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Course and Prevalence of Schizophrenia

About 1% of the population will develop Schizophrenia at some point in their lifetime. The disorder typically begins in the early 20's in men and in the late 20's in women, though some women will first show signs of the condition in their late 50's or early 60's. Men outnumber women with Schizophrenia by about 30%.

There is some evidence that years before the full condition develops, individuals with Schizophrenia already differed somewhat from their peers. In childhood they may have reached their developmental milestones, like walking and talking, somewhat late than others. Growing up they may have had more difficulties in school and in getting along with their peers. They may also have had neurological soft signs, like poor coordination, involuntary movements of the upper extremities, decreased ability to recognize objects by touch and feel, and abnormal smooth-pursuit eye movements (the eyes do not track objects properly that they are seeing). 

In the few years before the full sydrome develops, many people with Schizophrenia experience a prodromal phase when the core symptoms of the disorder first start to emerge.  In this phase, the person may start to have some of the positive or negative symptoms of Schizophrenia, but in an attenuated form.  For example, they may have some unusual or odd beliefs that have not yet reached the point of being delusional, they may develop eccentric ideas and interests, or they may have some odd perceptual experiences that are not quite hallucinations.  More commonly, the person will start to show some changes in their personality; they may become more withdrawn and introverted, or perhaps testy, tense and irritable, and they may lose interest in school or work or find it harder to concentrate at their usual tasks.

Once the person experiences the full syndrome of Schizophrenia they are said to be in the active phase of the illness.  By definition, this lasts a minimum of 6 months, but may last for much longer, especially if the person does not receive treatment.   Yet even with treatment, the course of the illness is usually chronic, meaning that it continues for the rest of the person's life to a lesser or greater extent.  Although the active phase may resolve, the person will usually continue to experience residual symptoms, including positive and negative symptoms and possibly some cognitive deficits.  In times of stress, or when not taking one's medication, or even for no clear reason, the person's symptoms can suddenly worsen and they will once again be in an active phase of the illness. Oftentimes, a person will need to be hospitalized when they are in the active phase.    

Schizophrenia tends to be a cause of signficant disability. Probably less than a quarter of people diagnosed with Schizophrenia recover fully from this disorder. The rest will continue to suffer from residual symptoms, cognitive deficits and relapses into the active phase, and as a results will have signficiant impairments in their abilities to function in school or at work, to maintain relationships, and in some cases even to function independently. People with Schizophrenia are much less likely than the general population to find steady employment and to marry, and those with the most severe forms of the illness will tend to require supervised living arrangements or may become homeless.

Individuals with Schizophrenia have a 20% shorter life expectancy than the population at large [ref, ref].  They tend to have unhealthy lifestyles with poor diets, little exercise, and high rates of smoking and use of alcohol and drugs.  For these and perhaps other reasons, they have very high rates of serious medical illnesses.  Many people with Schizophrenia also die by suicide.

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Psychological and Social Factors

Prognosis