document_title: Schizophrenia

question_text: what is the most common symptom of schizophrenia

question_tokens: what is the most common symptom of schizophrenia

text: Schizophrenia

text: Signs and symptoms

text: Individuals with schizophrenia may experience hallucinations (most reported are hearing voices), delusions (often bizarre or persecutory in nature), and disorganized thinking and speech. The last may range from loss of train of thought, to sentences only loosely connected in meaning, to speech that is not understandable known as word salad. Social withdrawal, sloppiness of dress and hygiene, and loss of motivation and judgment are all common in schizophrenia.[20]

text: Distortions of self-experience such as feeling as if one's thoughts or feelings are not really one's own to believing thoughts are being inserted into one's mind, sometimes termed passivity phenomena, are also common.[21] There is often an observable pattern of emotional difficulty, for example lack of responsiveness.[22] Impairment in social cognition is associated with schizophrenia,[23] as are symptoms of paranoia. Social isolation commonly occurs.[24] Difficulties in working and long-term memory, attention, executive functioning, and speed of processing also commonly occur.[9] In one uncommon subtype, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation, all signs of catatonia.[25] People with schizophrenia often find facial emotion perception to be difficult.[26] It is unclear if the phenomenon called "thought blocking", where a talking person suddenly becomes silent for a few seconds to minutes, occurs in schizophrenia.[27][28]

text: About 30 to 50 percent of people with schizophrenia fail to accept that they have an illness or comply with their recommended treatment.[29] Treatment may have some effect on insight.[30]

text: People with schizophrenia may have a high rate of irritable bowel syndrome but they often do not mention it unless specifically asked.[31] Psychogenic polydipsia, or excessive fluid intake in the absence of physiological reasons to drink, is relatively common in people with schizophrenia.[32]

text: Positive and negative

text: Schizophrenia is often described in terms of positive and negative (or deficit) symptoms.[33] Positive symptoms are those that most individuals do not normally experience, but are present in people with schizophrenia. They can include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis.[34] Hallucinations are also typically related to the content of the delusional theme.[35] Positive symptoms generally respond well to medication.[35]

text: Negative symptoms are deficits of normal emotional responses or of other thought processes, and are less responsive to medication.[20] They commonly include flat expressions or little emotion, poverty of speech, inability to experience pleasure, lack of desire to form relationships, and lack of motivation. Negative symptoms appear to contribute more to poor quality of life, functional ability, and the burden on others than positive symptoms do.[36] People with greater negative symptoms often have a history of poor adjustment before the onset of illness, and response to medication is often limited.[20][37]

text: Cognitive dysfunction

text: Deficits in cognitive abilities are widely recognized as a core feature of schizophrenia.[38][39][40] The extent of the cognitive deficits an individual experiences is a predictor of how functional an individual will be, the quality of occupational performance, and how successful the individual will be in maintaining treatment.[41] The presence and degree of cognitive dysfunction in individuals with schizophrenia has been reported to be a better indicator of functionality than the presentation of positive or negative symptoms.[38] The deficits impacting the cognitive function are found in a large number of areas: working memory, long-term memory,[42][43] verbal declarative memory,[44] semantic processing,[45] episodic memory,[41] attention, learning (particularly verbal learning).[42] Deficits in verbal memory are the most pronounced in individuals with schizophrenia, and are not accounted for by deficit in attention. Verbal memory impairment has been linked to a decreased ability in individuals with schizophrenia to semantically encode (process information relating to meaning), which is cited as a cause for another known deficit in long-term memory.[42] When given a list of words, healthy individuals remember positive words more frequently (known as the Pollyanna principle); however, individuals with schizophrenia tend to remember all words equally regardless of their connotations, suggesting that the experience of anhedonia impairs the semantic encoding of the words.[42] These deficits have been found in individuals before the onset of the illness to some extent.[38][40][46] First-degree family members of individuals with schizophrenia and other high-risk individuals also show a degree of deficit in cognitive abilities, and specifically in working memory.[46] A review of the literature on cognitive deficits in individuals with schizophrenia shows that the deficits may be present in early adolescence, or as early as childhood.[38] The deficits which an individual with schizophrenia presents tend to remain the same over time in most patients, or follow an identifiable course based upon environmental variables.[38][42]

text: Although the evidence that cognitive deficits remain stable over time is reliable and abundant,[41][42] much of the research in this domain focuses on methods to improve attention and working memory.[42][43] Efforts to improve learning ability in individuals with schizophrenia using a high- versus low-reward condition and an instruction-absent or instruction-present condition revealed that increasing reward leads to poorer performance while providing instruction leads to improved performance, highlighting that some treatments may exist to increase cognitive performance.[42] Training individuals with schizophrenia to alter their thinking, attention, and language behaviors by verbalizing tasks, engaging in cognitive rehearsal, giving self-instructions, giving coping statements to the self to handle failure, and providing self-reinforcement for success, significantly improves performance on recall tasks.[42] This type of training, known as self-instructional (SI) training, produced benefits such as lower number of nonsense verbalizations and improved recall while distracted.[42]

text: Onset

text: Late adolescence and early adulthood are peak periods for the onset of schizophrenia,[9] critical years in a young adult's social and vocational development.[47] In 40% of men and 23% of women diagnosed with schizophrenia, the condition manifested itself before the age of 19.[48] The onset of the disease is usually later in women than in men.[49] To minimize the developmental disruption associated with schizophrenia, much work has recently been done to identify and treat the prodromal (pre-onset) phase of the illness, which has been detected up to 30 months before the onset of symptoms.[47] Those who go on to develop schizophrenia may experience transient or self-limiting psychotic symptoms[50] and the non-specific symptoms of social withdrawal, irritability, dysphoria,[51] and clumsiness before the onset of the disease.[52] Children who go on to develop schizophrenia may also demonstrate decreased intelligence, decreased motor development (reaching milestones such as walking slowly), isolated play preference, social anxiety, and poor school performance.[53][54][55]

text: Causes

text: A combination of genetic and environmental factors play a role in the development of schizophrenia.[9][14] People with a family history of schizophrenia who have a transient psychosis have a 20–40% chance of being diagnosed one year later.[56]

text: Genetic

text: Estimates of the heritability of schizophrenia is around 80%, which implies that 80% of the individual differences in risk to schizophrenia is explained by individual differences in genetics.[57] These estimates vary because of the difficulty in separating genetic and environmental influences.[58] The greatest single risk factor for developing schizophrenia is having a first-degree relative with the disease (risk is 6.5%); more than 40% of monozygotic twins of those with schizophrenia are also affected.[14] If one parent is affected the risk is about 13% and if both are affected the risk is nearly 50%.[57]

text: Many genes are known to be involved in schizophrenia, each of small effect and unknown transmission and expression.[13][59] The summation of these effect sizes into a polygenic risk score can explain at least 7% of the variability in liability for schizophrenia.[60] Around 5% of cases of schizophrenia are understood to be at least partially attributable to rare copy number variants (CNVs), including 22q11, 1q21 and 16p11.[61] These rare CNVs increase the risk of an individual developing the disorder by as much as 20-fold, and are frequently comorbid with autism and intellectual disabilities.[61] There is a genetic relation between the common variants which cause schizophrenia and bipolar disorder, an inverse genetic correlation with intelligence and no genetic correlation with immune disorders.[62]

text: Environment

text: Environmental factors associated with the development of schizophrenia include the living environment, drug use, and prenatal stressors.[9]

text: Maternal stress has been associated with an increase risk of schizophrenia, possibly in association with reelin. Maternal Stress has been observed to lead to hypermethylation and therefore under-expression of reelin, which in animal models leads to reduction in GABAergic neurons, a common finding in schizophrenia.[63] Maternal nutritional deficiencies, such as those observed during a famine, as well as maternal obesity have also been identified as possible risk factors for schizophrenia. Both maternal stress and infection have been demonstrated to alter fetal neurodevelopment through pro-inflammatory proteins such as IL-8 and TNF.[64][65]

