Schizophrenia Over Time
Schizophrenia has a devastating effect on all aspects of human thought, emotion, and expression, although the course of the disease varies from one person to the next. Even though there is no cure, new drugs offer to improve the patient's life.
Progression and Long-Term Outlook
The symptoms of schizophrenia can appear suddenly or gradually. In about one-third of all patients the disease is merciless and progresses straight from the first episode onward. In other sufferers however, schizophrenia follows a fluctuating course with psychotic flare-ups, then followed by remission. In fact, about one-third of cases experience a complete remission of symptoms within three years after the initial episode. Women are much more likely to go into remission, perhaps because of estrogen's effects on the brain. Patients typically develop cognitive dysfunction within the first four years of the illness. Psychosis, disorganized thought, and negative symptoms quite often improve over time. However, deficits in verbal memory usually remain. After 20 to 30 years, it seems that almost half of all schizophrenic patients are able to care for themselves, as well as work and participate socially out in the world. Unfortunately, depression becomes common later on in adulthood.
Decline in Social Status
Even if schizophrenic symptoms improve, work and relationship problems are usually severe and often difficult to repair. Decline in social status and the inability to earn a living is often determined by the age of the disease’s onset – usually the later in life the onset, the milder the effect.
Self-Destructive Behavior
People with schizophrenia are no more likely to behave violently than are those in the general population, despite their sometimes-frightening behavior. In fact, they are far more likely to withdraw from others or harm themselves even. About 15% of people with schizophrenia commit suicide, with between 20% and 40% of males attempting it. At certain times the risk is higher: within the first five years of the disease, during the first six months after hospitalization, and following an severe psychotic episode.
Addiction
A rather large majority of people with schizophrenia abuse nicotine, alcohol, and various other substances. Substance abuse decreases response rate of anti-psychotic drugs in schizophrenia patients. Schizophrenics tend to be heavy smokers. Nicotine actually helps reduce psychotic symptoms, probably by inhibiting the activity of a protein called monoamine oxidase B (MAO-B), which has been linked to improved mood and possibly to nerve protection.
Cost to Society
Schizophrenia damages, to individuals and society, induce enormous costs. In 1991, it was estimated that schizophrenia cost the US 65 billion dollars - including health care costs, money paid to the criminal justice system for dealing with people with schizophrenia, and lost productivity at work and home by both patients and their caregivers. Historically, schizophrenia was treated with long-term stays in mental hospitals. But after the introduction of anti-psychotic drugs in the 1950s and 60s, political pressure for medical cost reductions inflated the hope that these drugs would be more effective than they actually were. Thus, in the mid 1970s, thousands and thousands of patients were released from institutions into the community. However, most of the communities and families were ill-prepared to handle these individuals, and the incidence of homelessness dramatically increased with this de-institutionalization. Today, schizophrenia still accounts for over 40% of all long-term hospitalization, and more than half require public assistance within a year of their reentry into the community.