Literature review on schizophrenia

Schizophrenia represents a major burden for patients, their families, healthcare systems and societies. The objective of this literature review is to document the economic burden of schizophrenia. The grey literature search was performed using several databases e. The studies that met the following criteria were included:

A substantial body of research has highlighted the evolution of ToM in nonhuman primates, its emergence during human ontogeny, and impaired ToM in a variety of neuropsychiatric disorders, including schizophrenia. In addition to these potential research areas, future studies may also address whether patients could benefit from cognitive training in this domain.

Theoretical Background

Interestingly, the term was first used by primatologists and psychologists Premack and Woodruff, who asked whether the chimpanzee had a theory of mind Premack and Woodruff It is therefore crucial that every person who imputes mental states to others be able to crosscheck his or her inference against reality—that is, to interpret signals from the social environment supporting or refuting his or her assumption.

Extract the relevant meaning from speech depends upon an intact ToM. To effectively use and interpret language, one usually has to go beyond the literal meaning of words and utterances on the basis of contextual information Sperber and Wilson In fact, impaired ToM has been described in a variety of neuropsychiatric disorders.

The most extensive ToM studies have been carried out in autistic spectrum disorders e. Clinical findings strongly suggest that patients with schizophrenia Literature review on schizophrenia impaired in social interaction relating to their reduced capacity to effectively engage in communication e.

There is dispute, however, over such questions as whether ToM is impaired or exaggerated in some types of schizophrenia, whether ToM represents a state or trait marker of these disorders, and the extent to which ToM abnormalities in schizophrenia are linked to the execution of other cognitive functions and language.

The first part deals with some critical theoretical issues relating to ToM; the second part outlines the main findings of empirical research of Literature review on schizophrenia in schizophrenia. Theoretical Background Evolutionary Trajectories of ToM The evolutionary perspective of ToM in the context of schizophrenia is helpful insofar as the emergence of ToM in humans is paralleled by adaptive changes in the brain.

Second, it is precisely the brain areas involved in ToM that are frequently, although not exclusively, found to be abnormal in schizophrenia, such as parts of the prefrontal cortex of particular interest could be the paracingulate cortex and the temporal cortex, including cortical connectivity e.

Furthermore, ToM research in nonhuman primates has helped clarify how ToM may best be conceptualized and tested Brownell et al. ToM probably emerged quite recently during the late Pleistocene in hominids because individuals needed to cope with an increasingly complex social environment Whiten However, exploration of this topic surpasses the scope of this article.

Ontogeny of ToM Understanding the ontogeny of ToM abilities in the context of ToM research in schizophrenia is critical for two reasons: Baron-Cohen has proposed an ontogenetic model of ToM maturation based on an evolutionary concept.

According to his model, very early in development, infants selectively pay attention to eyelike stimuli. At the same time, the child starts to recognize him- or herself in a mirror.

At 6 to 7 years old, children learn to understand higher order representations—for instance, to know that someone else thinks that a third person believes something. A faux pas is somewhat more difficult to comprehend, because it involves the capacity to understand a situation in which one character should have kept information from another but did not.

However, this rather fixed model of ToM acquisition in ontogeny partly neglects the impact of the social environment on the development of ToM skills in infants and children. As Carpendale and Lewis in press have pointed out, for instance, young children whose parents frequently use expressions referring to mental states when talking to them pass ToM tests at an earlier age than children whose parents use such terms less often.

Thus, there is clearly input from the social environment that facilitates cognitive maturation, including ToM. More relevant is the fact that there are different theoretical conceptualizations regarding the cognitive architecture of ToM. Like other domain-specific cognitive capacities represented in the brain that operate on only a certain class of information, the ToMM is supposed to process information restricted to social inference.

Cognitive modules are supposed to be reliable, efficient, and economic. This model suggests that infants and children acquire different levels of representational skills in steps during ontogeny, starting out with primary representations of the self as an acting agent.

Secondary representation, accomplished after the second year of age, allows for distinction between reality and hypothetical situations.

In other words, the theory-theory model maintains that metarepresentational skills are not necessarily restricted to the execution of ToM.

In contrast to the theory-theory model, the simulation theory posits that attributing mental states to oneself is at the core of inferring the mental states of others by replicating or mimicking the mental life of other individuals.

This model has recently received additional support from the observation that monkeys and humans possess mirror neurons that are active when certain hand or mouth movements are being observed in others. This overview article certainly cannot explore these divergent theoretical models in depth.

All of them have gained empirical support, but it remains unclear which one best underpins the cognitive architecture of ToM. It seems likely that the divergent positions in this debate are not irreconcilable, but such a discussion is beyond the scope of this article. Furthermore, schizophrenia patients who have difficulties in experiencing their behavior as the result of their own intentions may interpret their actions as being under alien control.

Patients with prominent negative or disorganized behavioral symptoms would accordingly be most impaired in ToM performance, similar to autistic persons, because of their incapacity to represent mental states at all. Clearly, paranoid patients have an intact ToM in the sense that they know that other people have mental states.

According to this model, ToM deficits are expected to occur exclusively in patients with prominent thought and language disorganization, whereas patients without disorganization symptoms are predicted to have preserved ToM abilities.

This model would best fit into the simulation theory of ToM. Abu-Akel and Bailey have further proposed a continuity model of ToM deficits: Similarly, Walston et al. These theoretical models of how ToM may be involved in schizophrenic symptoms, divergent as they may be, are open to empirical testing.

As discussed in the next section, the crucial task, then, is to develop ToM tests that are suitable for adults with schizophrenia and do not interfere too much with other cognitive functions.The most recent comprehensive review [Velligan et al.

] on nonadherence in schizophrenia, which involved both a literature review and experts’ ratings on the findings in the literature, found that poor insight and lack of illness awareness, a belief that medications are no longer needed, and lack of treatment efficacy were key factors.

Consultant Psychiatrist, Center for Psychiatry and Psychotherapy, University of Bochum, Bochum, Germany; and was Research Fellow, Centre for the Mind, Research School of Biological Sciences, Australian National University, Canberra, Australia, and University of .

The aim of this review is to consider, compile and describe the humanistic burden of schizophrenia as documented in the literature. Materials and methods We conducted a literature review assessing the worldwide disease burden of schizophrenia, taking into account all humanistic burden topics.

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