What Is The Prognosis For Schizophrenia
The prognosis for people with schizophrenia can vary depending on the amount of support and treatment the patients receives. Many people with schizophrenia are able to function well and lead normal lives. However, people with schizophrenia have a higher death rate and higher incidence of substance abuse. When medications are taken regularly and the family is supportive, patients can have better outcomes.
- American Academy of Child and Adolescent Psychiatry: “Schizophrenia In Children.”
- Brown University: “Schizophrenia .”
- National Alliance on Mental Illness : “Schizophrenia in Children and Adolescents.”
Schizophrenia: Symptoms Causes And Treatments
Schizophrenia is a severe mental illness that causes changes in perception, thoughts and behaviour. Find out how to spot the signs.
Schizophrenia is a severe mental illness that can cause changes in perception, thoughts and behaviour. Schizophrenia is present in two to four people per 1000 of the global population at any one time. One in 100 people will develop schizophrenia in their lifetime.
It is often described by doctors as a type of psychosis, meaning that a person with schizophrenia may not be able to distinguish their own thoughts and ideas from reality.
It is a complex condition that defies simple description, but a distinction can be made between two broad types: acute schizophrenia and chronic schizophrenia.
Voluntary And Compulsory Detention
More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it’s necessary.
People can also be compulsorily detained at a hospital under the Mental Health Act , but this is rare.
It’s only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder and if detention is necessary:
- in the interests of the person’s own health and safety
- to protect others
People with schizophrenia who are compulsorily detained may need to be kept in locked wards.
All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.
An independent panel will regularly review your case and progress. Once they feel you’re no longer a danger to yourself and others, you’ll be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.
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Are People With Schizophrenia Dangerous
Popular books and movies often depict people with schizophrenia and other mental illnesses as dangerous and violent. This usually isnât true. Most people with schizophrenia are not violent. More typically, they prefer to withdraw and be left alone. When people with mental illness do take part in dangerous or violent behaviors, itâs generally a result of their psychosis and the fear that theyâre being threatened in some way by their surroundings. Drug or alcohol use can make it worse.
On the other hand, people with schizophrenia can be a danger to themselves. Suicide is the top cause of premature death among people with schizophrenia.
Positive Symptoms Of Schizophrenia
In this case, the word positive doesnât mean good. It refers to added thoughts or actions that arenât based in reality. Theyâre sometimes called psychotic symptoms and can include:
- Delusions: These are false, mixed, and sometimes strange beliefs that arenât based in reality and that the person refuses to give up, even when shown the facts. For example, a person with delusions may believe that people can hear their thoughts, that they are God or the devil, or that people are putting thoughts into their head or plotting against them.
- Hallucinations: These involve sensations that aren’t real. Hearing voices is the most common hallucination in people with schizophrenia. The voices may comment on the person’s behavior, insult them, or give commands. Less common types include seeing things that aren’t there, smelling strange odors, having a funny taste in your mouth, and feeling sensations on your skin even though nothing is touching your body.
- Catatonia: In this condition, the person may stop speaking, and their body may be fixed in a single position for a very long time.
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Positive Symptoms Of Schizophrenia: Things That Might Start Happening
Positive symptoms are highly exaggerated ideas, perceptions, or actions that show the person canât tell whatâs real from what isnât. Here the word “positive” means the presence of symptoms. They can include:
- Hallucinations. People with schizophrenia might hear, see, smell, or feel things no one else does. The types of hallucinations in schizophrenia include:
- Auditory. The person most often hears voices in their head. They might be angry or urgent and demand that they do things. It can sound like one voice or many. They might whisper, murmur, or be angry and demanding.
- Visual. Someone might see lights, objects, people, or patterns. Often itâs loved ones or friends who are no longer alive. They may also have trouble with depth perception and distance.
- Olfactory and gustatory. This can include good and bad smells and tastes. Someone might believe theyâre being poisoned and refuse to eat.
- Tactile. This creates a feeling of things moving on your body, like hands or insects.
Signs That Immediate Medical Attention Is Needed
If the patient is a danger to himself or others and is unwilling to seek treatment, they can be involuntarily committed to a hospital and held for a period of evaluation usually lasting three to seven days. A court order is required for involuntary commitment to be extended.11
Film and news media have characterized schizophrenia as a violent condition, however, the majority of people with schizophrenia are not violent. The majority of violent crime is committed by individuals who do not suffer from this disorder. The risk of violence in schizophrenia drops dramatically when treatment is in place.12
Schizophrenia is associated with a higher risk of suicide. If the patient is suicidal contact the National Suicide Prevention Lifeline at 800-273-TALK or call 911 immediately.
