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Facts you should know about schizophrenia
What is the history of schizophrenia?
What research is being done on schizophrenia?
Where can people get more information about schizophrenia? How can people find a support group, specialists who treat the illness, or other assistance for schizophrenia?
How common is schizophrenia in children?
What are schizophrenia causes? Is schizophrenia hereditary?
Symptoms/Signs
What are schizophrenia symptoms and signs?
What professionals diagnose and treat schizophrenia? Are there particular tests that assess schizophrenia?
What are treatments for schizophrenia and the side effects of those treatments?
What are potential complications of schizophrenia? What is the prognosis for schizophrenia?
Is it possible to prevent schizophrenia?
Symptoms of schizophrenia include positive, more overtly psychotic symptoms and negative symptoms, potentially less overtly psychotic.
Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the population -- more than 2 million people in the United States alone.
With the sudden onset of severe psychotic symptoms, the individual is said to be experiencing acute psychosis. Psychotic means out of touch with reality or unable to separate real from unreal experiences.
There is no known single cause of schizophrenia. As discussed later, it appears that genetic and other biological factors produce a vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals.
There are a number of various schizophrenia treatments. Given the complexity of this disorder, the major questions about the illness (its cause or causes, prevention, and treatment) are unlikely to be resolved in the near future. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia.
Schizophrenia is one of the psychotic, also called thought-disordered, mental disorders and affects a person's thoughts, behaviors, and social functioning.
Symptoms of schizophrenia may include
delusions,
hallucinations,
catatonia,
negative symptoms, and/or
disorganized speech or behavior.
While schizophrenia used to be divided into different types of the disorder, like paranoid and undifferentiated forms, it is now considered to have various symptoms of one inclusive disorder.
Children as young as 6 years of age can be found to have all the schizophrenia symptoms as their adult counterparts and to continue to have those symptoms into adulthood.
Although the term schizophrenia has only been in use since 1908, its symptoms have been described throughout written history.
Schizophrenia is considered to be the result of a complex group of genetic, psychological, and environmental risk factors.
Health care professionals diagnose schizophrenia by gathering comprehensive medical, family, mental health, and social/cultural information.
The practitioner will also either perform a physical examination or request that the person's primary care doctor perform one. The medical evaluation will usually include lab tests.
In addition to providing treatment that is appropriate to the diagnosis, practitioners attempt to determine the presence of other mental illnesses that may co-occur with schizophrenia.
People with schizophrenia are at increased risk of having a number of medical problems, other mental health conditions, committing suicide or engaging in other self-harm, and otherwise dying earlier than people without this disorder.
Medications that systematic reviews of published studies (meta-analyses) have found to be most effective in treating the positive symptoms of schizophrenia are first- and second-generation antipsychotics.
Psychosocial interventions for schizophrenia include education of family members, assertive community treatment (ACT), substance-abuse treatment, social-skills training, supported employment, cognitive behavioral therapy, and weight management.
The use of repetitive transient magnetic stimulation (rTMS), cognitive remediation, peer-to-peer interventions, weight-management therapies, and continued medication refinement are current topics for research.
Paranoid-type schizophrenia is distinguished by paranoid behavior, including delusions and auditory hallucinations.
Sometimes colloquially but inaccurately referred to as split personality disorder, schizophrenia is a chronic, severe, debilitating mental illness. It affects about 1% of the general population, corresponding to more than 2 million people in the United States alone. Other statistics about schizophrenia include that it affects men about one and a half times more commonly than women. While the first episode of schizophrenia tends to occur from 18-25 years of age for men, the age of onset for women peaks initially from 25-30 years of age and again at about 40 years of age. People who experience the first episode of this mental illness after the age of 40 years are considered to have late-onset schizophrenia.
Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms of thought, behavior, and social problems. The thought problems associated with schizophrenia are described as psychosis, in that the person's thinking is completely out of touch with reality at times. For example, the sufferer may hear voices, smell odors, detect tastes, see people that are in no way present, or feel like bugs are crawling on their skin when there are none. The individual with this thought disorder may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are defined as ideas that have no basis in reality (for example, the individual might experience paranoia, in that he or she thinks others are plotting against them when they are not; a false belief of superiority, that thoughts are not one's own or that ordinary events have a special and personal meeting). While compulsive behaviors and obsessional thinking are not included as part of the diagnosis of schizophrenia, these symptoms occur in many people with this disorder.
Given that an individual can have various predominant symptoms of schizophrenia at different times as well as at the same time, the most recent Diagnostic Manual for Mental Disorders (DSM-5) has done away with what used to be described as five types of schizophrenia.
Types of Schizophrenia
There are five types of schizophrenia. They are categorized by the types of symptoms the person exhibits when they are assessed:
Paranoid schizophrenia
Disorganized schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Residual schizophrenia
Schizophrenia is the most disabling mental illness. See Answer
Schizophrenia in young children is rare. The National Institute of Mental Health (NIMH) estimates only 1 in 40,000 children experience the onset of schizophrenia symptoms before the age of 13.
Although there have been fewer studies on schizophrenia in children compared to adults, researchers are finding that children as young as 6 years of age can be found to have all the symptoms of their adult counterparts and to continue to have those symptoms into adulthood.
The word schizophrenia has only been in use since about 1908, attributed to psychiatrist Eugen Bleuler. It was deemed a separate mental illness in 1887 by Emil Kraepelin. The positive, disorganized symptoms of psychosis were called hebephrenia. Despite that relatively recent history, it has been described throughout written history. Ancient Egyptian, Hindu, Chinese, Greek, and Roman writings described symptoms similar to the positive symptoms of schizophrenia. During medieval times, schizophrenia, like other illnesses, was often viewed as evidence of the sufferer being possessed by spirits or having evil powers.
A number of accomplished individuals suffer from schizophrenia. The film A Beautiful Mind describes the life of John Nash, a noted scientist, and his struggles with what was previously called paranoid schizophrenia. The film The Soloist explores the challenges faced by Juilliard-trained musician Nathaniel Ayers as a result of schizophrenia. Despite those prominent portrayals of people with schizophrenia, this condition, like most mental illnesses, usually remains shrouded in secrecy and shame.
