Editing Schizophrenia (section)

==Prognosis==
{{Main|Prognosis of schizophrenia}}{{See also|Physical health in schizophrenia}}
[[File:Schizophrenia world map - DALY - WHO2004.svg|thumb|upright=1.3|[[Disability-adjusted life year]]s lost due to schizophrenia per 100,000&nbsp;inhabitants in 2004
{{Col-begin}}
{{Col-break}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|≤&nbsp;185}}
{{legend|#fff200|185–197}}
{{legend|#ffdc00|197–207}}
{{legend|#ffc600|207–218}}
{{legend|#ffb000|218–229}}
{{legend|#ff9a00|229–240}}
{{Col-break}}
{{legend|#ff8400|240–251}}
{{legend|#ff6e00|251–262}}
{{legend|#ff5800|262–273}}
{{legend|#ff4200|273–284}}
{{legend|#ff2c00|284–295}}
{{legend|#cb0000|≥&nbsp;295}}
{{col-end}}]]
<!-- Life expectancy -->
Schizophrenia has great human and economic costs.<ref name=Lancet2016/> It decreases life expectancy by between 10<ref name=Laursen2014/><!-- Laursen2014 shows a range of 10-25 in the article text--> and 28 years.<ref name=NIHStat/> This is primarily because of its association with heart disease,<ref name=Kritharides2017>{{cite journal |vauthors=Kritharides L, Chow V, Lambert TJ |date=6 February 2017 |title=Cardiovascular disease in patients with schizophrenia |journal=The Medical Journal of Australia |volume=206 |issue=2 |pages=91–95 |doi=10.5694/mja16.00650 |pmid=28152356 |s2cid=5388097}}</ref> diabetes,<ref name=NIHStat/> [[obesity]], poor diet, a [[sedentary lifestyle]], and smoking, with an increased rate of suicide playing a lesser role.<ref name=Laursen2014/><ref>{{cite journal | vauthors = Erlangsen A, Eaton WW, Mortensen PB, Conwell Y | title = Schizophrenia—a predictor of suicide during the second half of life? | journal = Schizophrenia Research | volume = 134 | issue = 2–3 | pages = 111–117 | date = February 2012 | pmid = 22018943 | pmc = 3266451 | doi = 10.1016/j.schres.2011.09.032 }}</ref> Side effects of antipsychotics may also increase the risk.<ref name=Laursen2014/>

Almost 40% of those with schizophrenia die from complications of cardiovascular disease which is seen to be increasingly associated.<ref name=Rastogi2020/> An underlying factor of sudden cardiac death may be [[Brugada syndrome]] (BrS) – BrS mutations that overlap with those linked with schizophrenia are the [[calcium channel]] mutations.<ref name=Rastogi2020/> BrS may also be drug-induced from certain antipsychotics and antidepressants.<ref name=Rastogi2020/> [[Primary polydipsia]], or excessive fluid intake, is relatively common in people with chronic schizophrenia.<ref>{{cite book| vauthors = Goroll AH, Mulley AG |title=Primary Care Medicine: Office Evaluation and Management of The Adult Patient |edition=Sixth|date=2011|publisher=Lippincott Williams & Wilkins|isbn=978-1-4511-2159-9|page=Chapter 101|url=https://books.google.com/books?id=fXpKo1afC2YC&pg=PT1766}}</ref><ref name=Rizvi2019>{{cite journal | vauthors = Rizvi S, Gold J, Khan AM | title = Role of Naltrexone in Improving Compulsive Drinking in Psychogenic Polydipsia. | journal = Cureus | date = 5 August 2019 | volume = 11 | issue = 8 | page =e5320 | doi = 10.7759/cureus.5320 | doi-access = free | pmid = 31598428| pmc = 6777931 }}</ref> This may lead to [[hyponatremia]] which can be life-threatening. Antipsychotics can lead to a [[Xerostomia#Drug induced xerostomia|dry mouth]], but there are several other factors that may contribute to the disorder; it may reduce life expectancy by 13 percent.<ref name=Rizvi2019/> Barriers to improving the mortality rate in schizophrenia are poverty, overlooking the symptoms of other illnesses, stress, stigma, and medication side effects.<ref>{{cite journal |vauthors=Seeman MV |s2cid=170078453 |title=Schizophrenia Mortality: Barriers to Progress |journal=The Psychiatric Quarterly |volume=90 |issue=3 |pages=553–563 |date=September 2019 |pmid=31147816 |doi=10.1007/s11126-019-09645-0}}</ref><ref name=":0">{{Cite book |last=Farrell |first=Michael |title=Controversies in schizophrenia: issues, causes, and treatment |date=2024 |publisher=Routledge, Taylor & Francis Group |isbn=978-1-003-41355-4 |location=New York, NY}}</ref><ref name=":1">{{Cite book |last1=Assis |first1=Jorge Cândido de |url=https://link.springer.com/10.1007/978-3-031-24556-5 |title=Between Reason and Illusion: Demystifying Schizophrenia |last2=Villares |first2=Cecília Cruz |last3=Bressan |first3=Rodrigo Affonseca |date=2023 |publisher=Springer Nature Switzerland |isbn=978-3-031-24555-8 |series=Copernicus Books |location=Cham |language=en |doi=10.1007/978-3-031-24556-5}}</ref>

