Schizophrenia social impact

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2] Irfan Dotani

Social Impact and Misconceptions

• Views held by the public about mental disorders, including schizophrenia, may not coincide with available evidence or with the views held by some mental health professionals.

Treatment

• Some psychiatrists believe patients can be discouraged by friends or family members from taking prescribed medication because of the latters' non-biological views of mental disorders.
• There is scientific difference of opinion about the use of medication in schizophrenia.
• Consumers' views on treatment and recovery may differ from those of mental health professionals.

Violence

• The relationship between violent acts and schizophrenia is a contentious topic.
• One survey found that 61% of Americans judged individuals with schizophrenia as likely to commit an act of interpersonal violence, while only 17% thought such an act likely to be committed by a person described as "troubled".

• Research on violence indicates that the percentage of people with schizophrenia who commit violent acts is several times higher than the percentage of people without any disorder, but lower than is found for disorders such as alcoholism, and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse.
• Studies have indicated that 5 to 10% of those charged with murder in Western countries have a schizophrenia spectrum disorder.

• The occurrence of psychosis in schizophrenia has sometimes been linked to a higher risk of violent acts. Findings on the specific role of delusions or hallucinations have been inconsistent, but have focused on delusional jealousy, perception of threat and command hallucinations.
• It has been proposed that a certain type of individual with schizophrenia may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to diagnosis.

• A consistent finding is that individuals with a diagnosis of schizophrenia are often the victims of violent crime—at least 14 times more often than they are perpetrators.
• Another consistent finding is a link to substance misuse, particularly alcohol, among the minority who commit violent acts. Violence by or against individuals with schizophrenia typically occurs in the context of complex social interactions within a family setting, and is also an issue in clinical services and in the wider community.
• Despite its etymology, schizophrenia is not synonymous with dissociative identity disorder, previously known as multiple personality disorder or split personality; in popular culture the two are often confused.

Diagnostic Issues and Controversies

• Schizophrenia as a diagnostic entity has been criticized as lacking in scientific validity or reliability, part of a larger criticism of the validity of psychiatric diagnoses in general.
• One alternative suggests that the issues with the diagnosis would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill.
• This approach appears consistent with research on schizotypy and of a relatively high prevalence of psychotic experiences and often non-distressing delusional beliefs amongst the general public.

• Another criticism is that the definitions used for criteria lack consistency; this is particularly relevant to the evaluation of delusions and thought disorder.
• More recently, it has been argued that psychotic symptoms are not a good basis for making a diagnosis of schizophrenia as "psychosis is the 'fever' of mental illness — a serious but nonspecific indicator".

• Perhaps because of these factors, studies examining the diagnosis of schizophrenia have typically shown relatively low or inconsistent levels of diagnostic reliability.
• Most famously, David Rosenhan's 1972 study, published as On being sane in insane places, demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable.
• More recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at best.
• This, and the results of earlier studies of diagnostic reliability (which typically reported even lower levels of agreement), have led some critics to argue that the diagnosis of schizophrenia should be abandoned.

• In 2004 in Japan, the Japanese term for schizophrenia was changed from Seishin-Bunretsu-Byo (mind-split-disease) to Tōgō-shitchō-shō (integration disorder).
• In 2006, campaigners in the UK, under the banner of Campaign for Abolition of the Schizophrenia Label, argued for a similar rejection of the diagnosis of schizophrenia and a different approach to the treatment and understanding of the symptoms currently associated with it.

• Alternatively, other proponents have put forward using the presence of specific neurocognitive deficits to make a diagnosis.
• These take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving.
• It is these sorts of difficulties, rather than the psychotic symptoms (which can in many cases be controlled by antipsychotic medication), which seem to be the cause of most disability in schizophrenia.
  • However, this argument is relatively new and it is unlikely that the method of diagnosing schizophrenia will change radically in the near future.

• The diagnosis of schizophrenia has been used for political rather than therapeutic purposes.
• In the Soviet Union, an additional sub-classification of sluggishly progressing schizophrenia was created.
  • Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), this diagnosis was used for the purpose of silencing political dissidents or forcing them to recant their ideas by the use of forcible confinement and treatment.
• In 2000, there were similar concerns regarding detention and 'treatment' of practitioners of the Falun Gong movement by the Chinese government.
• This led the American Psychiatric Association's Committee on the Abuse of Psychiatry and Psychiatrists to pass a resolution to urge the World Psychiatric Association to investigate the situation in China.