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Changes In Behaviour And Thoughts
A person’s behaviour may become more disorganised and unpredictable.
Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else.
Another feeling is that thoughts are disappearing, as though someone is removing them from their mind.
Some people feel their body is being taken over and someone else is directing their movements and actions.
What Causes Schizophrenia
The exact cause of schizophrenia isnât known. But like cancer and diabetes, schizophrenia is a real illness with a biological basis. Researchers have uncovered a number of things that appear to make someone more likely to get schizophrenia, including:
- Genetics : Schizophrenia can run in families, which means a greater likelihood to have schizophrenia may be passed on from parents to their children.
- Brain chemistry and circuits: People with schizophrenia may not be able to regulate brain chemicals called neurotransmitters that control certain pathways, or “circuits,” of nerve cells that affect thinking and behavior.
- Brain abnormality: Research has found abnormal brain structure in people with schizophrenia. But this doesnât apply to all people with schizophrenia. It can affect people without the disease.
- Environment: Things like viral infections, exposure to toxins like , or highly stressful situations may trigger schizophrenia in people whose genes make them more likely to get the disorder. Schizophrenia more often surfaces when the body is having hormonal and physical changes, like those that happen during the teen and young adult years.
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Clearing Up The Confusion
The seemingly random ways in which these terms are applied can often create confusion in a patient’s expectations.
For example, can cancer truly be considered chronic when only a few types are able to be managed chronically? Should a traumatic injury like a broken leg be considered acute even if it fits within the broader definition of the term?
In the end, defining an illness or injury as acute or chronic may not only not be necessary, but it may confuse more than enlighten.
Some health experts advocate for a simpler approach to help clear up confusion and inconsistencies. Rather than adhering to a specific timeframe or list of conditions, they endorse definitions that express the concepts behind the terms more generally.
Merriam-Webster’s dictionary, for example, defines them as follows:
- Acute: “Having a sudden onset, sharp rise, and short course”
- Chronic: “Continuing or occurring again and again for a long time”
Negative Symptoms Of Schizophrenia
The word “negative” here doesnât mean “bad.” It notes the absence of normal behaviors in people with schizophrenia. Negative symptoms of schizophrenia include:
- Lack of emotion or a limited range of emotions
- Withdrawal from family, friends, and social activities
- Less energy
- Loss of pleasure or interest in life
- Poor hygiene and grooming habits
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What Use Of These Terms Means For Your Health
Broadly speaking, acute conditions occur suddenly, have immediate or rapidly developing symptoms, and are limited in their duration . Chronic conditions, on the other hand, are long-lasting. They develop and potentially worsen over time .
These descriptions can vary somewhat, though, depending on who you speak to or what sources you reference. While the terms may apply in specific circumstances, they don’t always, and they often fall short in describing what you may be faced with if given an acute or chronic diagnosis.
What Is The Outlook For People With Schizophrenia
With proper treatment, most people with schizophrenia can lead productive and fulfilling lives. Depending on how severe the condition is and how well they get and stick with treatment, they should be able to live with their families or in community settings rather than in long-term psychiatric hospitals.
Ongoing research on the brain and how brain disorders happen will likely lead to more effective medicines with fewer side effects.
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How Is Schizophrenia Treated
The goal of schizophrenia treatment is to ease the symptoms and to cut the chances of a relapse, or return of symptoms. Treatment for schizophrenia may include:
- Medications: The primary medications used to treat schizophrenia are called antipsychotics. These drugs donât cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations, and thinking problems.
- Older antipsychotic medications used include:
Note: Clozapine is the only FDA-approved medication for treating schizophrenia that is resistant to other treatments. Itâs also used to lessen suicidal behaviors in those with schizophrenia who are at risk.
What Is Acute Schizophrenia
Acute schizophrenia is considered an active phase of schizophreniaa mental health disorder that can affect an individuals thoughts, feelings, and behaviors.
The media tends to play up the diagnosis as who only hear voices and are talking to themselves, says Abigale Johnson, LCSW. This can be an aspect of schizophrenia, but not everyone presents the same way.
Stephen Geisler, M.D., staff psychiatrist at Brooklyn Minds, adds that people might experience hallucinations or delusions, but their thoughts can be completely logical and coherent. Because of this, schizophrenia can be sometimes be misdiagnosed and mistaken for another mental health disorder.
