Schizophrenia and Other Psychoses

Schizophrenia is a severe mental disorder, affecting 20 million people worldwide (by GBD 2017). Psychoses, including schizophrenia, are characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior. Common psychotic experiences include hallucinations (hearing, seeing, or feeling things that are not there) and delusions (fixed false beliefs or suspicions that are firmly held even when there is evidence to the contrary). The disorder can make it difficult for people affected to work or study normally.

Schizophrenia is typically diagnosed in the late teen years to the early thirties and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties). A diagnosis of schizophrenia often follows the first episode of psychosis, when individuals first display symptoms of schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually starting in mid-adolescence. Schizophrenia can occur in younger children, but it is rare for it to occur before late adolescence.

The symptoms of schizophrenia generally fall into the following three categories:

Psychotic symptoms

Psychotic symptoms include altered perceptions (e.g., changes in vision, hearing, smell, touch, and taste), abnormal thinking, and odd behaviors. People with psychotic symptoms may lose a shared sense of reality and experience themselves and the world in a distorted way. Specifically, individuals typically experience:

  • Hallucinations, such as hearing voices or seeing things that aren’t there

  • Delusions, which are firmly held beliefs not supported by objective facts (e.g., paranoia - irrational fears that others are “out to get you” or believing that the television, radio, or internet are broadcasting special messages that require some response)

  • Thought disorder, which includes unusual thinking or disorganized speech

Negative symptoms

Negative symptoms include loss of motivation, disinterest or lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, and difficulty functioning normally. Specifically, individuals typically have:

  • Reduced motivation and difficulty planning, beginning, and sustaining activities

  • Diminished feelings of pleasure in everyday life

  • “Flat affect,” or reduced expression of emotions via facial expression or voice tone

  • Reduced speaking

Cognitive symptoms

Cognitive symptoms include problems in attention, concentration, and memory. For some individuals, the cognitive symptoms of schizophrenia are subtle, but for others, they are more prominent and interfere with activities like following conversations, learning new things, or remembering appointments. Specifically, individuals typically experience:

  • Difficulty processing information to make decisions

  • Problems in using information immediately after learning it

  • Trouble focusing or paying attention

 

Stigma and discrimination can result in a lack of access to health and social services. Furthermore, people with psychosis are at high risk of exposure to human rights violations, such as long-term confinement in institutions.

Schizophrenia typically begins in late adolescence or early adulthood. Treatment with medicines and psychosocial support is effective. With appropriate treatment and social support, affected people can lead a productive life and be integrated in society. Facilitation of assisted living, supported housing, and supported employment can act as a base from which people with severe mental disorders, including schizophrenia, can achieve numerous recovery goals as they often face difficulty in obtaining or retaining a place to live and normal employment.