text: Parenting style seems to have no major effect, although people with supportive parents do better than those with critical or hostile parents.[14] Childhood trauma, death of a parent, and being bullied or abused increase the risk of psychosis.[66] Living in an urban environment during childhood or as an adult has consistently been found to increase the risk of schizophrenia by a factor of two,[9][14] even after taking into account drug use, ethnic group, and size of social group.[67] Other factors that play an important role include social isolation and immigration related to social adversity, racial discrimination, family dysfunction, unemployment, and poor housing conditions.[14][68]

text: It has been hypothesized that in some people, development of schizophrenia is related to intestinal tract dysfunction such as seen with non-celiac gluten sensitivity or abnormalities in the intestinal flora.[69] A subgroup of persons with schizophrenia present an immune response to gluten different from that found in people with celiac, with elevated levels of certain serum biomarkers of gluten sensitivity such as anti-gliadin IgG or anti-gliadin IgA antibodies.[70]

text: Substance use

text: About half of those with schizophrenia use drugs or alcohol excessively.[71] Amphetamine, cocaine, and to a lesser extent alcohol, can result in a transient stimulant psychosis or alcohol-related psychosis that presents very similarly to schizophrenia.[14][72] Although it is not generally believed to be a cause of the illness, people with schizophrenia use nicotine at much higher rates than the general population.[73]

text: Alcohol abuse can occasionally cause the development of a chronic, substance-induced psychotic disorder via a kindling mechanism.[74] Alcohol use is not associated with an earlier onset of psychosis.[75]

text: Cannabis can be a contributory factor in schizophrenia,[12][76][77] potentially causing the disease in those who are already at risk.[77] The increased risk may require the presence of certain genes within an individual[77] or may be related to preexisting psychopathology.[12] Early exposure is strongly associated with an increased risk.[12] The size of the increased risk is not clear,[78] but appears to be in the range of two to three times greater for psychosis.[76] Higher dosage and greater frequency of use are indicators of increased risk of chronic psychoses.[76]

text: Other drugs may be used only as coping mechanisms by individuals who have schizophrenia, to deal with depression, anxiety, boredom, and loneliness.[71][79]

text: Developmental factors

text: Factors such as hypoxia and infection, or stress and malnutrition in the mother during fetal development, may result in a slight increase in the risk of schizophrenia later in life.[9] People diagnosed with schizophrenia are more likely to have been born in winter or spring (at least in the northern hemisphere), which may be a result of increased rates of viral exposures in utero.[14] The increased risk is about five to eight percent.[80] Other infections during pregnancy or around the time of birth that may increase the risk include Toxoplasma gondi and Chlamydia.[81]

text: Mechanisms

text: A number of attempts have been made to explain the link between altered brain function and schizophrenia.[9] One of the most common is the dopamine hypothesis, which attributes psychosis to the mind's faulty interpretation of the misfiring of dopaminergic neurons.[9]

text: Psychological

text: Many psychological mechanisms have been implicated in the development and maintenance of schizophrenia. Cognitive biases have been identified in those with the diagnosis or those at risk, especially when under stress or in confusing situations.[82] Some cognitive features may reflect global neurocognitive deficits such as memory loss, while others may be related to particular issues and experiences.[83][84]

text: Despite a demonstrated appearance of blunted affect, recent findings indicate that many individuals diagnosed with schizophrenia are emotionally responsive, particularly to stressful or negative stimuli, and that such sensitivity may cause vulnerability to symptoms or to the disorder.[85][86] Some evidence suggests that the content of delusional beliefs and psychotic experiences can reflect emotional causes of the disorder, and that how a person interprets such experiences can influence symptomatology.[87][88][89] The use of "safety behaviors" (acts such as gestures or the use of words in specific contexts) to avoid or neutralize imagined threats may actually contribute to the chronicity of delusions.[90] Further evidence for the role of psychological mechanisms comes from the effects of psychotherapies on symptoms of schizophrenia.[91]

text: Neurological

text: Schizophrenia is associated with subtle differences in brain structures, found in forty to fifty percent of cases, and in brain chemistry during acute psychotic states.[9] Studies using neuropsychological tests and brain imaging technologies such as fMRI and PET to examine functional differences in brain activity have shown that differences seem to occur most commonly in the frontal lobes, hippocampus and temporal lobes.[93] Reductions in brain volume are most pronounced in grey matter structures, and correlate with duration of illness, although white matter abnormalities have also been found. A progressive increase in ventricular volume as well as a progressive reduction in grey matter in the frontal, parietal, and temporal lobes has also been observed.[94][95] These differences have been linked to the neurocognitive deficits often associated with schizophrenia.[96] Because neural circuits are altered, it has alternatively been suggested that schizophrenia could be thought of as a neurodevelopmental disorder with psychosis occurring as a possibly preventable late stage.[97] There has been debate on whether treatment with antipsychotics can itself cause reduction of brain volume.[98]

text: Particular attention has been paid to the function of dopamine in the mesolimbic pathway of the brain. This focus largely resulted from the accidental finding that phenothiazine drugs, which block dopamine function, could reduce psychotic symptoms. It is also supported by the fact that amphetamines, which trigger the release of dopamine, may exacerbate the psychotic symptoms in schizophrenia.[99] The influential dopamine hypothesis of schizophrenia proposed that excessive activation of D2 receptors was the cause of (the positive symptoms of) schizophrenia. Although postulated for about 20 years based on the D2 blockade effect common to all antipsychotics, it was not until the mid-1990s that PET and SPET imaging studies provided supporting evidence. While dopamine D2/D3 receptors are elevated in schizophrenia, the effect size is small, and only evident in medication naive schizophrenics. On the other hand, presynaptic dopamine metabolism and released is elevated despite no difference in dopamine transporter.[100] The altered synthesis of dopamine in the nigrostriatal system have been confirmed in several human studies.[101][102] Hypoactivity of dopamine D1 receptor activation in the prefrontal cortex has also been observed.[103] The hyperactivity of D2 receptor stimulation and relative hypoactivity of D1 receptor stimulation is thought to contribute to cognitive dysfunction by disrupting signal to noise ratio in cortical microcircuits.[104] The dopamine hypothesis is now thought to be simplistic, partly because newer antipsychotic medication (atypical antipsychotic medication) can be just as effective as older medication (typical antipsychotic medication), but also affects serotonin function and may have slightly less of a dopamine blocking effect.[105]

text: Interest has also focused on the neurotransmitter glutamate and the reduced function of the NMDA glutamate receptor in schizophrenia, largely because of the abnormally low levels of glutamate receptors found in the postmortem brains of those diagnosed with schizophrenia,[106] and the discovery that glutamate-blocking drugs such as phencyclidine and ketamine can mimic the symptoms and cognitive problems associated with the condition.[107] Reduced glutamate function is linked to poor performance on tests requiring frontal lobe and hippocampal function, and glutamate can affect dopamine function, both of which have been implicated in schizophrenia; this has suggested an important mediating (and possibly causal) role of glutamate pathways in the condition.[108] But positive symptoms fail to respond to glutamatergic medication.[109] Closely related to evidence of glutamate dysfunction in schizophrenia is the observed changes GABAergic transmission. Post-Mortem studies demonstrate decreased expression of GAD67, GAT-1 and GABAA receptor subunits in the prefrontal cortex, although this appears to be restricted to a certain subsets of parvalbumin containing GABAergic neurons. While in vivo imaging of GABAergic signaling appears to be moderately reduced, this may be dependent upon treatment and disease stage.[110]

text: Diagnosis

text: Schizophrenia is diagnosed based on criteria in either the American Psychiatric Association's (APA) fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), or the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10). These criteria use the self-reported experiences of the person and reported abnormalities in behavior, followed by a clinical assessment by a mental health professional. Symptoms associated with schizophrenia occur along a continuum in the population and must reach a certain severity and level of impairment, before a diagnosis is made.[14] As of 2013 there is no objective test.[5]

text: Criteria

text: In 2013, the American Psychiatric Association released the fifth edition of the DSM (DSM-5). To be diagnosed with schizophrenia, two diagnostic criteria have to be met over much of the time of a period of at least one month, with a significant impact on social or occupational functioning for at least six months. The person had to be suffering from delusions, hallucinations, or disorganized speech. A second symptom could be negative symptoms, or severely disorganized or catatonic behaviour.[111] The definition of schizophrenia remained essentially the same as that specified by the 2000 version of DSM (DSM-IV-TR), but DSM-5 makes a number of changes.

