[Health in the 100-Year Life Era] Schizophrenia... It's Unfair and Scary That It Happens Only to Me

Typical Symptoms Include Hallucinations or Delusions
Early Detection Is Important, and With Consistent Treatment
One Can Live Well as a Regular Member of Society

Professor Hye-Yeon Park, Department of Psychiatry, Bundang Seoul National University Hospital.

#. Suddenly, I hear laughter. When I turn my head, passing people are staring at me and sneering. They probably know that I got on the wrong bus yesterday. As I try to avoid the laughter and leave the neighborhood, my phone suddenly rings. Checking it, the number is unknown. When I don’t answer, it seems like they are trying to figure out what I’m doing, even sending messages. Feeling scared outside, I go back home, where a strange voice interrogates me. I’m so frightened that I tell my family, "My phone has been hacked and I’m being monitored," but they don’t believe me and instead mention treatment. I feel scared and wronged, not knowing what I did wrong or why this is happening. I need to gather evidence to catch the strange voice that is monitoring me.

‘Schizophrenia’ is a disorder that occurs when major brain functions such as perception, cognition, thinking, emotion, and behavior do not work harmoniously. It was formerly called ‘split mind disorder’ but was renamed to reduce social prejudice and discrimination. Various mechanisms contribute to its onset, including biological issues such as imbalances in neurotransmitters (dopamine, serotonin, etc.) and abnormalities in brain neural circuits related to higher functions, as well as psychosocial problems like psychological trauma during developmental stages. It occurs in about 0.7% of the general population worldwide, typically emerging from late teens to late twenties, and often persists lifelong. Moreover, as in the case above, it not only greatly affects an individual’s suffering and social functioning but also imposes significant social burdens such as treatment and accidents.

The hallmark symptoms of schizophrenia are hallucinations and delusions. These cause patients to experience confusion as the boundary between themselves and the real world breaks down. For example, during hallucinations, auditory hallucinations such as hearing voices or music without actual stimuli are common, which may lead to talking to oneself or laughing alone. Among delusions, persecutory delusions?believing one is being threatened or harmed?are typical, causing extreme anxiety, emotional changes, and sometimes impulsive behavior. Additionally, thought process disturbances may result in speaking in incomprehensible or strange ways or repeating meaningless movements, showing abnormal behaviors. Furthermore, many patients lack motivation, neglect hygiene, and do not find joy in interpersonal relationships or external activities, often leading to social isolation. Due to these diverse and distinctive symptoms, many patients with schizophrenia struggle in social relationships and find it difficult to maintain employment.

Early detection and treatment of schizophrenia are very important. Delayed treatment worsens psychosocial functioning and leads to poor prognosis. Therefore, active pharmacological treatment can be helpful when mild symptoms begin or when a high risk of onset is predicted. The most effective treatment is antipsychotic medication, along with psychosocial interventions such as stress management. Also, since patients often refuse treatment due to lack of insight into their illness caused by various symptoms, involvement of caregivers and social support is crucial. In cases where hallucinations or delusions pose risks of violence or self-harm, hospitalization is necessary.

After diagnosis, continuous treatment and prevention of relapse are important. The variety of medications, including long-acting injectable treatments, has increased compared to the past and shows high effectiveness. Although the incidence of schizophrenia has not decreased, the number of patients who receive proper treatment and fulfill social roles is increasing. This suggests that with active treatment, patients can live well as ordinary members of society.

Hye-Yeon Park, Professor, Department of Psychiatry, Bundang Seoul National University Hospital

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