Foreword

Summary

Schizophrenia may be the leading unsolved disease afflicting humans. Ranked fourth among causes of disability worldwide, the disease syndrome is associated with an immense financial burden for clinical care and living support across the 50 or so years that the average patient is identified as ill. Secondary costs in lost productivity, homelessness and entanglement with law enforcement are also high, but the most poignant burden of illness is experienced by patients and their families. Subtle impairments in information processing and neurointegrative function are often present from birth, curtailing achievement and social engagement years before hallucinations, delusions, disorganized thought and behaviour make public the presence of illness and the need for treatment. Erosion of the fundamental building blocks of human experience lead to a reduced level of functioning and quality of life. Stigma further pains and isolates the person who suffers from this illness. The picture is also complicated by low drive and restricted affect in many patients, and dysphoric mood and suicide in others. Patients are at increased risk for drug abuse, and intense nicotine consumption causes additional health problems. Although illness manifestations, treatment response, course pattern and functional outcome are quite variable, most life stories reflect serious adverse effects of schizophrenia.

Treatment remains a part-way technology. Antipsychotic drugs and supportive and educationally oriented psychosocial therapies reduce psychotic symptoms and relapse rate, but no treatment is documented as efficacious for primary negative symptom and cognitive impairments.