Schizophrenia

Schizophrenia is a health condition. People with schizophrenia have thoughts, emotions and  behaviors that other people cannot easily understand. A special type of doctor, known as psychiatrist, decides on a diagnosis after meeting a patient. Schizophrenia as a diagnosis is a medical description of an illness or disease. After the diagnosis, different things can be done to help a person who has the condition. There is medical treatment for the symptoms, but the anti-psychotic medication that is used to treat the condition is not a cure.

The cause of schizophrenia is not known. For the patient, schizophrenia is part of who they are. For other people, schizophrenia is a medical term that is defined by scientific research, concepts and ideas.  

There are many social problems associated with schizophrenia. Not having a job, poverty, homelessness, exploitation and victimization are commonly connected with schizophrenia.

Schizophrenia can be a large problem for people who have it. Someone who has schizophrenia may hurt themselves. This is known as "self-harm". Not all people with schizophrenia want to hurt themselves. People with the condition need psychiatric assessment because of the possibility of self-harm. If a young person begins to show signs of having the condition, they should see a psychiatrist as soon as possible.  People with schizophrenia are more likely to commit suicide than the average person. They also have more physical health problems.  In 2015, about 16,900 deaths were linked to schizophrenia. A study was done of over 4million people who were diagnosed with schizophrenia. Using data from 1957 to 2021, the most common reasons for death were suicide, injury-poisoning, and undetermined non-natural cause. These were followed by pneumonia. In one study, use of anti-psychotic medication was found to be the most common cause for diagnosis of pneumonia. The statistical average of people in these study groups had a life expectancy that is about 11.2  to 25 years lower than that of the general population.

Schizophrenia is thought of as being abnormal. There is no cure for the condition, but there is treatment. Most  people recover and can live a normal life. Schizophrenia is not infectious. There is no microorganism that is spread from one person to another.

Most of the time, the symptoms of schizophrenia starts in the late teens or early 20s.  It is a common condition. In 2022, about 24 million people worldwide had the condition.  It affects about the same number of men and women. In men, it seems to start about five years earlier than in women.

Some people refuse to believe that they have schizophrenia, when someone tells them they do.

The term schizophrenia was made by Dr Eugen Bleuler sometime before 1908. It was used to describe patients in mental institutions who did not recover.

Classification 
Schizophrenia is a classification.  Schizophrenia is classed by clinical psychiatrists, as a mental and behavioral disorder  a "mental disorder", and a "disease". Schizophrenia is classified as a "primary psychotic disorder". "Schizophrenia" "behavioral" problem is a subject of psychology, the science of behaviour. Usually, it is seen as a field of psychiatry.

The word  schizophrenia is: 
uncountable  
and countable:  for example: «there are [four  schizophrenias]  in Dr Bleulers Gruppe der Schizophrenien»  & «[A schizophrenia]  of the group which is named after a symptom is catatonic.»

Meaning

schizo & phren
The meaning of the word and how it became a word (its etymology) is that the word schizophrenia splits into "schizo", or schizein, and "phren" or phrenes. The literal meaning only is split mind by joining the parts. Dr Eugen Bleuler invented the word:

The original meaning of the word schizophrenia is described in Dr Bleuler's writing MONOGRAPH SERIES ON SCHIZOPHRENIA NO. 1 Dementia Praecox or the Group of Schizophrenias. Dr. Bleulers word is neoclassical thought  
because it uses word parts from ancient Greek. 

Phren is in the original work the "psychic functions", 
which is the mind.  The ancient Greek word φρήν which is phren meant "midriff, heart, mind, thought".   

The ancient Greek νοῦς which is nous had the meaning "mind, understanding, reason"  of meta-physical (metaphysical) realities:  the intellect.

phrenia
The word -phrenia is only a condition,  
or a disorder.

phrenic
The word phren is also used to describe part of the inside of some-ones body (human anatomy): the phrenic nerve.

History

Schizophrenia and its treatment have a long history. Problems with phren which are problems of mental health are in Ancient Greek and in the Middle Ages in England. The first to use the modern term was Eugen Bleuler, a Swiss doctor, who invented it in 1908. Another doctor who used the term was  Emil Kraepelin. Before 1908, the term dementia precox was used for a number of diseases resembling Schizophrenia. Kraepelin used it for diseases that were characterized by a destruction of the personality, with damage to the mood and the will. Kraepelin distinguished them from what he called "manisch-depressives Irresein" ("manic-depressive madness", called manic-depressive disorder or Bipolar disorder today).  At a conference in 1908, Bleuler said that the illnesses described as "dementia preaecox" had nothing to do with dementia, and the term praecox (early-onset) didn't apply in all cases; he proposed the term "Schizophrenia" instead.

