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SCHIZOPHRENIA: A SERIOUS, CHRONIC BRAIN DISEASE Schizophrenia Facts Schizophrenia is a chronic brain disorder characterized by a disruption of thought processes that can cause delusions and hallucinations,1 and affects about 2.4 million Americans2,3 and 24 million people worldwide.4 Schizophrenia often becomes apparent in late adolescence or early adulthood, but the signs and symptoms vary from person to person. Initial signs can include isolating oneself, sleep problems, and irritability. 1 While experts are not entirely clear on the cause of schizophrenia, they believe the disease is influenced by several factors, including genetics, the environment and a possible imbalance in chemical reactions of the brain.1 Patients are at risk for relapse, which is a re-emergence or worsening of psychotic symptoms.5 Certain criteria often are used to define relapse, including aggravation of psychotic symptoms and hospital admission.6,7 Common contributors to disease relapse include substance abuse, stressful life events, and poor adherence to medication.8 Recurring relapses may result in decreased functioning, increased morbidity, and progression of the illness.5 The Significant Personal and Social Costs of Schizophrenia Employment Increased Healthcare Costs At any given time, the vast majority of people with schizophrenia – 73% to 89% – are not employed. Of those who are employed, many work in noncompetitive employment situations (e.g., do not compete with applicants from the general public) or work part-time.9 In 2002, the cost of schizophrenia to the U.S. healthcare system was estimated to be $62.7 billion.11 Direct costs estimated at $30.3 billion included expenditures for hospital and nursing home care, physician and other professional services and drugs, among other expenses. Indirect costs estimated at $32.4 billion included lost productivity due to morbidity and premature mortality and legal encounters. Hospitalization As treatment adherence in schizophrenia patients decreases, the risk of rehospitalization goes up. In one data review study, even a 1- to 10-day maximum gap in treatment in one year nearly doubled patients' risk of hospitalization (from approx. 6% to approx.12%, OR=1.98, p=0.004).5, 10 Increased Morbidity & Mortality In a review of multiple studies, it was calculated that the mortality rate for people with schizophrenia is 1.6 times greater than in a general population of similar age and gender, and the risk of suicide is 9 times greater.12 Unfortunately, suicide is one of the leading causes of premature death among people with schizophrenia, with an estimated 10 to 13% taking their lives and approximately 40% attempting suicide at least once.13 See References on Reverse Side Community Impact Based on a review of multiple studies, the average rate of schizophrenia among the homeless population is about 11% .14 Substance abuse is common among patients with schizophrenia, with reports of lifetime abuse estimated to be as high as 47% and approximately 33% of patients with an alcohol dependence disorder.8 Individuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population. In one retrospective study, about half (46%) of participants reported at least one encounter with the criminal justice system.15 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. National Institute of Mental Health (NIMH). Schizophrenia Booklet (2009). Available at http://www.nimh.nih.gov/health/publications/schizophrenia/schizophrenia-booket2009.pdf. Accessed November 1, 2012. National Institutes of Mental Health (NIMH). The Numbers Count: Mental Disorders in America. Available at http://www.nimh.nih.gov/health/publications/the-numbers-countmental-disorders-in-america/index.shtml. Accessed November 1, 2012. Regier, D et al. The de Facto US Mental and Addictive Disorder Service System. Arch Gen Psychiatry, 1993; 50: 85-94. World Health Organization (WHO). Schizophrenia Fact Sheet (2010). Available at http://www.who.int/mental_health/management/schizophrenia/en/. Accessed November 1, 2012. Lieberman JA et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry, 2001; 50(11): 884-897. Almond, S et al. Relapse in schizophrenia: costs, clinical outcomes and quality of life. British Journal of Psychiatry, 2004;184: 346-351 Lader, M. What is relapse in schizophrenia? International Clinical Psychopharmacology, 1995, 5-9. Kazadi, NJB et al. Factors associated with relapse in schizophrenia. South African Journal of Psychiatry. 2008; 14(2): 52-62. Slade E et al. Symptom effects on employment in a structural model of mental illness and treatment: Analysis of patients with schizophrenia. Jour Mental Health Policy Econ, 2001; 4: 25-34 Weiden PJ et al. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr Serv, 2004; 55: 886-891. E.Q. W et al. The Economic Burden of Schizophrenia in the United States in 2002. Journal of Clinical Psychiatry, 2005; 66(9): 1122-1129. Knapp M et al. The Global Costs of Schizophrenia. Oxford Journal, 2004; 30(2): 279-293 Nieto G et al. Homeless Mentally Ill Persons: A bibliography review. International Journal of Psychosocial Rehabilitation, 2008; 12(2): 1-25. Folsom, D and Jeste, D. Schizophrenia in homeless persons: A systematic review of the literature. Acta Psychiatrica Scandinavia, 2002; 105(6): 404-413. Ascher-Svanum H et al. Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia. BMC Psychiatry, 2010; 10(11): 1-10. ©2013 Otsuka America Pharmaceutical, Inc. Rockville, MD 20850 February 2013 0912N-6191