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Prognosis for People with Schizophrenia

Learn what the prognosis is for people with schizophrenia from psychiatrist Jeanie Tse in this Howcast video.


Hi. I'm Jeanie Tse, and I'm here to talk to you about the prognosis or expected outcome for people with schizophrenia. The prognosis is very variable so some people do very well and some do not do so well. We know from the international study of schizophrenia that at least half of people have a favorable outcome over time, which is very encouraging for people who are really struggling with the illness initially.

We know too that the course in the first two years of the illness predicts how the course will be over time. Risk factors for better functioning and better prognosis in schizophrenia include being female, having a more sharp onset, so instead of a long, what we call, prodromal period of deterioration of functioning. If you suddenly develop a lot of paranoia or hallucinations all at once, that's actually a sign for better prognosis in schizophrenia.

So, some of the strengths that can be protective for people who have schizophrenia include having good, what we call, premorbid functioning. So, before you were ill; if you were able to work, being able to have good relationships, if you have a higher IQ. Those kinds of things can be protective. Having a support network is a very important strength. Being able to develop and maintain that support network is a very important strength that bodes well for someone with schizophrenia.

We know that people who have schizophrenia have up to a 25 year earlier mortality compared to the general population, which is a frightening figure, actually. That's looking at mortality rates closer to those in developing countries. From the media, we would think it'd be due to the mental illness itself, or to suicide or violence, but in fact the increased mortality happens due to heart disease, diabetes, and lung disease, just like for the general population.

So, what we know is that people with schizophrenia and other serious mental illnesses, like bipolar disorder and major depression, are more at risk for developing those illnesses. There's a lot of reasons for that, including difficulties with self care, some of the medications cause weight gain and higher cholesterol, and a risk for diabetes, not having access to resources, like healthy foods.

The negative symptoms that make you more likely to not want to exercise, to not want to be active. All of those thing contribute to the increased risk of mortality. And there's a high rate of smoking, too, among people with schizophrenia and a higher rate of substance use as well, meaning people try to self medicate using substances and so those present risks to physical health as well leading to the early mortality.

There's estimates that at least 60 percent of the increased mortality and, what we call, morbidity or illness burden of schizophrenia can be treated and prevented, and so working with treatment providers and taking care of yourself are ways of addressing that risk.

The risk of suicide in schizophrenia is serious. About five percent of people with schizophrenia do die by suicide and about 20 to 40 percent attempt. So, that's higher than the general population, still a minority of people with schizophrenia. It does tend to occur among younger people around their first few episodes. When, generally, it's the people who were doing best before they became ill who had the most insight into the fact that they've lost a lot because of the illness, who are most at risk for suicide. It's that sense of despair and hopelessness when they feel like they cannot achieve the goals that they had had for themselves and have lost their quality of life. That's the biggest risk for suicide.

And so, that's why that's a sensitive period. And we really need to support young people who have schizophrenia, to feel like there's hope and to get back on track with their goals and to learn about their illness and what they need to self manage their illness.

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