How Does Schizophrenia Affect Daily Life?

Summary: Schizophrenia can affect daily life by causing changes in the brain that alter the way a person thinks, feels, and experiences the world. Symptoms can partially or completely disrupt work, school, relationships, and self-care.

Key Points:

• Cognitive changes caused by schizophrenia can make it difficult to carry out basic daily tasks, especially when they involve interacting with other people.
• Symptoms such as hallucinations and/or delusions may impair contact with reality, which can make it difficult to work and/or go to school.
• Cognitive changes caused by schizophrenia include reduced emotional expressiveness and reduced motivation to communicate, which reduces the ability to form lasting and meaningful relationships.

How Many People Have Schizophrenia?

The report “An Evaluation Of Variation In Published Estimates Of Schizophrenia Prevalence From 1990─2013: A Systematic Literature Review” offers the best and most recent large scale data on the prevalence of schizophrenia in the U.S.

The report shows that close to 850,000 people had a schizophrenia diagnosis in the past year, and about 1.25 million people had a schizophrenia diagnosis during their lifetime.

That’s roughly 0.33 and 0.50 percent of the total adult population, respectively.

How does schizophrenia affect daily life for this group of people?

Let’s take a closer look at the symptoms to get a better understanding of their experience.

The Symptoms of Schizophrenia and How Symptoms of Schizophrenia Affect Daily Life

It’s important to understand that all the symptoms we share below exist on a continuum from mild to moderate to severe. The more severe the disorder, the more severe the difficulty and disruption the symptoms of schizophrenia affect daily life.

For the following information, we used resources such as “Schizophrenia,” published by the National Library of Medicine, and “Schizophrenia: Professional Guide,” published in Merck Manual: Professional Version.

People with schizophrenia are likely to experience several types of symptoms that affect their daily life. For this article, we’ll divide them into three categories:

1. Positive symptoms, also called psychotic symptoms.
2. Negative symptoms, associated with emotion and motivation
3. Cognitive symptoms, associated with thoughts and thinking

Positive symptoms include:

• Hallucinations
• Delusions
• Disorganized speech
• Disorganized behavior
• Catatonia

Negative symptoms include:

• Reduced/low facial expressiveness
• Reduced/low level of interest in talking
• Decreased interest in social interaction or relationships

Cognitive symptoms include:

• Problems with attention
• Reduced processing speed
• Impaired memory
• Difficulty problem solving

It’s easy to see how these symptoms can cause problems with the typical responsibilities of daily life. However, with professional treatment – most often involving antipsychotic medication and psychotherapy – a person diagnosed with schizophrenia can achieve remission of many of the most disruptive symptoms.

But what happens if a person with schizophrenia doesn’t get treatment?

The Consequences of Delaying, Denying, or Discontinuing Treatment

When schizophrenia goes undiagnosed and a person with schizophrenia doesn’t receive/commit to treatment, or when a person with schizophrenia voluntarily discontinues medication and therapy, the consequences impact everyone involved. They affect the person with schizophrenia, their family, friends, and loved ones. Therefore, one thing that determines how schizophrenia can affect daily life is whether a person receives an accurate, timely diagnosis. And further, the impact of schizophrenia on daily life depends on whether the individual receives and adheres to treatment.

Untreated schizophrenia is associated with negative outcomes in the following areas of daily life:

Social, Family, Friends

• Strained interpersonal relationships with family
• Problems establishing and maintaining relationships with friends
• Difficulty establishing and maintaining romantic relationships/partnerships
• Isolation

Behavioral

• Suicidality
• Alcohol/substance misuse
• Co-occurring mental health disorders
• Withdrawal from friends and family
• Aggression

Note: the idea that people with schizophrenia are by default violent and dangerous to people around them is false. In fact, a person with schizophrenia is more likely to be the victim, rather than the perpetrator, of any type of violence. Aggression in people with schizophrenia is the result of the combination of high emotion, frustration, and confusion, rather than a propensity for or drive to harm others.

Functional

• Reduced academic ability/educational achievement
• Reduced vocational ability/achievement
• Financial difficulty
• Homelessness
• Chronic illness

Treatment for schizophrenia most often involves antipsychotic medication, psychotherapy, and family participation in treatment. When clinicians combine these modalities and augment them with support designed to improve functional capacity and self-efficacy, it’s called Coordinated Specialty Care (CSC). Treatment with CSC includes:

• Collaboration between clinicians, family, and patients
• Individual and group psychotherapy
• Family participation and education
• Medication
• Case management
• Support to improve educational and vocational capacity

The earlier a person receives treatment after diagnosis, the better the outcome. Intensive treatment can reduce the degree to which the symptoms of schizophrenia affect daily life.

Schizophrenia Across the Lifespan: How Symptoms of Schizophrenia Affect Daily Life Over Time

The course of the disorder and the prognosis for a person diagnosed with schizophrenia depends on several factors.

With some exceptions, patients with rapid onset later in life – early to mid-20s – experience a less disruptive form of the disorder. Other factors associated with positive outcomes include:

• High level of functioning before onset
• Minor cognitive impairment
• Minor negative symptoms
• Early intervention after diagnosis

In contrast, when symptoms appear earlier in life, the disorder is often more disruptive. Factors associated with long-term difficulties include:

• Early onset of symptoms, such as subthreshold psychosis during early adolescence
• Low level function before onset
• Presence of schizophrenia in family
• Significant negative symptoms
• Delayed intervention after onset of symptoms

With the use of antipsychotic medication, between 15 and 25 percent of patients who experience first-episode psychosis (FEP) associated with schizophrenia experience remission of symptoms and return to pre-diagnosis level of function. Close to 40 percent have significant long-term problems, and nearly 10 percent of people with schizophrenia die by suicide.

Despite the effectiveness of antipsychotic medication in reducing hallucinations and delusions, recent research shows the cumulative impact of cognitive changes over years may explain the frequency of long-term problems and increased rate of suicide. Those long-term outcomes are instructive and reveal the depth with which the symptoms of schizophrenia affect daily life.

There is good news, however. Experts indicate that an over-emphasis on psychotic symptoms and a lesser emphasis on cognitive deficiencies may be changing, and a new treatment focus – as seen in the CSC model – that prioritizes family involvement, case management, and practical support to increase daily functional efficacy can help mitigate the impact of symptoms of schizophrenia on daily life, and improve both short- and long-term outcomes for people with schizophrenia.