Are People with Schizophrenia Better Off?

Despite improved identification and treatment of schizophrenia in recent decades, it appears the answer is no.

Two studies recently published by the Archives of General Psychiatry suggest that people with schizophrenia might not be doing as well as we would expect, given all of the advances in care for people with this disorder.

Schizophrenia is a serious debilitating mental disorder that strikes most people in their early to mid 20s. It’s characterized by the person experiencing either hallucinations or delusions (or both), and as a result, having an extremely difficult time coping with normal everyday activities. People with schizophrenia often have a hard time with ordinary thought processes, like following a “to-do” list or being able to concentrate on a task for any significant period of time. Psychologists refer to this problem as experiencing “cognitive impairment.”

The first study conducted by Goldberg and colleagues wanted to test the hypothesis that second-generation antipsychotic medications significantly enhance cognition (e.g., organized thought) in schizophrenia. They came up with this idea after a number of clinical trials have been published suggesting this was happening, but none of the clinical trials were designed to test specifically for this issue.

Unfortunately for people with schizophrenia, the researchers discovered that the latest, newest antipsychotic medications do little to help them with their thinking. In other words, the positive cognitive effects touted by some previous studies were found to be artifacts of the way those studies were designed, not effects of the medication itself.

There are many ways scientists measure how better off one person is over another in society. Economists do it via incomes, consumer spending and living conditions; educators look at how many people in a given segment graduated from high school or college; and psychologists might examine emotional factors and level of happiness. Surgeons often look at mortality rates to determine whether their colleagues are within the expected mortality rates for a given procedure.

The second study examined the mortality rate of people with schizophrenia across 37 published studies spanning 25 countries over the last 26 years (up until Jan. 1 2006). Despite improvements in mental health services in recent decades, it was unclear to the researchers whether the risk of mortality in schizophrenia has changed over time.

Rather than seeing the mortality rate decreasing over time for people with schizophrenia, as it is with the general population, the researchers actually found the mortality rate increasing. In other words, people with schizophrenia are dying more often than in the past. They blame this largely on people with schizophrenia not benefiting as much from general improvements in healthcare — they are either not seeking out healthcare or are not getting the same level of healthcare available to most people.

Part of that may be related to the illness itself, as the researchers note:

With respect to schizophrenia, the onset of the illness can result in a cascade of unhealthy lifestyle factors that elevate the risk of various somatic diseases and consequently increase the risk of death. People with schizophrenia are thought to be less inclined to seek health care, to consume less medical care, to engage in high risk behaviors, and to be less compliant with their treatments.

They also suggest that there may be gene or environmental factors that put people with schizophrenia at greater risk, especially from a general health perspective.

Because atypical antipsychotics are relatively new, not enough research has been conducted to assess whether they are helping to reduce the mortality rate of people with schizophrenia. Given what the researchers did find, however, we wouldn’t expect them to have much of a positive effect.

The problem lies with the fact that people with schizophrenia simply have (a) poorer health in general because they do not seek out or have access to typical health care services and (b) have a higher suicide rate related to the disorder itself. Atypical antipsychotics are likely to worsen (a) because they appear to carry a greater risk of weight gain and metabolic syndrome, but they may help (b), and therefore, have the potential to at least stabilize the mortality rates of people with schizophrenia. It’s simply too soon to tell though.

Philip over at Furious Seasons also has an interesting take on the latter study.

References:

Goldberg, T.E., Goldman, R.S., et. al. (2007). Cognitive Improvement After Treatment With Second-Generation Antipsychotic Medications in First-Episode Schizophrenia: Is It a Practice Effect? Archive of General Psychiatry, 64, 1115-1122.

Saha, S., Chant, D., & McGrath, J. (2007). A Systematic Review of Mortality in Schizophrenia: Is the Differential Mortality Gap Worsening Over Time? Archives of General Psychiatry, 64, 1123-1131.