Learn about the symptoms, similar diagnoses, and treatment options for acute schizophrenia.
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Negative Symptoms Of Schizophrenia: Things That Might Stop Happening
Negative symptoms refer to an absence or lack of normal mental function involving thinking, behavior, and perception. You might notice:
- Lack of pleasure. The person may not seem to enjoy anything anymore. A doctor will call this anhedonia.
- Trouble with speech. They might not talk much or show any feelings. Doctors call this alogia.
- Flattening: The person with schizophrenia might seem like they have a terrible case of the blahs. When they talk, their voice can sound flat, like they have no emotions. They may not smile normally or show usual facial emotions in response to conversations or things happening around them. A doctor might call this affective flattening.
- Withdrawal. This might include no longer making plans with friends or becoming a hermit. Talking to the person can feel like pulling teeth: If you want an answer, you have to really work to pry it out of them. Doctors call this apathy.
- Struggling with the basics of daily life. They may stop bathing or taking care of themselves.
- No follow-through. People with schizophrenia have trouble staying on schedule or finishing what they start. Sometimes they can’t get started at all. A doctor might call this avolition.
Depression has some of the same symptoms, too. They can be hard to spot, especially in teens, because even healthy teens can have big emotional swings between highs and lows.
Family Education And Support
These programs are geared towards the family members and close friends of people who have schizophrenia. They aim to help loved ones understand the condition, learn ways to support the person who has undifferentiated schizophrenia, and find support for themselves.
These programs can be done individually, as a family, or as a group with other families.
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What Is The Course Of The Disease
- About a quarter of the people diagnosed with schizophrenia will have one episode of illness, make a good recovery and have no further problems.
- A further 25 per cent will develop a long-term chronic illness with no periods of remission.
- The remaining 50 per cent of those diagnosed will have a long-term illness that comes and goes with periods of remission and relapse.
The long-term outcome may be worse in people:
- with poor social support
- with a strong family history of schizophrenia
- in whom the illness came on slowly
- in whom treatment was delayed.
Male sex and continuing use of illicit drugs are also associated with a poorer outcome.
The risk of relapse is significantly improved by continuing appropriate medication for at least six months after an acute episode.
Positive family intervention may also help to maintain periods without illness, as can help with social skills training and psychological therapy.
People with schizophrenia have higher rates of depression than the general population. There are also high rates of suicide among people with schizophrenia.
Where Definitions Fall Short
As tidy as the definitions may seemsix months or more for chronic versus less than six months for acutethese timeframes in no way suggest what you may be faced with if diagnosed with an acute or chronic illness.
After all, an acute bout of the flu does not compare to an acute hepatitis C infection. Neither does HIV compare to multiple sclerosis .
In the end, labeling an illness as acute or chronic cannot describe the nature of a disease, nor predict outcomes.
This non-specificity of definitions not only affects healthcare providers and patients but also researchers who look for concise ways to evaluate the course of a disease. Thresholds are frequently changed from six months to three months or extended to a year or more, which only adds to confusion.
Even pubic health authorities aren’t immune to these discrepancies. The U.S. Department of Health and Human Services , for instance, lists 20 diseases as chronic including stroke, autism, and cancerwhile the Centers for Medicare and Medicaid Services lists 19, many of which are different from the HHS list.
Within this context, the definition can often bend to fit the situation. With the HHS, chronic is used to describe a public health concern for surveillance purposes. With the CMMS, the term broadly describes a disease for healthcare utilization purposes.
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How Is Schizophrenia Diagnosed
A diagnosis for schizophrenia is often first made in the active stage. This is when symptoms become most obvious. Other people may recognize the disordered thoughts and behavior patterns for the first time.
At that point, a doctor may work with friends and family members to understand when early symptoms began. Symptoms of the first phase are often not recognized until a person is in the active phase.
Once a diagnosis is made, a doctor will also be able to determine when the active phase is over based on symptoms and behaviors.
Where to Find Help
Advocacy organizations can help you find immediate help. They can also connect you with local resources that can help you find sustained, long-term treatment. These mental health resources include:
Most people with schizophrenia arent diagnosed until the second phase, once symptoms worsen and become more obvious.
At this point, treatment options include:
Where to Seek Emergency Care
If you or a loved one is experiencing suicidal thoughts or dangerous behaviors, seek emergency care:
- Dial 911 or your local emergency number
- Visit a hospital or emergency department