10 schizophrenia facts
In this article we will describe 10 schizophrenia facts.
Key Points
- Schizophrenia is a chronic, severe mental health disorder characterized by disturbances in thought, perception, emotion, and behaviour.
- Symptoms are classified into positive (hallucinations, delusions), negative (social withdrawal, apathy), and cognitive (impaired memory, attention).
- The condition affects around 1% of the population worldwide, with onset typically in late adolescence or early adulthood – and is one of the most disabling diseases affecting humankind.
- Early diagnosis and intervention, along with antipsychotic medication and psychosocial support, can significantly improve outcomes.
- Schizophrenia is associated with a higher risk of comorbid physical health conditions, substance abuse, and reduced life expectancy.
1. Definition
- Schizophrenia is a chronic psychiatric disorder that affects how a person thinks, feels, and behaves.
- It is characterised by episodes of psychosis (loss of touch with reality), involving hallucinations, delusions, disorganised thinking, and behaviour.
- Negative symptoms, such as reduced emotional expression, motivation, and social engagement, are also common.
2. Epidemiology
- Prevalence: Schizophrenia affects approximately 1 in 100 people worldwide, with similar prevalence in the UK.
- Age of Onset: Most commonly diagnosed between the ages of 15 and 35, with males typically presenting earlier (late teens to early twenties) than females (mid-twenties to early thirties).
- Gender: Slightly more common in men, but women may have a later onset and a potentially better prognosis.
3. Risk Factors
- Genetic Factors: Family history of schizophrenia significantly increases the risk. Having a first-degree relative with the condition raises the risk to around 10%.
- Prenatal and Perinatal Factors: Complications during pregnancy or birth (e.g., low birth weight, exposure to infections, and malnutrition) can increase susceptibility.
- Environmental Factors: Urban upbringing, migration, and childhood adversity (e.g., abuse, neglect) are associated with higher risk.
- Substance Abuse: Use of cannabis, amphetamines, and other psychoactive drugs during adolescence can increase the risk of developing schizophrenia, especially in genetically predisposed individuals.
4. Causes
The exact cause of schizophrenia remains unclear, but it is understood to be multifactorial, involving:
- Genetic Vulnerability: Multiple genes contribute to the risk, but no single gene has been identified as responsible.
- Neurochemical Imbalance: Dopamine dysregulation is a central hypothesis; excessive dopamine activity in certain brain pathways is associated with positive symptoms.
- Brain Structure Abnormalities: Studies have identified structural brain changes, including enlarged ventricles and reduced grey matter in specific areas.
- Environmental Triggers: Stressful life events, substance abuse, and social factors may precipitate episodes in susceptible individuals.
5. Symptoms
Positive Symptoms
- Hallucinations: Perceptual disturbances, often auditory (hearing voices), but can also be visual, tactile, or olfactory.
- Delusions: Fixed, false beliefs that are not in line with reality, such as paranoid delusions (belief that one is being persecuted) or delusions of grandeur (belief in having special powers).
- Disorganized Thinking: Difficulty organising thoughts, leading to incoherent speech or ‘word salad.’
- Disorganized or Catatonic Behaviour: Agitation, bizarre postures, or lack of movement and response (catatonia).
Negative Symptoms
- Affective Flattening: Reduced emotional expression.
- Avolition: Lack of motivation and inability to initiate and sustain activities.
- Anhedonia: Inability to experience pleasure from activities that were previously enjoyable.
- Social Withdrawal: Reduced interest in engaging with others.
Cognitive Symptoms
- Impaired Attention and Concentration: Difficulty focusing on tasks.
- Memory Deficits: Particularly working memory, affecting day-to-day functioning.
- Impaired Executive Function: Difficulty planning, organising, and problem-solving.
6. Diagnosis
Clinical Assessment
Diagnosis is based on a thorough psychiatric evaluation, which includes:
- History: Detailed assessment of symptoms, duration, and impact on daily functioning. Collateral information from family or caregivers is often vital.
- DSM-5 Criteria: Requires two or more of the core symptoms (delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, and negative symptoms) persisting for at least one month, with some disturbance present for at least six months.
Investigation
- Laboratory Tests: Routine blood tests (e.g. FBC, U&E, LFTs) to rule out organic causes of symptoms.
- Toxicology Screen: To check for substance abuse, which may mimic or exacerbate symptoms.
- Brain Imaging: MRI or CT scans may be used to exclude structural brain lesions or other neurological conditions, though they are not diagnostic for schizophrenia.
Differential Diagnosis
- Bipolar Disorder: May present with psychotic features during manic or depressive episodes but distinguished by the episodic nature of mood disturbance.