Hospital
People with schizophrenia are sometimes admitted to a hospital to be treated. There are three cases:

 Voluntary admission - The patient wants to be admitted, or does not disagree with being admitted. A survey done with 134,100 cases showed that  61.9 % were in  this category.
 Involuntary admission - The patient does not want to be admitted. This was the case for 43% of the people in the survey above. These people dont want to be hospital patients.  Many states have laws that allow placing people in hospitals, even if they don''t want to. Usually, this is done to protect the people, or to protect other people. In England, this law is the Mental Health Act 1983. It allows to place people in a hospital for 72 hours, 28 days or up to six months. 
 Forensic schizophrenia -The patient is admitted after committing a crime. Being put in a specialized hospital is part of the sentence (after the trial).  admission is made to hospitals with security of low, medium, or high  (maximum security).    In maximum-security  Broadmoor Hospital, England, about the year 2017, there were more people with a diagnosis of schizophrenia than other diagnoses.

About schizophrenia

Course
Possible stages are: premorbid  (without symptoms),  (1st) prodromal  (with symptoms though these are not unique to schizophrenia and many person/people/individuals do not develop schizophrenia)  (2nd) deterioration, (3rd) chronic/residual

Diagnosis
A study of 2018 found that some doctors, perhaps many,  diagnose schizophrenia within the first few minutes  based on the  "praecox feeling".  The "feeling" is perhaps like first impressions.  The "praecox feeling" is not in the  "symptom checklists" of DSM and ICD. 

To decide if a person has schizophrenia  
a doctor uses The Diagnostic and Statistical Manual of Mental Disorders (DSM)  
made by the American Psychiatric Association  
for the United States of America (US)  
and the International Classification of Diseases (ICD),  
involving the World Health Assembly and the  World Health Organisation,  
for all of the world,  
although used in the US with a US only version made by The Centers for Disease Control and Prevention because of the different cultures.

Differential diagnosis
There are no medical tests that can be used to say if a person has schizophrenia or not, so getting a diagnosis depends on which list of symptoms are used. It also depends on the doctor or psychologist who talks to the person. Some scientists think that schizophrenia is several separate illnesses that have some of the same symptoms. These scientists claim that the research done on schizophrenia is not accurate since different researchers mean different things when they use the word "schizophrenia" in scientific studies. Similarly named mental illnesses include schizotypal personality disorder, schizoaffective disorder, and schizoid personality disorder.

Unlike what the name suggests, people with schizophrenia do not have a split personality.

Symptoms
Schizophrenia  has many different symptoms.  

People with this disorder often do not behave the way most people do towards others. They also may not know what is real (this is called psychosis). Some common signs are strange beliefs, unclear or confused thinking and language, hallucinations (such as hearing voices that aren't there), poor interaction with others, less expression of feelings, and not doing much. They also may not care about many things. 

Many people with Schizophrenia have fixed beliefs that look strange to other people. Nevertheless, people believe they are true. Such beliefs are called delusions. Many people also see, feel or hear things that don't exist. These are called hallucinations. A common hallucination with Schizophrenia is hearing voices.

These symptoms include having different behaviour (ICD: "alterations") which the doctor understands as: "Delusions" which when questioned or queried by doctors stay as the same thoughts and don't become an agreement with the doctors opinion. "Hallucinations" which the doctor thinks is not possible in reality. A symptom of schizophrenia which the doctors is expected to discover and, or, find in speaking, the ICD doesn't give any other examples; speaking which the doctor doesn't understand as having any meaning, which the doctor thinks is because the persons thinking is disorganised - so from speech the doctor is thought to know the actual real-world in a time period of assessment existing reality of thoughts the person is having ("disorganised thinking") - "disorganised speech" which is heard by a doctor is exactly the same for doctor as disorganised thinking. Very (ICD: "grossly", here is very) not organised ("disorganised") behaviour, the ICD doesn't show what this is. Experiences of passivity and control.   

The symptoms occur with sufficient frequency and intensity to deviate from expected cultural or subcultural norms.  