One frequently asked question about schizophrenia is if it is hereditary. As with most other mental disorders, schizophrenia is not directly passed from one generation to another genetically, and there is no single specific cause for this illness. Rather, it is the result of a complex group of genetic and other biological vulnerabilities, as well as psychological and environmental risk factors. Biologically, it is thought that people who have abnormalities in the brain neurochemical dopamine and lower brain matter in some areas of the brain are at higher risk for developing the condition. Other brain issues that are thought to predispose people to developing schizophrenia include abnormalities in the connections between different areas of the brain, called default mode network connectivity. Recent research is emerging that implicates potential abnormalities in the transmission of the brain neurochemical glutamate as a risk factor for having schizophrenia.
Schizophrenia is thought to have a significant but not solely genetic component. People who have immediate family members (first-degree relatives) with psychosis are more vulnerable to developing schizophrenia compared to people who do not have such a family history. Genetically, schizophrenia and bipolar disorder have much in common, in that the two disorders share a number of the same risk genes. However, the fact is that both illnesses also have some genetic factors that are unique. There are some genetic commonalities with schizophrenia and epilepsy, as well.
Environmentally, the risks of developing schizophrenia can even occur before birth. For example, the risk of schizophrenia is increased in individuals whose father is of advanced age or whose mother was malnourished or had one of certain infections during pregnancy. Difficult life circumstances during childhood, like the early loss of a parent, parental poverty, bullying, witnessing domestic violence; being the victim of emotional, sexual, or physical abuse or of physical or emotional neglect; and insecure attachment have been associated with increased risks of developing this illness. Using drugs, particularly marijuana (cannabis), amphetamines, and hallucinogens, has been found to increase the risk of developing schizophrenia. Factors like recent migration, being discriminated against, and how well represented an ethnic group is in a neighborhood can also be a risk or protective factor for developing schizophrenia in the long term. For example, some research indicates that ethnic minorities may be more at risk for developing this disorder if there are fewer members of the ethnic group to which the individual belongs in their neighborhood.
Schizophrenia: Symptoms, Types, Causes, Treatment See Slideshow
Schizophrenia symptoms include social withdrawal, anxiety, delusions, hallucinations, paranoid feelings or feelings of persecution, and more.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), symptoms of schizophrenia include the following:
Positive, more overtly psychotic symptoms
Delusions are beliefs that have no basis in reality. Types of delusions include erotic, grandiose (for example, religious or false belief or superiority), jealous, persecutory, physical (somatic), mixed, and nonspecific.
Hallucinations: hearing (for example, hearing voices), seeing, feeling (for example, feeling like bugs are crawling on the skin), smelling, or tasting things that have no basis in reality
Disorganized speech: incoherent or often grossly off-topic (derailed) speech
Disorganized behaviors
Negative symptoms, potentially less overtly psychotic
Inhibition of facial expressions and/or a lack of emotional responsiveness
Catatonic behaviors: difficulty moving, resistance to moving, hyperactivity, repetitive or otherwise abnormal movements, and/or nonsense word repetition or of what others say or do
Self-neglect, poor grooming, and lack of good hygiene
Lack of speech
Apathy/lack of motivation
Prior to the development of the full-blown disorder, people who go on to develop schizophrenia often exhibit subtler and/or less specific symptoms, also called prodromal symptoms. Some characteristics of prodromal schizophrenia are thought to include slowness in activity and thought, lower cognitive functioning, including memory loss, disorientation, and mental confusion; abnormal speech, including circumstantial, vague, or stereotyped speech. Individuals suffering from the prodromal symptoms of schizophrenia may exhibit odd ideas that have not reached the level of being delusions, like feeling detached from themselves, having beliefs that an ordinary event has special and personal meaning or a belief that their thoughts aren't their own. People with prodromal schizophrenia also tend to have mood problems, like general discontent, inappropriate emotional responses, fear, mistrust, hostility, anger, aggression, excitability, agitation, and inability to feel pleasure in activities they used to enjoy; social isolation, the self-centeredness that borders on narcissism, and other problems socializing.
As is true with virtually any mental health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, health care professionals like psychiatrists or other psychiatric medication prescribers, clinical psychologists or primary care providers diagnose this illness by gathering comprehensive medical, family, and mental health information. Patients tend to benefit when the practitioner performs a systematic review of their client's entire life and background. Examples of this include the person's gender, sexual orientation, cultural, religious and ethnic background, socioeconomic status, family, and other social relationships. The symptom sufferer might be asked to fill out a self-test that the professional will review if the person being evaluated is able to complete it.
The practitioner will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical assessment will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition or has been exposed to certain medications (for example, amphetamines like methylphenidate [Ritalin or Concerta] or amphetamine and dextroamphetamine [Adderall] in the treatment of attention deficit hyperactivity disorder or corticosteroids for the treatment of severe asthma) that might produce psychological symptoms.
In asking questions about mental health symptoms, mental health professionals are often exploring if the individual suffers from hallucinations or delusions, depression and/or manic (for example, excessive anger or elevated mood, inappropriate emotional responses, rapid, pressured, and/or frenzied speaking, a lack of behavioral restraint, overexcitement, decreased need for sleep) symptoms as occurs in bipolar disorder or schizoaffective disorder, anxiety, substance abuse, as well as some personality disorders (like schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders including the condition that was formerly called Asperger disorder). How long symptoms occur is a factor in determining diagnosis. For example, psychosis sufferers whose symptoms resolve in no more than a month may qualify for the diagnosis of schizophreniform disorder rather than schizophrenia. Since some of the symptoms of schizophrenia can also occur in other psychiatric illnesses, the mental health screening is to assess if the individual suffers from schizoaffective disorder or other psychotic disorder, depressive disorder, bipolar disorder, an anxiety disorder, a personality disorder, or a substance-abuse/drug-induced psychosis (for example, marijuana, cocaine, amphetamines, or psychedelic drugs).
