Schizophrenia

Key facts

• Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide (1).
• Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self and behavior. 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 (2). 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.

 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 behaviour such as wandering aimlessly, 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 facial expression or body language.

Magnitude and impact

Schizophrenia affects 20 million people worldwide but is not as common as many other mental disorders. Schizophrenia 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 (2). 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 to schizophrenia.

Services

More than 69% 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 is effective. However, most 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 and United Republic of 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.