🕷️ Crawler Inspector

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Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 113 (from laksa153)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa113.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://bestpractice.bmj.com/topics/en-gb/406\')), getAhrefsUnparsedNoserviceFromURL(\'https://bestpractice.bmj.com/topics/en-gb/406\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406","crawl_time":1773203873,"first_indexed_time":0,"http_code":200,"src_unparsed":"com,bmj!bestpractice,\/topics\/en-gb\/406 s443","src_root_hash":"7270522143396850113","history_drop_reason":null,"meta_title":"Schizophrenia - Symptoms, diagnosis and treatment | BMJ Best Practice","meta_descriptions":["Schizophrenia symptoms typically begin in early adulthood and may be preceded by a prodromal period, with changes in the person’s thoughts, mood, and behaviour prior to the start of psychotic symptoms. Early psychosis services focus on an ‘at-risk mental state’, which is characterised by psychotic s"],"attrs_boilerpipe_text":"BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:\nFiona Gaughran, MB BCh, BAO (Hons), MRCPI, MD NUI, FRCP, FRCPI, FRCP Edin, FRCPsych, FHEA\nLead Consultant Psychiatrist\nNational Psychosis Service\nDirector of Research and Development\nSouth London and Maudsley NHS Foundation Trust\nReader in Psychopharmacology and Physical Health\nInstitute of Psychiatry, Psychology and Neuroscience\nKings College London\nUK\nToby Pillinger, MA(Oxon), BM, BCh, MRCP, PhD\nAcademic Clinical Lecturer\nInstitute of Psychiatry, Psychology and Neuroscience\nKing's College London\nUK\nAdrian Preda, MD\nProfessor of Clinical Psychiatry\nDepartment of Psychiatry and Human Behavior\nUniversity of California, Irvine School of Medicine\nIrvine\nCA\nRobert G. Bota, MD\nHealth Sciences Clinical Professor of Psychiatry\nUniversity of California\nIrvine\nCA\nDisclosures\nFG has received support or honoraria for CME, advisory work, and lectures from Lundbeck, Otsuka, and Sunovion; collaborated with a research group supported by NHS Innovations and Janssen; has a family member with professional links to Lilly and GSK, including shares; and is in part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity and the Stanley Medical Research Institute. TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka. AP declares that he has no competing interests. RGB declares that he has no competing interests.","attrs_markdown":"[Skip to main content](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#main-content)[Skip to search](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#mainSearchField)\n\n- Log in\n\n- [Personal account](https:\/\/bestpractice.bmj.com\/log-in)\n- [Access through your institution](https:\/\/bestpractice.bmj.com\/access-through-your-institution)[(Open Athens)](https:\/\/bestpractice.bmj.com\/oac)\n\n- [Subscribe](https:\/\/bestpractice.bmj.com\/info\/subscribe)\n- [Access through your institution](https:\/\/bestpractice.bmj.com\/access-through-your-institution)\n- [Log in](https:\/\/bestpractice.bmj.com\/log-in)\n\n[Home](https:\/\/bestpractice.bmj.com\/info\/)\n\n[Home](https:\/\/bestpractice.bmj.com\/info\/)\n\n![open menu](https:\/\/bestpractice.bmj.com\/images\/burger-menu.svg)\n\n- [About us](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  Overview[What is BMJ Best Practice?](https:\/\/bestpractice.bmj.com\/info\/about-bmj-best-practice)[Our history](https:\/\/bestpractice.bmj.com\/info\/history-of-bmj-best-practice)\n  \n  Key features[Clinical tools](https:\/\/bestpractice.bmj.com\/info\/clinical-tools) [Local guidance](https:\/\/bestpractice.bmj.com\/info\/local-guidance)[Earn CME\/CPD points](https:\/\/bestpractice.bmj.com\/info\/earn-cme-cpd-points)[Comorbidities Manager](https:\/\/bestpractice.bmj.com\/info\/\/comorbidities)[Access anywhere](https:\/\/bestpractice.bmj.com\/info\/access-anywhere)[Our app](https:\/\/bestpractice.bmj.com\/info\/\/app)[Integration](https:\/\/bestpractice.bmj.com\/info\/integration)\n  \n  Our Evidence approach[Trusted content](https:\/\/bestpractice.bmj.com\/info\/trusted-content)[Updating process](https:\/\/bestpractice.bmj.com\/info\/evidence-based)\n- [Who we help](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  Best Practice for...