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Schizofreni

Sist oppdatert: Sist revidert:
Sist revidert av:

Definisjon:
Er en alvorlig psykisk lidelse, psykose, som preges av hallusinasjoner og vrangforestillinger og som fører til sosial tilbaketrekning og svekket sosial fungering
Forekomst:
Livstidsrisiko angis til 0,3-1,0%. Prevalens er ca. 3-5 per 1.000
Symptomer:
Vrangforestillinger, tankeforstyrrelser, hallusinasjoner, språklige forstyrrelser, forstyrrelser i jeg-funksjon, kataton adferd og negative symptomer
Funn:
Ingen somatiske funn
Diagnostikk:
Standardiserte spørreskjemaer anvendes i kartleggingen. CT og MR tas ved førstegangs psykose
Behandling:
Det er tre effektive behandlingsmetoder: Medikamentell behandling, individuell kognitiv adferdsterapi og familieintervensjon
  1. Gaughran F, Pillinger T. Schizophrenia. BMJ Best Practice, last updated 14 Jan 2021. bestpractice.bmj.com  
  2. Holder SD, Wayhs A. Schizophrenia. Am Fam Physician. 2014 Dec 1;90(11):775-82. PMID: 25611712. PubMed  
  3. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 2008; 30: 67-76. PubMed  
  4. Laursen TM, Nordentoft M, Mortensen PB, Excess early mortality in schizophrenia. Annu. Rev. Clin. Psychol 2014; 10: 425-448. PubMed  
  5. Kendall T, Hollis C, Stafford M, Taylor C. Recognition and management of psychosis and schizophrenia in children and young people: summary of NICE guidance. BMJ 2013; 346: f150. BMJ (DOI)  
  6. Johannessen JO. Schizofreni - omfang og betydning. Tidsskr Nor Lægeforen 2002; 122: 2011-4. PubMed  
  7. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 2008; 30:67. PubMed  
  8. Harrison PJ, Weinberger DR. Schizophrenia genes, gene expression, and neuropathology: on the matter of their convergence. Mol Psychiatry 2005; 10: 40-68. PubMed  
  9. Ripke S, Sanders AR, Kendler KS, et al. Genome-wide association study identifies five new schizophrenia loci. Nature Genetics 2011. doi:10.1038/ng.940.
  10. Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 2007; 370: 319-28. PubMed  
  11. Fischer BA, Buchanan RW. Schizophrenia in adults: Epidemiology and pathogenesis. UpToDate, last updated Nov 10, 2020. UpToDate  
  12. Helsedirektoratet: Nasjonal faglig retningslinje for utredning, behandling og oppfølging av personer med psykoselidelser. IS-1957. Utgitt 01.07.2013. helsedirektoratet.no  
  13. Larsen TK. Tidlig påvisning av schizofreni - er primærprofylakse mulig?. Tidsskr Nor Lægeforen 2002; 122: 2015-8. PubMed  
  14. Larsen TK, McGlashan TH, Johannessen JO, et al. Shortened duration of untreated first episode of psychosis: changes in patient characteristics at treatment. Am J Psychiatry 2001;158:1917-9 American Journal of Psychiatry  
  15. Woo TU. Neurobiology of schizophrenia onset. Curr Top Behav Neurosci. 2014;16:267-95. PMID: 23975845 PubMed  
  16. Goldman AL, Pezawas L, Mattay VS, et al. Widespread reductions of cortical thickness in schizophrenia and spectrum disorders and evidence of heritability. Arch Gen Psychiatry 2009; 66: 467. PubMed  
  17. McCutcheon RA, Reis Marques T, Howes OD. Schizophrenia-An Overview. JAMA Psychiatry. 2020 Feb 1;77(2):201-210. PMID: 31664453. PubMed  
  18. Hameed MA, Lewis AJ. Offspring of parents with schizophrenia: A Systematic Review of Developmental Features Across Childhood. Harv Rev Psychiatry. 2016 Mar-Apr;24(2):104-17. pmid: 26954595 PubMed  
  19. Wang SH, Hsiao PC, Yeh LL, et al. Advanced Paternal Age and Early Onset of Schizophrenia in Sporadic Cases: Not Confounded by Parental Polygenic Risk for Schizophrenia. Biol Psychiatry. 2019;86(1):56-64. PMID: 30926130.
  20. Bernstein CN, Hitchon CA, Bolton JM, et al. Increased burden of psychiatric disorders in inflammatory bowel disease. Inflamm Bowel Dis. 2019 Jan 10;25(2):360-368 . pmid:29986021 PubMed  
  21. Jardim PSJ, Borge TC, Johansen TB. Effekten av antipsykotika ved førstegangspsykose. Folkehelseinstituttet, Oslo 2021. www.fhi.no  
  22. Tiihonen J, Mittendorfer-Rutz E, Torniainen M, et al. Mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines in patients with schizophrenia: An observational follow-up study. Am J Psychiatry 2015. PMID: 26651392 PubMed  
  23. Correll CU, Galling B, Pawar A, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: A systematic review, meta-analysis, and meta-regression. JAMA Psychiatry. 2018 May 2.
