When Someone Has Schizophrenia

Schizophrenia is a serious mental disorder — one the most chronic and disabling types of mental illness. The first signs of schizophrenia, which typically emerge in young people in their teens or twenties, can be confusing and even shocking to families and friends. Hallucinations, delusions, disordered thinking, unusual speech or behavior, and social withdrawal impair the ability to interact with others. Most people with schizophrenia suffer chronically or episodically throughout their lives, losing opportunities for careers and relationships. 1 They often are stigmatized by lack of public understanding about the disease. However, several new antipsychotic medications developed within the last decade, which have fewer side effects than the older medications, in combination with psychosocial interventions have improved the outlook for many people with schizophrenia. 2

Basic Facts About Schizophrenia

  • In the U.S., over 2 million adults 3 , or about 0.7 to 1.1 percent of the population age 18 and older in a given year 4, have schizophrenia.
  • Rates of schizophrenia are very similar from country to country — about 1 percent of the population.5
  • Schizophrenia ranks among the top 10 causes of disability in developed countries worldwide.6
  • Psychotic features of schizophrenia typically start between a person’s late teens and mid-30s. For men, peak emergence of psychotic symptoms is in their early to mid-20s. For women, the peak time is in their late 20s.
  • The risk of suicide is serious in people with schizophrenia.7

News and entertainment media tend to link mental illnesses including schizophrenia to criminal violence. Most people with schizophrenia, however, are not violent toward others but are withdrawn and prefer to be left alone. Drug or alcohol abuse raises the risk of violence in people with schizophrenia, particularly if the illness is untreated, but also in people who have no mental illness.8,9

Research Into Schizophrenia

  • Family studies indicate that genetic vulnerability may be a risk factor for schizophrenia.10 A person with a parent or sibling with schizophrenia has approximately a 10 percent risk of developing the disorder compared to a 1 percent risk for a person with no family history of schizophrenia. At the same time, among individuals with schizophrenia who have an identical twin, and thus share the exact genetic makeup, there is only a 50 percent chance that both twins will be affected with the disease. Scientists conclude that nongenetic factors, such as environmental stress perhaps occurring during fetal development or at birth, also may contribute to the risk of schizophrenia.11, 12
  • Research suggests that schizophrenia may be a developmental disorder resulting from impaired migration of neurons in the brain during fetal development.13
  • Advances in neuroimaging have shown that some people with schizophrenia have abnormalities in brain structure consisting of enlarged ventricles, the fluid-filled cavities deep within the brain.14
  • Schizophrenia can appear in children, though it is very rare. Neuroimaging research of childhood-onset schizophrenia has shown evidence of progressive abnormal brain development.15

While providing clues about the brain regions involved in schizophrenia, these findings are not yet sufficiently specific to schizophrenia to be useful as a diagnostic test.

Treatments for Schizophrenia

The newer medications for schizophrenia — the atypical antipsychotics — are very effective in the treatment of psychosis, including hallucinations and delusions, and may also help treat the symptoms of reduced motivation or blunted emotional expression.16 Intensive case management, cognitive-behavioral approaches that teach coping and problem-solving skills, family educational interventions, and vocational rehabilitation can provide additional benefit.2 Evidence suggests that early and sustained treatment involving antipsychotic medication improves the long-term course of schizophrenia.17 Over time, many people with schizophrenia learn successful ways of managing even severe symptoms.

Because schizophrenia sometimes impairs thinking and problem solving, some people may not recognize they are ill and may refuse treatment. Others may stop treatment because of medication side effects, because they feel their medication is no longer working, or because of forgetfulness or disorganized thinking. People with schizophrenia who stop taking prescribed medication are at high risk for a relapse of illness.18 A good doctor-patient relationship may help people with schizophrenia continue to take medications as prescribed.19

Present and Future Research Directions

In addition to the development of new treatments, schizophrenia research is focusing on the relationships among genetic, behavioral, developmental, social and other factors to identify the cause or causes of schizophrenia. Utilizing increasingly precise imaging techniques, scientists are studying the structure and function of the living brain. New molecular tools and modern statistical analyses are enabling researchers to close in on the particular genes that affect brain development or brain circuitry involved in schizophrenia. Scientists are continuing to investigate possible prenatal factors, including infections, which may affect brain development and contribute to the development of schizophrenia.

 

References

1 Harrow M, Sands JR, Silverstein ML, et al. Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study. Schizophrenia Bulletin, 1997; 23(2): 287-303.

2 Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin, 1998; 24(1): 1-10.

3 Narrow WE. One-year prevalence of mental disorders, excluding substance use disorders, in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1, 1998. Unpublished.

4 Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 1993; 50(2): 85-94.

5 Report of the international pilot study of schizophrenia.Volume 1. Geneva, Switzerland: World Health Organization, 1973.

6 Murray CJL, Lopez A.D, eds. Summary: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press, 1996.

7 Fenton WS, McGlashan TH, Victor BJ, et al. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. American Journal of Psychiatry, 1997; 154(2): 199-204.

8 Swartz MS, Swanson JW, Hiday VA, et al. Taking the wrong drugs: the role of substance abuse and medication noncompliance in violence among severely mentally ill individuals. Social Psychiatry and Psychiatric Epidemiology, 1998; 33(Suppl 1): S75-S80.

9 Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 1998; 55(5): 393-401.

10 NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.

11 Geddes JR, Lawrie SM. Obstetric complications and schizophrenia. British Journal of Psychiatry, 1995; 167(6): 786-93.

12 Olin SS, Mednick SA. Risk factors of psychosis: identifying vulnerable populations premorbidly. Schizophrenia Bulletin, 1996; 22(2): 223-40.

13 Murray RM, O’Callaghan E, Castle DJ, et al. A neurodevelopmental approach to the classification of schizophrenia. Schizophrenia Bulletin, 1992; 18(2): 319-32.

14 Suddath RL, Christison GW, Torrey EF, et al. Anatomical abnormalities in the brains of monozygotic twins discordant for schizophrenia. New England Journal of Medicine, 1990; 322(12): 789-94.

15 Rapoport JL, Giedd J, Kumra S, et al. Childhood-onset schizophrenia. Progressive ventricular change during adolescence. Archives of General Psychiatry, 1997; 54(10): 897-903.

16 Dawkins K, Lieberman JA, Lebowitz BD, et al. Antipsychotics: past and future. National Institute of Mental Health Division of Services and Intervention Research Workshop, July 14, 1998. Schizophrenia Bulletin, 1999; 25(2): 395-405.

17 Wyatt RJ, Henter ID. The effects of early and sustained intervention on the long-term morbidity of schizophrenia. Journal of Psychiatric Research, 1998; 32(3-4): 169-77.

18 Owens RR, Fischer EP, Booth BM, et al. Medication non-compliance and substance abuse among patients with schizophrenia. Psychiatric Services, 1996; 47(8): 853-8.

19 Fenton WS, Blyler CB, Heinssen RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophrenia Bulletin, 1997; 23(4): 637-51.