[Clinicians](https:\/\/bestpractice.bmj.com\/info\/clinicians)[Hospitals](https:\/\/bestpractice.bmj.com\/info\/hospitals)[Medical librarians](https:\/\/bestpractice.bmj.com\/info\/us\/librarian)[Medical schools](https:\/\/bestpractice.bmj.com\/info\/medical-schools)[Medical students](https:\/\/bestpractice.bmj.com\/info\/medical_student)[Nurses](https:\/\/bestpractice.bmj.com\/info\/nurses)[Pharmacists](https:\/\/bestpractice.bmj.com\/info\/pharmacists)[Primary care](https:\/\/bestpractice.bmj.com\/info\/clinics)[Paramedics](https:\/\/bestpractice.bmj.com\/info\/paramedics)[Telehealth](https:\/\/bestpractice.bmj.com\/info\/telehealth)\n- [How we help](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  Impact and effectiveness[Evidence of effectiveness](https:\/\/bestpractice.bmj.com\/info\/impact\/evidence-of-effectiveness) [Global impact](https:\/\/bestpractice.bmj.com\/info\/global_impact)[Customer stories](https:\/\/bestpractice.bmj.com\/info\/recent-updates)\n- [Browse clinical content](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  [Recent updates](https:\/\/bestpractice.bmj.com\/recent-updates)\n  \n  [Specialties](https:\/\/bestpractice.bmj.com\/specialties)\n  \n  [Try a free topic](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/3000086)\n  \n  [Patient information](https:\/\/bestpractice.bmj.com\/patient-leaflets)\n  \n  [Videos](https:\/\/bestpractice.bmj.com\/procedural-videos)\n  \n  [Calculators](https:\/\/bestpractice.bmj.com\/calculators)\n- [What’s new](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  [Clinical updates](https:\/\/bestpractice.bmj.com\/recent-updates)\n  \n  [News](https:\/\/bestpractice.bmj.com\/info\/news)\n  \n  [Podcast](https:\/\/bestpractice.bmj.com\/info\/podcast)\n- [Access](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  Log in via...[Personal subscription or user profile](https:\/\/bestpractice.bmj.com\/log-in)[Access through your institution](https:\/\/bestpractice.bmj.com\/access-through-your-institution)\n  \n  [Access code](https:\/\/myaccount.bmj.com\/myaccount\/signup.html?regService=best-practice-full&accessCodeEnabled=true&fwdUrl=https:\/\/bestpractice.bmj.com)\n  \n  [Subscribe](https:\/\/bestpractice.bmj.com\/info\/subscribe)\n  \n  [Free trial](https:\/\/bestpractice.bmj.com\/info\/free-trial)\n  \n  [How do I get access?](https:\/\/bestpractice.bmj.com\/info\/how-do-i-get-access)\n  \n  [Download the app](https:\/\/bestpractice.bmj.com\/info\/app)\n- [Help](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  [FAQs](https:\/\/bestpractice.bmj.com\/info\/faq)\n  \n  [How do I get access?](https:\/\/bestpractice.bmj.com\/info\/how-do-i-get-access)\n  \n  [Contact us](https:\/\/bestpractice.bmj.com\/info\/contact-us)\n\n# Schizophrenia\n[View PDF](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/3000091\/pdf\/3000091\/Schizophrenia.pdf)\n\n[ Menu Close](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n\n- Overview \n- Theory \n- Diagnosis \n- Management \n- Follow up \n- Resources \n\n- [Overview](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  - [Summary](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/3000091)\n- [Theory](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  - Epidemiology\n  - Aetiology\n  - Case history\n- [Diagnosis](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  - Recommendations\n  - History and exam\n  - Investigations\n  - Differentials\n  - Criteria\n- [Management](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  - Recommendations\n  - Treatment algorithm\n  - Emerging\n  - Prevention\n  - Patient discussions\n- [Follow up](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  - Monitoring\n  - Complications\n  - Prognosis\n- [Resources](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406)\n  - Guidelines\n  - References\n  - Patient information\n  - Evidence\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\nWhen viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.