text:
Subtype classifications – such as catatonic and paranoid schizophrenia  – are removed. These were retained in previous revisions largely for reasons of tradition, but had subsequently proved to be of little worth.[112]
Catatonia is no longer so strongly associated with schizophrenia.[113]
In describing a person's schizophrenia, it is recommended that a better distinction be made between the current state of the condition and its historical progress, to achieve a clearer overall characterization.[112]
Special treatment of Schneider's first-rank symptoms is no longer recommended.[112]
Schizoaffective disorder is better defined to demarcate it more cleanly from schizophrenia.[112]
An assessment covering eight domains of psychopathology – such as whether hallucination or mania is experienced – is recommended to help clinical decision-making.[114]

text: The ICD-10 criteria are typically used in European countries, while the DSM criteria are used in the United States and to varying degrees around the world, and are prevailing in research studies. The ICD-10 criteria put more emphasis on Schneiderian first-rank symptoms. In practice, agreement between the two systems is high.[115] The current proposal for the ICD-11 criteria for schizophrenia recommends adding self-disorder as a symptom.[21]

text: If signs of disturbance are present for more than a month but less than six months, the diagnosis of schizophreniform disorder is applied. Psychotic symptoms lasting less than a month may be diagnosed as brief psychotic disorder, and various conditions may be classed as psychotic disorder not otherwise specified, while schizoaffective disorder is diagnosed if symptoms of mood disorder are substantially present alongside psychotic symptoms. If the psychotic symptoms are the direct physiological result of a general medical condition or a substance, then the diagnosis is one of a psychosis secondary to that condition.[111] Schizophrenia is not diagnosed if symptoms of pervasive developmental disorder are present unless prominent delusions or hallucinations are also present.[111]

text: Subtypes

text: With the publication of DSM-5, the APA removed all sub-classifications of schizophrenia.[116] The five sub-classifications included in DSM-IV-TR were:[117][118]

text:
Paranoid type: Delusions or auditory hallucinations are present, but thought disorder, disorganized behavior, or affective flattening are not. Delusions are persecutory and/or grandiose, but in addition to these, other themes such as jealousy, religiosity, or somatization may also be present. (DSM code 295.3/ICD code F20.0)
Disorganized type: Named hebephrenic schizophrenia in the ICD. Where thought disorder and flat affect are present together. (DSM code 295.1/ICD code F20.1)
Catatonic type: The subject may be almost immobile or exhibit agitated, purposeless movement. Symptoms can include catatonic stupor and waxy flexibility. (DSM code 295.2/ICD code F20.2)
Undifferentiated type: Psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types have not been met. (DSM code 295.9/ICD code F20.3)
Residual type: Where positive symptoms are present at a low intensity only. (DSM code 295.6/ICD code F20.5)

text: The ICD-10 defines two additional subtypes:[117]

text:
Post-schizophrenic depression: A depressive episode arising in the aftermath of a schizophrenic illness where some low-level schizophrenic symptoms may still be present. (ICD code F20.4)
Simple schizophrenia: Insidious and progressive development of prominent negative symptoms with no history of psychotic episodes. (ICD code F20.6)

text: Latent schizophrenia (F21.1), schizophrenic reaction (F21.2), pseudoneurotic schizophrenia (F21.3), pseudopsychopathic schizophrenia (F21.4), “symptom-depleted” schizophrenia (F21.5) are in the Russian version of the ICD-10. They are in the category of “schizotypal” disorder in section F21 of chapter V.[119]

text: Differential diagnosis

text: Psychotic symptoms may be present in several other mental disorders, including bipolar disorder,[120] borderline personality disorder,[121] drug intoxication, and drug-induced psychosis. Delusions ("non-bizarre") are also present in delusional disorder, and social withdrawal in social anxiety disorder, avoidant personality disorder and schizotypal personality disorder. Schizotypal personality disorder has symptoms that are similar but less severe than those of schizophrenia.[5] Schizophrenia occurs along with obsessive-compulsive disorder (OCD) considerably more often than could be explained by chance, although it can be difficult to distinguish obsessions that occur in OCD from the delusions of schizophrenia.[122] A few people withdrawing from benzodiazepines experience a severe withdrawal syndrome which may last a long time. It can resemble schizophrenia and be misdiagnosed as such.[123]

text: A more general medical and neurological examination may be needed to rule out medical illnesses which may rarely produce psychotic schizophrenia-like symptoms, such as metabolic disturbance, systemic infection, syphilis, AIDS dementia complex, epilepsy, limbic encephalitis, and brain lesions. Stroke, multiple sclerosis, hyperthyroidism, hypothyroidism, and dementias such as Alzheimer's disease, Huntington's disease, frontotemporal dementia, and Lewy Body dementia may also be associated with schizophrenia-like psychotic symptoms.[124] It may be necessary to rule out a delirium, which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness, and indicates an underlying medical illness. Investigations are not generally repeated for relapse unless there is a specific medical indication or possible adverse effects from antipsychotic medication. In children hallucinations must be separated from typical childhood fantasies.[5]

text: Prevention

text: Prevention of schizophrenia is difficult as there are no reliable markers for the later development of the disorder.[125] There is tentative evidence for the effectiveness of early interventions to prevent schizophrenia.[126] While there is some evidence that early intervention in those with a psychotic episode may improve short-term outcomes, there is little benefit from these measures after five years.[9] Attempting to prevent schizophrenia in the prodrome phase is of uncertain benefit and therefore as of 2009 is not recommended.[127] Cognitive behavioral therapy may reduce the risk of psychosis in those at high risk after a year[128] and is recommended in this group, by the National Institute for Health and Care Excellence (NICE).[129] Another preventative measure is to avoid drugs that have been associated with development of the disorder, including cannabis, cocaine, and amphetamines.[14]

text: Management

text: The primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social supports.[9] Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) involuntarily. Long-term hospitalization is uncommon since deinstitutionalization beginning in the 1950s, although it still occurs.[16] Community support services including drop-in centers, visits by members of a community mental health team, supported employment[130] and support groups are common. Some evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizophrenia.[131]

text: Medication

text: The first-line psychiatric treatment for schizophrenia is antipsychotic medication,[132] which can reduce the positive symptoms of psychosis in about 7 to 14 days. Antipsychotics, however, fail to significantly improve the negative symptoms and cognitive dysfunction.[37][133] In those on antipsychotics, continued use decreases the risk of relapse.[134][135] There is little evidence regarding effects from their use beyond two or three years.[135] However use of anti-psychotics can lead to dopamine hypersensitivity increasing the risk of symptoms if antipsychotics are stopped.[136]

text: The choice of which antipsychotic to use is based on benefits, risks, and costs.[9] It is debatable whether, as a class, typical or atypical antipsychotics are better.[15][137] Amisulpride, olanzapine, risperidone, and clozapine may be more effective but are associated with greater side effects.[138] Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.[139] There is a good response in 40–50%, a partial response in 30–40%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people.[37] Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia),[140] but it has the potentially serious side effect of agranulocytosis (lowered white blood cell count) in less than 4% of people.[9][14][141]

text: Most people on antipsychotics have side effects. People on typical antipsychotics tend to have a higher rate of extrapyramidal side effects, while some atypicals are associated with considerable weight gain, diabetes and risk of metabolic syndrome; this is most pronounced with olanzapine, while risperidone and quetiapine are also associated with weight gain.[138] Risperidone has a similar rate of extrapyramidal symptoms to haloperidol.[138] It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome or tardive dyskinesia, a rare but serious neurological disorder.[142]