All the possible known symptoms of the condition  and, or, mental disorder  and, or, disease  known by doctors and professionals as schizophrenia are divided into three groups named: psychotic, negative, cognitive.    

Symptoms are within the self.

Psychotic symptoms
Psychotic symptoms are when someone has a reality in their thoughts and experiences which isn't the same as shared with people before the first contact with a doctor, or simply not the same as a known or knowable shared sense of reality. This is described as "lost touch" with reality,  or "loss of contact"  with reality.  

People with schizophrenia with psychotic symptoms have a problem with concrete thinking because they are thinking very much more about abstract things.  

These symptoms include having strange thoughts that do not make sense (delusions), disorganized thoughts and speech, and feeling, hearing, seeing, smelling, or tasting things that do not exist (hallucinations).

Delusions
People with psychotic schizophrenia sometimes have delusions. A delusion within schizophrenia is a belief that is very different from what other people with the same way of life believe.

Dr Bleuler created the idea "double-bookkeeping" to describe a factor of schizophrenia, which is "the patients’ ability to separate their delusional world from the everyday socially shared world".  Psychiatry describes this as being that patients consistently hold beliefs which are not possible or real, but don't act as the beliefs are true. This is described as a patient "failure".

Hallucinations
Hallucinations are usually experiences of things that from the senses don't exist from the physical word. 

Hearing voices that don't exist is a known hallucination. These voices could say unpleasant things to the person. Eugen Bleuler, who invented the word schizophrenia thought this hallucination was described as "thought-hearing".

Negative symptoms
Negative symptoms are thoughts, behaviors or emotions normally present in a healthy person that a person with a mental disorder has less of or may not have at all; they are 'minus' these. The sign for minus is -; it is also the sign for the word "negative". 

Negative symptoms  which includes the examples (ICD: "such as" which means, for example), but ICD doesn't give any other examples, "blunted affect"   which infact is meaning the person, individual is not moving as much as is expected (which is the "blunted" part) emotions (which the doctor thinks or writes as "affect"). This is meant as the person or individual the doctor or someone else with the doctor is talking to, the persons face doesn't move with a look which has the same meaning as the words the person is saying, or a movement a doctor would expect (Department of Psychiatry, Stellenbosch University: "diminished facial expression") having a blank inexpressive look on the face & the person, individuals hands and arms don't move while they are talking ("expressive gestures") & their voice doesn't move around in tone, an up or down change in the voice which goes with speaking the words ("vocal expression").  Flat affect and avolition, and psychomotor disturbances.

Cognitive symptoms (or cognitive deficits)
Cognitive symptoms are problems with attention, certain types of memory, the concept of time, and with the ability to plan and organize.

Insight
The word insight means to have a true and real understanding of a problem or situation.  

"Lacking insight" is not having insight and is not being aware of having a mental problem, a problem is known in medical thought as: mentally ill 

Meanings and problems of meaning of the word "insight"

The definition of the word by sources, for example: "The fact of penetrating with the eyes of the understanding" "deep"  "the power or act of seeing into a situation"  penetration,   penetrating 

"Mental health literacy" (literacy being literature)  could be very similar or the same as insight.

The word insight means literally to see inside, which is in & sight. This is obviously not possible because the human eye is the organ of seeing. Situations where actually insight is really possible (which means the eye of the mind), by the definition of seeing inside, is mental visualizations and dreams.

The Oxford University etymology has insight at the earliest in the Ormulum of circa 1175 AD. 

The optic nerve is part of the brain.

Treatments
Usually, schizophrenia is treated using one or more  drugs. Drugs are used to treat the symptoms. In addition, different therapies are used. A therapy helps the people cope with the disease. 

In most cases,  antipsychotics are used to treat Schizophrenia.  In many cases, the patient is unwilling or unable to take the drug, so many of these drugs also exist in a form that can directly be injected using a syringe.  When used in combination with mental and social interventions (treatment), such injectable medication can help people to continue their treatment.   In many cases, the drugs need to be taken for 1-2 weeks before there is a visible, effect. For this reason, they need to be chosen carefully. Like other drugs, these drugs also have unwanted side effects. 