\n\nOK\n\nCancel\n\nLast reviewed: 11 Feb 2026\n\nLast updated: 25 Jun 2024\n## Summary\nSchizophrenia symptoms typically begin in early adulthood and may be preceded by a prodromal period, with changes in the person’s thoughts, mood, and behaviour prior to the start of psychotic symptoms. Early psychosis services focus on an ‘at-risk mental state’, which is characterised by psychotic symptoms short of a full diagnosis.\n\nInitially, patients are usually referred by family members or friends. Many patients have acute treatment in the community, but admission may be considered if the patient is at significant risk of self-neglect or harming themselves or others. The care of patients with more chronic symptoms tends to involve community mental health workers or other professionals.\n\nAntipsychotic medications and psychosocial interventions are effective for most patients, but to varying degrees.\n\nPatients with schizophrenia have a higher mortality than the general population due to physical illness (e.g., cardiovascular diseases and cancers), accidents, and suicide. Suicidal ideation is common and suicide prevention is a key aspect of management. This should include monitoring for depressive symptoms and risk factors of suicide.\n### Definition\nSchizophrenia is a mental health condition in which a person’s perception, thoughts, mood, and behaviour are significantly altered.[\\[1\\]](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#referencePop1)National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. March 2014 \\[internet publication\\]. https:\/\/www.nice.org.uk\/guidance\/cg178  It is characterised by ‘positive symptoms’ (e.g., auditory hallucinations, bizarre delusions, and disrupted speech) and ‘negative symptoms’ (e.g., social withdrawal, demotivation, self-neglect, and flat affect).[\\[2\\]](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#referencePop2)Scottish Intercollegiate Guidelines Network. Management of schizophrenia: a national clinical guideline. March 2013 \\[internet publication\\]. https:\/\/www.sign.ac.uk\/assets\/sign131.pdf  There are specific diagnostic criteria based on symptom duration and\/or presence of particular combinations of positive and negative symptoms.[\\[3\\]](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#referencePop3)American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2023.[\\[4\\]](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#referencePop4)World Health Organization. International statistical classification of diseases and related health problems (ICD): ICD-11. Sep 2022 \\[internet publication\\]. https:\/\/icd.who.int\/en  For more information, see  [Criteria](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/3000091\/criteria).\n\nPsychotic symptoms can, however, be caused by a range of physical and mental illnesses.\n\nIt is important to recognise that not all patients with psychosis will develop schizophrenia.[\\[5\\]](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#referencePop5)National Collaborating Centre for Mental Health. Psychosis and schizophrenia in adults: the NICE guideline on treatment and management. 2014 \\[internet publication\\]. https:\/\/www.nice.org.uk\/guidance\/cg178\/evidence\/full-guideline-490503565  Most people make a good recovery following a first episode of psychosis and it is estimated that up to 20% of patients will make a full recovery.[\\[5\\]](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/406#referencePop5)National Collaborating Centre for Mental Health. Psychosis and schizophrenia in adults: the NICE guideline on treatment and management. 2014 \\[internet publication\\]. https:\/\/www.nice.org.uk\/guidance\/cg178\/evidence\/full-guideline-490503565  Many people who have subsequent episodes of psychosis maintain a good quality of life despite symptoms.\n\nThis topic focuses on the diagnosis and management of schizophrenia in adults; the management of schizophrenia in children is beyond the scope of this topic.