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 behaviour, and they find it difficult to judge reality. This can have a major impact on the life of the individual and his/her family.
Schizophrenia is caused by an imbalance in the chemicals that send signals to 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 characterised by episodes of psychosis (losing touch with reality) in between periods of blunted emotions and withdrawal.
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.
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.
Schizophrenia affects people regardless of race, culture or social class. It typically starts in early adulthood (from age 20)1 but it can develop at any age from late teens onwards. Schizophrenia affects both men and women, although men tend to develop the condition slightly earlier in life.2 The chance of an individual developing schizophrenia during his or her lifetime is approximately 1%.1
In 2004, the World Health Organisation estimated that over 26 million people suffered from schizophrenia, making it one of the top 20 causes of disability worldwide.3 Furthermore, in 2004, 30,000 deaths were attributed to the condition.3 Cardiovascular disease (CVD; including coronary heart disease [CHD]) is the most common cause of death in people with schizophrenia. 4 In schizophrenia patients, cardiovascular and pulmonary diseases have been estimated to account for approximately 60% of premature deaths. 5 Furthermore, patients with schizophrenia are more than twice as likely to die from CVD compared to the general population. 5 The excess mortality due to CVD associated with schizophrenia is widely attributed to an increased prevalence of well-known risk factors such as obesity, diabetes, hypertension, dyslipidaemia, and smoking. 6 However, schizophrenia patients also have restricted access to somatic care, and studies show under-treatment of CVD risk factors.
Schizophrenia is also among 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.7,8
Seeking diagnosis and care
Despite intensive research, a cure for schizophrenia has yet to be found. However, it is possible to treat and substantially reduce symptoms, and to recognise the ‘risk factors’ or ‘warning signs’ of a pending relapse into a new episode.
Schizophrenia requires long-term treatment. This usually consists of a combination of medication and psychosocial therapy, with a period in hospital often necessary for care and monitoring during psychotic episodes.
Despite the severity of the disorder, some people will only experience a single schizophrenic episode and may be able to return to many of their normal daily activities after treatment and rehabilitation. Unfortunately, others may develop long-standing, troublesome symptoms that limit their ability to study, work or have social interaction.
It is important that people with schizophrenia receive expert advice and medical care for their condition.
1. Tsuang MT, Farone SV. Schizophrenia. Second edition. Oxford University Press Inc., New York: 2005.
2. www.schizophrenia.com/szfacts.htm. Accessed 22/09/11.
3. World Health Organisation. The global burden of disease. 2004 update. www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html.
4. Hennekens et al., 2005; Osby , 2000; Brown, 1997
5. Osby, 2000; Tiihonen et al., 2009; Parks et al., 2006
6. De Hert et al., 2009
7. 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.
8. Lindström E, Eberhard J, Neovius M, Levander S. Costs of schizophrenia during 5 years. Acta Psychiatr Scand Suppl 2007; 116 (435): 33–40.