Therapies include counselling, but also cognitive-behavioral therapy, or CBT. In CBT, the person talks to a professional who helps the person recognise that some of their strange thoughts are not real. These strange thoughts are usually called delusions. The therapist can also design an experiments for paranoia, a false fear of danger. This can help the people find out, for example, if there are cameras everywhere in the house. For hallucinations, cognitive therapy focuses on normalizing: many people hear voices without being stressed, and we all hear voices in the form of thoughts, it is just that people with schizophrenia hear them a bit more clearly than most people.

Effect
Antipsychotic drugs can reduce the positive symptoms in about seven to fourteen days. However, medication fails to improve negative symptoms or problems in thinking significantly. Many antipsychotics are Dopamine antagonists (a substance interfering with how another substance works.) High concentrations of Dopamine are thought to be the cause of hallucinations and delusions. For this reason blocking Dopamine reception helps against hallucinations and delusions.

A drug called clozapine is an effective treatment for people who respond poorly to other drugs, but clozapine can lower the white blood cell count in 1 to 4 percent of people who take it. This is a serious side effect.

Antipsychotic treatment
Antipsychotic medication as the treatment of acute schizophrenia was thought proven (before 1980) by the results of many  ("well-controlled, double-blind") studies which compared the drug chlorpromazine and other antipsychotic drugs to placebo.  
The Royal College of Psychiatrists of the United Kingdom states antipsychotics can help to reduce symptoms.  
Some reviews of research sponsored by the makers of antipsychotic drugs claim that about 40 to 50 percent of people have a good response to medication, 30 to 40 percent have a partial response, and 20 percent have an unsatisfactory response (after 6 weeks on two or three different drugs). 
Research from The British Journal of Psychiatry found that amisulpride and olanzapine were the most helpful of the drugs they had tested for, and also other studies had tested for, but that comparing 1st generation and 2nd generation drugs for treatment, there wasn't very much improvement. Second generation are intended to be better at treating schizophrenia. This study included 22 428 patients and 11 antipsychotic drugs.

Treatment without antipsychotics
In a family oriented treatment program in Finland, Open Dialog, 8 out of 10 people with schizophrenia get well with no medication or very limited drug use, often only anxiety medication.

During the years 1998 to 2000 a small number of first-episode patients (which means acute not chronic) became; without  symptoms ("remission": "41%") and perhaps (depending on the meaning of the quote) returned to the same everyday activities as before without change ("recovery functional": "33%")  of the number of patients who refused treatment of a total of "584" total patients who were attending the Early Psychosis Prevention and Intervention Centre for more than 6 weeks. 

Peter R. Breggin, M.D. former teaching fellow at Harvard Medical School and full-time consultant at the National Institute of Mental Health  founded the International Center for the Study of Psychiatry and Psychology, and was on the editorial boards of several scientific journals  has written in his 2007 publication Brain Disabling Treatments in Psychiatry Effexor, Risperdal, Zyprexa, Abilify, lithium and Depakote produce dangerous abnormal behavior and dangerous brain changes.  Dr Breggins first anti-drug book was criticised by a Professor of Psychiatry during 1994.  Dr. Breggin wrote with David Cohen Your Drug May Be Your Problem: How and Why to Stop Taking Psychotropic Medications which was published during 1999. Breggin and Cohen state that psychiatrists do not know enough information to safely recommend drugs routinely or to take for more than a briefer time which is the continued use recommended for treatment.

Psychosocial therapies
Numerous mental and social interventions can be useful in treating schizophrenia. Such interventions include various types of therapy, 
community-based treatments, supported employment, skills training, token economic interventions, and mental interventions for drug or alcohol use and weight management. 
Family therapy or education, which addresses the whole family system of an individual, might reduce a return of symptoms or the need for hospitalizations (having to go into hospital.) 
There is growing evidence for the effectiveness of cognitive behavioral therapy (also known as “talk therapy”) .

The British national guidelines for treatment (NICE) recommend for both people are at risk of getting schizophrenia and people who have got it, cognitive behavioral therapy (CBT) and family therapy. Getting support from people who have become well from schizophrenia is also strongly recommended.

