Consequences of schizophrenia
Although schizophrenia is not in itself a fatal disease, death rates of people
with schizophrenia are at least twice as high as those in the general population. The excess mortality has been related in the past to poor conditions of prolonged institutional care, leading to high occurrence of tuberculosis and other communicable diseases (Allebeck, 1989). This may still be an important problem wherever large numbers of patients spend a long time in crowded asylum-like institutions. However, recent studies of people with schizophrenia living in the community showed suicide and other accidents as leading causes of death in both developing
and developed countries (Jablensky et al., 1992).
2. Social disability:
According to the International classification of impairments, disability and
Handicaps (WHO, 1980) impairment represents any loss or abnormality of
psychological, physiological or anatomical structure or function, while disability
is any restriction or lack (resulting from an impairment) of ability to perform
an activity in the manner or within the range considered normal for an
individual in his or her socio-cultural setting.
In mental disorders, such as schizophrenia, disability can affect social functioning
in various broad areas (Janca et al., 1996), namely:
• self-care, which refers to personal hygiene, dressing and feeding;
• occupational performance, which refers to expected functioning in paid
activities, studying, homemaking;
• functioning in relation to family and household members, which refers to
expected interactions with spouses, parents, children or other relatives;
• functioning in a broader social context, which refers to socially appropriate
interaction with community members, and participation in leisure and other
Data from European and North American studies show persisting disability of
moderate or severe degree in about 40% of males with schizophrenia, in
contrast with 25% of females (Shepherd et al., 1989). Substantially lower
figures have been found in India, Africa and Latin America (Leff et al., 1992).
Global assessment of disability, however, hides wide variations across life
domains, which can be affected in different ways.
There is good evidence that for most patients nature and extent of social
disability are more relevant as outcome indicators than clinical symptoms.
3. Social stigma:
Social stigma refers to a set of deeply discrediting attributes, related to negative attitudes and beliefs towards a group of people, likely to affect a person’s identity and thus leading to a damaged sense of self through social rejection, discrimination and social isolation (Goffman, 1963). Stigma is strongly linked with the label of mentally ill and is, to a certain extent, unrelated to the actual characteristics or behaviours of those stigmatized. (Desjarlais et al., 1995).
4. Impact on caregivers:
The available data show that the proportion of persons with schizophrenia living with their relatives ranges between 40% in United States to more than 90% in China ( Torrey and Wolfe, 1986; Xiong et al., 1994).
Various aspects of impact on caregivers should be considered, including:
• The economic burden related to the need to support the patient and the loss of productivity of the family unit;
• Emotional reactions to the patient’s illness, such as guilt, a feeling of loss and fear about the future;
• The stress of coping with disturbed behaviour;
• Disruption of household routine;
• Problems of coping with social withdrawal or awkward interpersonal behaviour;
• Curtailment of social activities.
5. Social costs:
In recent years a major effort has been made towards the quantification of the
global social burden of all illnesses and injuries, taking into account not only
mortality but the extent of disability and allowing comparisons between
different categories of illness. The measure of disability-adjusted life years
(DALYs) lost has been used as a health status indicator (Murray and Lopez,
1996). Although this approach may not be completely suitable for most
mental disorders, including schizophrenia, because of their variable course and the fluctuating nature of the related disability, it enables social scientists and policy-makers to put the burden associated with schizophrenia within a comprehensive public health framework.
Management of schizophrenia is a protracted or more precisely a life time process that requires effective pharmacotherapy along with other lines of supportive therapy especially psychotherapy. Control of the disease may become a difficult target as other health challenges interfere. Schizophrenic patients may suffer co-morbid conditions especially diabetes mellitus, increased weight and serious cardiovascular disorders. On the other hand, symptoms of the disease not only affect the patients but also affect their families and “surroundings”. Therefore, it is sometimes important for physicians to provide guidance to all persons affected by the disease. Psychosocial and family interventions can improve outcomes.
With proper treatment, patients can lead productive lives.
Treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life.
Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of:
Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in a hospital.
The most common schizophrenia medications are:
• Risperidone (Risperdal) – less sedating than other atypical antipsychotics. Weight gain and diabetes are possible side effects, but are less likely to happen, compared with Clozapine or Olanzapine.
• Olanzapine (Zyprexa) – may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
• Quetiapine (Seroquel) – risk of weight gain and diabetes, however, the risk is lower than Clozapine or Olanzapine.
• Ziprasidone (Geodon) – the risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia.
• Clozapine (Clozaril) – effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors in patients with schizophrenia. The risk of weight gain and diabetes is significant.
• Haloperidol – an antipsychotic used to treat schizophrenia. It has a long-lasting effect (weeks).
The primary schizophrenia treatment is medication. Sadly, compliance (following the medication regimen) is a major problem. People with schizophrenia often come off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them.
The patient must continue taking medication even when symptoms are gone. Otherwise they will come back.
The first time a person experiences schizophrenia symptoms, it can be very unpleasant. They may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a person living with schizophrenia receives the full support of their family, friends, and community services when onset appears for the first time.
SCHIZOPHRENIA AND PUBLIC HEALTH
Various attempts have been made to classify symptoms of schizophrenia in order to define meaningful subtypes of the disorder. In the past 20 years the distinction between the two broad categories of positive and negative symptoms gained widespread popularity (Crow, 1980). However, more recent multivariate analysis has suggested not two but three symptom clusters: reality distortion, disorganization and psychomotor poverty (Liddle, 1987).