Understanding Schizophrenia: New Insights on Prevalence, Treatment, and Quality of Life

Announcer:

You're listening to NeuroFrontiers on ReachMD. On this episode, we’ll hear from Dr. Natalie Bareis, who’s an Assistant Professor of Clinical Behavioral Medicine in Psychiatry at Columbia University. Dr. Bareis is the lead author of a recent study that provides new insights into the prevalence and impacts of schizophrenia spectrum disorders. Let's hear from her now.

Dr. Bareis:

Our paper is based on the Mental and Substance Use Disorders Prevalence Study, which was funded by SAMSA. The goal was to identify the prevalence of schizophrenia in the U.S. It hasn’t been done effectively in the past because people who run surveys to do these prevalence estimates usually use screeners, and with schizophrenia, you can’t just rely on a screener to get an accurate diagnosis. So because we were trying to identify schizophrenia in particular, we had to use a better method to diagnose it.

There is an interview called the Structured Clinical Interview for the DSM, which is the SCID, and this diagnoses all of the psychiatric illnesses found in the DSM. And that interview is semi-structured, and clinicians administer it to identify schizophrenia diagnoses. So we trained 63 interviewers, which were clinicians in their terminal degree, so social work and psychology. They had already administered SCIDs before, so we trained them for that. And then we also conducted the interviews virtually with video and audio so that they could observe people’s responses to the questions, as this really helps differentiate schizophrenia from other disorders, such as depression with psychosis or bipolar disorder with psychotic features.

So there were, I would say, three really important findings. One is that the prevalence of schizophrenia in the U.S. is much higher than we ever thought it would be. We found that 1.8 percent of the population had schizophrenia sometime in their lifetime, either in the past year or sometime in their lifetime, and that is more than double what we thought before. Generally, we found in the U.S. that schizophrenia was only diagnosed in about 50 percent of individuals in the country, so this was a really surprising finding.

The next finding, which was a little bit less of a good thing, is that folks with schizophrenia are still not doing well. They have low levels of employment. They have low GAF scores, which shows general functioning. They have low levels of education. And so that was a disappointment because in the past 20 years, we had hoped that treatments that had been devised and medications that had been identified would somehow improve the life of folks with schizophrenia, so that was another finding. That was a big disappointment.

And then another finding was that only about a quarter of folks with schizophrenia are receiving minimally adequate treatment. And how that is defined is taking one antipsychotic in the past year and going to at least four outpatient visits in the past year for mental health, and so that was a big disappointment for us. Although individuals with schizophrenia may not be receiving minimally adequate treatment, we did find that over 90 percent had healthcare coverage, and 70 percent did report receiving some type of mental health care in the past year, so that was a big positive.

And I guess some other high-level takeaways: We need to provide established treatments for folks with schizophrenia, and we need to provide them to folks who aren’t receiving them now because there are some really good treatments out there that are very poorly administered to people outside of big cities and they have been found to be effective, so we need to have policies in place that can really get these to the people who need it.

Announcer:

That was Dr. Natalie Bareis talking about the prevalence and impacts of schizophrenia spectrum disorders. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!