Foods
Certain foods could perhaps help,  although the benefits are not exactly proven, studies on the benefits found improvements within the study design participants (sometimes scientists used animals not humans). Although the benefits are not proven, all the foods listed are part of a healthy diet, if used correctly (eating not more than enough, and not less than necessary): Saffron (PRECAUTION: can cause miscarriage during pregnancy ) green oats  wild green-oat extract,  Skullcap,  Ashwagandha,  Fish-oil  Omega 3,  Tea,  B vitamin supplement "B6, B8 and B12",  N-acetylcysteine supplement,  glycine supplement or foods,  N-methyl-glycine (sarcosine) supplement,  betel nut,  panax ginseng,  turmeric  (Curcumin) 

Foods which would help with brain health: the most to drink in one day: males 15 cups, females 11 cups:  water  4, 5 or 6 cups every day should help 

Foods to perhaps avoid (the research is for general brain health not schizophrenia only): ultra-processed foods

Risk factors and causes 
There are many risk factors that may cause a person to develop schizophrenia. They include trauma (damage caused by stressful events) and genetics (schizophrenia running in families). Having a schizophrenic parent may be very stressful, and there may also be genes that influence the development of schizophrenia. It is very easy to show that trauma, such as sexual abuse (forced unwanted sexual behaviour towards somebody) increases the risk, but 40 years of searching for the right genes has not found anything that has been confirmed by independent research groups.

Medical illnesses, and treatment with certain medicines, can cause symptoms very similar to that of schizophrenia. In fact, there are over a hundred medical problems that can cause the same symptoms of schizophrenia. For this reason, it is important to rule out the possibility of either of these things being the cause for the person's symptoms. For this reason, the person should have a thorough medical exam to rule out problems like;
 Not having enough vitamin B12, magnesium, sodium, or other chemicals the body needs
 Sleep disorders
 A stroke or brain tumor
 A metabolism (chemical reactions keeping the person alive) that is too high or too low

Others problems cause very similar or the same behaviours as schizophrenia as is seen and heard by doctors, or experiences by people: medical conditions, other psychiatric conditions, the behaviours caused by certain plants and chemicals which when eaten or inhaled in the breath as smoke, or powder. Many medications (licensed drugs to cure or treat an illness) may also cause the same symptoms as schizophrenia. The most common ones are antidepressants (medicines to treat depression) and ADHD medication (medication to treat ADHD, a condition affecting the brain, including memory and focusing on surroundings.) If a person has taken anti-vomiting medication (medication to stop them being sick) for some time and suddenly stops, he or she may get schizophrenia symptoms. Hundreds of medications have schizophrenia symptoms as rare side effects (unintended effects of taking them). Illegal drugs such as LSD, amphetamines, magic mushrooms and cocaine may cause schizophrenia symptoms.

The medical condition delirium can cause visual hallucinations, or an unpredictable changing levels of consciousness. Schizophrenia occurs along with obsessive-compulsive disorder (OCD), a disorder in which a person becomes obsessed with certain ideas or actions. However, separating the obsessions of OCD from the delusions of schizophrenia can be difficult. The condition in which a person has more than one personality, meaning they act like a different person at different times, is dissociative identity disorder.  Many people can hear voices like this without being schizophrenic, for instance right before falling asleep. This is called a hypnagogic hallucination. The brain cannot tell them apart from normal sounds that are heard. This is not yet fully understood by science.

Cognitive deficits are also caused by side effects of anti-psychotic drugs, antidepressants, sleeping medication and anti-anxiety drugs.

Inherited factors
Doctors think genetics is part of schizophrenia.  It is difficult to know if schizophrenia is inherited because it is hard to find out whether something comes from genes or the environment. 
Those who have a parent,  a brother or sister  with schizophrenia have a higher risk of developing schizophrenia. The risk is even higher if you have an identical twin with schizophrenia. 
This may seem to show that schizophrenia is inherited. However, it may be the stress of living with a schizophrenic family member that is traumatic. Identical twins are much closer and are treated much more in the same way, and this may be the reason why one of them is more likely to get schizophrenia if the other has it. Dr Jay Joseph has found many problems with the scientific studies of inheriting schizophrenia, including false reporting of results. Joseph also claims that 40 years of the search for the schizophrenia gene has not found a single gene that independent research groups have confirmed. 

rA combination of what has happened to a person and the person’s genes may play a role in the development of schizophrenia. 
People who have family members with schizophrenia and who experienced a brief period of psychotic symptoms have a 20 to 40 percent chance of being diagnosed one year later. This may be both the result of stressful events because of the family member and possibly a genetic effect.

