Schizophrenia is a serious mental illness that affects about 1% of the population worldwide. It usually begins in young adulthood and is characterized by hallucinations, delusions, disorganized thinking and behavior, and impaired cognitive functioning. Schizophrenia is typically treated with antipsychotic medications and psychosocial therapies. However, many people with schizophrenia do not receive adequate treatment for their illness. When schizophrenia goes untreated, it often leads to a chronic course with increasing severity of symptoms and poor long-term outcomes.
What are the symptoms of untreated schizophrenia?
When schizophrenia is left untreated, symptoms tend to worsen over time. Common symptoms of untreated schizophrenia include:
- Hallucinations – hearing, seeing, smelling, or tasting things that are not real
- Delusions – fixed, false beliefs that are firmly held even when there is contradictory evidence
- Disorganized speech and behavior
- Negative symptoms – lack of emotion, motivation, interest in everyday life
- Cognitive difficulties – problems with attention, memory, decision-making
Without treatment, these symptoms make it very difficult for a person to function normally in daily life. They have problems caring for themselves, relating to others, and performing roles such as work, school, or parenting.
How does untreated schizophrenia progress over time?
In the early stages when symptoms first appear, untreated schizophrenia may come and go in episodes. People can experience periods of remission when symptoms seem to improve. However, over the long-term course of schizophrenia, symptoms tend to worsen and remissions become shorter and less frequent without adequate treatment.
Longitudinal research studies have helped map out the progression of untreated schizophrenia:
- Prodromal phase: mild symptoms and behavioral changes emerge that precede the active phase.
- Acute phase: onset of severe, overt psychotic symptoms like hallucinations and delusions. This phase can involve a psychotic break.
- Residual phase: acute symptoms improve, but negative symptoms like lack of motivation and interest persist.
- Late residual phase: symptoms gradually worsen, psychosocial functioning deteriorates as repeated psychotic episodes damage the brain over time.
Over a course of 5 to 10 years, an untreated person with schizophrenia often declines into severe disability and poverty. Being caught in recurring psychotic episodes can lead to further brain abnormalities and cognitive deterioration.
What are the risks and complications of untreated schizophrenia?
Leaving schizophrenia untreated comes with considerable risks:
Inability to function normally
As schizophrenia progresses, people become unable to care for themselves, interact socially, maintain relationships, or succeed at school or work. Rates of unemployment are very high due to the effects of psychotic symptoms and cognitive deficits.
Homelessness
Severely mentally ill people make up a large proportion of the homeless population. Without treatment and family/social support, severely disabling psychotic symptoms often lead to job loss and poverty, making homelessness more likely.
Violence
A subset of people with untreated schizophrenia, especially those with paranoia and substance abuse issues, may commit violent acts during severe psychotic episodes. Violence risk is greatly increased by lack of treatment.
Substance abuse
Roughly half of people with schizophrenia have a co-occurring substance use disorder. Those without treatment are especially vulnerable to “self-medicating” with drugs or alcohol. This often makes the progression of schizophrenia worse.
Incarceration
Untreated mental illness interacts with poverty, homelessness, and substance abuse to increase risk of criminal behavior and incarceration. Up to 15% of inmates in jails and prisons have schizophrenia or another psychotic disorder.
Suicide
The suicide rate is extremely high among people with schizophrenia—about 5-10% end their lives by suicide. Lack of treatment makes suicidal behavior more likely.
Physical health problems
Side effects of antipsychotic medications contribute to health problems like diabetes, high cholesterol, and obesity. Without medication treatment, people may still have unhealthy lifestyles, poor access to healthcare, and higher risk of infections that impact physical health over the long-term.
What is the life expectancy for someone with untreated schizophrenia?
Unfortunately, the life expectancy of people with untreated schizophrenia is low compared to the general population.
| Study | Life Expectancy Loss |
|---|---|
| Nielsen et al. 2013 | 10-22 years |
| Laursen et al. 2014 | 15 years |
| Olfson et al. 2015 | 28 years |
The reasons for reduced lifespan include:
- Suicide
- Accidental death due to injuries, accidents
- Adverse effects of smoking, substance use, poor diet
- Lack of access to healthcare
- Higher rates of cardiovascular disease, infections, diabetes
With proper treatment, the life expectancy for schizophrenia can be significantly improved. So early diagnosis and consistent long-term treatment is critical.
What treatments help people with schizophrenia?
Although schizophrenia cannot be cured, it can be effectively managed with a combination of medication and psychosocial treatments. With comprehensive treatment, many people with schizophrenia are able to function well and enjoy a good quality of life.
Medications
Antipsychotic medications are the foundation of treatment for schizophrenia. They work by blocking dopamine receptors in the brain, which improves psychotic symptoms like hallucinations, delusions, and disordered thinking. Antipsychotics can also help reduce the risk of suicide and violent behavior when taken regularly.
Some commonly prescribed antipsychotics include:
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
- Aripiprazole (Abilify)
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
Psychotherapy
Different types of talk therapy and psychosocial interventions can help people with schizophrenia:
- Cognitive behavioral therapy (CBT) – focuses on changing negative thought patterns
- Cognitive remediation – improves cognitive skills like memory and attention
- Counseling – provides education, support, and coping strategies
- Family therapy – teaches families to optimize the home environment
- Social skills training – improves interpersonal and self-care abilities
Case management
Case managers coordinate care, help access community resources, assist with housing and employment, provide crisis intervention, and support functioning. This can improve treatment adherence and quality of life.
Peer support services
Having social support from others who have schizophrenia can reduce isolation and give hope that recovery is possible. Peer support groups, mentoring programs, and drop-in centers led by people in recovery contribute to better outcomes.
Lifestyle changes
Making positive changes to diet, exercise, sleep habits, and avoiding substance use can help manage schizophrenia symptoms and side effects of treatment. Stress management skills are also very important for coping with the illness.
Conclusion
Schizophrenia has the potential to be a very disabling mental disorder when left untreated over the long term. Severe symptoms make it difficult for people to care for themselves and function in society without adequate treatment and support. The risks of homelessness, incarceration, substance abuse, and suicide all rise substantially when people lack access to proper medical and psychosocial treatments. With comprehensive therapies and social services, people with schizophrenia have hope for stability, improved functioning, and a better quality of life. Consistent treatment can help manage symptoms, regain functioning, and prevent the downward spiral of disability that comes with unmanaged psychosis.