\n### History and exam\n#### Key diagnostic factors\n- hallucinations\n- delusions\n- passivity phenomena\n- negative symptoms\n- disorganised thinking (formal thought disorder)\n- catatonia\n\nFull details\n\n#### Other diagnostic factors\n- agitation or distress\n- suicidal thoughts\n- altered cognition\n- loss of insight\n\nFull details\n\n#### Risk factors\n- family history of schizophrenia\n- increasing paternal age\n- obstetric complications\n- cannabis use\n- low IQ\n- motor dysfunction\n- psychological stress\n- childhood adversity\n- migrant status\n\nFull details\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\n### Diagnostic investigations\n#### 1st investigations to order\n- clinical diagnosis\n\nFull details\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\n### Treatment algorithm\nACUTE\n\n### acute psychosis\nONGOING\n\n### known schizophrenia: long-term management\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\n### Contributors\n#### Expert advisers\nVIEW ALLExpert advisers\n\n##### Stephen Lawrie, MB ChB, MRCPsych, MPhil, MD (Hons), FRCPsych, Hon.FRCP(Edin), FRSE\nProfessor of Psychiatry and Neuroimaging\n\nUniversity of Edinburgh\n\nHonorary Consultant Psychiatrist\n\nNHS Lothian\n\nRoyal Edinburgh Hospital\n\nEdinburgh\n\nUK\n\n###### Disclosures\nSL declares that he has no competing interests.\n\n##### Acknowledgements\nBMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:\n\nFiona Gaughran, MB BCh, BAO (Hons), MRCPI, MD NUI, FRCP, FRCPI, FRCP Edin, FRCPsych, FHEA\n\nLead Consultant Psychiatrist\n\nNational Psychosis Service\n\nDirector of Research and Development\n\nSouth London and Maudsley NHS Foundation Trust\n\nReader in Psychopharmacology and Physical Health\n\nInstitute of Psychiatry, Psychology and Neuroscience\n\nKings College London\n\nUK\n\nToby Pillinger, MA(Oxon), BM, BCh, MRCP, PhD\n\nAcademic Clinical Lecturer\n\nInstitute of Psychiatry, Psychology and Neuroscience\n\nKing's College London\n\nUK\n\nAdrian Preda, MD\n\nProfessor of Clinical Psychiatry\n\nDepartment of Psychiatry and Human Behavior\n\nUniversity of California, Irvine School of Medicine\n\nIrvine\n\nCA\n\nRobert G. Bota, MD\n\nHealth Sciences Clinical Professor of Psychiatry\n\nUniversity of California\n\nIrvine\n\nCA\n\nDisclosures\n\nFG has received support or honoraria for CME, advisory work, and lectures from Lundbeck, Otsuka, and Sunovion; collaborated with a research group supported by NHS Innovations and Janssen; has a family member with professional links to Lilly and GSK, including shares; and is in part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity and the Stanley Medical Research Institute. TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka. AP declares that he has no competing interests. RGB declares that he has no competing interests.\n\n#### Peer reviewers\nVIEW ALLPeer reviewers\n\n##### Jonathan Mitchell, MBChB, MRCPsych\nConsultant Psychiatrist\n\nSheffield Health and Social Care NHS Foundation Trust\n\nSheffield\n\nUK\n\n###### Disclosures\nJM has been involved in production of National Institute for Health and Care Excellence (NICE) guidance on this topic and is a member of the expert advisors panel for the NICE centre for guidelines. He was involved in an NIHR-funded research project on the physical health of people with schizophrenia.\n\n##### Peer reviewer acknowledgements\nBMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.\n\n###### Disclosures\nPeer reviewer affiliations and disclosures pertain to the time of the review.\n\n### References\n*Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.*\n\n#### Key articles\nNational Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. March 2014 \\[internet publication\\].[Full text](https:\/\/www.nice.org.uk\/guidance\/cg178)\n\nScottish Intercollegiate Guidelines Network. Management of schizophrenia: a national clinical guideline. March 2013 \\[internet publication\\].[Full text](https:\/\/www.sign.ac.uk\/assets\/sign131.pdf)\n\nAmerican Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2023.