Interview with Dr Attila Nemeth on schizophrenia in practice

Q. When you first tell a patient they have schizophrenia, do you tell them this is a lifelong condition?

A. Usually we tell patients that schizophrenia is a lifelong condition but that 20% of patients may only experience a single psychotic episode.

Q. Having made a diagnosis of schizophrenia – do you tell patients at that point how long they are likely to need to be on medication?

A. It depends on the condition of the patients. We believe in the early pharmacological treatment of all patients with schizophrenia but we monitor patients. If they are symptom-free for 3 years or more, we would consider stopping therapy but would continue with regular follow-ups.  A maximum of 25% of patients with schizophrenia may be medication-free after 3 years.

Q. What factors have a large contribution to the quality of life of a patient with schizophrenia?

A. Live-in family support and having a place of work, rather than being in a hospital or an institution, definitely contribute positively to a patient’s quality of life.

Q. Do you think of schizophrenia as a neurodevelopmental disorder or as a neurodegenerative disease?

A. Schizophrenia has a complex aetiology; genetics, recreational drug use, family circumstances and psychological factors all contribute towards the disease. In my opinion, genetic and biological factors are likely to be more important contributory factors than psychological factors.

Q. What proportion of patients with schizophrenia have the potential to achieve improvements in relationships?

A. 80-90% of those patients with a good prognosis due to effective therapy are likely to improve their relationships. Of course, if patients don’t comply with their medication, this doesn’t help their prognosis.