Schizophrenia

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}

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

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

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

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

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

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

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}

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

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.