Question 1

What is schizophrenia?

Accepted Answer

Schizophrenia is a severe mental disorder characterised by psychosis — a disrupted relationship with reality. It causes positive symptoms (hallucinations, most commonly auditory voices; delusions — fixed false beliefs; disorganised thinking); negative symptoms (flat affect, avolition, social withdrawal, poverty of speech); and cognitive impairment affecting memory, attention and executive function. It begins typically in late adolescence or early adulthood and affects approximately 1 in 300 people worldwide.

Question 2

What causes schizophrenia?

Accepted Answer

Schizophrenia results from complex gene-environment interactions. Genetic factors: approximately 80% heritability; over 100 common genetic variants contribute small risks; rare copy number variants (22q11.2 deletion) confer large risks. Environmental factors: prenatal infections (influenza, toxoplasma), urban birth, cannabis use (particularly high-potency cannabis), childhood adversity and trauma, migration stress, and head trauma. Neurodevelopmental changes (dopamine dysregulation, glutamate dysfunction, cortical thinning) are the neurobiological basis.

Question 3

How is schizophrenia treated?

Accepted Answer

Treatment combines antipsychotic medication and psychosocial support. Antipsychotics: first-generation (haloperidol, chlorpromazine) and second-generation (olanzapine, risperidone, quetiapine, aripiprazole, clozapine for treatment-resistant cases) reduce positive symptoms effectively in approximately 70% of patients. Psychosocial: cognitive behavioural therapy for psychosis (CBTp); family therapy; assertive community treatment; supported employment; social skills training. Long-acting injectable antipsychotics (LAIs) improve adherence. Early intervention in first episode psychosis is critical.

Question 4

What is clozapine?

Accepted Answer

Clozapine is the most effective antipsychotic — uniquely effective for the 30% of patients with treatment-resistant schizophrenia (who do not respond to two adequate antipsychotic trials). It also reduces suicide risk. Its use requires regular blood count monitoring (every 1-4 weeks) due to the rare but potentially fatal risk of agranulocytosis. Despite compelling evidence, clozapine is severely underprescribed — even in high-income countries — due to monitoring requirements and prescriber unfamiliarity.

Question 5

Why do people with schizophrenia die so early?

Accepted Answer

People with schizophrenia die 10-20 years earlier than the general population — predominantly from preventable physical health conditions. Causes: cardiovascular disease (higher rates of smoking, obesity, metabolic syndrome from antipsychotics, diabetes, hypertension — all underscreened and undertreated); respiratory disease; suicide; and accidents. The mortality gap has widened rather than narrowed despite improved psychiatric treatments — reflecting inadequate integration of physical health care into mental health services.

Question 6

What is the treatment gap for schizophrenia?

Accepted Answer

69% of people with schizophrenia in LMICs receive no mental health care. Even in high-income countries, many receive inadequate or delayed treatment. Barriers: insufficient mental health infrastructure (few psychiatrists, limited community services); severe stigma preventing help-seeking and disclosure; poverty (schizophrenia causes inability to work and financial dependence); rights violations in some settings (forced treatment, institutionalisation); and family caregiver burden without adequate support. WHO's mhGAP programme aims to close this gap through primary care integration.

Question 7

What is first episode psychosis and why does early treatment matter?

Accepted Answer

First episode psychosis (FEP) is the initial presentation of psychotic symptoms. Duration of untreated psychosis (DUP) — the time between first symptoms and treatment — is a critical predictor of long-term outcomes: longer DUP predicts worse symptom response, more relapses and poorer functional recovery. Early intervention programmes (EIP) — providing rapid access to antipsychotics, CBTp, family education and vocational support — achieve substantially better outcomes than standard care. Reducing DUP is a global priority.

Question 8

Does cannabis cause schizophrenia?

Accepted Answer

High-potency cannabis (containing high THC concentrations) substantially increases schizophrenia risk — approximately 5-fold for daily high-potency use (Di Forti et al., Lancet Psychiatry 2019). The risk is highest when use begins in adolescence, when the brain is most vulnerable, and in people with genetic predisposition. Approximately 30% of schizophrenia cases in high-cannabis-use populations may be attributable to high-potency cannabis. With the increasing availability of high-potency products globally, this represents a significant preventable psychosis risk.

Question 9

What human rights issues affect people with schizophrenia?

Accepted Answer

People with schizophrenia experience systematic human rights violations: forced hospitalisation and coercive treatment; physical restraint and seclusion; chaining to beds or walls in some settings; institutionalisation in conditions of deprivation; police encounters and criminalisation; homelessness; denial of legal capacity (decisions made by others); discrimination in employment, housing and healthcare. WHO's QualityRights initiative supports countries to transform mental health practice toward rights-based, recovery-oriented, community-based care.

Question 10

What is schizoaffective disorder?

Accepted Answer

Schizoaffective disorder involves concurrent psychotic symptoms (hallucinations, delusions) and affective symptoms (mania, depression or both) — a condition bridging schizophrenia and bipolar disorder. Diagnosis requires psychotic symptoms persisting without mood symptoms. Treatment combines antipsychotics with mood stabilisers (lithium, valproate) or antidepressants. Prognosis is generally intermediate between schizophrenia and bipolar disorder.

Question 11

How does GMJ News cover schizophrenia?

Accepted Answer

GMJ News covers WHO schizophrenia data, mhGAP implementation for psychosis management in primary care, clozapine underuse, first episode psychosis early intervention, human rights and recovery-oriented care. Mental health system strengthening — including psychosis management — is directly relevant to PHIG's public health work and the Georgian Medical Journal.

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