April 28, 2018

Schizophrenia: Symptoms, Causes, Treatment and Other Kay Facts

Schizophrenia is a severe long-term mental health condition. It causes a range of different psychological symptoms. It is often described as a type of psychosis which means the person may not always be able to distinguish their own thoughts and ideas from reality. There are effective treatments for schizophrenia and people affected by it can lead a productive life and be integrated in society.

Symptoms

Schizophrenia is a psychosis, a type of mental illness characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include:
  • Hallucination: hearing, seeing or feeling things that are not there.
  • Delusion: fixed false beliefs or suspicions not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary.
  • Abnormal Behaviour: disorganised behavior such as wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt
  • Disorganised speech; incoherent or irrelevant speech
  • Disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language

Magnitude and impact

Schizophrenia affects more than 23 million people worldwide but is not as common as many other mental disorders. It typically begins in late adolescence or early adulthood. Schizophrenia is more common among males (12 million), than females (9 million). It also commonly starts earlier among men.

Schizophrenia is associated with considerable disability and may affect educational and occupational performance.

People with schizophrenia are 2-3 times more likely to die early than the general population. This is often due to physical illnesses, such as cardiovascular, metabolic and infectious diseases.

Stigma, discrimination and violation of human rights of people with schizophrenia is common.

Causes of schizophrenia

Research has not identified one single factor. It is thought that an interaction between genes and a range of environmental factors may cause schizophrenia. Psychosocial factors may also contribute.

People who are genetically prone to schizophrenia may have a stressful or emotional life event trigger a psychotic episode. However, it's not known why some people develop symptoms while others don't. Triggers are things that can cause schizophrenia to develop in people who are at risk. The main psychological triggers of schizophrenia are stressful life events, such as bereavement, losing your job or home, divorce, the end of a relationship, and abuse which may be physical, sexual or emotional.

Research suggests a change in the level of two brain neurotransmitters: dopamine and serotonin; or a change in the body's sensitivity to them may be responsible. Other research suggest sufferers are more likely to have experienced complications before and during their birth. Finally, recreational drug misuse increases the risk of developing schizophrenia or a similar illness.

Services

More than 50% of people with schizophrenia are not receiving appropriate care. Ninety per cent of people with untreated schizophrenia live in low- and middle- income countries. Lack of access to mental health services is an important issue. Furthermore, people with schizophrenia are less likely to seek care than the general population.

Management

Schizophrenia is treatable. Treatment with medicines and psychosocial support tailored to each individual is effective. In most cases, this will include antipsychotic medicines and cognitive behavioural therapy (CBT). However, the majority of people with chronic schizophrenia lack access to treatment.

There is clear evidence that old-style mental hospitals are not effective in providing the treatment that people with mental disorders need and violate basic human rights of persons with mental disorders. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. The engagement of family members and the wider community in providing support is very important.

Programmes in several low- and middle- income countries (e.g. Ethiopia, Guinea-Bissau, India, Iran, Pakistan, Tanzania) have demonstrated the feasibility of providing care to people with severe mental illness through the primary health-care system by:
  • training primary health-care personnel;
  • providing access to essential drugs;
  • supporting families in providing home care;
  • educating the public to decrease stigma and discrimination;
  • enhancing independent living skills through recovery-oriented psychosocial interventions (e.g., life skills training, social skills training) for people with schizophrenia and for their families and/or caregivers; and
  • facilitating independent living, if possible or assisted living, supported housing and supported employment for people with schizophrenia. This can act as a base for people with schizophrenia to achieve recovery goals. People affected by schizophrenia often face difficulty in obtaining or retaining normal employment or housing opportunities.
Many people recover from schizophrenia, although they may have periods when symptoms return (relapses). Support and treatment can help reduce the impact the condition has on daily life.

Human rights violations

People with schizophrenia are prone to human rights violations both inside mental health institutions and in communities. Stigma of the disorder is high. This contributes to discrimination, which can in turn limit access to general health care, education, housing and employment.

Key facts

In summary, the key points are:
  • Schizophrenia is a chronic and severe mental disorder affecting more than 21 million people worldwide.
  • Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include hallucinations - hearing voices or seeing things that are not there and delusions – fixed, false beliefs.
  • Worldwide, schizophrenia is associated with considerable disability and may affect educational and occupational performance.
  • People with schizophrenia are 2-3 times more likely to die early than the general population. This is often due to preventable physical diseases, such as cardiovascular disease, metabolic disease and infections.
  • Stigma, discrimination and violation of human rights of people with schizophrenia is common.
  • Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective.
  • Facilitation of assisted living, supported housing and supported employment are effective management strategies for people with schizophrenia.

WHO response

WHO's Mental Health Gap Action Programme (mhGAP), launched in 2008, uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is implemented in more than 100 Member States.

The WHO QualityRights Project involves improving the quality of care and human rights conditions in mental health and social care facilities and to empower organizations to advocate for the health of people with mental disorders.

WHO’s Mental Health Action Plan 2013-2020, endorsed by the World Health Assembly in 2013, highlights the steps required to provide appropriate services for people with mental disorders including schizophrenia. A key recommendation of the Action Plan is to shift services from institutions to the community.

Reference(s)
1). World Health Organization: Schizophrenia - WHO Fact Sheets. Accessed 28.04.18. Available here: www.who.int/news-room/fact-sheets/detail/schizophrenia
2). NHS Choices: Schizophrenia. Accessed 27.04.18. Available here: https://www.nhs.uk/conditions/schizophrenia/

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