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ABOUT SCHIZOPHRENIA

The Key Facts

• Schizophrenia is a biological disease of the brain. Research suggests that schizophrenia may be a developmental disorder resulting from alterations in the usual maturing process of the nervous system.

• Around 1 in 100 people will develop schizophrenia during their lifetime, and this figure is the same all over the world. Around 2000 people are newly diagnosed annually in Australia. The incidence of schizophrenia tends to be slightly higher in males compared to females.

• Schizophrenia ranks among the top 10 causes of disability in developed countries worldwide. Onset is typically between the ages of 15 and 25, making schizophrenia probably the biggest single cause of permanent disability starting in youth.

• Families often mistake early symptoms of schizophrenia for adolescent behaviour. Many of those affected do not seek medical help, and reject advice from family and friends to do so. As a result, many do not receive appropriate treatment for 2 - 8 years from the onset of symptoms.

• The disease is characterised by a retreat from reality with delusion formation, hallucinations, emotional disregulation and disorganised behaviour. There are also more subtle signs that develop over time - slow decline in mental function and social relationships leading to marked personality change, social isolation and occupational disability.

• It is a major cause of youth suicide - 30 percent of people with schizophrenia will attempt suicide, 5 percent will succeed. People with schizophrenia have 2.5 times the death rate of the general population, and their life expectancy is reduced by an average of 10 years.

• There are genetic factors involved. For example, it is known that a child of a parent with schizophrenia has a 10-fold greater chance than other children of developing the illness - whether or not the child is brought up by birth parents. However, the majority of cases arise in families with no medical history of the condition, and it is possible for one identical twin to be affected and the other not. It is now estimated that genetic factors contribute 80 percent to the cause(s) of schizophrenia.

• In addition to the profound emotional cost to families, the disease costs the Australian community approximately $1.5 billion per annum in both direct health costs and loss of productivity. Around 85 percent of sufferers receive welfare benefits.

• There is as yet no known cause or cure, but many sufferers are able to live stable and productive lives with the help of regular medication.

The Effect on Families

The impact of schizophrenia on families is uniquely distressing and disruptive. The first signs in a family member appear as confusing or shocking changes in behaviour.

Parents often assume that early signs are symptoms of adolescence, and suffer increasing stress and confusion as the condition worsens. After diagnosis, coping with the continuing symptoms of schizophrenia can be especially difficult for family members who remember how vivacious or empathetic a person was before they became ill.

The impact upon families is compounded by the common tendency of patients to deny that they are ill, and to interpret the family's efforts to get help as unnecessary interference. This interpretation is often supported in the patient's mind by delusions of persecution, or grandiose ideas about personal destiny. Unless the patient gains insight into his/her condition, these delusions can lead to non-compliance with medication, and long-term disability. Unemployment, drug and alcohol abuse, homelessness, physical deterioration, and crime and imprisonment are common outcomes of untreated schizophrenia.

Family disruption is often exacerbated by the tendency of parents or siblings to look for a reason why the illness has happened. This instinctive reaction sometimes leads to the 'shame and blame' syndrome, causing rifts between family members. It is difficult for such families to accept that the illness arises from a genetic vulnerability - which is nobody's fault.

The Stigma of Schizophrenia

Schizophrenia has a long history of neglect, demonisation and concealment. Even today, the illness does not receive the levels of public attention and research funding warranted by the numbers of individuals and families it affects. It is also common for affected families to conceal the illness from relatives, friends and workplace associates, thereby diminishing its impact upon public awareness.

What Causes Schizophrenia?

The latest research results indicate that schizophrenia may be a developmental disorder resulting from alterations in the usual maturing process of the nervous system.

Scientists do not yet understand all the factors causing this alteration, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness:

GENETIC FACTORS: It appears likely that multiple genes are involved in creating a predisposition to develop the disorder. However, it is not yet understood how the genetic predisposition is transmitted or created at conception, and it cannot yet be accurately predicted whether a given person will or will not develop the disorder.

CHEMICAL FACTORS: Knowledge about brain chemistry and its link to schizophrenia is expanding rapidly. Disruptions to neurotransmitters (substances that allow communication between nerve cells) have long been thought to be involved in the development of schizophrenia. It is likely, although not yet certain, that the disorder is associated with some imbalance of the complex, interrelated chemical systems of the brain.

ANATOMICAL FACTORS: There have been dramatic advances in neuroimaging technology that permit scientists to study brain structure and function in living individuals. Use of this technology has provided evidence that people who develop schizophrenia may be subject to abnormalities in the cellular 'pruning' process which occurs normally in the brain during adolescence. Many other studies have found abnormalities in brain structure (for example, enlargement of the fluid-filled cavities called the ventricles in the interior of the brain, and decreased size of certain brain regions) or function (for example, decreased activity in certain brain regions). Microscopic studies of brain tissue after death have also shown small changes in distribution or number of brain cells in people with schizophrenia. It appears that many (but probably not all) of these changes are present before an individual becomes ill.

ENVIRONMENTAL FACTORS: The current model of schizophrenia is as a genetic predisposition which is triggered by environmental stressors. These stressors may include intrauterine infections or nutritional deficiencies, difficulties during birth, viral infections during infancy, emotional trauma and adolescent drug abuse. Whereas most people may suffer such stressors without long-term effects, those with the genetic predisposition may develop schizophrenia.

Our clinical studies show differences in brain activity and eye tracking in schizophrenia.

How is Schizophrenia Treated?

Since schizophrenia may not be a single condition and its causes are not yet known, current treatment methods are based on both clinical research and experience. These approaches are chosen on the basis of their ability to stabilise the condition, and to reduce the likelihood that florid psychotic symptoms will return.

During the 1990s there were dramatic advances in the treatment of schizophrenia. Just as the serotonin re-uptake inhibitor (SRI) class of antidepressants has largely replaced the older and more problematic tricyclic antidepressants, a shift in the treatment of schizophrenia has now taken place. The new 'atypical' antipsychotic medication clozapine was introduced in 1992, and soon followed by risperidone, olanzapine, quetiapine and others. Studies indicate that these new medications are less likely to produce the sometimes severe side effects of earlier medicines, and that they have have allowed many sufferers to achieve long-term stability by maintaining their regular dosages.

What is the Outlook?

The outlook for people with schizophrenia has improved over the last decade. Although no totally effective therapy has yet been devised, it is important to remember that many people with the illness improve enough to lead independent, satisfying lives. As we learn more about the causes and treatments of schizophrenia, we should be able to help more patients achieve successful outcomes. Given the complexity of the illness, the major questions about this disorder - its cause or causes, prevention and treatment - must be addressed with research.

Although progress has been made toward better understanding and treatment of schizophrenia, continued investigation is urgently needed. This is a time of hope for people with schizophrenia and their families. Research is gradually leading to new and safer medications and to unraveling the complex causes of the disease. Scientists are using many approaches from the study of molecular genetics to the study of populations to learn about schizophrenia.

The more research we do now, the sooner we will be able to prevent any more young people from developing schizophrenia.