Any disorder that is associated with bizarre behavior, mood, or thinking, like another psychotic disorder, borderline personality disorder or dissociative identity disorder (DID), previously called multiple personality disorder (MPD), may be particularly challenging to distinguish from schizophrenia. However, people with DID often suffer from feeling detached from oneself, as well as what looks like amnesia for their dissociative episodes, which does not tend to be a characteristic of schizophrenia. In order to assess the person's current emotional state, health care professionals perform a mental-status examination, as well. In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental health conditions that may co-occur (be comorbid) with schizophrenia is important in improving the life of schizophrenia sufferers. For example, people with schizophrenia are at increased risk of having a substance-abuse, depressive, or anxiety disorder and committing suicide.
Schizophrenia medication
Given the seriousness and chronic nature of schizophrenia, self-care without also getting treatment by a professional or home remedies are not deemed appropriate treatment for this illness. There is currently not thought to be a cure for schizophrenia, but there are a number of helpful treatments available, of which medication remains the cornerstone of treatment for people with this condition. These medications are often referred to as antipsychotics since they help decrease the intensity of psychotic symptoms. Many health care professionals prescribe one of these medications, sometimes in combination of one or more other psychiatric medications, in order to maximize the benefit for the person with schizophrenia.
Medications that have been found to be particularly effective in treating the positive symptoms of schizophrenia and therefore are considered top choices or first-line treatments, include orally taken medications like risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), lurasidone (Latuda), brexpiprazole (Rexulti), and iloperidone (Fanapt). Medications that may be taken by injection or by mouth include chlorpromazine, haloperidol (Haldol), fluphenazine, risperidone (Risperdal Consta), olanzapine (Zyprexa Relprevv), aripiprazole (Abilify, Abilify Maintena, Aristrada), and paliperidone (Invega Sustenna). Injectable medications tend to be more long-acting compared to oral preparations, lasting as much as four weeks at a time, thereby improving consistency of treatment.
Although older antipsychotic medications in this class like haloperidol (Haldol), thioridazine (Mellaril), perphenazine (Trilafon), and molindone (Moban) are more likely to cause muscle stiffness, impaired motor coordination, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health care professionals appropriately monitor the people they treat for these potential side effects, as well. Some of the abnormal muscle movements, like tremors (for example, akathisia) or stiffness (dystonia) can be managed using anti-tremor medications like benztropine (Cogentin) or amantadine (Symmetrel). Also, more recent research regarding all antipsychotic medications seems to demonstrate that the older (first-generation) antipsychotics are just as effective as the newer ones, both in the management of current symptoms and prevention of future symptoms, and have no higher rate of people stopping treatment because of any side effect the medications cause. Not all medications that treat schizophrenia in adults have been approved for use in treating childhood schizophrenia.
Clozapine (Clozaril), while thought to be highly effective for treating schizophrenia, has potentially serious, even fatal side effects that prevent it from being used prescribed more often. Those side effects can include dangerously low white blood cell count, inflammation of the heart muscle (myocarditis), as well as what are classified as metabolic side effects, like elevated blood sugar and cholesterol levels, weight gain, and elevated prolactin levels. While reserpine, a medication that also reduces blood pressure, has also been found to decrease psychotic symptoms, the fact that safer, more effective medications now exist has resulted in its being far less frequently used these days. Prochlorperazine (Compazine) has strong antipsychotic effects but is used to treat nausea, vomiting, and vertigo.
Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) can be useful in treating mood swings that sometimes occur in individuals who have a diagnosable mood disorder in addition to psychotic symptoms (for example, schizoaffective disorder, depression, in addition to schizophrenia). These medications may take a bit longer to work compared to the antipsychotic medications. Some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, and some can be associated with birth defects when taken by pregnant women. Divalproex and lamotrigine carry the rare potential of causing a potentially rare autoimmune reaction (Stevens-Johnson syndrome).
Antidepressant medications are the primary medical treatment for the depression that can often accompany schizophrenia and meta-analyses (systematic reviews of published studies) of how people with this illness fare when taking antidepressants support treatment with these medications. Examples of antidepressants that are commonly prescribed for that purpose include serotonergic (SSRI) medications that affect levels of the neurotransmitter serotonin (like fluoxetine [Prozac], sertraline [Zoloft], paroxetine [Paxil], citalopram [Celexa], escitalopram [Lexapro], vortioxetine [Trintellix], and vilazodone [Viibryd]) and combination serotonergic/adrenergic medications (SNRIs) (like venlafaxine [Effexor] and duloxetine [Cymbalta] and levomilnacipran [Fetzima], as well as bupropion [Wellbutrin], which is a dopaminergic [affecting dopamine levels] antidepressant medication).
Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose schizophrenia has inadequately responded to a number of medication trials and psychosocial interventions.
When treating pregnant women with schizophrenia, health care practitioners take great care to balance the need to maintain the person's more stable thoughts and behavior while minimizing the problems that medications used to treat this disorder may present. While some medications that treat schizophrenia may carry risks to the fetus in pregnancy and during breastfeeding, careful monitoring of how much medication is administered and the health of the fetus and of the mother can go a long way toward protecting the fetus from any such risks, while maximizing the chance that the fetus will grow in the healthier environment provided by an emotionally healthy mother.
Psychosocial interventions for schizophrenia
Family psycho-education and support: In addition to educating family members about the symptoms, course, and treatment of schizophrenia, this form of treatment consists of providing family with supportive therapy, problem-solving skills, and access to ongoing community supports, including care providers during times of crises. When this intervention is consistently provided for at least several months, it has been found to decrease the relapse rate for the person with schizophrenia and improve social and emotional outcomes. Also, the burden that family members experience as a result of having a loved one with schizophrenia is less, family members tend to be more knowledgeable about the disorder and feel more supported by the professionals involved, and family relationships are improved.
Assertive community treatment (ACT): This intervention consists of members of the person's treatment team meeting with that individual on a daily basis, in community settings (for example, home, work, or other places the person with schizophrenia frequents) rather than in an office or hospital setting. The treatment team is made up of a variety of professionals. For example, a psychiatrist, nurse, case manager, employment counselor, and substance-abuse counselor often make up an ACT team. Over the long term, ACT tends to be successful in reducing how often people with schizophrenia are psychiatrically hospitalized or become homeless.