Environmental factors
There are may environmental risk factors factors for schizophrenia such as drug use, stress before birth and in some cases exposure to infectious diseases (a disease that spreads from person to person). 
In addition, living in a city during childhood or as an adult has been found to double the risk of schizophrenia . 
This is true even after taking into account drug use, race, and the size of one’s social group. 
Other factors that play an important role include whether the person feels socially isolated, as well as social adversity, racial discrimination (treating a person badly because of their race), the person's family not working properly, unemployment, and poor housing conditions. 
There is evidence that childhood experiences of abuse or trauma are risk factors for developing schizophrenia later in life.

Psychotic symptoms often respond to drug treatment Stopping anti-psychotic or anti-vomiting drugs too quickly may cause these symptoms.

Substance use and or abuse
Several drugs have been linked with the development of schizophrenia and the abuse (harmful use) of certain drugs can cause symptoms like those of schizophrenia. 
About half of those people who have schizophrenia use too much drugs or alcohol, possibly to deal with depression, anxiety, boredom, or loneliness. 
Frequent marijuana use may double the risk of serious mental illness, including schizophrenia.

More people with schizophrenia smoke tobacco than the general population; it is estimated that at least 60% to as many as 90% of people with schizophrenia smoke tobacco. Recent research suggests that cigarette smoking may be a risk factor for developing schizophrenia. Smoking also reduces the effects and side effects of anti-psychotic drugs, and this may be one of the reasons for the high smoking rate. Patients taking anti-psychotic drugs die up to 20 years earlier than others, possibly because the medication makes them overweight, gives diabetes and leads to them smoking.

Pre-birth factors
Factors such as lack of oxygen, infection, or stress and lack of healthy foods in the mother during pregnancy, might result in a slight increase in the risk of schizophrenia later in life. 
People who have schizophrenia are more likely to have been born in winter or spring (at least in the northern half of the world). This might relate to increased rates of exposures to viruses before birth. 
This difference is about 5 to 8 percent.

Brain structure

Some people who have schizophrenia have differences in their brain structure compared to those who do not have the disorder. These differences are often in the parts of the brain that manage memory, organization, emotions, the control of impulsive behavior, and language. 
For example, there is less brain volume in the frontal cortex and temporal lobes, and problems within the corpus callosum, the band of nerve fibers which connects the left side and the right side of the brain. People with schizophrenia also tend to have larger lateral and third ventricles. The ventricles are spaces within the brain filled with cerebrospinal fluid.

Prevention
There is no clear evidence that treating schizophrenia with anti-psychotic drugs early is effective. 
The British NICE guidelines recommend cognitive behavioural talk therapy for all people at risk. 
In recent research, 76 patients at risk for schizophrenia were divided into two groups. One group got omega3 for 3 months and the other got a dummy pill (food oil). After 12 months only 4.9% of the omega 3 group had got schizophrenia compared to 27.5% in the other group. 
There is some evidence which shows that early treatment with drugs improves short term outcomes for people who have a serious episode of mental illness. These measures show little benefit five years later. 
Attempting to prevent schizophrenia in the pre-onset phase with anti-psychotic drugs is of uncertain benefit and so is not recommended (as of 2009). 
Prevention is difficult because there is no reliable way to find out in advance who will get schizophrenia.

Management

The treatment of schizophrenia is based upon the phase of the illness the person is in. There are three treatment phases:
 Acute Phase

There are some goals during the acute phase of treatment. Some of these goals are to prevent harm. To prevent harm, the person being treated will have the severity of psychosis and it's symptoms reduced. These symptoms include agitation, aggression, negative symptoms, self-disorder, and thought disorders. 
Another goal is to find and treat the things that led to the episode of psychosis. Then, the person will be treated by trying to go back to how they were before psychosis. Lastly, the person will be helped by forming social connections and finding out what treatment plans work for them. Some treatment plans can be for a long time, and others can be for a short time.
 Stabilization Phase
The stabilization phase also has goals. One is to reduce the stress the person feels. Another is to prevent the person from experiencing psychosis again. Then, the person is helped further with social connection and getting better. If the person has improved with a medication, it is recommended they keep taking it for at least 6 months.
 Stable Phase

The last phase of treatment is to make sure that the person is improving. If the treatment has bad side effects, it may be changed in this phase. Some treatments during this stage are psychotherapy and medication. Antipsychotic medications greatly reduce the risk of the person experiencing psychosis again. They are strongly recommended.