text: For people who are unwilling or unable to take medication regularly, long-acting depot preparations of antipsychotics may be used to achieve control.[143] They reduce the risk of relapse to a greater degree than oral medications.[134] When used in combination with psychosocial interventions, they may improve long-term adherence to treatment.[143] The American Psychiatric Association suggests considering stopping antipsychotics in some people if there are no symptoms for more than a year.[135]

text: Psychosocial

text: A number of psychosocial interventions may be useful in the treatment of schizophrenia including: family therapy,[144] assertive community treatment, supported employment, cognitive remediation,[145] skills training, token economic interventions, and psychosocial interventions for substance use and weight management.[146] Family therapy or education, which addresses the whole family system of an individual, may reduce relapses and hospitalizations.[144] Evidence for the effectiveness of cognitive-behavioral therapy (CBT) in either reducing symptoms or preventing relapse is minimal.[147][148] Evidence for metacognitive training is mixed with one 2016 review finding benefit and another not.[149][150] Art or drama therapy have not been well-researched.[151][152]

text: Prognosis

text:
no data
  ≤ 185
  185–197
  197–207
  207–218
  218–229
  229–240

  240–251
  251–262
  262–273
  273–284
  284–295
  ≥ 295

text: Schizophrenia has great human and economic costs.[9] It results in a decreased life expectancy by 10–25 years.[7] This is primarily because of its association with obesity, poor diet, sedentary lifestyles, and smoking, with an increased rate of suicide playing a lesser role.[9][7][153] Antipsychotic medications may also increase the risk.[7] These differences in life expectancy increased between the 1970s and 1990s.[154]

text: Schizophrenia is a major cause of disability, with active psychosis ranked as the third-most-disabling condition after quadriplegia and dementia and ahead of paraplegia and blindness.[155] Approximately three-fourths of people with schizophrenia have ongoing disability with relapses[37] and 16.7 million people globally are deemed to have moderate or severe disability from the condition.[156] Some people do recover completely and others function well in society.[157] Most people with schizophrenia live independently with community support.[9] About 85% are unemployed.[4] Some evidence suggests that paranoid schizophrenia may have a better prospect than other types of schizophrenia for independent living and occupational functioning.[158] In people with a first episode of psychosis a good long-term outcome occurs in 42%, an intermediate outcome in 35% and a poor outcome in 27%.[159] Outcomes for schizophrenia appear better in the developing than the developed world.[160] These conclusions, however, have been questioned.[161][162]

text: There is a higher than average suicide rate associated with schizophrenia. This has been cited at 10%, but a more recent analysis revises the estimate to 4.9%, most often occurring in the period following onset or first hospital admission.[19][163] Several times more (20 to 40%) attempt suicide at least once.[5][164] There are a variety of risk factors, including male gender, depression, and a high intelligence quotient.[164]

text: Schizophrenia and smoking have shown a strong association in studies worldwide.[165][166] Use of cigarettes is especially high in individuals diagnosed with schizophrenia, with estimates ranging from 80 to 90% being regular smokers, as compared to 20% of the general population.[166] Those who smoke tend to smoke heavily, and additionally smoke cigarettes with high nicotine content.[167] Among people with schizophrenia use of cannabis is also common.[71]

text: Epidemiology

text: Schizophrenia affects around 0.3–0.7% of people at some point in their life,[9] or 24 million people worldwide as of 2011.[168] It occurs 1.4 times more frequently in males than females and typically appears earlier in men[14]—the peak ages of onset are 25 years for males and 27 years for females.[169] Onset in childhood is much rarer,[170] as is onset in middle or old age.[171]

text: Despite the prior belief that schizophrenia occurs at similar rates worldwide, its frequency varies across the world,[5][172] within countries,[173] and at the local and neighborhood level.[174] This variation has been estimated to be fivefold.[4] It causes approximately one percent of worldwide disability adjusted life years[14] and resulted in 20,000 deaths in 2010.[175] The rate of schizophrenia varies up to threefold depending on how it is defined.[9]

text: In 2000, the World Health Organization found the percentage of people affected and the number of new cases that develop each year is roughly similar around the world, with age-standardized prevalence per 100,000 ranging from 343 in Africa to 544 in Japan and Oceania for men, and from 378 in Africa to 527 in Southeastern Europe for women.[176] About 1.1% of adults have schizophrenia in the United States.[177]

text: History

text: In the early 20th century, the psychiatrist Kurt Schneider listed the forms of psychotic symptoms that he thought distinguished schizophrenia from other psychotic disorders. These are called first-rank symptoms or Schneider's first-rank symptoms. They include delusions of being controlled by an external force, the belief that thoughts are being inserted into or withdrawn from one's conscious mind, the belief that one's thoughts are being broadcast to other people, and hearing hallucinatory voices that comment on one's thoughts or actions or that have a conversation with other hallucinated voices.[178] Although they have significantly contributed to the current diagnostic criteria, the specificity of first-rank symptoms has been questioned. A review of the diagnostic studies conducted between 1970 and 2005 found that they allow neither a reconfirmation nor a rejection of Schneider's claims, and suggested that first-rank symptoms should be de-emphasized in future revisions of diagnostic systems.[179] The absence of first-rank symptoms should raise suspicion of a medical disorder, however.[21]

text: The history of schizophrenia is complex and does not lend itself easily to a linear narrative.[180] Accounts of a schizophrenia-like syndrome are thought to be rare in historical records before the 19th century, although reports of irrational, unintelligible, or uncontrolled behavior were common. A detailed case report in 1797 concerning James Tilly Matthews, and accounts by Philippe Pinel published in 1809, are often regarded as the earliest cases of the illness in the medical and psychiatric literature.[181] The Latinized term dementia praecox was first used by German alienist Heinrich Schule in 1886 and then in 1891 by Arnold Pick in a case report of a psychotic disorder (hebephrenia). In 1893 Emil Kraepelin borrowed the term from Schule and Pick and in 1899 introduced a broad new distinction in the classification of mental disorders between dementia praecox and mood disorder (termed manic depression and including both unipolar and bipolar depression).[182] Kraepelin believed that dementia praecox was probably caused by a long-term, smouldering systemic or "whole body" disease process that affected many organs and peripheral nerves in the body but which affected the brain after puberty in a final decisive cascade.[183] His use of the term "praecox" distinguished it from other forms of dementia such as Alzheimer's disease which typically occur later in life.[184] It is sometimes argued that the use of the term démence précoce in 1852 by the French physician Bénédict Morel constitutes the medical discovery of schizophrenia. However, this account ignores the fact that there is little to connect Morel's descriptive use of the term and the independent development of the dementia praecox disease concept at the end of the nineteenth century.[185]

text: The word schizophrenia—which translates roughly as "splitting of the mind" and comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind")[186]—was coined by Eugen Bleuler in 1908 and was intended to describe the separation of function between personality, thinking, memory, and perception. American and British interpretations of Bleuler led to the claim that he described its main symptoms as four A's: flattened affect, autism, impaired association of ideas, and ambivalence.[187][188] Bleuler realized that the illness was not a dementia, as some of his patients improved rather than deteriorated, and thus proposed the term schizophrenia instead. Treatment was revolutionized in the mid-1950s with the development and introduction of chlorpromazine.[189]

text: In the early 1970s, the diagnostic criteria for schizophrenia were the subject of a number of controversies which eventually led to the operational criteria used today. It became clear after the 1971 US–UK Diagnostic Study that schizophrenia was diagnosed to a far greater extent in America than in Europe.[190] This was partly due to looser diagnostic criteria in the US, which used the DSM-II manual, contrasting with Europe and its ICD-9. David Rosenhan's 1972 study, published in the journal Science under the title "On being sane in insane places", concluded that the diagnosis of schizophrenia in the US was often subjective and unreliable.[191] These were some of the factors leading to the revision not only of the diagnosis of schizophrenia, but the revision of the whole DSM manual, resulting in the publication of the DSM-III in 1980.[192]