Substance abuse treatment: Providing medical and psychosocial interventions that address substance abuse should be an integral part of treatment as about 50% of individuals with schizophrenia suffer from some kind of substance abuse or dependence.
Social skills training: Also called illness management and recovery programming, social-skills training involves teaching clients ways to handle social situations appropriately. It may be conducted as part of individual or group psychotherapy and often involves the person scripting (thinking through or role-playing) situations that occur in social settings in order to prepare for those situations when they actually occur. This treatment type has been found to help people with schizophrenia resist using drugs of abuse, as well as improve their relationships with health care professionals and with people at work.
Supported employment: This intervention provides supports like a job coach (someone who periodically or consistently counsels the client in the workplace), as well as instruction on constructing a résumé, interviewing for jobs, and education and support for employers to hire individuals with chronic mental illness. Supported employment has been found to help schizophrenia sufferers secure and maintain employment, earn more money, and increase the number of hours they are able to work.
Cognitive behavioral therapy (CBT): CBT is a reality-based intervention that focuses on helping a client understand and change patterns that tend to interfere with his or her ability to interact with others and otherwise function. Except for people who are actively psychotic, CBT has been found to help individuals with schizophrenia decrease symptoms and improve their ability to function socially. This intervention can be done either individually or in group therapy.
Group therapy: Group therapy is usually supportive and expressive, in that participants are encouraged in their efforts to care for themselves and otherwise engage in healthy, appropriate behaviors in the community.
Weight management: Educating people with schizophrenia about weight gain and related health problems that can be a side effect of some antipsychotic and other psychiatric medications has been found to be helpful in resulting in a modest weight loss. That is also true when schizophrenia sufferers are provided with behavioral interventions to help with weight loss.
Possible complications for schizophrenia range from more medical conditions (morbidity) or shortened life span (mortality) to negative impacts on their family members as well. For example, people with schizophrenia who continue to suffer from residual symptoms have more trouble thinking than those whose negative symptoms are adequately managed with treatment. Women with schizophrenia are thought to be more likely to suffer from complications during their pregnancies, at delivery and during their children's newborn period.
Individuals with schizophrenia have more than twice the rate of death than those without the disorder. Almost half of people with schizophrenia will suffer from a drug-use disorder (for example, alcohol, marijuana, or other drug) during their lifetime. Research shows that people with schizophrenia or schizoaffective disorder have a better quality of life when their family members tend to be more supportive and less critical of them.
Prevention of schizophrenia for individuals who have yet to develop even the early symptoms of the disorder focuses on decreasing many of the environmental insults that increase the likelihood of developing the disorder. Therefore, improving prenatal care, ameliorating poverty, bullying, child abuse and neglect, as well as protecting people from family and community violence are important aspects of preventing schizophrenia. For people who show early signs of schizophrenia, some clinical trial research is exploring the potential use of medications to prevent full-blown schizophrenia.
Repetitive transient magnetic stimulation (rTMS), a procedure that involves multiple sessions of applying magnetic pulses to the brain, has been shown in some studies to decrease hearing voices (verbal auditory hallucinations) in schizophrenia sufferers as a result of stimulating certain areas of the brain. However, more studies are needed to determine the effectiveness of this intervention before it is widely used.
Cognitive remediation continues to be an experimental treatment that addresses the cognitive problems that are associated with schizophrenia (for example, memory problems, speech impairment, learning problems). Clinical trials using this intervention in combination with vocational rehabilitation to improve work functioning have shown some promise, but more research is needed, particularly that which focuses on improving how well the person with schizophrenia functions in real-world situations as a result of this treatment.
Peer-to-peer treatment is a promising possible intervention since it promotes active constructive involvement from people who have schizophrenia, provides role models for individuals whose functioning is less stable, and may be accessible in individual and group settings, in person as well as by telephone or through the Internet. However, further research is necessary to demonstrate its effectiveness in decreasing symptoms or otherwise clearly improving functioning for people with schizophrenia.
In terms of weight management, more research is needed to explore how to best help people with schizophrenia retain the weight loss they achieve and even to prevent weight gain.
Where can people get more information about schizophrenia? How can people find a support/self-help group, specialists who treat the illness, or other assistance for schizophrenia?
Compeer, Inc.
1600 South Avenue, Suite 230
Phone: 1-800-836-0475 (toll free)
http://www.compeer.org/
NARSAD
Bethesda, Maryland 20892
NAMI (National Alliance on Mental Illness)
http://www.nami.org/
Tardive Dyskinesia
Tardive Dyskinesia Assessment
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Read, J., and R. Bentall. "Schizophrenia and childhood adversity." American Journal of Psychiatry 167 June 2010: 717-718.
Ross, R.G. "Psychotic and manic-like symptoms during stimulant treatment of attention deficit hyperactivity disorder." American Journal of Psychiatry 163.7 (2006): 1149-1152.
Schultze-Lutter, F. "Subjective symptoms of schizophrenia in research and the clinic: The basic symptom concept." Schizophrenia Bulletin 35.1 Jan. 2009: 5-8.
Semple, D.M., A.N. McIntosh, and S.M. Lawrie. "Cannabis as a risk factor for psychosis: systemic review." Journal of Psychopharmacology 19 (2005): 187.
Sorensen, H.J., E.L. Mortensen, J.M. Reinisch, and S.A. Mednick. "Association between prenatal exposure to bacterial infection and risk of schizophrenia." Schizophrenia Bulletin 35.3 May 2009: 631-637.
Veling, W., E. Susser, J. van Os, J.P. Mackenbach, et al. "Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants." American Journal of Psychiatry Dec. 2007: 1-8.
Velligan, D.I., and L.D. Alphs. "Negative symptoms in schizophrenia: the importance of identification and treatment." Psychiatric Times 25.3 Mar. 2008.
Volkow, N.D. "Substance use disorders in schizophrenia: Clinical implications of comorbidity." Schizophrenia Bulletin 35.3 May 2009: 469-472.
Wasserman, S., A. Weisman de Mamani, and P. Mundy. "Parents' criticisms and attributions about their adult children with high functioning autism or schizophrenia." Autism 14 (2010): 127-138.
Woodberry, K.A., A.J. Giuliano, and L.J. Seidman. "Premorbid IQ in schizophrenia: a meta-analytic review." American Journal of Psychiatry 165 (2008): 579-587.


