WHAT IS IT?
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.
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:
Delusions (false beliefs despite evidence which proves these wrong)
Hallucinations (sensory experiences not shared by anyone else. These may be heard, seen, smelled, tasted or felt)
Lack or decline in emotional response
Lack or decline in speech
Grossly disorganised behaviour (e.g., dressing inappropriately, crying frequently, lack of self-care)
The disorder must cause social and/or occupational dysfunction
WHO IS AFFECTED?
Schizophrenia affects approximately one in every hundred people, with an estimated 29 million people affected worldwide. It normally occurs in the late teens or early adulthood, and is a life-long disease for most patients.
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.
Men have a 40% higher incidence of schizophrenia than women
Risk factors include:
• 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?
Schizophrenia is a difficult and challenging disease to treat and generally has a more unfavourable outcome than other disorders.
There are several predictors for poor outcome:
• 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?
An earlier age at onset has been linked to more severe behavioural disturbance as well as greater social disability. Nearly 50% of people with schizophrenia have a substance-abuse-related disorder at some point during their illness.
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. The risk of suicide remains over a long period of time.
Schizophrenia disrupts interpersonal relationships and family structures, and has significant direct economic costs to society.
CAN SCHIZOPHRENIA BE TREATED?
Many people with schizophrenia have a long duration of illness; and characteristically they lack insight into their illness and have frequent readmissions and relapses. Active and early intervention can improve long term outcomes.
While treatment with the appropriate medication remains the mainstay of therapy, psychosocial interventions are crucial in promoting recovery and improving quality of life.
People who have their first episode will be on medication for a minimum of one year provided:
• 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. 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.
WHAT HAPPENS IF TREATMENT IS NOT ADHERED TO?
It is very important for people with schizophrenia to take their medication continuously. This is particularly challenging as many lack insight into their illness and frequently relapse.
Approximately 50% of all patients who stop taking their medication will relapse within 6 – 10 months, compared to one-fifth who stay on treatment. Long-term antipsychotic treatment reduces the risk of relapse over several years by two-thirds.
HOW CAN THE FAMILY HELP?
In order to manage with the diagnosis in the best possible way, it is important to gain an understanding of schizophrenia in terms of:
The nature of the illness, as well as it course and possible outcomes
The importance of staying on treatment
Signs of relapse
Setting of realistic goals
It is also important to make contact with services within your community who can assist you.