in the West was classified into classified into simple, catatonic, hebephrenic simple, catatonic, hebephrenic (now known as disorganized), and paranoid(now known as disorganized), and paranoid. . The DSM contains five sub-classifications of The DSM contains five sub-classifications of schizophrenia:schizophrenia:

paranoid typeparanoid type: where delusions and : where delusions and hallucinations are present but thought hallucinations are present but thought disorder, disorganized behavior, and affective disorder, disorganized behavior, and affective flattening are absent (DSM code 295.3/ICD flattening are absent (DSM code 295.3/ICD code F20.0)code F20.0)

Subtypes, forms:Subtypes, forms: disorganized type:disorganized type: named 'hebephrenic schizophrenia' named 'hebephrenic schizophrenia'

in the ICD. Where thought disorder and flat affect are in the ICD. Where thought disorder and flat affect are present together (DSM code 295.1/ICD code F20.1)present together (DSM code 295.1/ICD code F20.1)

catatonic type:catatonic type: prominent psychomotor disturbances prominent psychomotor disturbances are evident. Symptoms can include catatonic stupor and are evident. Symptoms can include catatonic stupor and waxy flexibility (DSM code 295.2/ICD code F20.2)waxy flexibility (DSM code 295.2/ICD code F20.2)

undifferentiated typeundifferentiated type: psychotic symptoms are present : psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic but the criteria for paranoid, disorganized, or catatonic types have not been met (DSM code 295.9/ICD code types have not been met (DSM code 295.9/ICD code F20.3)F20.3)

residual typeresidual type: where positive symptoms are present at a : where positive symptoms are present at a low intensity only (DSM code 295.6/ICD code F20.5)low intensity only (DSM code 295.6/ICD code F20.5)

Subtypes, forms:Subtypes, forms:

The ICD-10 recognises a further two subtypes:The ICD-10 recognises a further two subtypes: post-schizophrenic depressionpost-schizophrenic depression: a depressive : a depressive

episode arising in the aftermath of a episode arising in the aftermath of a schizophrenic illness where some low-level schizophrenic illness where some low-level schizophrenic symptoms may still be present schizophrenic symptoms may still be present (ICD code F20.4)(ICD code F20.4)

simple schizophreniasimple schizophrenia: insidious but progressive : insidious but progressive development of prominent negative symptoms development of prominent negative symptoms with no history of psychotic episodes (ICD code with no history of psychotic episodes (ICD code F20.6)F20.6)

Epidemiology:Epidemiology:

Schizophrenia occurs equally in males and Schizophrenia occurs equally in males and females although typically appears earlier in females although typically appears earlier in men with the peak ages of onset being 20–28 men with the peak ages of onset being 20–28 years for males and 26–32 years for females. years for males and 26–32 years for females. Much rarer are instances of childhood-onset and Much rarer are instances of childhood-onset and late- (middle age) or very-late-onset (old age) late- (middle age) or very-late-onset (old age) schizophrenia. Schizophrenia is known to be a schizophrenia. Schizophrenia is known to be a major cause of disability. In a 1999 study of 14 major cause of disability. In a 1999 study of 14 countries, active psychosis was ranked the third-countries, active psychosis was ranked the third-most-disabling condition, after quadriplegia and most-disabling condition, after quadriplegia and dementia and before paraplegia and blindness.dementia and before paraplegia and blindness.

CausesCauses::

Data from a PET study suggests that the less the frontal lobes are activated (red) during a working memory task, the greater the increase in abnormal dopamine activity in the striatum (green), thought to be related to the neurocognitive deficits in schizophrenia.

Genetic:Genetic: Estimates of the heritability of schizophrenia tend to Estimates of the heritability of schizophrenia tend to

vary owing to the difficulty of separating the effects vary owing to the difficulty of separating the effects of genetics and the environment although twin of genetics and the environment although twin studies have suggested a high level of heritability. It studies have suggested a high level of heritability. It is likely that schizophrenia is a condition of complex is likely that schizophrenia is a condition of complex inheritance, with several genes possibly interacting inheritance, with several genes possibly interacting to generate risk for schizophrenia or the separate to generate risk for schizophrenia or the separate components that can co-occur leading to a diagnosis. components that can co-occur leading to a diagnosis. Recent work has suggested that genes that raise the Recent work has suggested that genes that raise the risk for developing schizophrenia are non-specific, risk for developing schizophrenia are non-specific, and may also raise the risk of developing other and may also raise the risk of developing other psychotic disorders such as bipolar disorder.psychotic disorders such as bipolar disorder.

