9. The Secondary Schizophrenias

  1. Daniel R. Weinberger MD3 and
  2. Paul J. Harrison MA, BM, BCh, DM(Oxon), FRCPsych4
  1. Thomas M. Hyde MD, PhD1 and
  2. Maria A. Ron MD, PhD, FRCP, FRCPsych2

Published Online: 8 MAR 2011

DOI: 10.1002/9781444327298.ch9

Schizophrenia, Third Edition

Schizophrenia, Third Edition

How to Cite

Hyde, T. M. and Ron, M. A. (2010) The Secondary Schizophrenias, in Schizophrenia, Third Edition (eds D. R. Weinberger and P. J. Harrison), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444327298.ch9

Editor Information

  1. 3

    Genes, Cognition and Psychosis Program, Clinical Studies Section, Clinical Brain Disorders Branch, National Institute of Health, Bethesda, MD, USA

  2. 4

    Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK

Author Information

  1. 1

    Lieber Institute for Brain Development, Baltimore, Maryland MD, USA

  2. 2

    Institute of Neurology, University College London, London, UK

Publication History

  1. Published Online: 8 MAR 2011
  2. Published Print: 10 DEC 2010

ISBN Information

Print ISBN: 9781405176972

Online ISBN: 9781444327298

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Keywords:

  • schizophrenia;
  • psychosis;
  • epilepsy;
  • cerebral trauma;
  • brain tumors;
  • cerebrovascular disease;
  • movement disorders;
  • autoimmune disorders;
  • CNS infections;
  • drug-related psychoses

Summary

Despite overwhelming evidence of its biological basis, primary schizophrenia remains a behavioral disorder that is a diagnosis of exclusion. Clinicians cannot rely upon routine laboratory tests, neuroimaging studies, electrophysiological paradigms or neuropsychological testing batteries to confirm the diagnosis of this disorder to the exclusion of phenocopies. Moreover, there are a number of disparate brain disorders that can, uncommonly, give rise to schizophrenia-like symptomatology. This chapter first outlines the nosological challenges and how recent classification systems have dealt with these, distinguishing secondary schizophrenia-like psychoses arising from defined neuropathological processes and those secondary to cerebral complications of systemic illness. Second, it attempts to estimate the prevalence of such secondary schizophrenias in relation to schizophrenia in general. Third, it examines the evidence for symptomatic differences between secondary and primary schizophrenia, and discusses their clinical diagnosis. Finally, the chapter reviews broadly which specific brain diseases seem to present a particularly increased risk of schizophrenic symptoms. In the past, mental disorders have been subdivided into “organic” and “functional” categories. These subdivisions are now less useful, as primary schizophrenia is as “organic” as any of the secondary schizophrenias. This chapter reviews the association of a variety of neurological and general medical conditions that are associated with schizophrenia-like signs and symptoms. These include epilepsy, cerebral trauma, space-occupying lesions of the central nervous system, cerebrovascular disease, movement disorders, demyelinating diseases, metabolic and autoimmune disorders, infections of the central nervous system, drug-related psychoses, and cytogenic/chromosomal disorders. Throughout, additional insights are offered relating the pathological bases of the secondary schizophrenias to primary schizophrenia.