  24. Melle I, Larsen TK, Haahr U, et al. Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Arch.Gen.Psychiatry 2004; 61: 143-150. PubMed  
  25. Melle I, Johannesen JO, Friis S, et al. Early detection of the first episode of schizophrenia and suicidal behavior. Am J Psychiatry 2006; mai.
  26. Frankenburg FR. Schizophrenia. Medscape, last updated Sep 17, 2020. emedicine.medscape.com  
  27. Haddock G, Barrowclough, Shaw JJ, et al. Cognitive-behavioural therapy v. social activity therapy for people with psychosis and a history of violence: randomised controlled trial. Bt J Psychiatry 2009; 194: 152-7. PubMed  
  28. Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. Cochrane Database of Systematic Reviews 2012; 4: CD008712. Cochrane (DOI)  
  29. De Silva MJ, Cooper S, Li HL, et al. Effect of psychosocial interventions on social functioning in depression and schizophrenia: meta-analysis. Br J Psychiatry. 2013 ;202(4):253-60. doi: 10.1192/bjp.bp.112.118018 DOI  
  30. Pharoah F, Mari J, Rathbone J, et al. Family intervention for schizophrenia. Cochrane Database of Systematic Reviews 2010; 12: CD000088. Cochrane (DOI)  
  31. Okpokoro U, Adams CE, Sampson S. Family intervention (brief) for schizophrenia. Cochrane Database Syst Rev. 2014 Mar 5;3:CD009802. PMID: 24595545 PubMed  
  32. Rosenbaum S, Tiedemann A, Sherrington C, et al. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry. 2014;75(9):964-74. doi: 10.4088/JCP.13r08765. DOI  
  33. Daumit GL, Dalcin AT, Dickerson FB, et al. Effect of a Comprehensive Cardiovascular Risk Reduction Intervention in Persons With Serious Mental Illness: A Randomized Clinical Trial. JAMA Netw Open. 2020 Jun 1;3(6):e207247. doi: 10.1001/jamanetworkopen.2020.7247. DOI  
  34. Åtgärder för att stödja personer med schizofreni att förändra ohälsosamma levnadsvanor. SBU-rapport (2015-03-11)
  35. Correll CU, Manu P, Olshanskiy V, Napolitano B, Kane JM, Malhotra AK. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA 2009; 302: 1765-73. Journal of the American Medical Association  
  36. Stroup TS, Marder S. Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment. UpToDate, last updated Apr 21, 2020. UpToDate  
  37. Leucht S, Cipriani A, Spineli L, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 2013 Jun 26. doi:10.1016/S0140-6736(13)60733-3 DOI  
  38. Rattehalli RD, Zhao S, Li BG, et al. Risperidone versus placebo for schizophrenia. Cochrane Database Syst Rev. 2016 Dec 15;12:CD006918. PMID: 27977041. PubMed  
  39. Leucht S, Leucht C, Huhn M, et al. Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors. Am J Psychiatry 2017. pmid:28541090 PubMed  
  40. Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008712. DOI: 10.1002/14651858.CD008712.pub2. DOI  
  41. Komossa K, Rummel-Kluge C, Schwarz S, Schmid F, Hunger H, Kissling W, Leucht S. Risperidone versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD006626. DOI: 10.1002/14651858.CD006626.pub2. DOI  
  42. Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, Kissling W, Leucht S. Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD006654. DOI: 10.1002/14651858.CD006654.pub2. DOI  
  43. Jones PB, Barnes TR, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 2006;63(10):1079-87. PubMed  
  44. Samara MT, Dold M, Gianatsi M, et al. Efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia: A network meta-analysis. JAMA Psychiatry. 2016 Feb 3. doi: 10.1001/jamapsychiatry.2015.2955. DOI  
  45. Asenjo Lobos C, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Leucht S. Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD006633. DOI: 10.1002/14651858.CD006633.pub2. DOI  
  46. Tiihonen J, Tanskanen A, Bell JS, et al. Long-term treatment with clozapine and other antipsychotic drugs and the risk of haematological malignancies in people with schizophrenia: a nationwide case-control and cohort study in Finland. Lancet Psychiatry 2022; 9: 353-362. pmid:35334224 PubMed  
  47. da Silva Freire Coutinho E, Fenton M, Quraishi SN. Zuclopenthixol decanoate for schizophrenia and other serious mental illnesses. Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD001164. DOI: 10.1002/14651858.CD001164. DOI  
  48. Kishimoto T, Hagi K, Kurokawa S, Kane JM, Correll CU. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies published online ahead of print, 2021 Apr 6. Lancet Psychiatry. 2021;S2215-0366(21)00039-0. PMID: 33862018. PubMed  
