Schizophrenia

schizophrenia-comp

01 February 2011

Schizophrenia is a serious and distressing mental illness that causes severe disruption to people’s lives and can have a major adverse impact on family and friends. However it can be successfully managed.

The Foundation wants to ensure that people with schizophrenia get the best possible care and support to manage their illness and to help them recover. There are a number of issues that need to be addressed:

  • it is particularly important that someone diagnosed with schizophrenia gets help early and that assessments include psychiatric, psychological and physical health assessments
  • a major health inequality is that people with schizophrenia have a significantly higher risk of dying early than the general population. Poor physical health can arise as a side effect of anti-psychotic medication (for example, weight gain and increased risk of developing diabetes) and as a result of a chaotic lifestyle, self-neglect, poor diet and high levels of smoking, increasing the risk of cardiovascular disease. GPs and other healthcare professionals involved must ensure that people's physical health is regularly kept under review
  • people with schizophrenia should not only get the best pharmacological and psychological interventions, based on National Institute for Clinical Excellence (NICE) guidance, but should also be helped to recover through employment, educational and occupational activities
  • more work is needed to help people with serious mental illness such as bipolar disorder and schizophrenia to self-manage their disorder. Through self-management, many service users gain the confidence, skills and knowledge to better manage their mental health and gain more control of their lives at a time when they may feel they have lost control
  • we want to see more research into the treatment of schizophrenia, including the development of antipsychotic medication that has fewer adverse side-effects. Current adverse side-effects are a significant factor in people stopping taking their medication, increasing the risk of relapse
  • a diagnosis of schizophrenia carries a good deal of stigma with it. The Foundation wants a wider understanding of the nature of the illness and balanced media reporting of incidents involving people with schizophrenia.

Some people in an acute episode of schizophrenia, especially if they also misuse drugs and alcohol, may become violent. It is important that risk assessments are properly undertaken. But it is also important that policies are not driven by a false belief that people with schizophrenia are commonly dangerous. The 2010 annual report from the National Confidential Inquiry into Suicide and Homicide by People with a Mental Illness suggests that there has been a fall in homicides by mentally ill people. In general, the number of homicides committed by people with a mental illness has remained stable for some years. 

Background

Schizophrenia is a diagnosis given to some people who have severely disrupted beliefs and experiences.  During an episode of schizophrenia, a person's experience and interpretation of the outside world is disrupted - they may lose touch with reality, see or hear things that are not there and act in unusual ways in response to these 'hallucinations'. An episode of schizophrenia can last for several weeks and can be very frightening.

Schizophrenia can affect men and women from all countries, cultures, backgrounds and walks of life. About 1 in 100 people will have one episode, and two-thirds of these will go on to have further episodes. Schizophrenia usually starts in the late teens or early twenties, but can also affect older people for the first time. The causes are unknown but episodes of schizophrenia appear to be associated with changes in some brain chemicals. Stressful experiences and some recreational drugs are thought sometimes to trigger an episode.

Treatment for schizophrenia

The National Institute for Clinical Excellence (NICE) has published guidelines on core interventions in the treatment and management of schizophrenia in adults in primary and secondary care (issued March 2009).
NICE guideline on schizophrenia (PDF file, 3.5MB)

The guidelines stress the importance not just of pharmacological interventions but also of psychological interventions such as Cognitive Behavioural Therapy (CBT). Recent research, for example, has shown the benefits for people with schizophrenia of exercise programs for improved mental state for measures including anxiety and depression, particularly when compared to standard care, and also potential changes in physical health outcomes (Gorczynski P, Faulkner G. Exercise therapy for schizophrenia. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD004412.)

Self-management of schizophrenia

The Foundation is developing, delivering and evaluating a range of self-management interventions for people with severe psychiatric diagnoses in Wales, including schizophrenia. The project is funded by the Big Lottery Fund and the Foundation is working in partnership with MDF, the BiPolar Organisation and Cardiff University. See Self Management Wales.

Morbidity among people with schizophrenia

People with schizophrenia are at risk of dying earlier than the general population. Research has shown that most of the major causes-of-death categories were found to be elevated in people with schizophrenia. With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades (Saha S, Chant D, McGrath J (2007) A Systematic Review of Mortality in Schizophrenia, Arch Gen Psychiatry. 2007; 64(10): 1123-1131).

Homicides by people with schizophrenia

Homicides by people with schizophrenia, although only a small proportion of overall homicides in the UK, are often reported in the media, creating an impression that people with schizophrenia are a significant risk to the public. This perception of dangerous hinders people’s recovery and can lead to restrictive policies, such as the introduction of Community Treatment Orders across England and Wales in the Mental Health Act 2007. In fact people with schizophrenia are not usually dangerous to other people, although the risk can substantially increase as a result of substance misuse involving drugs and/or alcohol.

The 2010 annual report from the National Confidential Inquiry into Suicide and Homicide by People with a mental Illness, suggests that there has been a fall in homicide by mentally ill people. It states that "the rise in homicide reported in 2009 by people with psychosis or schizophrenia appears not to be continuing, although it is too early to confirm a downward trend in these figures. The 2009 report highlighted an increase in homicide committed by individuals psychotic at the time of the offence. Further analysis described in the 2010 report indicates that the likeliest explanation for the rise is the use of drugs and/or alcohol".
National Confidential Inquiry into Suicide and Homicide by People with a Mental Illness, 2010 – University of Manchester (PDF file 3.7MB)