\n\nAmerican Psychiatric Association. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia, third edition. 2021 \\[internet publication\\].[Full text](https:\/\/psychiatryonline.org\/doi\/book\/10.1176\/appi.books.9780890424841)\n\nBarnes TR, Drake R, Paton C, et al. Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2020 Jan;34(1):3-78.[Full text](https:\/\/journals.sagepub.com\/doi\/10.1177\/0269881119889296)  [Abstract](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31829775?tool=bestpractice.com)\n\n#### Reference articles\n##### A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.\n\n- #### Differentials\n  - Schizoaffective disorder\n  - Substance-induced psychotic disorder\n  - Dementia with psychosis\n  \n  More Differentials\n- #### Guidelines\n  - Psychosis and schizophrenia in adults: prevention and management\n  - Management of schizophrenia: a national clinical guideline\n  \n  More Guidelines\n- #### Patient information\n  Schizophrenia: what is it?\n  \n  Schizophrenia: questions to ask your doctor\n  \n  More Patient information\n- [![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\nUse of this content is subject to our [disclaimer](https:\/\/bestpractice.bmj.com\/info\/disclaimer\/)\n\n### Log in or subscribe to access all of BMJ Best Practice\nSee all options\n\n×\n\n### Log in or subscribe to access all of BMJ Best Practice\n### Log in to access all of BMJ Best Practice\n[personpersonal subscriptionor user profile](https:\/\/bestpractice.bmj.com\/log-in)\n\n[Access through your institution](https:\/\/bestpractice.bmj.com\/info\/access-through-your-institution\/)\n\nOR\n\n[SUBSCRIPTION OPTIONS](https:\/\/bestpractice.bmj.com\/info\/subscribe\/)\n\n## Browse\n- [Home](https:\/\/bestpractice.bmj.com\/)\n- [Recent updates](https:\/\/bestpractice.bmj.com\/recent-updates)\n- [Specialties](https:\/\/bestpractice.bmj.com\/specialties)\n- [Calculators](https:\/\/bestpractice.bmj.com\/calculators)\n- [Patient information](https:\/\/bestpractice.bmj.com\/patient-leaflets)\n- [Procedural videos](https:\/\/bestpractice.bmj.com\/procedural-videos)\n- 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2515-9615\n\n[![Eco-Friendly Web Alliance](https:\/\/bestpractice.bmj.com\/images\/EFWA-logo-2027.png)](https:\/\/ecofriendlyweb.org\/client\/bmj-best-practice\/)\n\nCookie Settings\n\n## Help us improve BMJ Best Practice\nClose ×\n\nPlease complete all fields.\n\n## Thank you\nYour feedback has been submitted successfully.\n\n FEEDBACK\n\n![](https:\/\/dc.ads.linkedin.com\/collect\/?pid=103646&fmt=gif)\n\n","attrs_readable_markdown":"BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:\n\nFiona Gaughran, MB BCh, BAO (Hons), MRCPI, MD NUI, FRCP, FRCPI, FRCP Edin, FRCPsych, FHEA\n\nLead Consultant Psychiatrist\n\nNational Psychosis Service\n\nDirector of Research and Development\n\nSouth London and Maudsley NHS Foundation Trust\n\nReader in Psychopharmacology and Physical Health\n\nInstitute of Psychiatry, Psychology and Neuroscience\n\nKings College London\n\nUK\n\nToby Pillinger, MA(Oxon), BM, BCh, MRCP, PhD\n\nAcademic Clinical Lecturer\n\nInstitute of Psychiatry, Psychology and Neuroscience\n\nKing's College London\n\nUK\n\nAdrian Preda, MD\n\nProfessor of Clinical Psychiatry\n\nDepartment of Psychiatry and Human Behavior\n\nUniversity of California, Irvine School of Medicine\n\nIrvine\n\nCA\n\nRobert G. Bota, MD\n\nHealth Sciences Clinical Professor of Psychiatry\n\nUniversity of California\n\nIrvine\n\nCA\n\nDisclosures\n\nFG has received support or honoraria for CME, advisory work, and lectures from Lundbeck, Otsuka, and Sunovion; collaborated with a research group supported by NHS Innovations and Janssen; has a family member with professional links to Lilly and GSK, including shares; and is in part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity and the Stanley Medical Research Institute. TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka. AP declares that he has no competing interests. RGB declares that he has no competing interests.","meta_canonical":null}