Substance use:Substance use: The relationship between schizophrenia and drug use The relationship between schizophrenia and drug use

is complex, meaning that a clear causal connection is complex, meaning that a clear causal connection between drug use and schizophrenia has been between drug use and schizophrenia has been difficult to distinguish. There is strong evidence that difficult to distinguish. There is strong evidence that using certain drugs can trigger either the onset or using certain drugs can trigger either the onset or relapse of schizophrenia in some people. It may also relapse of schizophrenia in some people. It may also be the case, however, that people with schizophrenia be the case, however, that people with schizophrenia use drugs to overcome negative feelings associated use drugs to overcome negative feelings associated with both the commonly prescribed antipsychotic with both the commonly prescribed antipsychotic medication and the condition itself, where negative medication and the condition itself, where negative emotion, paranoia and anhedonia are all considered emotion, paranoia and anhedonia are all considered to be core features.to be core features.

Substance use:Substance use: Amphetamines trigger the release of dopamine Amphetamines trigger the release of dopamine

and excessive dopamine function is believed to be and excessive dopamine function is believed to be responsible for many symptoms of schizophrenia responsible for many symptoms of schizophrenia (known as the dopamine hypothesis of (known as the dopamine hypothesis of schizophrenia), amphetamines may worsen schizophrenia), amphetamines may worsen schizophrenia symptoms. Schizophrenia can be schizophrenia symptoms. Schizophrenia can be triggered by heavy use of hallucinogenic or triggered by heavy use of hallucinogenic or stimulant drugs. One study suggests that cannabis stimulant drugs. One study suggests that cannabis use can contribute to psychosis, though the use can contribute to psychosis, though the researchers suspected cannabis use was only a researchers suspected cannabis use was only a small component in a broad range of factors that small component in a broad range of factors that can cause psychosis.can cause psychosis.

NeuralNeural::

Functional magnetic resonance Functional magnetic resonance imaging and other brain imaging imaging and other brain imaging technologies allow for the study of technologies allow for the study of differences in brain activity among differences in brain activity among people diagnosed with people diagnosed with schizophrenia.schizophrenia.

Signs and symptoms of paranoid Signs and symptoms of paranoid schizophreniaschizophrenia

Delusions of persecutionDelusions of persecution — Belief that others, — Belief that others, often a vague “they,” are out to get him or her. often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my me with radioactive particles delivered through my tap water”).tap water”).

Delusions of referenceDelusions of reference — A neutral environmental — A neutral environmental event is believed to have a special and personal event is believed to have a special and personal meaning. For example, a person with meaning. For example, a person with schizophrenia might believe a billboard or a person schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for on TV is sending a message meant specifically for them.them.

Signs and symptoms of paranoid Signs and symptoms of paranoid schizophreniaschizophrenia

Delusions of grandeurDelusions of grandeur — Belief that one is a — Belief that one is a famous or important figure, such as Jesus Christ famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual may involve the belief that one has unusual powers that no one else has (e.g. the ability to powers that no one else has (e.g. the ability to fly).fly).

Delusions of controlDelusions of control — Belief that one’s thoughts or actions — Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thought withdrawal (“The CIA is robbing me of my thoughts.”).thoughts.”).

Signs and symptoms of paranoid Signs and symptoms of paranoid schizophreniaschizophrenia

HallucinationsHallucinations are sounds or other sensations experienced are sounds or other sensations experienced as real when they exist only in the person's mind. While as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.their own inner self-talk as coming from an outside source.

Schizophrenic hallucinations are usually meaningful to the Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.be worse when the person is alone.

Signs and symptoms of paranoid Signs and symptoms of paranoid schizophreniaschizophrenia

Disorganized speechDisorganized speech Fragmented thinking is characteristic of schizophrenia. Fragmented thinking is characteristic of schizophrenia.

Externally, it can be observed in the way a person speaks. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak topic and end somewhere completely different, speak incoherently, or say illogical things. incoherently, or say illogical things.

Common signs of disorganized speech in schizophrenia Common signs of disorganized speech in schizophrenia include:include:Loose associationsLoose associations — Rapidly shifting from topic to — Rapidly shifting from topic to topic, with no connection between one thought and the topic, with no connection between one thought and the next.next.NeologismsNeologisms — Made-up words or phrases that only have — Made-up words or phrases that only have meaning to the patient.meaning to the patient.PerseverationPerseveration — Repetition of words and — Repetition of words and statements; saying the same thing over and over.statements; saying the same thing over and over.Clang Clang — — Meaningless use of rhyming words (“I said the bread and read Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head.").the shed and fed Ned at the head.").