text: The term schizophrenia is commonly misunderstood to mean that affected persons have a "split personality". Although some people diagnosed with schizophrenia may hear voices and may experience the voices as distinct personalities, schizophrenia does not involve a person changing among distinct, multiple personalities; the confusion arises in part due to the literal interpretation of Bleuler's term "schizophrenia" (Bleuler originally associated schizophrenia with dissociation, and included split personality in his category of schizophrenia).[193][194] Dissociative identity disorder (having a "split personality") was also often misdiagnosed as schizophrenia based on the loose criteria in the DSM-II.[194][195] The first known misuse of the term to mean "split personality" was in an article by the poet T. S. Eliot in 1933.[196] Other scholars have traced earlier roots.[197] Rather, the term means a "splitting of mental functions", reflecting the presentation of the illness.[198]

text: Society and culture

text: In 2002, the term for schizophrenia in Japan was changed from seishin-bunretsu-byō (精神分裂病, lit. "mind-split disease") to tōgō-shitchō-shō (統合失調症, lit. "integration disorder") to reduce stigma.[199] The new name was inspired by the biopsychosocial model; it increased the percentage of people who were informed of the diagnosis from 37 to 70% over three years.[200] A similar change was made in South Korea in 2012.[201] A professor of psychiatry, Jim van Os, has proposed changing the English term to "psychosis spectrum syndrome".[202]

text: In the United States, the cost of schizophrenia—including direct costs (outpatient, inpatient, drugs, and long-term care) and non-health care costs (law enforcement, reduced workplace productivity, and unemployment)—was estimated to be $62.7 billion in 2002.[203] The book and film A Beautiful Mind chronicles the life of John Forbes Nash, a Nobel Prize–winning mathematician who was diagnosed with schizophrenia.

text: Violence

text: Individuals with severe mental illness, including schizophrenia, are at a significantly greater risk of being victims of both violent and non-violent crime.[204] Schizophrenia has been associated with a higher rate of violent acts, but most appear to be related to associated substance abuse.[205] Rates of homicide linked to psychosis are similar to those linked to substance misuse, and parallel the overall rate in a region.[206] What role schizophrenia has on violence independent of drug misuse is controversial, but certain aspects of individual histories or mental states may be factors.[207] About 11% of people in prison for homicide have schizophrenia while 21% have mood disorders.[208] Another study found about 8-10% of people with schizophrenia had committed a violent act in the past year compared to 2% of the general population.[208]

text: Media coverage relating to violent acts by individuals with schizophrenia reinforces public perception of an association between schizophrenia and violence.[205] In a large, representative sample from a 1999 study, 12.8% of Americans believed that individuals with schizophrenia were "very likely" to do something violent against others, and 48.1% said that they were "somewhat likely" to. Over 74% said that people with schizophrenia were either "not very able" or "not able at all" to make decisions concerning their treatment, and 70.2% said the same of money-management decisions.[209] The perception of individuals with psychosis as violent has more than doubled in prevalence since the 1950s, according to one meta-analysis.[210]

text: Research directions

text: Research has found a tentative benefit in using minocycline to treat schizophrenia.[211] Nidotherapy or efforts to change the environment of people with schizophrenia to improve their ability to function, is also being studied; however, there is not enough evidence yet to make conclusions about its effectiveness.[212] Negative symptoms have proven a challenge to treat, as they are generally not made better by medication. Various agents have been explored for possible benefits in this area.[213] There have been trials on drugs with anti-inflammatory activity, based on the premise that inflammation might play a role in the pathology of schizophrenia.[214]


document_title: Picnic at Hanging Rock (film)

question_text: where was the original picnic at hanging rock filmed

root

text: Picnic at Hanging Rock (film)

text: Plot[edit]

text: At Appleyard College, a girls' private school, near the town of Woodend, Victoria, Australia, the students are dressing on the morning of Valentine's Day, 1900. Miranda (Anne-Louise Lambert), Irma (Karen Robson), Marion (Jane Vallis), Rosamund (Ingrid Mason), waifish Sara (Margaret Nelson), and outsider Edith (Christine Schuler) read poetry and Valentine's Day cards.

tag: p

text: The group prepares for a picnic to a local geological formation known as Hanging Rock, accompanied by the mathematics mistress Miss Greta McCraw (Vivean Gray) and the young and beautiful Mlle. de Poitiers (Helen Morse). On the authority of the stern headmistress Mrs. Appleyard (Rachel Roberts), jittery teacher Miss Lumley (Kirsty Child) advises Sara that she is not allowed to attend.

text: Driven by buggy operator Ben Hussey (Martin Vaughan), the party pass through and arrive at the Rock by mid-afternoon. After a meal, Mr. Hussey notes his watch has stopped at the stroke of twelve, as has the watch of Miss McCraw. With permission from Mlle. de Poitiers, Miranda, Marion and Irma decide to explore Hanging Rock and take measurements, with Edith allowed to follow. The group is observed several minutes later by a young Englishman, Michael Fitzhubert (Dominic Guard), who is lunching at the Rock with his uncle Colonel Fitzhubert (Peter Collingwood), aunt Mrs. Fitzhubert (Olga Dickie), and valet Albert (John Jarratt). At the top of Hanging Rock, the group lies on the ground, apparently dazed by the sun. Miss McCraw, still at the base of the Rock, stares up. Miranda, Marion, and Irma awake and move, as if in a trance, into a recess in the rock face. Edith, who watches them, screams and flees down the Rock in terror.

text: The distraught and hysterical party eventually returns to the College, where Mlle. de Poitiers explains to Mrs. Appleyard that Miss McCraw has been left behind. Sara notes the absence of Miranda; and Mr. Hussey explains to Mrs. Appleyard that Miranda, Irma, Marion, and Miss McCraw went missing. A search party, led by Sgt. Bumpher (Wyn Roberts) and Constable Jones (Garry McDonald) of the local police, finds nothing, although Edith reveals that she witnessed Miss McCraw climbing the Rock without her skirt. Michael Fitzhubert is questioned and reveals he watched the schoolgirls but can provide no clues as to their whereabouts.

text: Michael becomes obsessed with finding Miranda; and, with Albert, he conducts another search of Hanging Rock. Despite Albert's protests, Michael decides to remain overnight and begins climbing again the next day, leaving a trail of paper. When Albert follows the markers, he finds a nearly catatonic Michael. Just before leaving on a buggy with a local doctor, Michael passes to Albert a fragment of lace from a dress. Albert returns to Hanging Rock and discovers Irma, unconscious but alive. The residents of Woodend become restless as news of the discovery spreads. At the Fitzhubert home, Irma is treated for dehydration and exposure, and tells the police and Mlle. de Poitiers she has no memory of what happened. A servant notes that Irma's corset is missing but is advised by Mrs. Fitzhubert that it is not important.

text: Michael befriends the recovered Irma but alienates her when he demands to know what happened on the Rock. Mrs. Appleyard advises Miss Lumley that several parents have withdrawn their children from the school. Before leaving for Europe, Irma visits her classmates a final time; but they become hysterical and demand to know what happened to their missing friends. Mlle. de Poitiers intervenes; and, as Irma flees, she also notices that Sara has been strapped to a wall by Miss Lumley to correct her posture. That night, Miss Lumley gives notice to a drunken Mrs. Appleyard that she is resigning.

text: Mrs. Appleyard tells Sara that, as her guardian has not paid her tuition, Sara must return to the orphanage. Afterwards, Mrs. Appleyard lies to Mlle. de Poitiers and claims that Sara's guardian collected her early that morning. The next morning, Sara's body is found in the greenhouse by Mr. Whitehead, the school gardener. Believing Sara committed suicide by leaping from her bedroom window, Whitehead confronts Mrs. Appleyard, who is calm in full mourning dress with her possessions packed. Michael tells Albert he has decided to travel north, with Albert revealing he had a dream in which his lost sister Sara visited him.

