Schizophrenia Progression and Treatments

Medically Reviewed By William C. Lloyd III, MD, FACS
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Schizophrenia is a serious mental disorder that causes symptoms, including hallucinations, delusions, confused thinking and speech, as well as lack of emotion and withdrawal from society. The prognosis for people with schizophrenia varies widely according to the severity of their condition and treatment. Though schizophrenia doesn’t cause death directly, people with the disease are more likely to have other health conditions that shorten life expectancy. They also have a high rate of suicide, especially in the first years following diagnosis. Recent advances in treatment options; however, have improved the outlook for some people with schizophrenia.

How Schizophrenia Progresses

Schizophrenia is usually diagnosed in males in their late teens and early twenties, and in females in their late twenties to mid-thirties. The first signs often include depression, an inability to concentrate, withdrawal, and disturbed sleep. As the disease progresses, people develop psychotic symptoms like hallucinations and delusions.

About 15% of people with schizophrenia have only one episode and recover, but 70% will continue to have symptoms and require long-term medication and counseling. The other 15% of people with schizophrenia will have severe symptoms that render them unable to function in daily life.

The prognosis varies widely, but some of the key factors that affect it are:

  • Age: The older a person is when symptoms appear, the better the prognosis.
  • Sex: Females generally have a better prognosis than men.
  • Type of symptoms: People with “positive” symptoms like hallucinations and delusions have a better prognosis than those with “negative” symptoms like withdrawal and apathy.
  • Support: People who are married or who have a strong social network tend to have a better prognosis.

Schizophrenia shortens life expectancy, though it varies from person to person. In general, the lifespan of a person with schizophrenia can be 15 to 25 years less than the general population, because of associated conditions and circumstances, including:

  • Unhealthy lifestyle including smoking, poor nutrition, and lack of physical activity.
  • Infrequent medical care due to lifestyle and behavioral issues
  • Declining or refusing to take medication due to side effects or mental state
  • Committing suicide, which occurs in as many as 10% of people with schizophrenia. Medication, counseling, and other treatment can lower the likelihood of suicide.

Treatment Options for Improving Prognosis and Life Expectancy

People with schizophrenia who receive a diagnosis and begin treatment right away have a better prognosis than those who are not. People with schizophrenia may not take their prescriptions, however, because they are not aware they need them or because of unwanted side effects. When the symptoms of schizophrenia are controlled, prognosis and life expectancy improve. Newer medications have fewer side effects and people with schizophrenia may be more likely to take them.

The first-generation antipsychotics, which are still used, were developed in the 1950s. They can treat positive symptoms, such as hallucinations and delusions, but can make the negative symptoms worse, causing slurred speech, tremors, and tardive dyskinesia (uncontrolled muscle movement).

Second-generation antipsychotics appeared in the 1990s. They may be more effective in treating both positive and negative symptoms and don’t cause the movement and speech problems. However, they have other side effects, including sedation, low blood pressure, weight gain, and sexual dysfunction.

In 2019, the FDA approved lumateperone (Caplyta) for schizophrenia, which may be less likely to cause weight gain and other side effects. A skin patch containing asenapine (Secuado) can help both positive and negative symptoms in some people with schizophrenia, and the patch means that people don’t have to remember or refuse to take their medicine.

There are other drugs on the horizon. SEP-363856, currently designated by the FDA as a breakthrough therapy, may address a broader range of schizophrenia symptoms with fewer side effects. It is currently under evaluation for safety. KarXT, a novel antipsychotic that works differently than others, may also bring significant positive and negative symptom improvement and have fewer side effects.

Counseling and support are important factors in the treatment of schizophrenia, in addition to medication, that can improve prognosis, quality of life, and life expectancy.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Mar 18
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