Outlook
Schizophrenia has great human and economic costs. People with a diagnosis have on average a decreased life expectancy of 12 to 15 years, primarily because of its association with being overweight, not exercising, and smoking cigarettes. An increased rate of suicide (a person killing themself) plays a lesser role. 
These differences in life expectancy increased between the 1970s and 1990s.

Schizophrenia is a major cause of disability, with active psychosis ranked as the third-most-disabling condition. 
Approximately three-fourths of people with schizophrenia have an ongoing disability with symptoms that keep coming back. 
Some people do recover completely and others function well in society. 
Most people with schizophrenia live independently, with community support. 
In people with a first episode of serious mental symptoms, 42 percent have a good long-term outcome, 35 percent have an intermediate outcome and 27 percent have a poor outcome. Outcomes for schizophrenia appear better in the developing world than in the developed world, although that conclusion has been questioned.

The suicide rate of people who have schizophrenia is estimated to be about 4.9 percent, most often occurring in the period following the first appearance of symptoms or the first hospital admission. 
20 to 40 percent try to kill themselves at least once.

Schizophrenia and smoking have shown a strong association in studies worldwide. 
Use of cigarettes is especially high in individuals who have schizophrenia, with estimates ranging from 80 to 90 percent of these people being regular smokers, compared to 20 percent of the general population. 
Those individuals who smoke tend to smoke heavily and to smoke cigarettes with a high nicotine content.

Research continues on schizophrenia. In the spring of 2013, genetics associations were shown between five major psychiatric disorders: autism, ADHD, bipolar disorder, depression, and schizophrenia per recent study. In the summer of 2013, for the first time, brain tissue development was replicated in three dimensions by scientists cloning a human "mini-brain" using stem cells. This could help with schizophrenia and autism neurological research (research related to the brain.)

Hope 
People with schizophrenia may also have other mental health disorders, like depression, anxiety and drug abuse. They often have problems functioning in society, and have difficulty keeping a job. However, there are a number of people with schizophrenia who get well and have earned college degrees and had professional careers. For example, Elyn. R. Saks successfully became a law professor at the University of Southern California and a published author.

In a family treatment called "Open dialog" in Finland, eight out of every ten people with schizophrenia "get well." In developing countries, where doctors use less drugs, 2 out of 3 patients get well from schizophrenia. In western countries, where medications are used as treatment, 1 of 3 get well, but many suffer from drug side effects such as diabetes, obesity, and brain damage.

Sometime before 1911 In the hospital of Eugen Bleuler, who made and first used the word schizophrenia:

Likelihood
As of 2011, schizophrenia affects around 0.3% to 0.7% of people, or 24 million people worldwide, 
at some point in their lives. More men are affected than women: the number of males with the disorder is 1.4 times greater than that of females. Schizophrenia usually appears earlier in men. 
For males the symptoms usually start from 20 to 28 years of age, and in females it is 26 to 32 years of age. 
Symptoms that start in childhood, 
middle or old age are much rarer. 
Despite the received wisdom that schizophrenia occurs at similar rates worldwide, its rate of likelihood varies across the world, 
within countries, 
and at the local level. 
The disorder causes approximately 1% of worldwide disability adjusted life years (in other words, years spent with a disability). The rate of schizophrenia varies depending on how it is defined.

Society 
Negative social judgment has been identified as a major obstacle in the recovery of people who have schizophrenia.

The word schizophrenic is used in reporting as a metaphor in newspapers of the US, Greece and the UK. 

In the United States in 2002, the cost of schizophrenia, including direct costs (people who were not hospitalized, people who were hospitalized, medicines, and long-term care) and non-healthcare costs (law enforcement, reduced workplace productivity, and unemployment), was estimated to be $62.7 billion.

Culture

The book “A Beautiful Mind” and the film of the same name are about the life of John Forbes Nash, an American mathematician and Nobel Prize winner who has schizophrenia. The movie “The Soloist” is based on the life of Nathaniel Ayers, a gifted musician who dropped out of the Julliard School, in New York City after the symptoms of schizophrenia began. He later became homeless in Los Angeles, California, in the notorious Skid Row section. One of the children of Dr. Albert Einstein was diagnosed with schizophrenia, and lived his life in a hospital.  The sister of Dr Eugen Bleuler was admitted to a Zurich hospital with a catatonic illness . Dr Bleuler would sometime after be the director of the same hospital where he diagnosed his sister with schizophrenia.

Artistic expression

References 

Schizophrenia