Schizophrenia is a chronic and serious mental disorder that affects around 20 million people worldwide, according to the World Health Organization. Symptoms and characteristics include distorted thinking, emotions, and sense of self, auditory and visual hallucinations, and delusions. Most people with schizophrenia develop it in early adulthood, and men tend to show symptoms earlier than women. Annually, the new number of schizophrenia cases is 1.5 per 10,000 people.
Schizophrenia is in the top 15 leading causes of disability worldwide. In the U.S., around 1.5 million people get diagnosed with it every year. Risk factors for schizophrenia include genetic traits, chemical imbalances in the brain, and environmental stress in early life. People with this disorder are 2-3 times more likely to die early than the general population. This is mostly due to physical illnesses like cardiovascular disease or infections.
- 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 behavior: disorganized behavior such as wandering, mumbling or laughing to self, strange appearance, self-neglect, or appearing unkempt;
- disorganized speech: incoherent or irrelevant speech; and/or
- disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed, such as a facial expression or body language.
Other symptoms may include:
- The poverty of speech: Minimal speech or giving short-responses to questions.
- Anhedonia: Lack of pleasure from things they used to enjoy, decreasing interests. This leads to decreased involvement in a person’s community, affecting the quality of life.
- Lack of motivation: A person may not have the internal motivation to follow through with tasks in everyday life, such as getting ready in the morning.
Despite the severity of this disorder, it’s highly treatable. Research suggests that Cognitive Behavioral Therapy (CBT) is most effective in treating schizophrenia. A study recently published in the Journal of Psychological Medicine found that antipsychotic medicines, along with therapy, led to significant improvements. Specifically, UCLA scientists and colleagues found that patients receiving both treatments showed better cognition and increased productivity.
Researchers also said that patients using this combined treatment approach saw dramatic improvements in work and school performance. This is partially due to memory, and problem-solving skills taught in therapy sessions. Since schizophrenia affects how a person thinks, feels, and behaves, cognitive treatments help them organize their thoughts better. This leads to improvements in all-around functioning, helping them integrate with society and have a chance at a normal life.
People with this disorder may appear to “be in their own world” or lose touch with reality, leading to permanent disability. Many sufferers don’t even recognize it as a problem at first because the hallucinations appear so real. It usually causes distress for friends and family, but therapies can help the patient reconnect with loved ones. Consistent treatment can help patients perform better in school or work settings and regain independence.
For the research, the team put patients through a 12-month randomized controlled trial. 60 patients from the UCLA Aftercare Program who had recently experienced a schizophrenic episode for the first time took part in the study. They either received oral or long-acting injectable antipsychotic medication and either cognitive therapy or healthy behavior training.
Cognitive-behavioral therapy included training in attention, memory, and problem-solving skills to help patients handle complex, real-life situations. Healthy behavior training included proper nutrition, stress management, and exercise, with the same treatment time. All patients received help with employment and education to encourage them to re-enter work or school environments.
The study confirmed that cognitive training and consistent doses of long-acting antipsychotic medication significantly improved symptoms of schizophrenia. The therapies showed a separate positive impact on work and school functioning.
UCLA researchers included: Keith Nuechterlein, Joseph Ventura, Kenneth Subotnik, Denise Gretchen-Doorly, Luana Turner, Laurie Casaus, John Luo, Michael Boucher, and Jacqueline Hayata. Morris Bell of Yale University and Alice Medalia of Columbia University also contributed to the study.
The value of early detection and treatment
Early treatment can significantly improve the long-term outlook for patients with this disorder. Patients often experience the worst symptoms in the early stages of the illness, when the risk of suicide is highest. At the onset of schizophrenia, around 5% of people die by suicide. 20% of people with the disorder attempt suicide at least once.
The majority of people with schizophrenia get better over time with proper treatment. In fact, 20% of people improve within five years of showing symptoms. Since genetics is a huge risk factor, people with a family history of this disorder may want to seek mental health treatment. This way, treatment can begin early, increasing the chances of improvement.
Unfortunately, only around 31% of people with the disorder seek treatment. Usually, the stigma attached to the disorder and being low income prevents people from getting help. 90% of people with untreated schizophrenia live in low- and middle- income countries.
Racial inequities are evident in schizophrenia
Schizophrenia diagnosis by race/ethnicity
- The lifetime prevalence of self-reported psychotic symptoms is highest in African Americans (21.1%), Latino Americans (19.9%), and white Americans (13.1%). (Psychiatric Services, 2013)
- The lifetime prevalence of self-reported psychotic symptoms is lowest in Asian Americans (5.4%). (Psychiatric Services, 2013)
- Research has found that Black Americans are three to four times more likely than white Americans to be diagnosed with schizophrenia. (World Journal of Psychiatry, 2014)
While schizophrenia is a severe, debilitating mental illness, studies show that cognitive therapies, along with medication, can lead to significant improvement. In fact, around 20% of people with the disorder improve within 5 years of first showing symptoms. As with any mental illness, early treatment and intervention significantly increase the chances of getting better. If you have a family history or show early symptoms of schizophrenia, you may consider seeking mental health treatment.