Schizophrenia

Schizophrenia is a psychotic disorder, often long-lasting, which may lead to marked changes in a person’s perception of reality.

Schizophrenia overview
Schizophrenia is caused by an imbalance in the chemicals facilitating the communication between neurons in the brain, leading to the perception (seeing/hearing/thinking) of things that are not real. The factors that create this imbalance are not fully understood.

Schizophrenia is a common form of severe mental illness that carries a notable ‘stigma’ and is often misunderstood. People with schizophrenia experience disturbed thoughts, emotions and behavior, and they find it difficult to judge reality.1 This can have a major impact on the life of the individual and his/her family.

Symptoms
Schizophrenia is characterized by episodes of psychosis (losing touch with reality) in between periods of blunted emotions and withdrawal.Schizophrenia symptoms can be defined by what are known as positive symptoms and negative symptoms, along with cognitive symptoms, mood symptoms, and motor symptoms.

Positive symptoms - The symptoms that occur during the episodes of psychosis are known as ‘positive symptoms’ and include thought disorder, delusions (false beliefs, often with paranoia), and hallucinations – mainly hearing voices. These symptoms are often accompanied by anxiety, depression and excessive activity – moving around constantly and becoming agitated.

Negative symptoms - In contrast, the episodes of withdrawal consist of ‘negative symptoms’. These include reduced emotions, less fluency of speech, poor capacity to plan, initiate and/or persist in activities, and reduced feelings of pleasure or interest. Negative symptoms are usually responsible for problems with social interaction and daily activities.

Epidemiology and burden
The World Health Organization estimates that over 21 million people suffer from schizophrenia, making it one of the top 20 causes of disability worldwide.2 Schizophrenia affects people regardless of race, culture or social class. It typically starts in early adulthood (from age 20)but it can develop at any age. Schizophrenia affects both men and women, although men tend to develop the condition slightly earlier in life.The chance of an individual developing schizophrenia during his or her lifetime is approximately 1%.3

Schizophrenia is also amongst the most financially costly illnesses in the world and, together with other psychotic illnesses, has been shown to account for 1.5% (UK), 2% (Netherlands, France) and 2.5% (US) of total national healthcare budgets.5-6

Diagnosis and care
People who are concerned that they – or their loved ones – are experiencing symptoms of schizophrenia should see their doctor for help and advice. Schizophrenia is diagnosed using both patient interviews and may involve discussions with loved ones. There are numerous assessment scales that can also be used to help identify the symptoms, and severity of schizophrenia.

Schizophrenia requires treatment. With appropriate treatment it’s possible to substantially reduce the symptoms associated with schizophrenia, and to recognize the ‘risk factors’ or ‘warning signs’ of a pending relapse. Treatment usually consists of a combination of medication and psychosocial therapy, with a period in hospital often necessary for care and monitoring during psychotic episodes.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Washington, D.C.: American Psychiatric Association; 2013.
  2. World Health Organization. Schizophrenia fact sheet, 2018. Available at http://www.who.int/mediacentre/factsheets/fs397/en/. Accessed November 2018.
  3. Tsuang MT, Farone SV. Schizophrenia. Second edition. Oxford University Press Inc., New York: 2005.
  4. Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treatment. 2012;2012:916198.
  5. Lindström E, Eberhard J, Neovius M, Levander S. Costs of schizophrenia during 5 years. Acta Psychiatr Scand Suppl. 2007;116(435):33–40.
  6. Rössler W, Salize HJ, van Os J, Riecher-Rössler A. Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol. 2005;15(4):399-409.
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