Schizophrenia: An Overview

John, a 25-year-old man, has been acting strange lately. He started saying he was the president of the United States, pointing out sounds that nobody hears, and speaking incoherently, often jumbling his words together or derailing while expressing his opinions. John is a man with schizophrenia. Schizophrenia is a complex and incurable mental health condition that is characterized by a wide range of symptoms (Patel et al.). Some of the most common symptoms include delusions, hallucinations, isolation, and disorganized speech (Aquino). There are two types of symptoms: positive and negative. Positive symptoms materialize as new additions to a person’s lifestyle, such as hallucinations and paranoia. Negative symptoms are limiting changes in a person’s lifestyle, such as the loss of emotions and interest. To this day, there is no way to prevent schizophrenia.

For a very long time, individuals have been affected by this disease worldwide. In the 19th century, Dr. Emil Kraeplin, the director of a psychiatric clinic at the University of Estonia, first described schizophrenia. He called the condition “dementia praecox” and “premature dementia”; however, later on, Eugen Bleuler, a Swiss psychiatrist, built on Kraeplin’s ideas and named the condition “schizophrenia” (Jablensky). 

There is a common misconception that schizophrenia is a disease that occurs when an individual is in their elderly stages. However, it is during a person’s late adolescent years or early twenties when the first symptoms appear and when, if they do, the patient first experiences psychosis, a mental disorder in which a person loses touch with reality, experiences disturbances in perception and thought, and struggles to distinguish between real and unreal (Gogtay et al.). It is mainly during that time that the onset of this disease is diagnosed. Even though a person can be diagnosed at a young age, one can also be affected by it later on.

There is no exact cause of schizophrenia, as physicians are unable to locate and identify the activity in the brain that influences this disorder. While it may be true that nobody knows exactly what happens in the brain, there are still some contributing risk factors. Irvin Gottesman, a behavioral geneticist and American psychologist who fundamentally altered previous understandings of schizophrenia, proved that both genetics and the environment play a role in this disease. Gottesman confirmed this proposition through the Gottesman-Shields Twin Study, an experiment in collaboration with Eliot Slater, the director of the Medical Research Council in this country. The core concept of the classic twin approach is simple. Identical twins share all of their genes while fraternal twins only share half, and whether they are identical or fraternal, they usually grow up in the same environment; therefore, since schizophrenia co-occurs in identical twins more than in fraternal twins, this provides evidence of a hereditary component. Similarly, the lack of 100% concordance of schizophrenia is proof of environmental influences (McGuffin). Irvin Gottesman’s work radically changed how scientists and physicians approach schizophrenia nowadays and left an incredible impact on those globally. He has received many accolades and awards throughout his career, and most recently received a honorary fellowships from King's College London and the Royal College of Psychiatrists (McGuffin). 

Although schizophrenia is a world-renowned disease, only approximately 1% of the global population and 1% of the United States population suffers from it (“Mental Health Disorder Statistics”). Regardless of the low percentage of patients in the United States, the economic burden caused by this condition is an estimated 343.2 billion dollars. Due to the mysterious nature of this disease, debt builds up in the economy, causing a substantial economic impact (Kadakia et al.). 

Contributing to the overall economic impact on society, individual patients diagnosed with schizophrenia are estimated to face an average annual cost of 44,773 dollars for treatment and medication (Wander). In order to help patients reintegrate into society, different treatments aim to “target symptoms, prevent relapse, and increase adaptive functioning” (Patel et al.). A major and classic treatment for schizophrenia is antipsychotic drugs which are also known as antischizophrenic drugs. Many patients take this drug their whole life to alleviate suffering and improve cognitive functions. Antipsychotic drugs are more helpful towards positive symptoms, while they are less effective for negative symptoms. In addition to antipsychotic drugs, patients dealing with schizophrenia should also engage in psychotherapy which is treatment through verbal and physical interactions. Psychotherapy helps improve a patient’s social skills, behaviors, and family involvement. 

Like any other field of medicine, there are also advanced treatments for schizophrenia. Most recently, the FDA approved a drug called UZEDY, which is used to treat schizophrenia relapse. UZEDY is a prefilled injection, administered once or twice a month depending on the patient's needs. Through numerous clinical trials, it has been proven to reduce schizophrenia relapse by 80%. It does so by slowly releasing risperidone over the span of one or two months to help block dopamine since the increased activity of dopamine can contribute to the positive symptoms exhibited (Neporent). 

Overall, schizophrenia is an incredibly complex mental disorder that needs to be consulted about immediately when an individual experiences their first episode of psychosis. Although symptoms can be mitigated after some treatments, schizophrenia is still chronic; therefore, it is hoped that future studies and further research can help find a cure. 

References

Aquino, Patrick. “Diagnosing and Treating Schizophrenia.” AMA Journal of Ethics, vol. 11, no. 1, American Medical Association, 2009, pp. 43–48, https://doi.org/10.1001/virtualmentor.2009.11.1.cprl1-0901.

‌Jablensky, Assen. “The Diagnostic Concept of Schizophrenia: Its History, Evolution, and Future Prospects.” Taylor and Francis Online, vol.12, no. 3, Sept. 2010, pp. 271–87, https://doi.org/10.31887/dcns.2010.12.3/ajablensky. 

Kadakia, Aditi, et al. “The Economic Burden of Schizophrenia in the United States”. The Journal of Clinical Psychology, vol. 86, no. 6, Oct. 2022, https://doi.org/10.4088/jcp.22m14458. 

McGuffin, Peter. “Irving Gottesman”. BJPsych Bulletin, vol. 41, no. 2, Apr. 2017, pp. 124–25, https://doi.org/10.1192/pb.bp.116.055582.

“Mental Health Disorder Statistics.” Hopkinsmedicine.org, Feb. 2023, www.hopkinsmedicine.org/health/wellness-and-prevention/mental-health-disorder-statistics.

Neporent, Liz. “Slow-Release UZEDY Gains FDA Approval, Reduces Schizophrenia Relapse by 80%.” Psychiatrist.com, 5 May 2023, www.psychiatrist.com/news/slow-release-uzedy-gains-fda-approval-reduces-schizophrenia-relapse-by-80/#:~:text=The%20US%20Food%20and%20Drug,of%20one%20to%20two%20months. 

Nitin Gogtay, et al. “Age of Onset of Schizophrenia: Perspectives from Structural Neuroimaging Studies”. Schizophrenia Bulletin, vol. 37, no. 3, Apr. 2011, pp. 504–13, https://doi.org/10.1093/schbul/sbr030. 

Patel, Krishna R., et al. “Schizophrenia: Overview and Treatment Options.” P & T : A Peer-Reviewed Journal for Formulary Management, vol. 39, no. 9, 2014, pp. 638–45, www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/. 

‌Wander, Curtis. “Schizophrenia: Opportunities to Improve Outcomes and Reduce Economic Burden through Managed Care”. American Journal of Managed Care, vol. 26, American Journal of Managed Care, Apr. 2020, www.ajmc.com/view/schizophrenia-opportunities-to-improve-outcomes-and-reduce-economic-burden-through-managed-care.