Orlando Airport is 6.5 miles (10.5km) south-east of Orlando, and one of the busiest airports in Florida. Offering around 100 domestic and international flights, the airport serves both business and leisure travellers from around the world.
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To make your money go further, you will see deals which include something 'extra' in the price (such as a GPS, additional drivers or a free tank of fuel). Alternatively, you can avoid hidden fuel charges by booking a car with a full-to-full fuel policy — simply refill the tank just before the end of the rental and you won't pay any extra fuel fees when you drop the car off.
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When leaving the airport, take the North Exit to the Martin Andersen Beachline Expressway for International Drive.
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If you are unfamiliar with the area, you might want to request a GPS (which you will pay for at the pick-up counter).


In a special episode recorded the last time that Barry, Dave and Tod were in the same room, the Regular Joes take a stab at being producers, pitching sequels they have always wanted to see made. While most follow up films emerge within a few years of the original, our team focus on films and characters they've wanted to see resuscitated for decades. Also, Who Would Win in a Fight and a Desert Island DVDs installment devoted to films they should already have picked but had not.


As our worlds become more and more high-tech, so do our expectations for our vehicles. In fact, many of us now rank technology over safety when shopping for a new car. As an insurance company, the idea of so many nifty gadgets distracting drivers from the road makes us twitch a little. But as an online innovator with roots in the dot-com era, the opportunity for technology to advance vehicle safety makes our actuarial hearts go pitter-patter.
Using GPS and Wi-Fi, intelligent vehicles will be able to talk to each other (within 1,500 feet), communicating things like latitude, longitude, and speed.
Like its name implies, Blind Spot Detection (BSD) technology uses sensors to detect if there's a vehicle in your car's blind spots. It then alerts you using lights in the mirrors or audible alarms.
Already available in certain Audi, Buick, Cadillac, Mazda, Mercedes-Benz, and Volvo models, Business Wire reports that BSD systems could be in 25% of new cars by 2016.
Simply put (for those of us who don't have advanced engineering degrees), CWS warns drivers if an object is approaching too quickly. Some systems will even apply the brakes if imminent threat of collision is detected.
In addition to built-in safety devices, many manufacturers are also developing vehicle-specific apps for smartphones. GM's OnStar app enables you to control your vehicle remotely (can't remember if you locked the car?), access info like fuel levels and tire pressure, and track average miles per gallon. It even recommends oil changes.
Similarly, the Nissan LEAF™ app lets you begin charging your battery, see when a charge is complete, check estimated driving range, and turn the climate control system on or off.
While all of this technology may one day deliver an accident-proof car, the best way to avoid collisions in the meantime is to stick with good old-fashioned safe driving. Check out these 7 Tips for Good Driving, and be your own safety device.
Know of any cutting-edge technological advancements for cars? Let us know.
Just how do Google's driverless cars get around?


