schizophrenia

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. 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

POSITIVE SYMPTOMS 4

  • 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

NEGATIVE SYMPTOMS 4

  • 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

WHO IS AFFECTED?

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

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. 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

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. 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

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.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

WHAT HAPPENS IF TREATMENT IS NOT ADHERED TO?

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

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: 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

WHERE TO GO FOR HELP

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 http://www.merckmanuals.com/professional/psychiatric_disorders/schizophrenia_and_related_disorders/schizophrenia.html?qt=Schizophrenia&alt=sh

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 http://www.biomedcentral.com/1471-244X/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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