Signs and symptoms of Signs and symptoms of disorganized schizophreniadisorganized schizophrenia Disorganized schizophrenia generally appears at an Disorganized schizophrenia generally appears at an

earlier age than other types of schizophrenia. Its onset is earlier age than other types of schizophrenia. Its onset is gradual, rather than abrupt, with the person gradually gradual, rather than abrupt, with the person gradually retreating into his or her fantasies. The distinguishing retreating into his or her fantasies. The distinguishing characteristics of this subtype are disorganized speech, characteristics of this subtype are disorganized speech, disorganized behavior, and blunted or inappropriate disorganized behavior, and blunted or inappropriate emotions. People with disorganized schizophrenia also emotions. People with disorganized schizophrenia also have trouble taking care of themselves, and may be have trouble taking care of themselves, and may be unable to perform simple tasks such as bathing or feeding unable to perform simple tasks such as bathing or feeding themselves.themselves.

The symptoms of disorganized schizophrenia include:The symptoms of disorganized schizophrenia include: Impaired communication skillsImpaired communication skills Incomprehensible or illogical speechIncomprehensible or illogical speech Emotional indifferenceEmotional indifference

Signs and symptoms of Signs and symptoms of disorganized schizophreniadisorganized schizophrenia Inappropriate reactions (e.g. laughing at a Inappropriate reactions (e.g. laughing at a

funeral)funeral) Infantile behavior (baby talk, giggling)Infantile behavior (baby talk, giggling) Peculiar facial expressions and mannerismsPeculiar facial expressions and mannerisms

People with disorganized schizophrenia People with disorganized schizophrenia sometimes suffer from hallucinations and sometimes suffer from hallucinations and delusions, but unlike the paranoid subtype, delusions, but unlike the paranoid subtype, their fantasies aren’t consistent or organized.their fantasies aren’t consistent or organized.

Signs and symptoms of catatonic Signs and symptoms of catatonic schizophreniaschizophrenia

The hallmark of catanoic schizophrenia is a disturbance in The hallmark of catanoic schizophrenia is a disturbance in movement: either a decrease in motor activity, reflecting a movement: either a decrease in motor activity, reflecting a stuporous state, or an increase in motor activity, reflecting an stuporous state, or an increase in motor activity, reflecting an excited state.excited state.

Stuporous motor signsStuporous motor signs — The stuporous state reflects a dramatic — The stuporous state reflects a dramatic reduction in activity. The person often ceases all voluntary reduction in activity. The person often ceases all voluntary movement and speech, and may be extremely resistant to any movement and speech, and may be extremely resistant to any change in his or her position, even to the point of holding an change in his or her position, even to the point of holding an awkward, uncomfortable position for hours. awkward, uncomfortable position for hours.

Excited motor signsExcited motor signs — Sometimes, people with catatonic — Sometimes, people with catatonic schizophrenia pass suddenly from a state of stupor to a state of schizophrenia pass suddenly from a state of stupor to a state of extreme excitement. During this frenzied episode, they may extreme excitement. During this frenzied episode, they may shout, talk rapidly, pace back and forth, or act out in violence—shout, talk rapidly, pace back and forth, or act out in violence—either toward themselves or others.either toward themselves or others.

People with catatonic schizophrenia can be highly suggestible. People with catatonic schizophrenia can be highly suggestible. They may automatically obey commands, imitate the actions of They may automatically obey commands, imitate the actions of others, or mimic what others say.others, or mimic what others say.

Prognosis:Prognosis: Numerous international studies have Numerous international studies have

demonstrated favorable long-term outcomes demonstrated favorable long-term outcomes for around half of those diagnosed with for around half of those diagnosed with schizophrenia, with substantial variation schizophrenia, with substantial variation between individuals and regions. One between individuals and regions. One retrospective study found that about a third of retrospective study found that about a third of people made a full recovery, about a third people made a full recovery, about a third showed improvement but not a full recovery, showed improvement but not a full recovery, and a third remained ill.and a third remained ill.

Prognosis:Prognosis: The World Health Organization conducted two The World Health Organization conducted two

long-term follow-up studies involving more than long-term follow-up studies involving more than 2,000 people suffering from schizophrenia in 2,000 people suffering from schizophrenia in different countries. These studies found patients different countries. These studies found patients have much better long-term outcomes in have much better long-term outcomes in developing countries (India, Colombia and Nigeria) developing countries (India, Colombia and Nigeria) than in developed countries (USA, UK, Ireland, than in developed countries (USA, UK, Ireland, Denmark, Czech Republic, Slovakia, Japan, and Denmark, Czech Republic, Slovakia, Japan, and Russia), despite the fact antipsychotic drugs are Russia), despite the fact antipsychotic drugs are typically not widely available in poorer countries, typically not widely available in poorer countries, raising questions about the effectiveness of such raising questions about the effectiveness of such drug-based treatments.drug-based treatments.

