Content area
Full Text
How will weview schizophrenia in 2030? Schizophrenia today is a chronic, frequently disabling mental disorder that affects about one per cent of the world's population. After a century of studying schizophrenia, the cause of the disorder remains unknown. Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia. These current unsatisfactory outcomes may change as we approach schizophrenia as a neurodevelopmental disorder with psychosis as a late, potentially preventable stage of the illness. This 'rethinking' of schizophrenia as a neurodevelopmental disorder, which is profoundly different from the way we have seen this illness for the past century, yields new hope for prevention and cure over the next two decades.
The challenge of creating a vision of schizophrenia for 2030, which I attempt here, is a difficult one. There is certainly a risk in predicting scientific progress-the most important discoveries will probably be ones we cannot imagine today. But it is equally true that we can use past experience and the present state of knowledge to predict some aspects of the future. For schizophrenia, our knowledge base in 2010 is mostly based on clinical observation.
Schizophrenia is a syndrome: a collection of signs and symptoms of unknown aetiology, predominantly defined by observed signs of psychosis. In itsmost commonform, schizophrenia presents with paranoid delusions and auditory hallucinations late in adolescence or in early adulthood.These manifestations of the disorder have changed little over the past century.
A century ago we had large public institutions for seriousmental illness, tuberculosis and leprosy. Of these three, today only mental illness, especially schizophrenia, remains unchanged in prevalence and disability1.
Sustained recovery occurs in less than 14% within the first five years following a psychotic episode2. Longer-term outcomesmay be marginally better: a large international 25-year follow-up study reported an additional 16% with late-phase recovery3. Throughout Europe, less than 20% of people with schizophrenia are employed4. A large US study found nearly 20% homeless in a one-year follow up5. And a recent report froma patient advocacy group reported that in the US those with serious mental illness were three times more likely to be found in the criminal justice system than in...