Schizophrenia

Schizophrenia is a chronic, severe, and disabling biologic brain disorder that has been recognized throughout recorded history. It affects about one percent of Americans and seriously impairs a persons’s ability to think clearly and relate to others.

People with schizophrenia may hear voices other people don’t hear or they may believe that others are reading their minds, controlling their thoughts, or plotting to harm them. They have trouble distinguishing between what is real and what is imaginary and may become withdrawn or have difficulty in everyday situations. Schizophrenia typically develops in adolescence or early adulthood, although it may occur later in life. It usually progresses slowly and varies among patients in its severity.

Symptoms of Schizophrenia fall into three broad categories:

Positive symptoms are unusual thoughts or perceptions, including hallucinations, delusions, thought disorder and disorders of movement that are "added" to an individual’s way of interacting with the world. These include visual, auditory, and/or tactile hallucinations [seeing, hearing, and feeling things that don’t exist], persistent delusions [false beliefs, that aren’t changed by reason or evidence], paranoid delusions, and disorganized or unusual thought processes and speech. Side effects or symptoms of medications also include movement disorders, including clumsiness, uncoordinated or involuntary movements, and rarely, catatonia.

Negative symptoms represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression. Examples include blunted emotions, inability to begin and follow through with activities, social withdrawal, negligent hygiene, and displeasure or disinterest in life.

As the illness progresses, these symptoms often become more intense. Schizophrenia often works in cycles, meaning the disease may get better and then reoccur at a latter date.

"While the word ‘Schizophrenia’ is less than 100 years old , the illness itself is generally believed to have been present in humans since the beginning of mankind". Worldwide, it is estimated that one person in every 100 develops schizophrenia and there currently are more than two million Americans who have schizophrenia , with men and women affected equally. Because of the typically early age of onset, and the lifelong burden of the disease on patients’ emotional and physical well-being, schizophrenia can be considered one of the most debilitating conditions.

According to the American Psychiatric Association, patients’ with schizophrenia occupy more hospital beds than do patients with almost any other illness. Federal costs of the disease total between $30 billion and $48 billion a year, when direct medical costs, lost productivity, and Social Security payments are considered. It is estimated that 50% to 80% of patients with schizophrenia live with or have routine contact with family members who are their care-givers. Other estimates therefore place the overall cost of schizophrenia at nearly $63 billion, when direct healthcare, societal, and family and care-giver costs are totaled.

Although the cause of schizophrenia remains unknown, antipsychotic medications can help people with this illness function better and more appropriately. In conjunction with counseling programs designed to help people manage and cope with their behavioral symptoms, these medications have been proven to significantly alleviate psychotic symptoms and reduce the chances that symptoms will return. Given the important role that medications play in allowing for symptom reduction or alleviation, continuity of medication therapy must receive highest priority.

In certain environments, systems designed to serve mental health patients and their care-givers experience serious shortcomings when it comes to the level and depth of communication, cooperation, and coordination of treatment and services necessary to avoid service fragmentation and discontinuity.

To address this, the National Council for Community Behavioral Healthcare released recommended new approaches to provide seamless continuity of treatment for people with schizophrenia and other serious mental illnesses. The National Council consensus statement was prepared by a 24-member panel composed of leading accrediting organizations, hospitals and community treatment organizations, patients, family members, researchers, state authorities, and psychiatric leaders. The findings, presented at the 37th Annual National Conference of the organization, focus on breaking down barriers between systems of care. The expert panel developed recommendations that address administrative, professional, and human elements required to ensure complete continuity of care.

Specific recommendations are as follows:

Encourage collaboration between hospitals and community-based organizations

Use a quality improvement approach to enhance continuity of therapy by bench-marking performance and outcomes standards at the organizational level.

Ensure that all patients have a level of care management for the transition from inpatient to community including reimbursable care management services by all payers.

Focus on the "Pull Model" of transition from inpatient to outpatient care by involving community providers in the transition before patients get discharged.

Align Accreditation standards that address and improve continuity of therapy.

Educate patients and their families on the importance of maintaining a personal heath-care history.

Promote more thoughtful use of inpatient services to reduce emergency room use and eventually decrease the number of hospitalizations.

Share data about mental health services with appropriate organizations in usable and timely ways.

Involve patients and their advocates in all levels of system delivery and evaluation.

Sources:

1. MedicineNet.com. Schizophrenia. November 5, 2007

2. The National Council For Community Behavioral Healthcare. Backgrounder: Schizophrenia and Continuity of Therapy Overview. March 27, 2007