By Yerin Cho, Emma Willard School, Troy, New York, USA
Summary: Schizophrenia affects approximately 24 million people worldwide, and research shows that individuals with schizophrenia are about ten times more likely to commit crimes than the general population. Despite this concerning statistic, there is inadequate research and support regarding treatments. Throughout the past few years, medication was the only treatment, showing a high relapse rate and less efficiency. Since the 1990s, cognitive behavioral therapy (CBT) has been introduced as an effective treatment, especially for schizophrenia. Moreover, CBT offers numerous benefits, including increased engagement, education, and adaptation, and decreased symptoms of anxiety and depression among schizophrenia patients. Given the many advantages of CBT, schizophrenia patients should have access to more support for this evidence-based treatment option.
Schizophrenia is a complex behavioral and cognitive mental disorder that disrupts brain development, impairing a person’s ability to think, perceive, and behave clearly (Owen, 2016). Globally, approximately 24 million people are affected by schizophrenia, with a prevalence of 1 in 222 adults (WHO, 2022). The symptoms of schizophrenia vary ranging from relatively positive to negative, such as depression, anxiety, delusion, and hallucination. Additionally, schizophrenia patients tend to be forced out into social isolation, and many patients are involved in several crimes, abuse of illegal drugs, and unemployment (Turkington et al., 2006; WHO, 2022). Unfortunately, schizophrenia is often overlooked as insignificant compared to other mental disorders, but it has not only been negatively contributing to in-person relationship problems but also big-scale social problems.
The Increasing Global Prevalence of Schizophrenia Patients
Figure 1: The Annual Global Prevalence of Schizophrenia Patients (IMHE, 2019).
Figure 1 shows the increasing number of schizophrenia patients in the past decade. The data demonstrates that the number of schizophrenia patients is expected to rise.
Figure 2: A Number of Crime Offenders Among Schizophrenia Patients (Rearranged by the author, based on Ghoreishi et al., 2015).
Figure 2 shows the percentage of offenders among schizophrenia patients in the 2015 study. Approximately, 59 percent of patients were crime offenders, which is a surprisingly large percentage compared to other disease patients.
Figure 3. A Number of Legal Offenders Among Crime Offenders who are Schizophrenia Patients (Rearranged by the author, based on Ghoreishi et al., 2015).
Figure 3 shows the percentage of legal offenders among schizophrenia patients who were crime offenders. Approximately, 10 percent of the crime offenders were legal offenders.
Figure 4. The Substance Abuse Comorbidity Rates for Normal People (Rearranged by the author, based on Fazel et al., 2016).
Figure 4 shows the substance abuse comorbidity rates among normal people, and it is approximately about 2 percent of all participants in the study.
Figure 5. The Substance Abuse Comorbidity Rates for Schizophrenia Patients (Rearranged by the author, based on Fazel et al., 2016).
Figure 5 shows the substance abuse comorbidity rates among schizophrenia patients, and it is about a quarter of all schizophrenia patients in the study.
Patients suffering from schizophrenia are more likely to commit crimes and use illicit drugs. According to a 2015 study conducted by Iran researchers, along with the Figures 2 and 3, among 358 patients, 59.2% of schizophrenia patients were crime offenders, and 9.8% were legal offenders (Ghoreishi et al., 2015). Furthermore, according to a 2016 study, as evident in Figures 4 and 5, the percentage of substance abuse comorbidity of schizophrenia patients (24.5%) was more than ten times higher than that of the general population (2.3%) (Fazel et al., 2016). The high percentage of crime offender rates and substance abuse among schizophrenia patients emphasize that some actions are needed to take place to improve patients' quality of life.
The Problem in the Current Medication for Schizophrenia
Despite the severity of schizophrenia in promoting global health, current medications and treatments are often inadequate and ineffective. Traditionally, schizophrenia patients receive medical treatments such as Haloperidol, fluphenazine, and chlorpromazine (NYU Langone, 2023).
However, the current medical treatment causes increased rates of relapse and rehospitalization (Stevens et al., 2016). Moreover, treating schizophrenia with only medication has a high chance of having side effects and increasing relapse rates (Braken, 2000). In addition to the problem of not having adequate or effective treatments, drug treatment-resistant schizophrenia is also a serious problem. According to research conducted in 2006, over half of the patients who received continuous medications still have schizophrenia symptoms (Turkington et al., 2006). The lack of adequate and effective treatments for schizophrenia highlights the urgent need for continued research and development of new approaches to treating this challenging disorder.
Cognitive Behavioral Therapy (CBT), the Rising Treatment for Schizophrenia
Cognitive behavioral therapy (CBT) has emerged as an effective treatment for schizophrenia. CBT shows effectiveness in reducing symptoms and preventing the chances of relapse. This treatment improves symptoms of auditory hallucinations and delusions and leads to less percentage of experiencing phobic symptoms and depression (Addington et al., 2019; Kart et al., 2021; Stevens et al., 2015, Turkington et al., 2006; Weiden, 2016). Furthermore, CBT can improve various psychological aspects such as engagement, education, adaptation, anxiety, and depression (Addington et al., 2010).
Patients who receive CBT are more likely to recognize the severity of their symptoms, learn coping skills, and engage in activities to improve their psychosocial aspects, leading to less illicit drug use (Turkington et al. 2006).
Given the limitations of current medications and treatments for schizophrenia, it’s crucial to explore alternative approaches to promote better mental health outcomes. The use of cognitive behavioral therapy (CBT) offers several benefits, such as the increased percentage of engagement, education, and adaptation, while CBT diminishes the likelihood of anxiety and depression among schizophrenia patients (Addington et al., 2010). To result in more successful outcomes for patients, the close analysis of CBT will enhance treatment for not only schizophrenia but also different psychiatric disorders.
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