Persistent symptoms, medication side effects, and higher rates of substance use are a few of the challenges of schizophrenia.
Over the last several decades, our understanding of schizophrenia has increased significantly.
Several effective medications, such as atypical antipsychotics, have been developed to manage symptoms of psychosis, allowing for greater functioning and well-being for people with schizophrenia.
Still, many challenges remain. Some of these challenges are symptoms that have yet to respond to treatments, while others are side effects of current medications.
Schizophrenia is a complex mental health condition that impacts a person’s feelings, thoughts, behaviors, and perception of reality. When symptoms are severe, the condition can reach a debilitating level and affect every area of life.
Though antipsychotic medications can manage the positive symptoms (hallucinations and delusions) of schizophrenia, these drugs often come with unwanted side effects for many people.
In addition, there are still no effective treatments to manage the ongoing negative and cognitive symptoms of schizophrenia. This lack can make it difficult to work and function in daily life.
Thus, many people with schizophrenia continue to live with the following challenges:
- untreated negative symptoms
- medication side effects
- weight management
- suicidal thoughts
- substance use
- job challenges
The negative symptoms of schizophrenia reduce or “take away” from someone’s personality. These symptoms often relate to motivation, interests, or verbal and emotional expression.
Negative symptoms consist of five key areas:
- difficulty expressing emotions, e.g., diminished facial expressions (called blunted- or flat affect)
- reduction in the number of words spoken (alogia)
- reduced goal-directed activity due to decreased motivation (avolition)
- reduced social activity (asociality)
- reduced experience of pleasure (anhedonia)
Negative symptoms don’t respond to current antipsychotic medications, and so they tend to be the most persistent and difficult aspect of the disorder for many people.
Negative symptoms account for a large part of the disorder’s long-term disability and functioning difficulty. Treatment for these symptoms is still considered an urgent unmet need in psychiatry.
People with schizophrenia who regularly take atypical antipsychotics may experience numerous side effects.
- sleepy during the day (about 83% of participants)
- difficulty sleeping (around 75% of participants)
- dry mouth (almost 64% of participants)
- problems enjoying sex (around 53% of participants)
- weight gain (about 52% of participants)
- weight gain
- insulin resistance
- abnormal cholesterol
These side effects may make people not want to take their medication.
One survey found that 26.5% of people with schizophrenia weren’t taking meds as prescribed, while another study found that percentage closer to 70%. Not taking prescriptions is linked to an increased chance of psychosis relapse, persistent symptoms, and suicide attempts.
Several factors may contribute to weight gain in those with schizophrenia:
- antipsychotic medication
- sedentary lifestyle
- largely consuming processed food
Most antipsychotic medications cause weight gain. Weight tends to increase rapidly in the initial period after starting these medications. Up to 86% of those with first-episode psychosis experience more than 7% of body weight gain in the first year of treatment.
These medications may increase weight via the following mechanisms:
- increased appetite
- altered gut microbiome
- impaired glucose metabolism
Ziprasidone was shown to cause the least weight gain.
Still, each individual with schizophrenia will respond best to a particular medication, so it’s important to take the one that most effectively reduces your symptoms with the fewest side effects.
Suicide is a cause of early death in nearly
The following factors may further increase the chances of suicidal behavior:
- being born male
- younger age
- being unmarried
- lack of family support or disrupted family relationships
- previous suicide attempt
- adverse childhood experiences
- early onset of schizophrenia
- current depressive disorder (A
2021 studyfound that more than 50% of people who died by suicide had symptoms of depression at the time of the suicide.)
- hopelessness or demoralization
- co-occurring substance use disorder
If you’re experiencing suicidal thoughts, help is available
You can access free support right away with these resources:
- 988 Suicide and Crisis Lifeline.Call the Lifeline at 988 for English or Spanish, 24 hours a day, 7 days a week.
- The Crisis Text Line.Text HOME to the Crisis Text Line at 741741.
- The Trevor Project. LGBTQIA+ and under 25 years old? Call 866-488-7386, text “START” to 678678, or chat online 24/7.
- Veterans Crisis Line.Call 988 and press 1, text 838255, or chat online 24/7.
- Deaf Crisis Line.Call 321-800-3323, text “HAND” to 839863, or visit their website.
- Befrienders Worldwide.This international crisis helpline network can help you find a local helpline.
The following factors may help reduce likelihood of attempting suicide:
- sound coping strategies
- social support
- insight into schizophrenia
- absence of psychotic symptoms
- good relationship or collaboration with clinician
People with schizophrenia are
A large study found that
Alcohol and substance use disorders can also increase the possibility of suicide. People with a SUD are nearly
Substance misuse contributes to an increased risk of psychosis. For many people, substance-induced psychosis is short-term, but in other cases, the symptoms may persist, mimicking the positive and negative symptoms of schizophrenia.
Working can be a challenge for many people with schizophrenia, though it is possible to have a job. According to the World Health Organization, schizophrenia is the fourth leading cause of disability.
If you or a loved one lives with schizophrenia, then you’re likely aware of the ongoing challenges the disorder can bring.
Researchers are working to develop better solutions for these unmet needs. It’s likely that in the near future, many of these challenges will be addressed with new and effective interventions.
These may include:
- antipsychotic medications with fewer side effects
- better interventions for substance use disorder
- effective treatments for schizophrenia’s negative and cognitive symptoms
Meanwhile, if you want the learn more about managing schizophrenia in everyday life, you can check out our schizophrenia hub.