text: During a flashback to the picnic scene, Sgt. Bumpher states in a voice over that the body of Mrs. Appleyard was found at the base of Hanging Rock from an apparent suicide. The search for the missing school girls and Miss McCraw continued sporadically for several years without success. Their disappearance is left as a mystery.

text: Cast[edit]

text:
Anne-Louise Lambert as Miranda St. Clair
Rachel Roberts as Mrs. Appleyard
Dominic Guard as Michael Fitzhubert
Helen Morse as Mlle. de Poitiers
Margaret Nelson as Sara Waybourne
John Jarratt as Albert Crundall
Wyn Roberts as Sgt. Bumpher
Karen Robson as Irma Leopold
Christine Schuler as Edith Horton
Jane Vallis as Marion Quade
Vivean Gray as Miss McCraw
Martin Vaughan as Ben Hussey
Kirsty Child as Miss Lumley
Jacki Weaver as Minnie
Frank Gunnell as Mr. Whitehead
Tony Llewellyn-Jones as Tom
John Fegan as Doc. McKenzie
Kay Taylor as Mrs. Bumpher
Peter Collingwood as Col. Fitzhubert
Garry McDonald as Const. Jones
Olga Dickie as Mrs. Fitzhubert
Jenny Lovell as Blanche

tag: ul

text: Production[edit]

text: The novel was published in 1967. Reading it four years later, Patricia Lovell thought it would make a great film. She did not originally think of producing it herself until Phillip Adams suggested she try it; she optioned the film rights in 1973, paying $100 for three months.[4] She hired Peter Weir to direct on the basis of Homesdale and Weir brought in Hal and Jim McElroy to help produce.[1]

text: Screenwriter David Williamson was originally chosen to adapt the film, but was unavailable and recommended noted TV writer Cliff Green.[5] Joan Lindsay had approval over who did the adaptation and she gave it to Green, whose first draft Lovell says was "excellent".[4]

text: The finalised budget was A$440,000, coming from the Australian Film Development Corporation, British Empire Films and the South Australian Film Corporation. $3,000 came from private investors.[4]

text: Filming began in February 1975 with principal photography taking six weeks.[6] Locations included Hanging Rock in Victoria, Martindale Hall near Mintaro in rural South Australia, and at the studio of the South Australian Film Corporation in Adelaide.

text: Director of photography Russell Boyd stated in an interview that he created the ethereal look of the picnic by placing simple bridal veil fabric over the camera lens.[5] The film was edited by Max Lemon.

text: Weir originally cast Ingrid Mason as Miranda, but realised after several weeks of rehearsals that it was "not working" and cast Anne-Louise Lambert. Mason was persuaded to remain in the role of a minor character by producer Patricia Lovell.[5] The role of Mrs Appleyard was originally to have been taken by Vivien Merchant; Merchant fell ill and Rachel Roberts was cast at short notice.[1] Several of the school girls' voices were dubbed in secrecy by professional voice actors. The voice actors were not credited, although actress Barbara Llewellyn revealed that she provided the voice for the role of Edith (Christine Schuler).[7]

text: Music[edit]

text: The main title music was derived from two traditional Romanian panpipe pieces: "Doina: Sus Pe Culmea Dealului" and "Doina Lui Petru Unc" with Romanian Gheorghe Zamfir playing the panpipe (or panflute) and Swiss born Marcel Cellier the organ. Australian composer Bruce Smeaton also provided several original compositions (The Ascent and The Rock) written for the film.[5]

text: Other classical additions included Bach's Prelude No. 1 in C from The Well-Tempered Clavier performed by Jenő Jandó; the Romance movement from Mozart's Eine kleine Nachtmusik; the Andante Cantabile movement from Tchaikovsky's String Quartet No. 1, Op. 11, and the Adagio un poco mosso from Beethoven's Piano Concerto No. 5 "Emperor" performed by István Antal with the Hungarian State Symphony Orchestra. Traditional British songs God Save the Queen and Men of Harlech also appear.

text: There is currently no official soundtrack commercially available. In 1976, CBS released a vinyl LP titled "A Theme from Picnic at Hanging Rock", a track of the same name and "Miranda's Theme". A 7" single was released in 1976 of the Picnic At Hanging Rock theme by the Nolan-Buddle Quartet.

text: Reception[edit]

text:
Horror need not always be a long-fanged gentleman in evening clothes or a dismembered corpse or a doctor who keeps a brain in his gold fish bowl. It may be a warm sunny day, the innocence of girlhood and hints of unexplored sexuality that combine to produce a euphoria so intense it becomes transporting, a state beyond life or death. Such horror is unspeakable not because it is gruesome but because it remains outside the realm of things that can be easily defined or explained in conventional ways."

Vincent Canby, writing about the film for The New York Times[8]

tag: div

text: Weir recalled that when the film was first screened in the United States, American audiences were disturbed by the fact that the mystery remained unsolved. According to Weir, "One distributor threw his coffee cup at the screen at the end of it, because he'd wasted two hours of his life—a mystery without a goddamn solution!"[5] Critic Vincent Canby noted this reaction among audiences in a 1979 review of the film, in which he discussed the film's elements of artistic "Australian horror romance", albeit one without the cliches of a conventional horror film.[8]

text: Despite this, the film was a critical success, with American film critic Roger Ebert calling it "a film of haunting mystery and buried sexual hysteria" and remarked that it "employs two of the hallmarks of modern Australian films: beautiful cinematography and stories about the chasm between settlers from Europe and the mysteries of their ancient new home."[9]

text: Cliff Green stated in interview that "Writing the film and later through its production, did I—or anyone else—predict that it would become Australia's most loved movie? We always knew it was going to be good—but that good? How could we?"[6]

text: Picnic at Hanging Rock has an approval rating of 94% on Rotten Tomatoes as of 13 May 2016.[10]

text: Box office[edit]

text: Picnic at Hanging Rock grossed $5,120,000 in box office sales in Australia.[11] This is equivalent to approximately $23,269,160 in 2016 Australian dollars.[12]

text: Accolades[edit]

text:
Award
Category
Subject
Result

AACTA Award
Best Film
Hal and Jim McElroy
Nominated

Best Direction
Peter Weir
Nominated

Best Actress
Helen Morse
Nominated

British Society of Cinematographer Award
Best Cinematography
Russell Boyd
Nominated

BAFTA Award
Best Cinematography
Won

Best Costume Design
Judith Dorsman
Nominated

Best Soundtrack
Nominated

Saturn Award
Best Writing
Cliff Green
Nominated

tag: table

text: Versions[edit]

text: Picnic at Hanging Rock was first released on DVD in the Criterion Collection on 3 November 1998. This release featured a director's cut of the film with an entirely new transfer, a theatrical trailer and liner notes about the film. The same year, the film was also re-released theatrically, with Weir removing seven minutes from the film that apparently detracted from the narrative.[5] The Criterion Collection re-released the director's cut on Blu-Ray on June 17, 2014. It includes a paperback copy of the novel and many supplemental features, most of which are not available on international releases.

text: The film was later released in a special 3-disc set on 30 June 2008 in the United Kingdom. This set included the director's cut and a longer original version, interviews with filmmakers and book author Joan Lindsay, poster and still galleries, a 120-minute documentary and deleted scenes. UK distributor Second Sights Films also released the film on Blu-ray on 26 July 2010.[13][14]

text: In Australia it was released on DVD by Umbrella Entertainment in August 2007, and re-released in a 2-disc Collector's Edition in May 2011. This edition includes special features such as the various theatrical trailers, poster and still galleries, documentaries and interviews with cast, crew and Joan Lindsay.[15] It was released on Blu-ray by Umbrella Entertainment with a newly restored print, the feature-length documentary A Dream Within A Dream, a 25-minute on-set documentary, A Recollection: Hanging Rock 1900 and the theatrical trailer on 12 May 2010.[16]

text: Legacy and influence[edit]

text: This section may contain improper references to self-published sources. Please help improve it by removing references to unreliable sources, where they are used inappropriately. (September 2014) (Learn how and when to remove this template message)

text: The film has gone on to inspire other more recent artists, who have come to regard the film for its themes as well as its unique visuals.

