Schizophrenia - WHO | World Health Organization

Schizophrenia causes psychosis and is associated with considerable disability and may affect all areas of life including personal, family, ... Home/ Newsroom/ Factsheets/ Detail/ Schizophrenia Schizophrenia 10January2022 Keyfacts Schizophreniacausespsychosisandisassociatedwithconsiderabledisabilityandmayaffectallareasoflifeincludingpersonal,family,social,educational,andoccupationalfunctioning. Stigma,discrimination,andviolationofhumanrightsofpeoplewithschizophreniaarecommon. Morethantwooutofthreepeoplewithpsychosisintheworlddonotreceivespecialistmentalhealthcare. Arangeofeffectivecareoptionsforpeoplewithschizophreniaexistandatleastoneinthreepeoplewithschizophreniawillbeabletofullyrecover. SymptomsSchizophreniaischaracterisedbysignificantimpairmentsinthewayrealityisperceivedandchangesinbehaviourrelatedto:persistentdelusions:thepersonhasfixedbeliefsthatsomethingistrue,despiteevidencetothecontrary;persistenthallucinations:thepersonmayhear,smell,see,touch,orfeelthingsthatarenotthere;experiencesofinfluence,controlorpassivity:theexperiencethatone’sfeelings,impulses,actions,orthoughtsarenotgeneratedbyoneself,arebeingplacedinone’smindorwithdrawnfromone’smindbyothers,orthatone’s thoughtsarebeingbroadcasttoothers;disorganizedthinking,whichisoftenobservedasjumbledorirrelevantspeech;highlydisorganisedbehavioure.g.thepersondoesthingsthatappearbizarreorpurposeless,orthepersonhasunpredictableorinappropriateemotionalresponsesthatinterferewiththeirabilitytoorganisetheirbehaviour;“negativesymptoms”suchasverylimitedspeech,restrictedexperienceandexpressionofemotions,inabilitytoexperienceinterestorpleasure,andsocialwithdrawal;and/or extremeagitationorslowingofmovements,maintenanceofunusualpostures.Peoplewithschizophreniaoftenalsoexperiencepersistentdifficultieswiththeircognitiveorthinkingskills,suchasmemory,attention,andproblem-solving.Atleastonethirdofpeoplewithschizophreniaexperiencescompleteremissionofsymptoms(1).Somepeoplewithschizophreniaexperienceworseningandremissionofsymptomsperiodicallythroughouttheirlives,othersagradualworseningofsymptomsover time.MagnitudeandimpactSchizophreniaaffectsapproximately24millionpeopleor1in300people(0.32%)worldwide.Thisrateis1in222people(0.45%)amongadults(2).Itisnotascommonasmanyothermentaldisorders.Onsetismostoftenduringlateadolescenceandthe twenties,andonsettendstohappenearlieramongmenthanamongwomen.Schizophreniaisfrequentlyassociatedwithsignificantdistressandimpairmentinpersonal,family,social,educational,occupational,andotherimportantareasoflife.Peoplewithschizophreniaare2to3timesmorelikelytodieearlythanthegeneralpopulation (3).Thisisoftenduetophysicalillnesses,suchascardiovascular,metabolic,andinfectiousdiseases.Peoplewithschizophreniaoftenexperiencehumanrightsviolationsbothinsidementalhealthinstitutionsandincommunitysettings.Stigmaagainstpeoplewiththisconditionisintenseandwidespread,causingsocialexclusion,andimpactingtheirrelationships withothers,includingfamilyandfriends.Thiscontributestodiscrimination,whichinturncanlimitaccesstogeneralhealthcare,education,housing,andemployment. Duringhumanitarianandpublichealthemergencies,extremestressandfear,breakdownofsocialsupports,isolationanddisruptionofhealth-careservicesandsupplyofmedicationcanoccur.Thesechangescanhaveanimpactonthelivesofpeoplewith schizophrenia,suchasexacerbationofexistingsymptoms.Duringemergencies,peoplewithschizophreniaaremorevulnerablethanotherstovarioushumanrightsviolations,includingneglect,abandonment,homelessness,abuseandexclusion.CausesofschizophreniaResearchhasnotidentifiedonesinglecauseofschizophrenia.Itisthoughtthataninteractionbetweengenesandarangeofenvironmentalfactorsmaycauseschizophrenia. Psychosocialfactorsmayalsoaffecttheonsetandcourseofschizophrenia. Heavyuseofcannabisisassociatedwithanelevatedriskofthedisorder.ServicesCurrently,thevastmajorityofpeoplewithschizophreniaaroundtheworldarenotreceivingmentalhealthcare.Approximately50%ofpeopleinmentalhospitalshaveaschizophreniadiagnosis(4).Only31.3%ofpeoplewithpsychosisreceivespecialist