Schizophrenia

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Schizophrenia is a severe, complex and debilitating mental illness that affects many aspects of everyday functioning, including changes in how people function socially, intellectually and in their day-to-day, real-world activities where changes are often noticed before the first episode of illness. 1, 2, 3
For schizophrenia to be diagnosed, there need to be continuous signs of a disturbance for at least six months, which include at least one month where two or more the following symptoms are observed: 4, 5

POSITIVE SYMPTOMS 4

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Delusions (false beliefs despite evidence which proves these wrong) 6
Hallucinations (sensory experiences not shared by anyone else. These may be heard, seen, smelled, tasted or felt) 6

NEGATIVE SYMPTOMS 4

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Lack or decline in emotional response
Lack or decline in speech
Disorganised speech 4
Grossly disorganised behaviour (e.g., dressing inappropriately, crying frequently, lack of self-care) 4
The disorder must cause social and/or occupational dysfunction 5

WHO IS AFFECTED?

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Schizophrenia affects approximately one in every hundred people,4 with an estimated 29 million people affected worldwide.2 It normally occurs in the late teens or early adulthood, and is a life-long disease for most patients. 4
The incidence of schizophrenia peaks between 10 and 25 years for men and between 25 and 35 for women. Another peak, particularly among women, occurs in midlife: about 23% of people with schizophrenia experience their first episode after the age of 40. 7
Men have a 40% higher incidence of schizophrenia than women 4
Risk factors include: 4

  • Genetics (a family history of schizophrenia)
  • Environmental factors (such as birth complications, prematurity)
  • Having an older father
  • Infections during pregnancy
  • Serious viral infections of the central nervous system during childhood
  • A lifetime history of cannabis / marijuana use

WHAT ARE THE PREDICTORS AND RECOVERY FACTORS?

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Schizophrenia is a difficult and challenging disease to treat and generally has a more unfavourable outcome than other disorders. 8
There are several predictors for poor outcome: 8, 9

  • Male
  • Injury during pregnancy or birth injury
  • Early onset in life
  • Severe hallucinations and delusions
  • Severe lack of attention
  • Inability to express emotion
  • Poor functioning before the onset of the illness
  • Long length of time that the mental disorder goes untreated
  • Unstable emotional environment

HOW DOES IT IMPACT QUALITY OF LIFE?

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An earlier age at onset has been linked to more severe behavioural disturbance as well as greater social disability.7 Nearly 50% of people with schizophrenia have a substance-abuse-related disorder at some point during their illness.4
Schizophrenia has an estimated suicide risk of 4–5%, with the highest risk during the first year after diagnosis. Many of the suicides occur during hospital admission or soon after discharge. 4 The risk of suicide remains over a long period of time. 4
Schizophrenia disrupts interpersonal relationships and family structures, and has significant direct economic costs to society. 5

CAN SCHIZOPHRENIA BE TREATED?

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Many people with schizophrenia have a long duration of illness; and characteristically they lack insight into their illness and have frequent readmissions and relapses.2 Active and early intervention can improve long term outcomes. 5
While treatment, with the appropriate medication remains the mainstay of therapy, psychosocial interventions are crucial in promoting recovery and improving quality of life. 5
People who have their first episode will be on medication for a minimum of one year provided: 5
  • They are symptom-free
  • The episode is mild
  • They respond well to treatment.

If the episode is severe or they respond slowly, treatment can last for up to two years. 5 People who already have their second-episode require at least two to five years of medication while symptom-free, while patients who have had three or more episodes should be treated for life. 5

WHAT HAPPENS IF TREATMENT IS NOT ADHERED TO?

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It is very important for people with schizophrenia to take their medication continuously. 10 This is particularly challenging as many lack insight into their illness and frequently relapse. 2
Approximately 50% of all patients who stop taking their medication will relapse within 6 – 10 months, compared to one-fifth who stay on treatment. 5, 10 Long-term antipsychotic treatment reduces the risk of relapse over several years by two-thirds. 5, 10

HOW CAN THE FAMILY HELP?

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In order to manage with the diagnosis in the best possible way, it is important to gain an understanding of schizophrenia in terms of: 9, 11

  • The nature of the illness, as well as it course and possible outcomes
  • The importance of staying on treatment
  • Signs of relapse
  • Coping strategies
  • Setting of realistic goals
  • It is also important to make contact with services within your community who can assist you. 9

WHERE TO GO FOR HELP

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The first step to effective long term treatment is to discuss your symptoms with your general practitioner or a healthcare professional at your local day clinic or hospital.

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