text: Director Sofia Coppola has borrowed heavily from Picnic at Hanging Rock for her productions of The Virgin Suicides as well as Marie Antoinette.[17] Both films, like Picnic at Hanging Rock, deal extensively with themes of death and femininity as well as adolescent perceptions of love and sexuality.[18][19]

text: Excerpts of the film's dialogue can be heard in the cello rock group Rasputina's song "Girls' School" which is featured on their album Frustration Plantation.[20][21] Rasputina's personal aesthetic has also been likened to Picnic at Hanging Rock by critics.[22]

text: American actress Chloë Sevigny has cited the film as an influence on her personal style.[23]

text: American television writer Damon Lindelof stated that the film was an influence on the second season of the television show The Leftovers.[24]


document_title: Collector (comics)

question_text: who does the collector have in guardians of the galaxy

text: Collector (comics)

text: Publication history[edit]

text: This section needs expansion. You can help by adding to it. (March 2015)

text: The Collector first appeared in The Avengers #28 (May 1966), and was created by Stan Lee and Don Heck.

text: Fictional character biography[edit]

text: Taneleer Tivan is one of the Elders of the Universe and is close to his fellow Elder En Dwi Gast (the Grandmaster). He apparently came to self-awareness billions of years ago, on the planet Cygnus X-1. He is an enormously powerful being who wielded the Power Primordial and, though at first he took the appearance of an old human, his true form is a powerful alien.[volume & issue needed]

text: For millions of years, the Collector lived on an unknown world with his wife and child, spending his days in thought and contemplation. Over three billion years ago, when his wife, Matani Tivan, lost the will to live and relinquished her immortality, the Collector realized he would need a hobby to maintain his own sanity, and began collecting interesting artifacts and life forms from around the universe. Eventually, his obsession reached such heights he collected anything he considered rare or valuable often just for the sake of collecting. As such, he has a wide variety of rare or unique items at his disposal.[volume & issue needed]

text: The Collector also had the power of prophecy, allowing him to foresee the rise of a being powerful enough to pose a threat to the Elders: Thanos. To protect life in the universe, the Collector created a massive museum of countless life forms to keep them safe from Thanos. For a time, he even possessed one of the six Infinity Gems, unaware of its true power, until Thanos took it.[volume & issue needed]

text: At some point over his billions of years of life he came into contact with other beings who, like him, are the sole survivors of the first species in the universe. He often refers to these fellow elders as brothers though they usually only work together if they have a common goal.[volume & issue needed]

text: In the modern era, the Collector eventually traveled to Earth. He captured the Wasp and sought to "collect" the other Avengers with help from the Beetle, but was defeated by them.[1] He later enslaved Thor, then captured the Wasp and the other Avengers. He restored Goliath's size-change powers, but was then defeated by the Avengers again.[2] He next compelled Iron Man to serve as his pawn against the warrior Val-Larr.[3] He attempted to "collect" the Avengers once more, in Rutland, Vermont.[4]

text: In The Incredible Hulk issues #197 ("...And Man-Thing makes three!") and #198 ("The Shangri-La syndrome!"), the Collector uses the previously captured Man-Thing and the Glob to capture the Hulk. After capturing the Hulk, the Collector muses on capturing the rest of the original Avengers. The Hulk escapes freeing several of the Collectors exhibits. The newly free exhibits die from old age because they are no longer artificially preserved by the power of the Collector's ship. Man-Thing also escapes disappearing into the Swamp. The Glob remains aboard the ship and though it is not shown, it is suggested that the Glob kills the Collector. The lines from the comic book are "What the Glob wants here is quite simple: He wants the Collectors life! The Collector's anguished scream fades long before it can filter through the museum-ships long corridors. For several seconds silence reigns both within the ship and without--"[5]

text: The Korvac Saga[edit]

text: After Thanos was defeated by Earth's superheroes, the Collector foresaw a second major threat: Korvac the Machine Man, a cyborg monstrosity from the 31st century of a divergent timeline, taking the form of a man named Michael in 20th century New York. The Avengers were also aware of a new threat but did not know his identity. In an attempt to protect them, the Collector added some of them to his collection and was probably planning to enlist their aid, when a second group of Avengers appeared and defeated him in combat.[6] After the defeat, the Collector remained in seclusion until a human named Peter Tran of Avondale summoned him to Earth.[volume & issue needed]

text: Sensing that his end was at hand, the Collector revealed that having learned of Korvac, he had made his own daughter, Carina, into a spy and living weapon to use against the Machine Man, imbuing her with the Power Primordial. Just as he was about to tell the heroes who their enemy was, Michael learned of his duplicity and used his cosmic powers to blast the Collector into atoms, proving the prediction of the aged scholar's own end to be correct.[7]

text: Subsequent activities[edit]

text: In the 1982 miniseries Marvel Super Hero Contest of Champions, the Elder known as the Grandmaster plays a game called the Contest of Champions with Death, which resulted in Death resurrecting his fellow Elder the Collector.[8] The Collector captured Marrina, then battled Alpha Flight and Spider-Man.[9] He aided the Grandmaster by tricking the Avengers into entering Death's realm.[10]

text: The Collector also assisted his fellow elders in a plot to kill Galactus and recreate the universe, but he was thwarted by the Silver Surfer and consumed by Galactus.[11] Since Death had vowed that the Elders could no longer die, they caused Galactus to have "cosmic indigestion" until they were forced out of him by Master Order and Lord Chaos.[12] The Collector was one of the four Elders who aided the Silver Surfer and Nova in helping Galactus to defeat the In-Betweener.[13] Once the battle was over the five Elders used their Infinity Gems to instantaneously travel very far away from Galactus and his vengeance.[14] He later gave his Infinity Gem to Thanos in exchange for the Runner, who Thanos was holding captive. The Runner beat the Collector up upon his release.[15]

text: The Collector re-appeared when the Avengers fought Thane Ector and the Brethren, who were noted to have escaped from the Collector's collection. It was then noted later that the Collector had planned all of this, intending the Brethren to lay waste to the Earth so that he could "collect" the surviving humans. It was at this point he showed his true form to the Avengers and was noted to be very powerful; enough to subdue Thane Ector. The Collector was eventually thwarted by the Avengers, and the Brethren's Uni-Mind.[16]

text: The Collector next used the Collection Agency and the Silver Surfer as pawns to capture a virus that caused insanity.[17]

text: The Collector has become involved with Galactus once again when the latter entity wished to devour one of the worlds that held many of the entities the Collector had taken. Among them were the Starjammers and Wolverine.[18]

text: The Grandmaster later makes a bet with the Collector who sets his team of Defenders (Hulk, Doctor Strange, Namor, and the Silver Surfer) against the Grandmaster's team of Offenders (which comprises the Red Hulk, Baron Mordo, Tiger Shark, and Terrax).[19] The game results in Hulk claiming victory and the Collector complies with the terms of the game, giving the Hulk the lifeless body of Jarella.[20]

text: Eight months after the events of Secret Wars as part of the All-New, All-Different Marvel event, the Collector is shown in charge of Battlerealm, the small surviving portion of Battleworld. He engages in a new Contest of Champions with the Grandmaster, with the prize being an ancient cosmic artifact called the Iso-Sphere.[21]

text: When the hammer of the Ultimate Thor fell to Asgard after Battleworld had been erased, the Collector took all of the currently-abandoned Asgard into his possession when he found that he was unable to lift the hammer himself. When Thor came to investigate rumors of the hammer's existence, the Collector took Thor prisoner, threatening to kill other aliens in his collection unless Thor would tell him the 'secret' of how to bypass the worthiness enchantment.[22] He then encounters Proxima Midnight and Black Swan, who were sent by Thanos to retrieve the hammer. After Odinson, Beta Ray Bill, Odinson's pet goat Toothgnasher and the Helhound Thori escape and battle his army, the Collector tries to recapture Odinson, only for him to break free and grab the hammer.[23] Odinson chooses not to claim the hammer, but he and Bill are able to channel its power to return Asgard to its true place, simultaneously decimating the Collector's forces, prompting him to kill his last soldier so that he can have the pleasure of destroying something unique.[24]