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zero-day vulnerability
Mozilla Issues Emergency Zero-Day Firefox Patch	June 19, 2019 at 3:50 pm
Mozilla advises all Firefox users to update to the latest version of the browser as soon as possible. The company has just become aware of a zero-day exploit affecting Firefox, meaning there are nefarious internet forces actively using it.
Fiat-Chrysler recalls 1.4 million vehicles in wake of hack	July 24, 2015 at 1:09 pm
Fiat Chrysler Automobiles (FCA) has announced it is voluntarily recalling 1.4 million vehicles across its various brands and model lines, in the wake of the discovery of a zero-day exploit that lets hackers remotely force late-model Jeep Cherokees off the road.
Zero-day exploit lets hackers remotely force cars off the road	July 21, 2015 at 4:48 pm
An exclusive investigation by Wired has revealed the most powerful car hack yet, one that could leave thousands of Jeep Cherokee drivers seriously vulnerable.
How to watch hacking, and cyberwarfare between the USA and China, in real time	June 25, 2014 at 8:54 am
You've probably read dozens of paragraphs on how the next great theater of war will be online rather than offline, and how China and the US are already battling each other for cyber supremacy. The truth is, though, unless you've actually been hacked, it's hard to appreciate just how real the prospect of cyberwar actually is. Now, though, a security company has produced a fascinating geographic map that shows you hacking attempts in real-time — and sure enough, you really can see China waging cyberwar against the US.
Microsoft patches IE bug in Windows XP, but it's a huge mistake	May 2, 2014 at 10:16 am
Microsoft, after officially retiring Windows XP back in April, has decided in its infinite wisdom to issue a patch for the Internet Explorer zero-day vulnerability that affected all versions of IE across Windows XP, Vista, 7, and 8. While this might seem like the right thing to do, it's actually a huge mistake that undercuts Microsoft's efforts to get the hundreds of millions of Windows XP holdouts to upgrade. After all, if Microsoft fixed this bug in Windows XP, who's to say it won't do it again? IT admins, faced with the harsh reality of finally having to upgrade to a modern operating system, will sleep well tonight knowing that Microsoft is a push over and will continue to support XP while it has a significant number of users. The status quo is preserved.
Please, Microsoft, don't put Windows XP to sleep on April 8 – the world isn't ready yet!	January 20, 2014 at 11:49 am
On April 8 2014, almost thirteen years after it was first released, Windows XP will finally breathe its last breath and die — officially, anyway. From that date, Microsoft will no longer support the inveterate OS, meaning instability bugs and security vulnerabilities will go forever unpatched. With Windows XP's desktop market share still around 30%, and many enterprises still months or years away from upgrading to Windows 7/8, these unsupported and insecure machines represent a serious risk to the health and security of the internet and other high-tech infrastructure. If just a single zero-day vulnerability is found after April 8, it will never be fixed. There's no telling what damage cybercriminals might sow with such an exploit.
Critical zero-day exploit in IE 6, 7, and 8 allows complete takeover	December 31, 2012 at 12:57 pm
Microsoft posted a security advisory that warns that Internet Explorer 6, 7, and 8 are vulnerable to a remote code execution bug. It even notes that an attempt to exploit this bug in IE 8 has already been found in the wild. Luckily, IE 9 and 10 are not affected. If you can update, do so immediately.
Internet Explorer flaw lets websites track your every mouse movement, and MS refuses to fix it	December 13, 2012 at 12:08 pm
Sadly, an exploit found in Internet Explorer that tracks mouse movement and certain key presses isn't getting patched by Microsoft. Unless it steps up and patches this flaw, it just isn't safe to use IE with JavaScript turned on.
Adobe Reader zero-day exploit shows us why sandboxes aren't a magic bullet	November 9, 2012 at 8:56 am
Software developers use sandboxes to segregate an application from the rest of the computer. The idea is that even if an exploit is found on a single app, it won't be able to run amok in the rest of the operating system. Sadly, sandboxes are not panaceas.
US Congress: China's cyberwarfare is becoming a serious problem for the United States	November 7, 2012 at 10:54 am
Chinese technology consumers are now a substantial group, but an ego-blow is the least of the western world's problems. Cyberwarfare is now a growing issue on the Chinese front, and that leaves the United States vulnerable in a very serious way.
Tens of millions of HP LaserJet printers vulnerable to remote hacking	November 29, 2011 at 9:15 am
It seems that researchers from Columbia University have found a security hole in "tens of millions" of HP LaserJet printers that allows a remote hacker to install new and dangerous firmware on the device. In one example, the researchers used the vulnerability to hack a printer's fuser, causing the paper to turn brown and begin to smoke.

