Some Statistics and Patterns (prevalence, course, prognosis)
Schizophrenia is not a terribly common disease but it can be a serious and chronic one. Worldwide about 1 percent of the population is diagnosed with schizophrenia, and approximately 1.2% of Americans (3.2 million) have the disorder. About 1.5 million people will be diagnosed with schizophrenia this year around the world. In the United States, this means about 100,000 people will be diagnosed, which translates to 7.2 people per 1,000 or about 21,000 people within a city of 3 million who are likely to be suffering from schizophrenia.
Schizophrenia can affect people throughout the lifespan although new instances of the illness are most likely to occur in early adulthood. It is relatively rare for children and older adults to develop schizophrenia, but it does happen. More commonly the incidence (rate of diagnosis) of new cases of schizophrenia increases in the teen years, reaching a peak of vulnerability between the ages of 16 and 25 years. Men and women show different patterns of susceptibility for developing schizophrenia. Males reach a single peak of vulnerability for developing schizophrenia between the ages of 18 and 25 years. In contrast, female vulnerability peaks twice; first between 25 and 30 years, and then again around 40 years of age.
The full onset of schizophrenia is typically preceded by a gradual 'prodromal' (pre-cursor) period where odd behaviors and experiences, such as anxiety, restlessness and hallucinations begin to occur, but not yet with their fullest force. There may be a gradual loss of reality. Many schizophrenia sufferers describe the onset of odd feelings, thoughts and perceptions a few months before anyone else can see visible evidence of them. It can be quite difficult to recognize schizophrenia during this early prodromal stage, particularly if it is a new diagnosis and has not occurred before for a given patient. Though the schizophrenic person may have been hearing criticizing voices and experiencing delusions for some time, these symptoms may not have been overwhelming or frightening enough to have caused them to break down and act in a bizarre manner. Patients experiencing these symptoms for the first time may be able to hide them for a while, but this becomes more difficult as the psychotic process sets in and their outer actions begin to reflect their inner perceptual distortions.
Schizophrenia is not generally recognized to be occurring until after truly odd and irrational behaviors are expressed during what is called a "psychotic break", or "first break". Though the schizophrenic person's internal experience during psychosis may be terrifying, it is the outward symptoms characteristic of the psychotic break that are noticed by family members and others: changes in self-care, sleeping or eating patterns, weakness, lack of energy, headaches, changes in school or work performance, strange sensations, and confused, strange, or bizarre thinking that gets expressed as bizarre behavior. Keep in mind, however, that the actual break with reality may occur prior to the time that people around the psychotic person have noticed that something is seriously wrong. The symptom-rich period following the psychotic break is sometimes called the 'active-phase' or, alternatively a period of 'florid' psychosis. The term florid means "flowering" and the term is a metaphorical usage denoting that the psychosis is the end result or goal of the schizophrenic illness, just as the bloom is the end result or goal of a flowering plant.
When schizophrenia does occur, it often becomes a chronic condition that continues throughout the remainder of life with varying degrees of intensity. The "first break" may be the last break if the case of schizophrenia is mild and if treatment is administered promptly and continued as directed by a psychiatrist (a medical doctor specializing in mental health issues). More typically, however, the first break leads to a pattern of varying periods of relative recovery (which are termed 'residual' phases) and periods of new active-phase psychosis that continue throughout the remainder of patients' lives.