<!-- Disability -->
Schizophrenia is a major cause of [[disability]]. In 2016, it was classed as the 12th most disabling condition.<ref>{{cite journal | vauthors = Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, McGrath JJ, Whiteford HA | title = Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016 | journal = Schizophrenia Bulletin | volume = 44 | issue = 6 | pages = 1195–1203 | date = October 2018 | pmid = 29762765 | pmc = 6192504 | doi = 10.1093/schbul/sby058 }}</ref> Approximately 75% of people with schizophrenia have ongoing disability with relapses.<ref>{{cite journal | vauthors = Smith T, Weston C, Lieberman J | title = Schizophrenia (maintenance treatment) | journal = American Family Physician | volume = 82 | issue = 4 | pages = 338–339 | date = August 2010 | pmid = 20704164}}</ref> Some people do recover completely and others function well in society.<ref>{{cite journal | vauthors = Warner R | s2cid = 26666000 | title = Recovery from schizophrenia and the recovery model | journal = Current Opinion in Psychiatry | volume = 22 | issue = 4 | pages = 374–380 | date = July 2009 | pmid = 19417668 | doi = 10.1097/YCO.0b013e32832c920b }}</ref> Most people with schizophrenia live independently with community support.<ref name=Lancet2009/> About 85% are unemployed.<ref name=Lancet2016/> In people with a first episode of psychosis in schizophrenia a good long-term outcome occurs in 31%, an intermediate outcome in 42% and a poor outcome in 31%.<ref>{{cite journal | vauthors = Menezes NM, Arenovich T, Zipursky RB | s2cid = 23475454 | title = A systematic review of longitudinal outcome studies of first-episode psychosis | journal = Psychological Medicine | volume = 36 | issue = 10 | pages = 1349–62 | date = October 2006 | pmid = 16756689 | doi = 10.1017/S0033291706007951 | url = https://pdfs.semanticscholar.org/8539/923c1b4f6bacb128d478b9ec7f6e95559210.pdf | archive-url = https://web.archive.org/web/20200922015257/https://pdfs.semanticscholar.org/8539/923c1b4f6bacb128d478b9ec7f6e95559210.pdf | archive-date = 22 September 2020}}</ref> Males are affected more often than females, and have a worse outcome.<ref>{{cite book |vauthors=Coyle JT |title=Neurodegenerative Diseases |chapter=Schizophrenia: Basic and Clinical |series=Advances in Neurobiology |volume=15 |pages=255–280 |date=2017 |pmid=28674984 |doi=10.1007/978-3-319-57193-5_9|isbn=978-3-319-57191-1 }}</ref> Studies showing that outcomes for schizophrenia appear better in the [[developing world|developing]] than the [[developed world]]<ref name=Isa07>{{cite journal | vauthors = Isaac M, Chand P, Murthy P | title = Schizophrenia outcome measures in the wider international community | journal = The British Journal of Psychiatry. Supplement | volume = 50 | pages = s71–77 | date = August 2007 | pmid = 18019048 | doi = 10.1192/bjp.191.50.s71 | doi-access = free }}</ref> have been questioned.<ref>{{cite journal | vauthors = Cohen A, Patel V, Thara R, Gureje O | title = Questioning an axiom: better prognosis for schizophrenia in the developing world? | journal = Schizophrenia Bulletin | volume = 34 | issue = 2 | pages = 229–244 | date = March 2008 | pmid = 17905787 | pmc = 2632419 | doi = 10.1093/schbul/sbm105 }}</ref> Social problems, such as long-term unemployment, poverty, homelessness, exploitation, [[Mental disorder#Stigma|stigmatization]] and victimization are common consequences, and lead to [[social exclusion]].<ref name=Killaspy2014/><ref name=Charleson2018/><ref name=":0" /><ref name=":1" />