text: Powers and abilities[edit]

text: The Collector possesses the ability to manipulate cosmic energy for a variety of effects, including projecting concussive force beams, and the increasing of his size and mass (and hence physical strength) at will. He also possesses limited shape-changing abilities. His precognitive abilities give him brief visions of alternate future, although he must meditate for long periods to identify the individuals he sees in the vision and its apparent point in time. He has telepathic abilities that enable him to make limited contact with the minds of other Elders. Due to a vow by Death, the Collector and all the Elders cannot die and are effectively immortal.[citation needed]

text: The Collector has a vast knowledge and comprehension of the advanced science and technology of numerous alien worlds, as well as a collection of devices and artifacts from those worlds. His armored battle-suit is made of the alien metal etherion, which amplifies the wearer's strength to superhuman levels, and it has jets that permit flight. He uses various weapons from many time periods and different worlds. Among his arsenal from Earth's past are catapults, Tibetan crystal balls that emit mystical rays, and magic beans that can conjure up warrior giants. He possesses a magic lamp that can summon a four-headed djinn with mystical powers. His "boxes" are rectangular "interdimensional traps" that can weaken a victim's strength or sanity. Other weapons include gigantic robot guards, a stun beam, and stasis beams. The Collector also has zoos of alien beasts which he can release to attack his adversaries. Among this is Snake-Eyes, an enormous alien serpent with hypnotic powers. Other items in his collection include the Obedience Potion, with which the Collector can compel a human victim to do his bidding; the Cosmic Viewer, with which he can monitor events on various worlds; a Kymellian translation/control device resembling a flute, with which he can communicate with other living beings; and a time probe enabling him to find and procure artifacts from other time periods. He uses starships holding museums of his collections, a Temporal Assimilator that allows time travel, Persian "flying carpets" and a "flying cape" that allowed flight. He formerly possessed the Infinity Gem that could control reality, but he did not understand its power.[25]

text: Other versions[edit]

text:
The Collector appears in issue 4 of Marvel Super Hero Squad.[26]
The Collector appears in The Avengers: United They Stand #6-7. He chooses to preserve a good population of Earth as he feels the planet is on the verge of ending. Although the Avengers escape, some citizens on Earth prefer to stay with The Collector.

text: In other media[edit]

text: Television[edit]

text:
The Collector appeared in Hulk and the Agents of S.M.A.S.H., voiced by Jeff Bennett.[27] His self-titled episode "The Collector" saw him arrive on Earth, where he seeks to abduct all of Earth's heroes to add to his collection, but his plans are foiled by the Agents of S.M.A.S.H. and Spider-Man. In the episode "It's a Wonderful Smash" (which is a Christmas episode), Collector uses a holographic neural inducer to place the Agents of S.M.A.S.H. in a virtual reality simulation in which each member lives an idealized life, but they are freed from the simulation by Rocket Raccoon. It was also revealed that he has the Orb of Truth in possession that the Guardians of the Galaxy were planning to give to the Shi'ar during their peace meeting with the Kree. Combining the holographic neural inducer and the Orb of Truth, the Agents of S.M.A.S.H. and the Guardians of the Galaxy were able to defeat Collector.
The Collector appears in Ultimate Spider-Man: Web Warriors,[28] voiced again by Jeff Bennett. In the four-part episode "Contest of Champions", he and the Grandmaster have a competition to determine the fate of the Earth. With Spider-Man being his favorite, Collector uses the heroes while Grandmaster uses the villains. Collector has a history of losing to Grandmaster and lacks the confidence to beat his brother, but is convinced by Spider-Man that he can be victorious. In part four, Collector teams up with Spider-Man and fights various supervillains and finally Grandmaster for one final game. As part of the deal for winning, Collector agrees to stop collecting things from Earth and is instead interested in experiences, relationships, and connections with other people after witnessing Aunt May's dedication during their fight. He refuses to have a rematch with his older brother to avoid further conflict.
The Collector appears in Guardians of the Galaxy, voiced by Tom Kenny.[citation needed] In the episode "One in a Million You", he brings the Guardians of the Galaxy and their ship onto his ship. Collector offers to tell the Guardians of the Galaxy where the crystals needed to power the Crypto-Map are in exchange that he borrows Rocket Raccoon. Rocket, feeling unappreciated by the Guardians and swayed by the resources in the Collector's lab, agrees to stay. Star-Lord is pointed to an asteroid while Rocket Raccoon gains access to the lab. What nobody knows is that Collector secretly wanted Rocket Raccoon in his collection due to him being the last of his kind. After having created a robot, Rocket Raccoon finds himself unable to leave the lab due to a special device Collector placed on him so that he can be part of his zoo. When the rest of the Guardians of the Galaxy return and fight Collector, Rocket Raccoon managed to free himself and ends up freeing the other alien creatures including Fin Fang Foom. Upon being pinned by Fin Fang Foom, Collector offered not to target other alien species in exchange that the Guardians of the Galaxy leave his ship and never return. Star-Lord accepts the deal in exchange that he tells him where they can find more crystals. Afterwards, Collector secretly follows the Guardians of the Galaxy to let them find the Star Seed for him. In the episode "Space Cowboys", the Guardians of the Galaxy encounter Collector on Knowhere. Collector plans to loan them a Repulsar Generator to get through a gravity storm in exchange for delivering Moombas to his brother, the Grandmaster on Conjunction while telling them to feed them nothing but grass or else they will explode. Star-Lord later found a metal on the alpha Moomba which contained a pre-recorded message for Grandmaster leading the Guardians of the Galaxy to find out that Collector planned to blow up Conjunction. Grandmaster hired Yondu's Ravagers to take the Moombas back to Collector on Knowhere. During the conflict between the Guardians the Galaxy and the Ravagers, the Nova Corps arrived where Cosmo the Spacedog stated that Collector was behind the trafficking. Collector had to disavow this and got away.

text: Film[edit]

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Benicio del Toro portrays Taneleer Tivan / The Collector in films set in the Marvel Cinematic Universe.

In the mid-credits scene of Thor: The Dark World,[29] Sif and Volstagg give the Aether to the Collector to keep in his collection, explaining that with the Tesseract already in Asgard, it would be unwise to keep two Infinity Stones close together. As they leave, the Collector remarks, "One down, five to go."[30]
In Guardians of the Galaxy,[31] the Collector contacts Gamora with an offer to purchase an Orb containing an Infinity Stone, but when it is delivered to him, the Collector's slave, Carina, touches it, causing a reaction in the stone that disintegrates her and destroys the Collector's gallery. In a post-credits scene, he and one of the items in his collection known as Howard the Duck are shown sitting in the ruins having drinks.
The Collector appears in Avengers: Infinity War,[32] as an illusion created by Thanos using the Reality Stone. His overall fate is unknown, though it is implied that Thanos killed him before the Guardians of the Galaxy arrived at Knowhere.

text: Video games[edit]

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The Collector appears in Disney Infinity: Marvel Super Heroes.[33]
The Collector is the main non-playable character in Marvel: Contest of Champions, where he works under the command of Maestro to run the Contest in a pocket universe called the Battlerealm.[citation needed]
The Collector appears as a playable character in Lego Marvel's Avengers, voiced once again by Jeff Bennett.[citation needed]
The Collector is featured in Guardians of the Galaxy: The Telltale Series.[citation needed] He is served by an alien representative named Vylla (voiced by Erin Yvette).[citation needed]

text: Theme park[edit]

text: The Collector appears in the Guardians of the Galaxy – Mission: Breakout! attraction at Disney California Adventure, with Benicio del Toro reprising his role from the films.[citation needed] In the attraction, the Collector has captured the Guardians of the Galaxy and put them on display in his collection.