Schizophrenia is a psychotic disorder that typically presents in young adulthood with diverse, potentially disabling symptoms. The term psychosis refers to an impairment of reality testing; the individual is unable to recognize illness-related distortions in perception and thinking. Although psychotic symptoms (hallucinations, delusions, and disorganization) are the most obvious and potentially frightening aspect of the illness, chronic disability more commonly stems from disease-related apathy, withdrawal, and cognitive deficits. Social and occupational functioning deteriorate, and repeated hospitalizations are common. Few people with this illness are able to work in competitive jobs; most are disabled and isolated. It has been estimated that in 1990, schizophrenia's annual cost in the United States, counting treatment expenses and lost productivity, was $33 billion; it accounted for 2.5% of all health care expenditures.<sup>189 Rupp A., Keith S.J. The costs of schizophrenia: Assessing the burden Psychiatr Clin North Am 1993 ;  16 : 413-423

Cliccare qui per andare alla sezione Riferimenti</sup> Some patients experience despair and demoralization as they struggle with schizophrenia; others are unaware that they have an illness. Of patients, 12% commit suicide. The suffering of family members can be considerable; often parents report feeling like they have lost their child to the illness.<sup>19 Atkinson S.D. Grieving and loss in parents with a schizophrenic child Am J Psychiatry 1994 ;  151 : 1137-1139

Cliccare qui per andare alla sezione Riferimenti</sup> Pharmacologic and behavioral treatments for schizophrenia have advanced substantially, reducing the burden of psychotic symptoms and of medication side effects in most patients. The pathophysiology of the illness remains elusive, however. Nonpsychiatric physicians should prepare to confront this illness in their practice. With a prevalence of 1%, schizophrenia is common. As discussed in this article, individuals with schizophrenia often have elevated risk factors for many forms of medical morbidity, tend to receive inadequate medical care, and may pose unique challenges for clinicians in medical settings.