Treatment:Treatment: Some Some Typical antipsychotics:Typical antipsychotics: TabletsTabletsTrade NameTrade Name Normal Daily Dose (mg)Normal Daily Dose (mg)Max. Daily Dose (mg)Max. Daily Dose (mg) ChlorpromazineChlorpromazineLargactilLargactil 75-30075-300 1000 1000 HaloperidolHaloperidol HaldolHaldol 3-15 3-15 30 30 PimozidePimozide OrapOrap 4-20 4-20 20 20 TrifluoperazineTrifluoperazine StelazineStelazine 5-205-20 SulpirideSulpiride DolmatilDolmatil 200-800 200-800 2400 2400 Depot InjectionsDepot Injections (may be given 2-4 weekly) (may be given 2-4 weekly) Trade NameTrade Name Normal 2 Normal 2

weekly doseweekly dose Max. 2 weekly doseMax. 2 weekly dose HaloperidolHaloperidol HaldolHaldol 5050 Flupenthixol decanoateFlupenthixol decanoate DepixolDepixol 4040 Fluphenazine decanoateFluphenazine decanoate ModecateModecate 12.5-10012.5-100 Pipothiazine palmitatePipothiazine palmitate PiportilPiportil 5050 Zuclopenthixol decanoateZuclopenthixol decanoate ClopixolClopixol200.200.

Treatment:Treatment: Some Some Atypical antipsychotics:Atypical antipsychotics: TabletsTablets Trade NameTrade Name Normal daily dose (mg)Normal daily dose (mg) Max. daily Max. daily

dose (mg)dose (mg) AmisulpirideAmisulpiride SolianSolian 50 - 80050 - 800 12001200 AripiprazoleAripiprazole AbilifyAbilify 10-3010-30 ClozapineClozapine ClozarilClozaril 200-450200-450 900900 OlanzapineOlanzapine ZyprexaZyprexa 10-2010-20 2020 QuetiapineQuetiapine SeroquelSeroquel 300-450300-450 750750 RisperidoneRisperidone RisperdalRisperdal 4-64-6 1616 SertindoleSertindole SerdolectSerdolect 12-2012-20 2424 ZotepineZotepine ZoleptilZoleptil 75-20075-200300300 Depot InjectionsDepot Injections Trade NameTrade Name Normal 2 weekly doseNormal 2 weekly dose

Max. 2 weekly doseMax. 2 weekly dose RisperidoneRisperidone Risperdal ConstaRisperdal Consta 2525 5050

Psychological Treatments:Psychological Treatments: Cognitive Behavioural Therapy Cognitive Behavioural Therapy

(CBT)(CBT) Counselling and supportive Counselling and supportive

psychotherapypsychotherapy Family workFamily work Cognitive remediationCognitive remediation

Cultural referencesCultural references:: The book and film The book and film A A Beautiful MindBeautiful Mind chronicled the life of chronicled the life of

John Forbes Nash, a Nobel-Prize-winning mathematician John Forbes Nash, a Nobel-Prize-winning mathematician who was diagnosed with schizophrenia. The Marathi film who was diagnosed with schizophrenia. The Marathi film Devrai Devrai (Featuring Atul Kulkarni) is a presentation of a (Featuring Atul Kulkarni) is a presentation of a patient with schizophrenia. The film, set in the Konkan patient with schizophrenia. The film, set in the Konkan region of Maharashtra in Western India, shows the region of Maharashtra in Western India, shows the behavior, mentality, and struggle of the patient as well as behavior, mentality, and struggle of the patient as well as his loved-ones. It also portrays the treatment of this mental his loved-ones. It also portrays the treatment of this mental illness using medication, dedication and plenty of patience illness using medication, dedication and plenty of patience by the close relatives of the patient. Other factual books by the close relatives of the patient. Other factual books have been written by relatives on family members; have been written by relatives on family members; Australian journalist Anne Deveson told the story of her Australian journalist Anne Deveson told the story of her son's battle with schizophrenia in son's battle with schizophrenia in Tell me I'm HereTell me I'm Here, later , later made into a movie.made into a movie.

Cultural referencesCultural references::

In Bulgakov's Master and Margarita the poet In Bulgakov's Master and Margarita the poet Ivan Bezdomnyj is institutionalized and Ivan Bezdomnyj is institutionalized and diagnosed with schizophrenia after witnessing diagnosed with schizophrenia after witnessing the devil (Woland) predict Berlioz's death. The the devil (Woland) predict Berlioz's death. The book The book The Eden ExpressEden Express by Mark Vonnegut by Mark Vonnegut recounts his struggle into schizophrenia and recounts his struggle into schizophrenia and his journey back to sanity.his journey back to sanity.

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