redpajama_set_name: RedPajamaCommonCrawl


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text:
Q: Append missing part I have a file on my backup drive that is foo.txt (30 GiB).
I have a file on my regular drive that is foo.txt (60 GiB, first 30 GiB is guaranteed to be exactly the same).
How can I only append the missing part without recopying the whole file?
Maybe something with dd would work?

A: Yes you can use dd - the trick is to choose both bs x skip and obs x seek equal to the exact required offset
Ex.
First lets generate a test file - I've chosen 60MiB rather than 60GiB for the sake of illustration:
$ dd if=/dev/urandom bs=1M iflag=fullblock count=60 of=origfile
60+0 records in
60+0 records out
62914560 bytes (63 MB, 60 MiB) copied, 0.376846 s, 167 MB/s

Now lets copy exactly the first half of it - again using dd (though that's not required)
$ dd if=origfile bs=1M iflag=fullblock count=30 of=newfile
30+0 records in
30+0 records out
31457280 bytes (31 MB, 30 MiB) copied, 0.063891 s, 492 MB/s

Verify that they're different:
$ cmp origfile newfile
cmp: EOF on newfile after byte 31457280, in line 122106

Now let's copy from origfile to newfile, skipping the first 30 x 1M blocks of both files:
$ dd if=origfile bs=1M iflag=fullblock skip=30 count=30 of=newfile seek=30
30+0 records in
30+0 records out
31457280 bytes (31 MB, 30 MiB) copied, 0.0632964 s, 497 MB/s

Finally, verify that the files are now identical:
$ cmp origfile newfile
$

A: To sync files there's rsync, it has an --append option to "append data onto shorter files":
rsync --append /path/to/foo.txt /path/to/foo.txt
#              ^- original      ^- copy

Example run
Test scenario flagrantly copied from steeldriver's answer – I added the -P and -v options for verbose output.
$ dd if=/dev/urandom bs=1M iflag=fullblock count=60 of=origfile
60+0 records in
60+0 records out
62914560 bytes (63 MB, 60 MiB) copied, 0.328983 s, 191 MB/s
$ dd if=origfile bs=1M iflag=fullblock count=30 of=newfile
30+0 records in
30+0 records out
31457280 bytes (31 MB, 30 MiB) copied, 0.0292976 s, 1.1 GB/s
$ cmp origfile newfile
cmp: EOF on newfile
$ rsync -Pv --append origfile newfile
origfile
     62,914,560 100%  365.47MB/s    0:00:00 (xfr#1, to-chk=0/1)

sent 31,465,039 bytes  received 35 bytes  20,976,716.00 bytes/sec
total size is 62,914,560  speedup is 2.00
$ cmp origfile newfile
$

A: That is a huge file, but if it handles the size, you could use the split command to split the 60GB file into file1 and file2.  Then use cat to put the parts you want back together.
Example:
split -n2 60Gfile
cat xab >> 30Gfile

split -n2 splits the file in half and makes 2 files called xaa and xab
If this doesn't do what you want, read the split manual as the command has other options.

redpajama_set_name: RedPajamaStackExchange


text:
Posted By The White Rose UK	On 10/12/2021 01/01/2022
The shift to the coronavirus Plan B is an attempt to "buy time" to avoid the threat of a million Omicron infections by the end of the year, Sajid Javid said as he fought back against Tory anger over the measures.
The Health Secretary defended the sudden shift in the Government's approach to tackling the virus in England, with an extension of mask-wearing from Friday, a return to working from home on Monday and mandatory Covid passports for large venues from Wednesday.
But Julia Hartley Brewer warns Plan B is the start of something more sinister: "Let's be honest. When you're announcing major restrictions on people's lives and businesses, without any scientific evidence or proper Cabinet discussion, we know we're heading in a very dangerous, scary direction." (talkRadio/YT)
A comment sent to us by a reader:
With all the crazy rules and now cocaine and traces of other drugs found in the House of Commons, are we seeing our country run by drug-fuelled crazy MPs? What is going on at present can only be the actions of people who are out of their minds on something!
It's time people woke up to reality, instead they are somehow being hypnotized into believing all this garbage.
Remember how at the start it was just three weeks to beat the virus, then just one jab which turned into three, now it's jabbing every year.
Again, like last year a new variant comes along, just in time for Christmas. Coincidence? No, it's planned. Yet the number of people who still believe in this virus bewilders me. I now see children as young as five years old in masks.
Maybe people should turn off the BBC and stop buying newspapers. The longer people swallow all this garbage, the longer it will go on STOP NOW and reclaim your life or lose it forever.
Patrick Christys: 'I miss the days when Plan B was just a rapper, now it's going to be a reality' (GBNews/YT)
Dictatorship, GB News, Julia Hartley-Brewer, Mandate, Omicron, Patrick Christys, Plan B, Plan C, Plan D, Sajid Javid, Talk Radio, Tyranny
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Off Guard Comment
Lord Sumption


