Understanding schizophrenia

I. Definition and key figures

Schizophrenia is a serious psychiatric illness characterized by a wide range of symptoms, including disturbances of thought, perception, emotion, language, self-esteem and even behavior. It can be very disabling for those affected. Indeed, this pathology can affect various aspects of life, including personal, family, social, educational and professional functioning. [1] 

Key figures: 

• According to the WHO, schizophrenia affects around 24 million people worldwide, or 1 in 300 (0.32%). In adults, the rate is 0.45%. [1] 
• The disease usually reveals itself between the ages of 15 and 25, but more often begins earlier, in an attenuated form. [2] 

 II. Causes

Although the exact causes of schizophrenia remain uncertain, several lines of research are providing a better understanding of the origin of this pathology, which results from a combination of genetic, biological and environmental factors. [4] 

• Genetic factors: there is a strong genetic predisposition. Indeed, the risk of suffering from schizophrenia is higher in cases where a family member is affected. [4] 

• Cerebral anomalies: brain’s abnormalities and its functioning have been observed in schizophrenics. These abnormalities could result from infection of the fetus during pregnancy or complications during childbirth. [5] 

• Environmental factors: exposure to stressful factors during childhood or adolescence, as well as the use of alcohol or drugs, particularly cannabis, can increase the risk of developing schizophrenia. [4] 

III. The symptoms 

Schizophrenia is characterized by numerous symptoms. They may vary from one person to another, are not always present at the same time, and the same person may present different symptoms at different stages of the illness. The symptoms of this pathology are generally classified into three categories: positive, negative and cognitive. [4] [5] 

Positive or productive symptoms: 

• Hallucinations: people with schizophrenia may experience unreal perceptions, such as hearing noises (auditory hallucinations), seeing things (visual hallucinations), smelling odors (olfactory hallucinations) or even experiencing unusual bodily sensations, such as electrical discharges (cenesthetic hallucinations). [5] 
• Delusions: these may be occasional or permanent, and often involve themes such as persecution or espionage, with no logical connection between the various delusional ideas. [5] 

Negative or deficit symptoms: 

• Demotivation: schizophrenic individuals frequently experience a lack of energy and motivation, preventing them from taking initiative or participating in even everyday activities. [5] 

• Depersonalization: this is a loss of sense of identity, often accompanied by anxiety. The schizophrenic person may feel that their body is separated from their person, or that their limbs are in danger of becoming detached. [5] 

• Emotional and social withdrawal: schizophrenic patients show a tendency to isolate themselves from the outside world and reduce social interactions, resulting in impoverished emotions and emotional relationships. [6] 

Cognitive or dissociative symptoms: 

• Thought and language disorders: schizophrenics may have difficulty organizing their ideas and lose their ability to reason logically. Their speech becomes confused, and they may have intrusive and excessive thoughts that disrupt their reasoning. [5] 

• Organizational difficulties: these are difficulties in planning simple daily tasks such as getting work done or running errands. [3] 

IV. Prevention

Prevention of schizophrenia is crucial, as it reduces the risk of the disease developing, improves treatment outcomes and limits the social and economic impact. Key measures include:  

• Early detection: early detection of at-risk individuals, before the onset of severe symptoms, is essential to prevent or delay the onset of schizophrenia, including early identification and treatment of warning signs in high-risk young people. [3] 

• Drugs use: all psychoactive substances, including cannabis, are strongly associated with the development of schizophrenia in young adults. Avoidance of these substances is therefore strongly recommended. [4] 

• Prenatal care: appropriate medical monitoring during pregnancy helps prevent complications that could alter the child’s cerebral development, and thus help reduce the risk of schizophrenia. [3] 

 V. Treatment

Schizophrenia is a chronic illness requiring long-term management. This management includes both drug treatments and non-drug approaches aimed at reducing symptoms and improving patients’ quality of life. 

Drug treatments are the most widely used approach in Africa, due to their relative accessibility and recognized efficacy: 

• Antipsychotic drugs: this is the main treatment for schizophrenia and is introduced gradually until an effective dose is reached. It should be continued for at least 2 years after a first episode and for more than 5 years after a second. [3] 

Non-medication approaches complement pharmacological treatments in the management of schizophrenia. However, their implementation is often hampered by a lack of training and awareness in Africa, highlighting the need to improve information and combat stigmatization. 

• Cognitive behavioral therapy: in addition to antipsychotic medication, this treatment is often used to help manage symptoms, prevent isolation and improve aspects such as self-esteem, stress management and social relationships. [3] 

• Cognitive rehabilitation: thanks to support aimed at improving impaired functions (attention, memory, organization) through exercises, role-playing and learning adapted to the patient. [3] 

• Social cognition sessions: occupational therapy and/or social and professional support sessions can also be considered as needed, developing skills for work, study and the patient’s social life. [3] 

• Patient psychoeducation: also known as therapeutic patient education (TPE), this will enable patients to gain a better understanding of their illness, symptoms, treatment, and health in general. [3] 

• Supporting and educating family and friends: this is essential to encourage the patient’s commitment to their treatment, while reassuring their families and facilitating a better understanding of the disease. [3] 

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POI 1012-01/25 

Sources : 

[1] Schizophrenia – Organisation mondiale de la santé (OMS)

[2] Schizophrénie et troubles délirants de l’adulte – Ameli 

[3] Schizophrénie – Inserm

[4] Schizophrénie – Institut du Cerveau

[5] Schizophrénie : symptômes – Vidal

[6] Schizophrénie et autres troubles psychotiques – Santé publique France