<!-- Suicide -->
There is a higher than average [[suicide rate]] associated with schizophrenia estimated at 5% to 6%, most often occurring in the period following onset or first hospital admission.<ref name=Ferri2019>{{cite book |title=Ferri's clinical advisor 2019: 5 books in 1 |pages=1225–1226|date=2019 |isbn=9780323530422 | vauthors = Ferri FF |publisher=Elsevier }}</ref><ref name=Jop2010/> Several times more (20 to 40%) attempt suicide at least once.<ref name=DSM5/><ref name=Chiang2016/> There are a variety of risk factors, including male sex, depression, a high [[IQ]],<ref>{{cite journal | vauthors = Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström P | s2cid = 204385719 | title = Suicide in schizophrenia | journal = Expert Review of Neurotherapeutics | volume = 10 | issue = 7 | pages = 1153–1164 | date = July 2010 | pmid = 20586695 | doi = 10.1586/ern.10.82 | doi-access = free }}</ref> heavy smoking,<ref>{{cite journal |vauthors=Tsoi DT, Porwal M, Webster AC |title=Interventions for smoking cessation and reduction in individuals with schizophrenia |journal=The Cochrane Database of Systematic Reviews |issue=2 |page=CD007253 |date=28 February 2013 |volume=2013 |pmid=23450574|doi=10.1002/14651858.CD007253.pub3|pmc=6486303 }}</ref> and substance use.<ref name=Khokhar2018/> Repeated relapse is linked to an increased risk of suicidal behavior.<ref name=Taylor2019/> The use of clozapine can reduce the risk of suicide, and of aggression.<ref>{{cite journal |vauthors=Sriretnakumar V, Huang E, Müller DJ |date=2015 |title=Pharmacogenetics of clozapine treatment response and side-effects in schizophrenia: an update |journal=Expert Opinion on Drug Metabolism & Toxicology |volume=11 |issue=11 |pages=1709–1731 |doi=10.1517/17425255.2015.1075003 |pmid=26364648 |s2cid=207492339}}</ref>

<!-- Drug use -->
A strong association between [[schizophrenia and tobacco smoking]] has been shown in worldwide studies.<ref>{{cite journal | vauthors = de Leon J, Diaz FJ | s2cid = 32975940 | title = A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors | journal = Schizophrenia Research | volume = 76 | issue = 2–3 | pages = 135–157 | date = July 2005 | pmid = 15949648 | doi = 10.1016/j.schres.2005.02.010 }}</ref><ref name=Keltner2006>{{cite journal | vauthors = Keltner NL, Grant JS | title = Smoke, smoke, smoke that cigarette | journal = Perspectives in Psychiatric Care | volume = 42 | issue = 4 | pages = 256–261 | date = November 2006 | pmid = 17107571 | doi = 10.1111/j.1744-6163.2006.00085.x }}</ref> [[Tobacco smoking|Smoking]] is especially high in those diagnosed with schizophrenia, with estimates ranging from 80 to 90% being regular smokers, as compared to 20% of the general population.<ref name=Keltner2006/> Those who smoke tend to smoke heavily, and additionally smoke cigarettes with high nicotine content.<ref name=DSMIV/> Some propose that this is in an effort to improve symptoms.<ref>{{cite journal | vauthors = Kumari V, Postma P | s2cid = 15581894 | title = Nicotine use in schizophrenia: the self medication hypotheses | journal = Neuroscience and Biobehavioral Reviews | volume = 29 | issue = 6 | pages = 1021–1034 | date = January 2005 | pmid = 15964073 | doi = 10.1016/j.neubiorev.2005.02.006 }}</ref> Among people with schizophrenia use of cannabis is also common.<ref name=Khokhar2018/>

