Schizophrenia is a complex disorder characterized by a constellation of distinctive and predictable symptoms that are most commonly associated with the disease. It is one of the most disabling and emotionally devastating illnesses known to man. schizophrenia is not a spilt personality, a rare and very different disorder. Like cancer and diabetes, schizophrenia has a biological basis; it is not caused by bad parenting or personal weakness. Itis a relatively common disease with an estimated one percent to one and a half percent of the US population being diagnosed with it over the course of their lives. while there is no known cure for it, it is a very treatable disease. Most of those afflicted by it respond to drug therapy, and many are able to lead productive and fulfilling lives.
Researchers usually describe the basic neuro-integrative deflect in terms of laboratory findings on cognitive tasks, but also a subjective experience. Schizophrenia usually begins by the individual having a “psychotic episode” (serious onset of symptoms)
The symptoms are divided into two main categories, positive and negative. positive does not mean good but rather indicates an excess of normal functions.
Delusions(a phenomenon that the persons culture would regard as totally implausible), and hallucinations(a sensory perception that has the compelling sense of reality of true perception but occurs without external stimulation of the relevant sensory organ.)
The person may also “slip off track” form the one topic to another in a way that makes no sense(derailment). They may make up strange words, or use words in ways that make no sense(called word salad). The person may also have bizarre or disorganized behaviors. Examples include difficulty performing simple activities of daily living, wearing multiple raincoats on clear hot days, or having trouble with hygiene.
The negative symptoms reflect a reduction in normal functioning.
Alogia, Affective Flattening, Anhedeonia(lack of pleasure), Apathy (not interested in anything) and difficulty in paying attention to anything. They may also demonstrate catatonic like behavior.
Others tend to view people with schizophrenia as very “odd” or “crazy.” These consumers are viewed as being different, and often somewhat scary and unpredictable. Since people with schizophrenia can be agitated or confused in stressful or over stimulated situations, they can appear threatening or violent. However, most research indicates that these consumers pose little risk of assault.
People with schizophrenia tend to have a great deal of trouble with interpersonal relationships. People with more severe or chronic schizophrenia tend to have few friends; they often have never had a serious or “romantic” relationship. Since the symptoms of schizophrenia tend to be frightening, painful and difficult for family members, over time the consumer may become cut-off, or distanced from their parents and siblings. People with chronic schizophrenia may live alone, and are at risk for homelessness. If left untreated the condition of the individual may be in danger or homelessness incarceration episodes of violence, ictimization, or even suicide
People with untreated psychiatric illnesses comprise one-third, or 200,000 people, of the approximately 600,000 homeless population. The quality of life for these individuals is abysmal. Many are victimized regularly. A recent study has found that 28 percent of homeless people with previous psychiatric hospitalizations obtained some food from garbage cans and eight percent used garbage cans as a primary food source.
People with untreated serious brain disorders comprise approximately 10 percent of the 1.7 million jail and prison population, or 170,000 people. These individuals are often incarcerated with misdemeanor charges, but sometimes with felony charges, caused by their psychotic thinking. People with untreated psychiatric illnesses spend twice as much time in jail than non-ill individuals and are more likely to commit suicide.
There are approximately 1,000 homicides – representing between four and five percent of total annual murders — committed each year by people with untreated schizophrenia and manic-depressive illness. According to a 1994 Department of Justice, Bureau of Justice Statistics Special Report, “Murder in Families,” 4.3 percent of homicides committed in 1988 were by people with a history of untreated mental illness.
Suicide is the number one cause of premature death among people with schizophrenia, with an estimated 10 percent to 13 percent killing themselves. Suicide is even more pervasive in individuals with bipolar disorder, with 15 percent to 17 percent taking their own lives. The extreme depression and psychoses that can result due to lack of treatment are the usual causes of death in these sad cases. These suicide rates can be compared to the general population, which is approximately one percent. prevention of suicide is only one of the many arguments in favor of early intervention. growing evidence suggests that the earlier therapy is begun, the better that individuals clinical, functional, and psychological outcomes.
The longer individuals with serious brain disorders go untreated, the more uncertain their prospects for long-term recovery become. Recent studies have suggested that early treatment may lead to better clinical outcomes, while delaying treatment leads to worse outcomes. For example:
A 1997 study from California (Wyatt et. al.) compared people with schizophrenia who received psychotherapy alone (89 patients) versus those who received antipsychotic medications (92 patients); those who received medications had much better outcomes three and seven years later.
A 1998 study from England (Hopkins et. al.) revealed that delusions and hallucinations among patients suffering from psychosis increased in severity the longer treatment was withheld from the time of the initial psychotic break (51 patients were included in the study).
A 1994 study from New York (Liebeman et. al.) showed that the longer a patient waited to receive treatment for a psychotic episode, the longer it took to get the illness into remission (70 patients were included in the study).
A 1998 study from Italy (Tondo et. al.) demonstrated that the sooner patients were started on lithium for their manic-depressive illness, the greater their improvement became (317 patients participated in the study).
Schizophrenia and manic-depressive illness are expensive diseases. A recent study found that the cost of schizophrenia alone was comparable to the cost of arthritis or coronary artery disease (D.J. Kupfer and F.E. Bloom, eds., Psychopharmacology:
The Fourth Generation of Progress, 1995):
schizophrenia costs $33 billion per year;
arthritis costs $38 billion per year; and
coronary artery disease costs $43 billion per year.
The costs included both direct costs of treatment as well as indirect costs such as lost productivity.
A significant percentage of government income benefits also go to people with severe mental illnesses. For example:
Fifteen percent of Medicaid recipients have a serious psychiatric disorder;
Thirty-one percent of Supplemental Security Income (SSI) recipients have a serious psychiatric disorder;
Twenty-six percent of Social Security Disability Insurance (SSDI) recipients have a serious psychiatric disorder;
Thirteen percent of those receiving VA disability benefits have a serious psychiatric disorder.
Schizophrenia and manic-depressive illness are thus major contributors to the escalating costs of state and federal programs.
It is a mistake to think that money is saved overall by not treating individuals with severe psychiatric disorders. Individuals who are untreated for their illness cost money by being incarcerated. For example, the total annual cost for these illnesses in jails and prisons is estimated by the Department of Justice Source Book on Criminal Justice Statistics (1996) to be $8.5 billion (based on an estimated cost of $50,000 per ill inmate per year, and 170,000 individuals with serious psychiatric disorders being incarcerated.)
Adding to this expense are court costs, police costs, social services costs, and ambulance and emergency room costs. A study of schizophrenia costs in England reported that “97 percent of direct costs are incurred by less than half the patients” and concluded that “treatments which reduce the dependence and disability of those most severely affected by schizophrenia are likely to have a large effect on the total cost of the disease to society and may, therefore, be cost-effective, even though they appear expensive initially.” (Davies and Drummond, British Journal of Psychiatry, 165 (Suppl. 25): 18-21, 1994).
When calculating the fiscal costs of untreated severe psychiatric disorders, intangible costs must also be included: the deterioration of public transportation facilities, loss of use of public parks, disruption of public libraries, and losses due to suicide. The largest intangible cost, of course, is the effect on the family.
In summary, severe psychiatric disorders such as schizophrenia and manic-depressive illness are costly three times over: Society must raise and educate the individual destined to become afflicted; people with the illnesses are often unable to contribute economically to society; and many require costly services from society for the rest of their lives.