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). Other research from The British Journal of Psychiatry were more negative and claimed that "the clinical relevance of antipsychotics is in fact limited". This study included 22 428 patients and 11 antipsychotic drugs.
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.
For people who are unwilling or unable to take drugs regularly, injectable long-acting preparations of antipsychotics can be used. When used in combination with mental and social interventions (treatment), such preparations can help people to continue their treatment.
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.
Schizophrenia has great human and economic costs. The condition results in 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.)
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.
Accounts of a schizophrenia-like syndrome are rare before the 19th century. Detailed case reports from 1797 and 1809, are regarded as the earliest cases of the disorder. Schizophrenia was first described as a distinct syndrome affecting teenagers and young adults by Bénédict Morel in 1853, termed "démence précoce" (literally 'early dementia'). The term dementia praecox was used in 1891 by Arnold Pick in a case report of a psychotic disorder. In 1893 Emil Kraepelin introduced a new distinction in the classification of mental disorders between "dementia praecox" and mood disorder (termed manic depression and including both unipolar and bipolar depression). Kraepelin believed that "dementia praecox" was primarily a disease of the brain, and a form of dementia, different from other forms of dementia such as Alzheimer's disease which usually happen later in life.
Eugen Bleuler coined the term ”schizophrenia”, which translates roughly as "split mind", in 1908. The word was intended to describe the separation of functioning between personality, thinking, memory, and perception. Bleuler realized that the illness was not a dementia because some of his patients improved rather than got worse.
In the early 1970s, the criteria for determining schizophrenia were the subject of numerous controversies. Schizophrenia was diagnosed far more often in the United States than in Europe. This difference was partly the result of looser criteria for determining whether someone had the condition in the United States, where the DSM-II manual was used. In Europe, the ICD-9 manual was used. A 1972 study, published in the journal Science, concluded that the diagnosis of schizophrenia in the United States was often unreliable. These factors resulted in the publication of the DSM-III in 1980 with a stricter and more defined criteria for the diagnosis.
Negative social judgment has been identified as a major obstacle in the recovery of people who have schizophrenia.
In 2002, the term for schizophrenia in Japan was changed from “Seishin-Bunretsu-Byō”　精神分裂病 (“mind-split-disease”) to “Tōgō-shitchō-shō”　統合失調症 (“integration disorder”), in an attempt to reduce feelings of shame or embarrassment. The idea that the disease is caused by multiple factors (not just one mental cause) inspired the new name. The change increased the percentage of people who were informed of the diagnosis from 37 percent to 70 percent over three years.
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.