health topics

Schizophrenia | Bipolar

Schizophrenia is a severe and debilitating psychosis in which sufferers appear to lose touch with reality and have trouble distinguishing fantasy from reality, thinking clearly and controlling their emotions.

Schizophrenia is a devastating illness characterised by acute episodes of delusions (false beliefs that cannot be corrected by reason) and hallucinations (usually in the form of non-existent voices) as well as long-term impairments such as diminished emotion, general lack of interest and depressive signs and symptoms.

Distressing life events and drug misuse are often triggering factors for the emergence of disease symptoms in susceptible individuals.

Causes of Schizophrenia

There is no single cause of schizophrenia. It is thought to be a clinical syndrome that encompasses several disorders.

There may be a genetic factor to the disease - the children of a schizophrenic parent have a 10% chance of developing schizophrenia, increasing to 50% if both parents have schizophrenia.¹

Prevalence
Schizophrenia is the most common severe mental illness, affecting one in 100 people worldwide at some time in their life, with an annual new incidence of about 15-30 per 100,000.2 There are as many as 45-50 million people with schizophrenia worldwide, more than 33 million of them in developing countries.

Although schizophrenia affects both sexes equally, onset in men is usually between the ages of 17 and 30, and between 20 and 40 in women. About 25% of patients experience one episode of schizophrenia and recover fully within a few months; half recover but suffer recurrent episodes throughout their lives; a quarter will remain permanently disabled and require constant intensive care and treatment.³

Diagnosis & Symptoms

Diagnosis is based on symptoms. These should have been present for at least six months*, but due to a number of factors, diagnosis of schizophrenia can be a lengthy and difficult process.

The symptoms of schizophrenia vary depending on each individual and the stage of the disease, but can be divided into ‘positive’ and ‘negative’ symptoms (the most difficult to treat):

Positive Symptoms	Negative Symptoms
Delusions (or false beliefs)	Diminished emotion
Hallucinations (non-existent voices)	Low motivation and general lack of interest
Disorganised speech	Reluctance to speak and socially interact
Grossly disorganised or catatonic behaviour	General apathy

The Social and Financial Impact of Schizophrenia
Schizophrenia is associated with social stigma, often derived from public misconceptions of what the condition is, and the symptoms associated with it. The impact of this on the sufferer can be to exacerbate some of the symptoms, such as social withdrawal. Sufferers may become increasingly withdrawn from the outside world, and become reclusive. This leads to further social isolation, the inability to work, the loss of jobs or education and subsequently income. This can then lead to homelessness in a self-perpetuating downwards spiral.

Many patients show symptoms of depression, appearing withdrawn and unable to cope with life. In many cases, suicide is seen as the only solution; the mortality rate for suicide in schizophrenia is approximately 10%4 and has been estimated at 12 times that of the general population.1 The rate of suicide attempts among patients with schizophrenia is 40%.⁵

Hospitalisation of patients is still common, despite the trend towards deinstitutionalisation, and many communities are ill-prepared to provide adequate care and shelter for patients with schizophrenia. Many who suffer from the disease are never able to work and must be cared for and financially supported throughout their lives. Thus, the economic impact of the disease parallels its clinical impact.

75% of direct healthcare costs in western countries are due to inpatient or residential care.6 In western countries these account for between 1.6 and 2.6% of total healthcare expenditures.³

50% of patients with schizophrenia are readmitted to hospital during the first year after an initial hospitalisation, costing $2.3 billion in the US. 80% are readmitted within 2 years, costing $2.0 billion.⁷

Non-compliance to medication accounts for 37% of these readmission costs and poor medication efficacy accounts for 63%.⁷

Treatment Options

Although there is no cure for schizophrenia, many people who develop the illness can be effectively treated and reintegrated into society.

The first ‘typical’ antipsychotics, developed in the 1950s, e.g. haloperidol (Haldol), are generally effective against the positive symptoms of schizophrenia. However, the ‘typical’ drugs have little effect on the negative symptoms of schizophrenia and some patients do not respond to these medications. Despite this, ‘typicals’ are still commonly used.

The ‘typical’ antipsychotics are also associated with the development of distressing and debilitating side-effects known as extrapyramidal symptoms (EPS) which can become permanent even when treatment is terminated. These effects can include akathisia (persistent restlessness), dystonia (sustained abnormal postures that arise from involuntary muscular contractions), and parkinsonism (tremor, rigidity and slow movement) and lead to poor compliance among patients, which in turn reduces their effectiveness and may result in the patient relapsing into episodes of psychosis.

In the last few years, newer generation ‘atypical’ antipsychotic drugs, such as Zyprexa^® have become available, and these have demonstrated further advantages over older therapies. These new ‘atypicals’ chemically block multiple neurotransmitters in the brain which at elevated levels are associated with schizophrenia. They control positive and negative symptoms, and also affective symptoms (mood and depression).

Zyprexa (olanzapine) has proven efficacy in the management of positive, negative, depressive and cognitive symptoms of schizophrenia, and patients taking Zyprexa are more likely to comply with medication due to its favourable side-effect profile.⁸ In clinical trials, Zyprexa has also shown a low incidence of extrapyramidal (EPS) side-effect levels.

Results from recent international studies that assess total direct costs and ensure comparable treatment groups suggest that Zyprexa’s favourable effectiveness and side-effect profile may translate into better quality of life and lower utilisation of medical resources and, as a result, equal or reduced total treatment costs relative to other antipsychotics.⁹

Reintegration

In addition to drug therapy, psychiatric care and social rehabilitation are critical elements in the treatment of people with schizophrenia to help them understand their illness and learn to cope with it.

As doctors understand more about schizophrenia and developments in drug therapy have continued, it has become clear that many patients can be treated safely and more effectively in the community rather than in institutional care, as was common in the past.

References

This site is intended for use of New Zealand Residents only aged 18 and over.

Positive Symptoms