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. 1, 2, 3

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: 4, 5


  • Delusions (false beliefs despite evidence which proves these wrong) 6
  • Hallucinations (sensory experiences not shared by anyone else. These may be heard, seen, smelled, tasted or felt) 6


  • Lack or decline in emotional response
  • Lack or decline in speech

Disorganised speech 4

Grossly disorganised behaviour (e.g., dressing inappropriately, crying frequently, lack of self-care) 4

The disorder must cause social and/or occupational dysfunction 5


Schizophrenia affects approximately one in every hundred people,4 with an estimated 29 million people affected worldwide. 2 It normally occurs in the late teens or early adulthood, and is a life-long disease for most patients. 4

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. 7

Men have a 40% higher incidence of schizophrenia than women 4

Risk factors include: 4
• 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


Schizophrenia is a difficult and challenging disease to treat and generally has a more unfavourable outcome than other disorders. 8

There are several predictors for poor outcome: 8, 9
• Male
• 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


An earlier age at onset has been linked to more severe behavioural disturbance as well as greater social disability. 7 Nearly 50% of people with schizophrenia have a substance-abuse-related disorder at some point during their illness. 4

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. 4 The risk of suicide remains over a long period of time. 4

Schizophrenia disrupts interpersonal relationships and family structures, and has significant direct economic costs to society. 5


Many people with schizophrenia have a long duration of illness; and characteristically they lack insight into their illness and have frequent readmissions and relapses.2 Active and early intervention can improve long term outcomes. 5

While treatment, with the appropriate medication remains the mainstay of therapy, psychosocial interventions are crucial in promoting recovery and improving quality of life. 5

People who have their first episode will be on medication for a minimum of one year provided: 5

• 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. 5 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. 5


It is very important for people with schizophrenia to take their medication continuously. 10 This is particularly challenging as many lack insight into their illness and frequently relapse. 2

Approximately 50% of all patients who stop taking their medication will relapse within 6 – 10 months, compared to one-fifth who stay on treatment. 5, 10 Long-term antipsychotic treatment reduces the risk of relapse over several years by two-thirds. 5, 10


In order to manage with the diagnosis in the best possible way, it is important to gain an understanding of schizophrenia in terms of: 9, 11

  • The nature of the illness, as well as it course and possible outcomes
  • The importance of staying on treatment
  • Signs of relapse
  • Coping strategies
  • Setting of realistic goals

It is also important to make contact with services within your community who can assist you. 9


The first step to effective long term treatment is to discuss your symptoms with your general practitioner or a healthcare professional at your local day clinic or hospital.

1. Harvey PD. What Is the Evidence for Changes in Cognition and Functioning Over the Lifespan in Patients With Schizophrenia? J Clin Psychiatry 2014;75(2):34–38

2. Chan SW. Global Perspective of Burden of Family Caregivers for Persons with Schizophrenia. Archives of Psychiatric Nursing. 2011;25(5):339–349

3. Gogtay N, Vyas NS, Testa R, Wood SJ, Pantelis C. Age of Onset of Schizophrenia: Perspectives From Structural Neuroimaging Studies. Schizophrenia Bulletin 2011;37(3):504–513

4. Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström
P. Suicide in schizophrenia. Expert Rev. Neurother. 2010;10(7):1153–1164.

5. Swingler D. Major Schizophrenia. The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders. SAJP 2013;19(3):153-156

6. Schulz SC. Schizophrenia. The Merck Manual. [online] 2013, October. [cited 2014, December 29] Available at

7. Rajji TK, Ismail Z, Mulsant. Age at onset and cognition in schizophrenia: metaanalysis. The British Journal of Psychiatry.2009;195:286–293

8. Lang FU, Kösters M, Lang S, Becker T, Jäger M. Psychopathological long-term outcome of schizophrenia – a review. Acta Psychiatr Scand 2013:127:173–182

9. Stahl SM, Morrissette DA, Citrome L, Saklad SR, Cummings MA, Meyer JM, et al. “Meta-guidelines” for the management of patients with schizophrenia. CNS Spectrums. 2013;18:150-162

10. Emsely R, Chiliza B, Asmal L, Harvey H. The nature of relapse in schizophrenia.BMC Psych 2013; 13:50

11. Bäuml J, Froböse T, Kraemer S, Rentrop M, Pitschel-Walz G. Psychoeducation: A Basic Psychotherapeutic Intervention for Patients With Schizophrenia and Their Families. Schizophrenia Bulletin 2006;32(S1):S1–S9

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