  49. Petersen L, Jeppesen P, Thorup A, et al. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. BMJ 2005; 331: 602. PubMed  
  50. Wu RR, Jin H, Gao K, et al. Metformin for treatment of antipsychotic-induced amenorrhea and weight gain in women with first-episode schizophrenia: a double-blind, randomized, placebo-controlled study. Am J Psychiatry 2012; 169: 813-21. American Journal of Psychiatry  
  51. Bighelli I, Huhn M, Schneider-Thoma J, et al. . Response rates in patients with schizophrenia and positive symptoms receiving cognitive behavioural therapy: a systematic review and single-group meta-analysis. BMC Psychiatry 2018; 18(1): 380. pmid:30514268 PubMed  
  52. Penney D, Sauvé G, Mendelson D, et al. Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis A Systematic Review and Meta-analysis. JAMA Psyciatry 2022. pmid:35320347 PubMed  
  53. Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD002831. DOI: 10.1002/14651858.CD002831.pub2. DOI  
  54. Gorczynski P, Faulkner G. Exercise therapy for schizophrenia. Cochrane Database Syst Rev. 2010 May 12;(5):CD004412. doi: 10.1002/14651858.CD004412.pub2. Pmid 20464730 www.cochranelibrary.com  
  55. Pearsall R, Smith DJ, Pelosi A, Geddes J. Exercise therapy in adults with serious mental illness: a systematic review and meta-analysis. BMC Psychiatry 2014 Apr 21. pmid:24751159 PubMed  
  56. Dauwan M, Begemann MJ, Heringa SM, et al. Exercise Improves Clinical Symptoms, Quality of Life, Global Functioning, and Depression in Schizophrenia: A Systematic Review and Meta-analysis. Schizophr Bull 2016 May; 42(3): 588-99. pmid:26547223 PubMed  
  57. Helsedirektoratet. Nasjonal faglig retningslinje om bruk av elektronkonvulsiv behandling - ECT. IS-2629. Oslo: Helsedirektoratet 2017. helsedirektoratet.no  
  58. Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD000076. DOI: 10.1002/14651858.CD000076.pub2. DOI  
  59. Amminger GP, Schäfer MR, Schlögelhofer , et al. Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study. Nat Commun 2015; 6: 7934. doi:10.1038/ncomms8934 DOI  
  60. Heilbronner U, Samara M, Leucht S, Falkai P, Schulze TG. The Longitudinal Course of Schizophrenia Across the Lifespan: Clinical, Cognitive, and Neurobiological Aspects. Harv Rev Psychiatry. 2016;24(2):118-128. PMID: 26954596. PubMed  
  61. Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol 2010; 24:81. PubMed  
  62. Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry 2005; 187: 9-20. British Journal of Psychiatry  
  63. Coyle JT. Substance use disorders and Schizophrenia: a question of shared glutamatergic mechanisms. Neurotox Res. 2006 Dec;10(3-4):221-33. PMID: 17197372 PubMed  
  64. Dold M, Li C, Tardy M, Khorsand V, Gillies D, Leucht S. Benzodiazepines for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD006391. DOI: 10.1002/14651858.CD006391.pub2. DOI  
  65. Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, for the INDIGO Study Group. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 2009; 373: 408-15. PubMed  
  66. Folsom D, Jeste DV. Schizophrenia in homeless persons: a systematic review of the literature. Acta Psychiatr Scand. 2002 Jun;105(6):404-13. PMID: 12059843 PubMed  
  67. Ayano G, Tesfaw G, Shumet S. The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis. BMC Psychiatry. 2019 Nov 27;19(1):370. PMID: 31775786 PubMed  
  68. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. 2015;72(12):1172-1181. PubMed  
  69. Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009; 360: 225-35. New England Journal of Medicine  
  70. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry 2007; 64: 1123-31. PubMed  
  71. Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry 2017; 74:686. PubMed  
  72. Tsuda Y, Saruwatari J, Yasui-Furukori N. Meta-analysis: the effects of smoking on the disposition of two commonly used antipsychotic agents, olanzapine and clozapine. BMJ Open. 2014 Mar 4;4(3):e004216. PMID: 24595134 PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim
  • Randolf Terje Vågen, medisinsk fagsjef, Divisjon psykisk helsevern, St. Olavs hospital

Tidligere fagmedarbeidere

  • Tor K. Larsen, spesialist i psykiatri, førsteamanuensis, dr. med., Universitetet i Bergen, og overlege, Helse Stavanger HF, psykiatrisk klinikk og forsker ved Universitet i Oslo, Ullevåll sykehus avdeling for forskning og undervisning
  • Olav Thorsen, spesialist allmennmedisin, Klubbgaten legesenter, Stavanger