3. Robots.txt Check

Query:

Response:

4. Spam/Ban Check

Query:

Response:

5. Seen Status Check

ℹ️ Skipped - page is already crawled

📄

INDEXABLE

✅

CRAWLED

1 month ago

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ROBOTS ALLOWED

Page Info Filters

Filter	Status	Condition	Details
HTTP status	PASS	`download_http_code = 200`	HTTP 200
Age cutoff	PASS	`download_stamp > now() - 6 MONTH`	1 months ago
History drop	PASS	`isNull(history_drop_reason)`	No drop reason
Spam/ban	PASS	`fh_dont_index != 1 AND ml_spam_score = 0`	ml_spam_score=0
Canonical	PASS	`meta_canonical IS NULL OR = '' OR = src_unparsed`	Not set

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Property	Value
URL	https://bestpractice.bmj.com/topics/en-gb/406
Last Crawled	2026-03-11 04:37:53 (1 month ago)
First Indexed	not set
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Meta Title	Schizophrenia - Symptoms, diagnosis and treatment \| BMJ Best Practice
Meta Description	Schizophrenia symptoms typically begin in early adulthood and may be preceded by a prodromal period, with changes in the person’s thoughts, mood, and behaviour prior to the start of psychotic symptoms. Early psychosis services focus on an ‘at-risk mental state’, which is characterised by psychotic s
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Boilerpipe Text	BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content: Fiona Gaughran, MB BCh, BAO (Hons), MRCPI, MD NUI, FRCP, FRCPI, FRCP Edin, FRCPsych, FHEA Lead Consultant Psychiatrist National Psychosis Service Director of Research and Development South London and Maudsley NHS Foundation Trust Reader in Psychopharmacology and Physical Health Institute of Psychiatry, Psychology and Neuroscience Kings College London UK Toby Pillinger, MA(Oxon), BM, BCh, MRCP, PhD Academic Clinical Lecturer Institute of Psychiatry, Psychology and Neuroscience King's College London UK Adrian Preda, MD Professor of Clinical Psychiatry Department of Psychiatry and Human Behavior University of California, Irvine School of Medicine Irvine CA Robert G. Bota, MD Health Sciences Clinical Professor of Psychiatry University of California Irvine CA Disclosures FG has received support or honoraria for CME, advisory work, and lectures from Lundbeck, Otsuka, and Sunovion; collaborated with a research group supported by NHS Innovations and Janssen; has a family member with professional links to Lilly and GSK, including shares; and is in part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity and the Stanley Medical Research Institute. TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka. AP declares that he has no competing interests. RGB declares that he has no competing interests.
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[Help](https://bestpractice.bmj.com/topics/en-gb/406) [FAQs](https://bestpractice.bmj.com/info/faq) [How do I get access?](https://bestpractice.bmj.com/info/how-do-i-get-access) [Contact us](https://bestpractice.bmj.com/info/contact-us) # Schizophrenia [View PDF](https://bestpractice.bmj.com/topics/en-gb/3000091/pdf/3000091/Schizophrenia.pdf) [ Menu Close](https://bestpractice.bmj.com/topics/en-gb/406) - Overview  - Theory  - Diagnosis  - Management  - Follow up  - Resources  - [Overview](https://bestpractice.bmj.com/topics/en-gb/406) - [Summary](https://bestpractice.bmj.com/topics/en-gb/3000091) - [Theory](https://bestpractice.bmj.com/topics/en-gb/406) - Epidemiology - Aetiology - Case history - [Diagnosis](https://bestpractice.bmj.com/topics/en-gb/406) - Recommendations - History and exam - Investigations - Differentials - Criteria - [Management](https://bestpractice.bmj.com/topics/en-gb/406) - Recommendations - Treatment algorithm - Emerging - Prevention - Patient discussions - [Follow up](https://bestpractice.bmj.com/topics/en-gb/406) - Monitoring - Complications - Prognosis - [Resources](https://bestpractice.bmj.com/topics/en-gb/406) - Guidelines - References - Patient information - Evidence [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance. OK Cancel Last reviewed: 11 Feb 2026 Last updated: 25 Jun 2024 ## Summary Schizophrenia symptoms typically begin in early adulthood and may be preceded by a prodromal period, with changes in the person’s thoughts, mood, and behaviour prior to the start of psychotic symptoms. Early psychosis services focus on an ‘at-risk mental state’, which is characterised by psychotic symptoms short of a full diagnosis. Initially, patients are usually referred by family members or friends. Many patients have acute treatment in the community, but admission may be considered if the patient is at significant risk of self-neglect or harming themselves or others. The care of patients with more chronic symptoms tends to involve community mental health workers or other professionals. Antipsychotic medications and psychosocial interventions are effective for most patients, but to varying degrees. Patients with schizophrenia have a higher mortality than the general population due to physical illness (e.g., cardiovascular diseases and cancers), accidents, and suicide. Suicidal ideation is common and suicide prevention is a key aspect of management. This should include monitoring for depressive symptoms and risk factors of suicide. ### Definition Schizophrenia is a mental health condition in which a person’s perception, thoughts, mood, and behaviour are significantly altered.