- Major Depressive Disorder with Psychotic Features: Severe depression can lead to psychosis, but delusions and hallucinations are mood-congruent.
- Schizoaffective Disorder: Features of both schizophrenia and mood disorders (bipolar or depressive) are present.
- Substance-Induced Psychosis: Cannabis, amphetamines, hallucinogens, and alcohol can cause psychotic symptoms.
- Delirium and Dementia: Particularly in older adults, acute or chronic cognitive impairment may present with hallucinations or delusions.
7. Treatment
Pharmacological
- Antipsychotic Medications: The cornerstone of treatment.
- First-Generation Antipsychotics (FGAs): Haloperidol, chlorpromazine. Effective but associated with extrapyramidal side effects (EPS).
- Second-Generation Antipsychotics (SGAs): Risperidone, olanzapine, quetiapine, aripiprazole. Generally preferred due to lower risk of EPS and broader symptom coverage, including negative symptoms.
- Clozapine: Reserved for treatment-resistant schizophrenia after failure of two other antipsychotics.
Non-Pharmacological
- Psychosocial Interventions: Cognitive-behavioral therapy (CBT) for psychosis, family therapy, and social skills training.
- Occupational Therapy: Helps patients regain daily functioning and improve social and vocational skills.
- Assertive Community Treatment (ACT): Multidisciplinary team approach for patients with severe and persistent symptoms.
8. Complications
- Suicide: The risk is significantly elevated, with up to 10% of individuals with schizophrenia dying by suicide.
- Substance Abuse: Common, especially with alcohol, nicotine, and cannabis, leading to poorer outcomes.
- Metabolic Syndrome: Associated with long-term antipsychotic use, leading to obesity, diabetes, and cardiovascular disease.
- Social and Occupational Impairment: Difficulty maintaining employment, relationships, and daily living skills, leading to social isolation.
9. Prognosis
- Varies Widely: Around 20% of individuals may recover completely, while others have relapsing-remitting courses, and some may experience chronic symptoms.
- Factors Influencing Prognosis:
- Early Intervention: Early and effective treatment improves long-term outcomes.
- Adherence to Treatment: Non-adherence is a major challenge, often leading to relapse.
- Social Support: A supportive environment can mitigate the impact of symptoms.
10. Prevention
- Early Detection and Treatment: Early intervention services (e.g. Early Intervention in Psychosis teams) aim to reduce the duration of untreated psychosis (DUP), which is linked to better outcomes.
- Reducing Risk Factors:
- Minimising Cannabis and Substance Use: Public health campaigns to educate on the risks of cannabis use, particularly in adolescents.
- Education and Awareness: Increasing awareness among healthcare providers and the public to recognize early warning signs.
How does schizophrenia affect mortality?
Individuals with schizophrenia die at a younger age than do healthy people. Males and females have a 5-6x greater than expected early mortality rate than the general population. Suicide is the single largest contributor to this excess mortality rate.
Suicide
About 10% of people with schizophrenia commit suicide. They are also are more likely to have a drug or alcohol problem. The extreme depression and psychoses that can result due to lack of treatment are the main causes. This suicide rate can be compared to the general population, which is around 0.01%. Other contributors to excess mortality include:
Accidents
Although individuals with schizophrenia do not drive as much as other people, studies have shown that they have double the rate of motor vehicle accidents per mile driven. A significant but unknown number of people with schizophrenia also are killed as pedestrians by motor vehicles.
Other diseases
There is some evidence that individuals with schizophrenia have more infections, heart disease, type 2 diabetes, and female breast cancer, all of which might increase their mortality rate.
Individuals with schizophrenia who become sick are less able to explain their symptoms to medical personnel, and medical personnel are more likely to disregard their complaints and assume that they are simply part of the illness.
There also is evidence that some people with schizophrenia have an elevated pain threshold; so they may not complain of symptoms until the disease has progressed too far to be treatable.
Homelessness
Homelessness increases the mortality rate of people with schizophrenia by making them even more susceptible to accidents and diseases.
Schizophrenia Big Myths
Big Myth 1 = People with schizophrenia are violent. This is not true. Most people prefer to be left alone and are not violent.
Big Myth 2 = People with schizophrenia have 2 (or ‘spilt’) personalities. They do not.
Note. Its important not to pass on these false beliefs to patients.
Summary
We have described 10 schizophrenia facts. We hope you understand it better now. It is important health professionals help to dispel the big myths.
Other resource
MyHSN schizophrenia podcast (2024) – 13 min, 10 sec
