Dr. Md. Rashidul Haque
MBBS, FCPS (Psychiatry)
International Member, American Psychiatric Association
The myth was that most people with schizophrenia were “deteriorating with schizophrenia”. In contrast to the current fact that many people with schizophrenia can recover – and are “ living beyond schizophrenia”.
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and acts.
Ancient Egyptian, Hindu, Chinese, Greek, and Roman writings described symptoms similar to the symptoms of schizophrenia. During medieval times (5th to 15th century) schizophrenia was often viewed as the sufferer being possessed by spirits or evil powers.
Benedict Morel (a French psychiatrist) in 1852 had used the term “de´mence pr´ecoce” to describe deteriorated patients whose illness began in adolescence.
Emil Kraepelin in 1887 separated the mental illness into “paranoia” and “manic-depressive psychosis” & in 1893 he translated Morel’s “de´mence pr´ecoce” into “dementia precox”.
The term “schizophrenia” has been first time in use since 1911 by the Swiss psychiatrist Eugen Bleuler.
Schizophrenia can occur anywhere and affect anyone. Prevalence 0.7% to 1% in general population globally. Incidence 0.1 – 0.4% per 1000 population per year (Jablensky et al., 1992).
The Male & Female ratio is equal. Peak ages of onset are 10 to 25 years for men and 25 to 35 years for women.
At least 26 million people are living with schizophrenia globally. Mortality rates are 2 to 2.5 times higher in schizophrenic patients than in the general population. 15 – 25 year life expectancy reduction in schizophrenic patients.
More than 50% of people with schizophrenia cannot access adequate treatment. 90% of untreated schizophrenia live in the developing world (WHO report).
There is no single etiology for the development of schizophrenia. It is the result of a complex group of genetic, neurochemical, psychological, social and environmental factors.
Not everyone who is diagnosed with schizophrenia has the same symptoms.
There are two types of symptoms –
a) Positive symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behaviors.
b) Negative symptoms: affective flattening, avolition, apathy, alogia, social isolation.
c) Cognitive symptoms: inattention to and processing of information, in understanding the environment, and in remembering simple tasks. ●
d) Affective symptoms: depression mostly.
There is no laboratory test for schizophrenia.
Schizophrenia is mainly a clinical diagnosis, based entirely on the psychiatric history and mental status examination.
Investigations are mainly used to rule out organic illnesses
Diagnosis of schizophrenia is a syndromal diagnosis which is based on
ICD- 10 criteria or
Schneider’s first & second rank symptoms of schizophrenia.
DSM-5 Diagnostic Criteria for Schizophrenia:
Criteria A: Two (or more) of the following: 1. Delusions 2. Hallucinations 3. Disorganized speech (e.g.- frequent incoherence) 4.Grossly disorganized or catatonic behavior 5. Negative symptoms.
Criteria B: Duration: persist for at least 6 months.
Criteria C: Social/occupational dysfunction
Criteria D: Substance / general medical condition exclusion
A. Pharmacological treatment:
Typical antipsychotics – Chlorpromazine (1952), Haloperidol, Fluphenazine, Thioridazine, Loxapine, Perphenazine
Atypical anti-psychotics –
B. Psychological intervention: Clozapine, , Risperidone,Olanzapine, Quetiapine, Ziprasidone, Aripiprazole, Arsenapine, Paliperidone,Iloperidone
Family psycho-education Social skill training Cognitive Behavior Therapy (CBT) Individual psychotherapy Group psychotherapy
C. Social therapy:
Supported employment Assertive community treatment Self-help group Rehabilitation
25% of schizophrenia do recover fully
25-35% improve considerably and live relatively independent lives.
20% improve but need extensive support.
10-15% remain unimproved or worsening.
5-10% commit suicide.
Schizophrenia is a disorder associated with high levels of social burden and cost, as well as an incalculable amount of individual pain and suffering.
qLoss in schizophrenic patients:
Lossing credibility Loss of -educational opportunities Loss of jobs or employability Loss of capacity to communicate effectively or coherently
Loss of physical fitness Loss of your home, your things, your potential, a family of your own. Loss of your future
“Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential”. (SAMHSA)
People living with schizophrenia will be able to do more than merely survive – to have opportunities to thrive and to live a contributing life.