[\[1\]](https://bestpractice.bmj.com/topics/en-gb/406#referencePop1)National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. March 2014 \[internet publication\]. https://www.nice.org.uk/guidance/cg178 It is characterised by ‘positive symptoms’ (e.g., auditory hallucinations, bizarre delusions, and disrupted speech) and ‘negative symptoms’ (e.g., social withdrawal, demotivation, self-neglect, and flat affect).[\[2\]](https://bestpractice.bmj.com/topics/en-gb/406#referencePop2)Scottish Intercollegiate Guidelines Network. Management of schizophrenia: a national clinical guideline. March 2013 \[internet publication\]. https://www.sign.ac.uk/assets/sign131.pdf There are specific diagnostic criteria based on symptom duration and/or presence of particular combinations of positive and negative symptoms.[\[3\]](https://bestpractice.bmj.com/topics/en-gb/406#referencePop3)American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2023.[\[4\]](https://bestpractice.bmj.com/topics/en-gb/406#referencePop4)World Health Organization. International statistical classification of diseases and related health problems (ICD): ICD-11. Sep 2022 \[internet publication\]. https://icd.who.int/en For more information, see [Criteria](https://bestpractice.bmj.com/topics/en-gb/3000091/criteria). Psychotic symptoms can, however, be caused by a range of physical and mental illnesses. It is important to recognise that not all patients with psychosis will develop schizophrenia.[\[5\]](https://bestpractice.bmj.com/topics/en-gb/406#referencePop5)National Collaborating Centre for Mental Health. Psychosis and schizophrenia in adults: the NICE guideline on treatment and management. 2014 \[internet publication\]. https://www.nice.org.uk/guidance/cg178/evidence/full-guideline-490503565 Most people make a good recovery following a first episode of psychosis and it is estimated that up to 20% of patients will make a full recovery.[\[5\]](https://bestpractice.bmj.com/topics/en-gb/406#referencePop5)National Collaborating Centre for Mental Health. Psychosis and schizophrenia in adults: the NICE guideline on treatment and management. 2014 \[internet publication\]. https://www.nice.org.uk/guidance/cg178/evidence/full-guideline-490503565 Many people who have subsequent episodes of psychosis maintain a good quality of life despite symptoms. This topic focuses on the diagnosis and management of schizophrenia in adults; the management of schizophrenia in children is beyond the scope of this topic. ### History and exam #### Key diagnostic factors - hallucinations - delusions - passivity phenomena - negative symptoms - disorganised thinking (formal thought disorder) - catatonia Full details #### Other diagnostic factors - agitation or distress - suicidal thoughts - altered cognition - loss of insight Full details #### Risk factors - family history of schizophrenia - increasing paternal age - obstetric complications - cannabis use - low IQ - motor dysfunction - psychological stress - childhood adversity - migrant status Full details [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) ### Diagnostic investigations #### 1st investigations to order - clinical diagnosis Full details [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) ### Treatment algorithm ACUTE ### acute psychosis ONGOING ### known schizophrenia: long-term management [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) ### Contributors #### Expert advisers VIEW ALLExpert advisers ##### Stephen Lawrie, MB ChB, MRCPsych, MPhil, MD (Hons), FRCPsych, Hon.FRCP(Edin), FRSE Professor of Psychiatry and Neuroimaging University of Edinburgh Honorary Consultant Psychiatrist NHS Lothian Royal Edinburgh Hospital Edinburgh UK ###### Disclosures SL declares that he has no competing interests. ##### Acknowledgements BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content: Fiona Gaughran, MB BCh, BAO (Hons), MRCPI, MD NUI, FRCP, FRCPI, FRCP Edin, FRCPsych, FHEA Lead Consultant Psychiatrist National Psychosis Service Director of Research and Development South London and Maudsley NHS Foundation