Schizophrenia leads to an increased risk of dementia.<ref>{{cite journal |vauthors=Cai L, Huang J |title=Schizophrenia and risk of dementia: a meta-analysis study |journal=Neuropsychiatr Dis Treat |volume=14 |issue= |pages=2047–2055 |date=2018 |pmid=30147318 |pmc=6095111 |doi=10.2147/NDT.S172933 |doi-access=free }}</ref>

===Violence===
Most people with schizophrenia are not aggressive, and are more likely to be victims of violence rather than perpetrators.<ref name=DSM5/> People with schizophrenia are commonly exploited and victimized by violent crime as part of a broader dynamic of social exclusion.<ref name=Killaspy2014/><ref name=Charleson2018/> People diagnosed with schizophrenia are also subject to forced drug injections, seclusion, and restraint at high rates.<ref name=BeckerKilian2006/><ref name=Capdevielle2009/>

The risk of violence by people with schizophrenia is small. There are minor subgroups where the risk is high.<ref name=Richard-Devantoy2009>{{cite journal |vauthors=Richard-Devantoy S, Olie JP, Gourevitch R |title=[Risk of homicide and major mental disorders: a critical review] |journal=L'Encephale |volume=35 |issue=6 |pages=521–530 |date=December 2009 |pmid=20004282 |doi=10.1016/j.encep.2008.10.009}}</ref> This risk is usually associated with a comorbid disorder such as a substance use disorder – in particular alcohol, or with antisocial personality disorder.<ref name=Richard-Devantoy2009/> Substance use disorder is strongly linked, and other risk factors are linked to deficits in cognition and social cognition including facial perception and insight that are in part included in [[theory of mind]] impairments.<ref>{{cite journal |vauthors=Ng R, Fish S, Granholm E |title=Insight and theory of mind in schizophrenia. |journal=Psychiatry Research |volume=225 |issue=1–2 |pages=169–174 |date=30 January 2015 |pmid=25467703 |doi=10.1016/j.psychres.2014.11.010|pmc=4269286 }}</ref><ref>{{cite journal |vauthors=Bora E |title=Relationship between insight and theory of mind in schizophrenia: A meta-analysis |journal=Schizophrenia Research |volume=190 |pages=11–17 |date=December 2017 |pmid=28302393 |doi=10.1016/j.schres.2017.03.029|s2cid=36263370 }}</ref> Poor cognitive functioning, decision-making, and facial perception may contribute to making a wrong judgement of a situation that could result in an inappropriate response such as violence.<ref>{{cite journal |vauthors=Darmedru C, Demily C, Franck N |title=[Preventing violence in schizophrenia with cognitive remediation] |journal=L'Encephale |volume=44 |issue=2 |pages=158–167 |date=April 2018 |pmid=28641817 |doi=10.1016/j.encep.2017.05.001}}</ref> These associated risk factors are also present in antisocial personality disorder which when present as a comorbid disorder greatly increases the risk of violence.<ref>{{cite journal | vauthors = Richard-Devantoy S, Bouyer-Richard AI, Jollant F, Mondoloni A, Voyer M, Senon JL | title = [Homicide, schizophrenia and substance abuse: a complex interaction] | journal = Revue d'Épidemiologie et de Santé Publique | volume = 61 | issue = 4 | pages = 339–350 | date = August 2013 | pmid = 23816066 | doi = 10.1016/j.respe.2013.01.096 }}</ref><ref>{{cite journal | vauthors = Sedgwick O, Young S, Baumeister D, Greer B, Das M, Kumari V | title = Neuropsychology and emotion processing in violent individuals with antisocial personality disorder or schizophrenia: The same or different? A systematic review and meta-analysis | journal = The Australian and New Zealand Journal of Psychiatry | volume = 51 | issue = 12 | pages = 1178–1197 | date = December 2017 | pmid = 28992741 | doi = 10.1177/0004867417731525 | s2cid = 206401875 | doi-access = free }}</ref>