When people think of what it means to 'go crazy,' quite often the common image that comes to mind is that of someone with schizophrenia. Schizophrenia is a serious mental health disorder that can be physically, socially, and personally destabilizing. "Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. Men tend to experience symptoms a little earlier than women. Most of the time, people do not get schizophrenia after age 45.Schizophrenia rarely occurs in children, but awareness of childhood-onset schizophrenia is increasing" (Schizophrenia, 2012, NIMH: 2). The disease is fairly rare "about 1% of Americans have this illness," but it is so debilitating the illness warrants further research and attention (Schizophrenia, 2012, NIMH: 2). While symptoms vary with every person, some of the most common include auditory hallucinations and disordered thinking. Movement disorders such as catatonia have also been noted and a 'negative effect' or an inability to respond normally to stimuli as well as the 'positive effect' of responding to stimuli others do not recognize (Schizophrenia, 2012, NIMH: 2).
Another important reason for further research on the topic is the fact that the causation of schizophrenia remains unclear. Genetics seems to play a key component in the development of the disorder. Although it only occurs in 1% of the population, schizophrenia occurs in 10% of persons "who have a first-degree relative with the disorder, such as a parent, brother, or sister" and even having second-degree relatives or distant relatives with schizophrenia significantly increase the likelihood of developing the disorder. "The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65% chance of developing the disorder" (Schizophrenia, 2012, NIMH: 6).
Yet this raises an intriguing question -- although genetics has a significant impact upon the likelihood of developing the disorder, even in the cases of identical twins not EVERY set of identical twins, raised together, becomes schizophrenic. Environment must play some role in the manifestation of schizophrenia, although the precise impact is unclear. This statistic points to the fact that schizophrenia is caused by multiple environmental factors. "Studies of brain tissue after death also have revealed differences in the brains of people with schizophrenia. Scientists found small changes in the distribution or characteristics of brain cells that likely occurred before birth" but it is uncertain that these brain changes are the result of the illness, or a precursor of the ailment (Schizophrenia, 2012, NIMH: 6).
As well as its complex causation, another motivating factor to study schizophrenia is the fact that treating schizophrenia can be so stubborn and so difficult. The severe and debilitating side effects of the original antipsychotics such as Thorazine and Haldol used to treat schizophrenia led many sufferers to not to take their medications. These antipsychotics caused tardiac dysconesia (Parkinson's disease-like tics) which did not abate even when the medications were discontinued. Another medication called clozapine was developed in the 1990s which did not cause as many symptoms but "can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. People who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people" (Schizophrenia, 2012, NIMH: 6: 7). More recent atypical antipsychotics such as Risperdal "can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol. A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication" (Schizophrenia, 2012, NIMH: 6: 7).
Cognitive behavioral therapy is often used in conjunction with drug treatments to help schizophrenics 'not listen' to their voices and to teach them psychological coping mechanism to deal with their illness. Other forms of therapy include occupational 'life skills' therapy and group therapy. Still, despite the available psychopharmacological treatments, life expectancies of persons with schizophrenia are 12 to 15 years less than the average person (Saha, Chant, & McGrath, 2007). Whether this is due to a higher suicide rate or side effects of medication remains unclear and further research is being conducted on the subject, some of which has apparently contradictory conclusions (Saha, Chant, & McGrath, 2007). Other factors that may contribute to morbidity lie in the fact that schizophrenics are more likely to be socially isolated than their non-schizophrenic peers and to suffer problems like homelessness (Saha, Chant, & McGrath, 2007).
According to Saha, Chant & McGrath (2007) in an article entitled "A systematic review of mortality in schizophrenia: Is the differential mortality gap worsening over time?" from the Archives of General Psychiatry, schizophrenics have substantially compromised mortality compared with the general population in a manner that is directly linked to the rise in atypical antipsychotics to treat the mental illness. "With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention" (Saha, Chant & McGrath 2007). The article suggests that new treatments are needed for schizophrenia to address this issue given the discrepancy between the rise of new drug treatments and the increased risk of death for schizophrenics.
The article also points to the fact that although the side effects of medications have been noted, "less widely appreciated is the fact that people with schizophrenia are at increased risk for premature death associated with comorbid somatic conditions. Apart from adverse effects related to medication, schizophrenia can trigger a cascade of socioeconomic and lifestyle factors that, in turn, can translate into adverse physical health outcomes. These comorbid physical conditions contribute to increased mortality risks among people with schizophrenia" (Saha, Chant & McGrath 2007). Social isolation, homelessness, and increased risk for substance abuse are all comorbid with schizophrenia and are all associated with higher mortality rates.
To determine whether mortality rates were improving for schizophrenics the authors conduced a literature review using search terms in MEDLINE, PsychINFO, Web of Science, and Google Scholar "to identify all studies that investigated mortality in schizophrenia, published between January 1, 1980, and January 31, 2006" (Saha, Chant & McGrath 2007). The authors used 37 articles drawn from 25 different nations to calculate the distribution of standardized mortality ratios (SMRs). "The median SMR for all persons for all-cause mortality was 2.58 (10%-90% quantile, 1.18-5.76), with a corresponding random-effects pooled SMR of 2.50 (95% confidence interval, 2.18-2.43)" (Saha, Chant & McGrath 2007). The authors were selective in determining which articles would be reviewed, assigning each a 'quality score,' rewarding studies with superior research design features and more comprehensive reporting.
Additional testimony to the thoroughness of the authors in their search for substantiated research lies in the fact that the authors conducted an electronic search of 1726 articles, in additional to manual reference checking which identified an additional 26 quality references. "We received responses from 16 authors, who provided an additional 11 references. Four articles from languages other than English were included after translation" (Saha, Chant & McGrath 2007). Regression analysis revealed a significant gap between SMRs between individuals suffering from schizophrenia and individuals without the condition that was widening rather than decreasing, confounding expectations that data regarding mortality would be improving and confirming the researcher's initial hypothesis. Moreover, the research found that SMRs associated with schizophrenia have actually been increasing over the past few decades, despite the logical assumption that they would be decreasing because of advances in medical science and treatments for the condition. In other words, the life expectations of schizophrenics had lowered in relation to the general population and also when comparing the morality rates of schizophrenics themselves.
As thorough as the research of the authors was in regards to finding studies, it is worthy of note that the majority of the studies reviewed were quantitative rather than qualitative in nature. None of the studies focused on small-scale interviews that might yield some clues as to how schizophrenics feel about their condition and their experiences. However, given the data-driven nature of the literature review, this was perhaps inevitable. The independent variable (mental health status) and dependent variable (time of death) was the focus of the study. The review also included specific segmentation regarding the cause of death. For example it was determined that "people with schizophrenia had 12 times the risk of dying of suicide compared with the general population," which was expected and had been confirmed by previous studies but the research review also found that even non-suicidal forms of death were increasing, confirming the hypothesis that the mortality rate of schizophrenics was increasing overall for reasons not simply…