Ionization technology is a method that uses vitamins as well as electrical energy to break liquid chemicals to acid solution and alkaline. It really is a thorough methodology that will completely remove pollutants of liquids. Vitamin Enhanced Water is available at Tru Balance Water. It gives you water full of ionizers to help in enriching your life.


text:
China's vaccine project offers new prospects of global collaboration
Vaccines by the Chinese firms Sinopharm and Sinovac are being administered across the world on terms far more favorable than those of US and UK-based pharma giants
July 01, 2021 by Peoples Health Dispatch
In May and June 2021, the World Health Organization's (WHO) Strategic Advisory Group of Experts (SAGE) listed two Chinese COVID-19 vaccines – Sinopharm's 'BBIBP-CorV-2' and Sinovac's 'CoronaVac' – for emergency use and issued interim policy recommendations.
The two vaccines, which were among the first to be developed globally, met the requirement of 50% efficacy needed for WHO approval. Though further data is expected, the existing preliminary data shows that Sinovac's vaccine has an efficacy of 51% against symptomatic COVID-19 infection and 100% against severe infection, while Sinopharm's has an efficacy of 79% against symptomatic cases and hospitalization.
The Chinese vaccines have contributed to addressing the shortfall in supplies and helped sustain immunization campaigns in low and middle income countries in the midst of a global vaccine inequity crisis. Many countries, including UAE, Bahrain, Egypt, Turkey, Hungary, Brazil, Malaysia and Indonesia, had approved one or both vaccines for emergency use even before the WHO process concluded. Currently, Sinopharm is approved in 53 countries and Sinovac in 32 countries. China has practically been filling in for the failure and delays of the Covax project in supplying vaccines.
China has committed to providing around 350 million doses of COVID-19 vaccines, of which quite a bit has already been supplied. The country has committed to provide them either in the form of aid or through commercial agreements. Incidentally, the first has seen China being criticized for engaging in vaccine diplomacy while the cost of the vaccine has been raised as an issue in countries like Sri Lanka and Bangladesh.
Public support key for technology development
China's modern biotechnology success is the result of government-led initiatives to drive indigenous innovation. Launched in 1986, the 'National High Technology Program or 863 program' was intended to stimulate the development of advanced technology. In addition to contributing to the foundation of research and development, it is to be noted that Sinopharm is a public sector undertaking. The research and manufacture is funded by the state, and the vaccines produced are free of cost for Chinese citizens. Though Sinovac is a private entity, it has been supported by the Chinese government through grants and aid to encourage research and development, and manufacturing.
On June 20, China announced that it had administered over one billion doses as part of its vaccine efforts. The Chinese government aims to fully vaccinate 40% of the country's population by July and the entire population by the end of this year. The reason for the success has been the ability to develop and manufacture vaccines at a large scale and under the strategic direction of the state.
Support for local production in low and middle income countries
An interesting feature of Chinese cooperation with various countries on vaccines is that both companies are involved in strengthening local production through the transfer of technology. For example, Sinopharm is helping local manufacturing in UAE, Egypt, Belarus, Serbia and Bangladesh. Sinovac has similar initiatives in Brazil, Egypt and Hungary. This stands in contrast to the model followed by US and UK-based companies who have been against technology transfer, despite their vaccines having largely been developed in public institutes and funded by public subsidies.
In Egypt, the state-owned Vacsera has entered into a comprehensive partnership with Sinovac for manufacturing the vaccine wherein Sinovac would assist with transfer of technology and technical assistance for manufacturing. This includes supporting Vacsera in developing technological capabilities for manufacturing, and testing of the final product.
Science and known technology
After the two vaccines got approval by the WHO, some sections were quick to cast doubts on their effectiveness. Certain sections of the global media argued that countries which inoculated their populations with Sinovac and Sinopharm had seen a surge in cases, thereby implying that the vaccines had failed. On a closer examination, one finds that the reports do not go into the details of severe disease and hospitalization or factors such as the role of variants, ease of restrictions and weather change in the southern hemisphere to winter.
Both Sinopharm and Sinovac vaccines are inactivated vaccines which contain the virus whose genetic material has been destroyed. The technology has been used in the past for many vaccines such as those for Hepatitis B and Tetanus. It is known to have a well-documented safety profile, and similar technology is being used in the development of other COVID-19 vaccines. In addition, countries which have not used the Chinese vaccines have also shown a surge, for instance India and the UK.
This raises the question of whether the recent media response relies on science or is politically motivated. On the issue, Professor Satyajit Rath, an immunologist, says "When one says that these two Chinese vaccines do not work, they are actually casting a doubt on the entire technology of inactivated vaccines. For example, even the Indian COVID-19 vaccine uses the same technology of inactivating the virus. We need not make it a mRNA vs inactivated vaccine story. The issue here is the capitalist model that made this into a global competition between vaccines while it should actually have been a global collaboration, where we could build on each other's work and mix and match the vaccines as they work best." Recent studies confirm that mixing vaccines does elicit a good immune response.
Western countries and market forces have miserably failed at ensuring vaccine equity. The negative reporting on the Chinese vaccine is a veiled attempt to discredit what represents an opportunity for countries from the south to reduce their dependence on western-controlled production.
Categories ChinaTags Chinese response to COVID-19COVAX InitiativeCOVID-19 pandemicCOVID-19 vaccinesPatent waiver on COVID-19 vaccinesatyajit rathSinopharm vaccineSinovacWorld Health Organization (WHO)
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