Trust Reader in Psychopharmacology and Physical Health Institute of Psychiatry, Psychology and Neuroscience Kings College London UK Toby Pillinger, MA(Oxon), BM, BCh, MRCP, PhD Academic Clinical Lecturer Institute of Psychiatry, Psychology and Neuroscience King's College London UK Adrian Preda, MD Professor of Clinical Psychiatry Department of Psychiatry and Human Behavior University of California, Irvine School of Medicine Irvine CA Robert G. Bota, MD Health Sciences Clinical Professor of Psychiatry University of California Irvine CA Disclosures FG has received support or honoraria for CME, advisory work, and lectures from Lundbeck, Otsuka, and Sunovion; collaborated with a research group supported by NHS Innovations and Janssen; has a family member with professional links to Lilly and GSK, including shares; and is in part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity and the Stanley Medical Research Institute. TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka. AP declares that he has no competing interests. RGB declares that he has no competing interests. #### Peer reviewers VIEW ALLPeer reviewers ##### Jonathan Mitchell, MBChB, MRCPsych Consultant Psychiatrist Sheffield Health and Social Care NHS Foundation Trust Sheffield UK ###### Disclosures JM has been involved in production of National Institute for Health and Care Excellence (NICE) guidance on this topic and is a member of the expert advisors panel for the NICE centre for guidelines. He was involved in an NIHR-funded research project on the physical health of people with schizophrenia. ##### Peer reviewer acknowledgements BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic. ###### Disclosures Peer reviewer affiliations and disclosures pertain to the time of the review. ### References Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible. #### Key articles National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. March 2014 \[internet publication\].[Full text](https://www.nice.org.uk/guidance/cg178) Scottish Intercollegiate Guidelines Network. Management of schizophrenia: a national clinical guideline. March 2013 \[internet publication\].[Full text](https://www.sign.ac.uk/assets/sign131.pdf) American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2023. American Psychiatric Association. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia, third edition. 2021 \[internet publication\].[Full text](https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890424841) Barnes TR, Drake R, Paton C, et al. Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2020 Jan;34(1):3-78.[Full text](https://journals.sagepub.com/doi/10.1177/0269881119889296) [Abstract](http://www.ncbi.nlm.nih.gov/pubmed/31829775?tool=bestpractice.com) #### Reference articles ##### A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice. - #### Differentials - Schizoaffective disorder - Substance-induced psychotic disorder - Dementia with psychosis More Differentials - #### Guidelines - Psychosis and schizophrenia in adults: prevention and management - Management of schizophrenia: a national clinical guideline More Guidelines - #### Patient information Schizophrenia: what is it? 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Readable Markdown	BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content: Fiona Gaughran, MB BCh, BAO (Hons), MRCPI, MD NUI, FRCP, FRCPI, FRCP Edin, FRCPsych, FHEA Lead Consultant Psychiatrist National Psychosis Service Director of Research and Development South London and Maudsley NHS Foundation Trust Reader in Psychopharmacology and Physical Health Institute of Psychiatry, Psychology and Neuroscience Kings College London UK Toby Pillinger, MA(Oxon), BM, BCh, MRCP, PhD Academic Clinical Lecturer Institute of Psychiatry, Psychology and Neuroscience King's College London UK Adrian Preda, MD Professor of Clinical Psychiatry Department of Psychiatry and Human Behavior University of California, Irvine School of Medicine Irvine CA Robert G. Bota, MD Health Sciences Clinical Professor of Psychiatry University of California Irvine CA Disclosures FG has received support or honoraria for CME, advisory work, and lectures from Lundbeck, Otsuka, and Sunovion; collaborated with a research group supported by NHS Innovations and Janssen; has a family member with professional links to Lilly and GSK, including shares; and is in part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity and the Stanley Medical Research Institute. TP has received honoraria for contributing to speaker meetings organised by Sunovion, Lundbeck, and Otsuka. AP declares that he has no competing interests. RGB declares that he has no competing interests.
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