mentalhealthcare(5).Mostresourcesformentalhealthservicesareinefficientlyspentoncarewithinmentalhospitals.Thereisclearevidencethatmentalhospitalsarenoteffectiveinprovidingthecarethatpeoplewithmentalhealthconditionsneedand,regularly,violatethebasichumanrightsofpersonswithschizophrenia.Effortstotransfercarefrommentalhealth institutionstothecommunityneedtobeexpandedandaccelerated.Sucheffortsstartwiththedevelopmentofarangeofqualitycommunity-basedmentalhealthservices.Optionsforcommunity-basedmentalhealthcareincludeintegrationinprimary healthandgeneralhospitalcare,communitymentalhealthcentres,daycentres,supportedhousing,andoutreachservicesforhome-basedsupport.Theengagementofthepersonwithschizophrenia,familymembersandthewidercommunityinprovidingsupport isimportant.ManagementandsupportArangeofeffectivecareoptionsforpeoplewithschizophreniaexist,andtheseincludemedication,psychoeducation,familyinterventions,cognitive-behaviouraltherapyandpsychosocialrehabilitation(e.g.,lifeskills training).Facilitatedassisted living,supportedhousingandsupportedemploymentareessentialcareoptionsthatshouldbeavailableforpeoplewithschizophrenia. Arecovery-orientedapproach–givingpeopleagencyintreatmentdecisions–isessentialforpeople withschizophreniaandfortheirfamiliesand/orcaregiversaswell.WHOresponseWHO’sComprehensiveMentalHealthActionPlan2013-2030highlightsthestepsrequiredtoprovideappropriateservicesforpeoplewithmentaldisordersincludingschizophrenia.AkeyrecommendationoftheActionPlanistoshiftservicesfrominstitutions tothecommunity.TheWHOSpecialInitiativeforMentalHealthaimstofurtherprogresstowardsobjectivesoftheComprehensiveMentalHealthActionPlan2013-2030byensuring100millionmorepeoplehaveaccesstoqualityandaffordablecarefor mentalhealthconditions.WHO'sMentalHealthGapActionProgramme(mhGAP)usesevidence-basedtechnicalguidance,toolsandtrainingpackagestoexpandserviceincountries,especiallyinresource-poorsettings.Itfocusesonaprioritizedsetofconditions,includingpsychosis, directingcapacitybuildingtowardsnon-specializedhealth-careprovidersinanintegratedapproachthatpromotesmentalhealthatalllevelsofcare.CurrentlymhGAPisbeingimplementedinmorethan100WHOMemberStates.TheWHOQualityRightsProjectinvolvesimprovingthequalityofcareandhumanrightsconditionsinmentalhealthandsocialcarefacilitiesandtoempowerorganizationstoadvocateforthehealthofpeoplewithmentalhealthconditionsandpsychosocial disabilities. TheWHOguidanceoncommunitymentalhealthservicesandperson-centredandrights-basedapproaches providesinformationandsupporttoallstakeholderswhowishtodeveloportransformtheirmentalhealthsystemandservicestoalignwithinternational humanrightsstandardsincludingtheUNConventionontheRightsofPersonswithDisabilities.References(1)HarrisonG,HopperK,CraigT,LaskaE,SiegelC,WanderlingJ.Recoveryfrompsychoticillness:a15-and25-yearinternationalfollow-upstudy.BrJPsychiatry2001;178:506-17.(2) InstituteofhealthMetricsandEvaluation(IHME).GlobalHealthDataExchange(GHDx). http://ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589dd7 (Accessed25September2021)(3) LaursenTM,NordentoftM,MortensenPB.Excessearlymortalityinschizophrenia. AnnualReviewofClinicalPsychology,2014;10,425-438.(4)WHO.Mentalhealthsystemsinselectedlow-andmiddle-incomecountries:aWHO-AIMScross-nationalanalysis.WHO:Geneva,2009 (5) JaeschkeKetal.Globalestimatesofservicecoverageforseverementaldisorders:findingsfromtheWHOMentalHealthAtlas2017GlobMentHealth2021;8:e27.  Related WHO’sComprehensiveMentalHealthActionPlan2013-2030WHOSpecialInitiativeforMentalHealthWHO'sMentalHealthGapActionProgramme(mhGAP)WHOQualityRightsProjectWHOguidanceoncommunitymentalhealthservicesandperson-centredandrights-basedapproachesMoreonmentalhealth  Factsheets Mentaldisorders 8June2022 Mentalhealthofolderadults 12December2017