“Schizophrenia is not an incurable disease. With early and consistent treatment, methods have been developed that allow individuals to live normally.”
Lee Jun-hee, a director of information at the Korean Society of Schizophrenia (professor of psychiatry at Seoul St. Mary's Hospital), noted on 24th of last month at Seoul St. Mary's Hospital in Seocho-gu, Seoul, “In Korea, there are still many cases where schizophrenia patients are neglected or their treatment is halted, worsening their condition,” and “Neither the patients themselves nor our society should hold onto incorrect prejudices.”
Professor Lee, a graduate of Seoul National University's medical school, has served as a resident and clinical instructor in the psychiatry department at Seoul National University Hospital, an associate professor of clinical practice, and a senior researcher at Seoul National University Medical Research Institute, and is currently specializing in the treatment of schizophrenia patients at Seoul St. Mary's Hospital. Previously, he also worked as the director of the mental health welfare center in Yangju city. He has received the Uspo Poster Award at the Korean Neuropsychiatric Association’s fall academic conference in 2018 and the Best Poster Award at the Asian College of Neuropsychopharmacology (AsCNP) in 2019.
Schizophrenia was long referred to as a split personality disorder. In order to improve the misconceptions and prejudices about the disease, the domestic medical community changed the name of the disorder, but incorrect perceptions still remain, such as regarding schizophrenia patients as possessed or that they should be isolated due to a propensity for violence.
The medical community explains that the cause of schizophrenia is an imbalance of neurotransmitters. Neurotransmitters are signaling substances secreted by brain neurons. Professor Lee explained, “Schizophrenia occurs when the balance of neurotransmitters in the brain, such as serotonin, dopamine, and glutamate, is disrupted,” emphasizing that “it is more of a biological disease than a psychological one.”
Schizophrenia is estimated to affect 0.5% to 1% of the global population. According to the Health Insurance Review and Assessment Service, as of 2022, there are 214,017 schizophrenia patients in Korea.
Professor Lee remarked, “The belief that there must have been problems in the upbringing environment of schizophrenia patients is also one of the incorrect prejudices,” saying that “among schizophrenia patients, there are many cases where individuals suddenly develop symptoms without any external stress factors while living in a stable environment.” He added, “This is a situation where there is no so-called ‘trigger,’ indicating that schizophrenia is a disease that manifests at some point due to a biological predisposition that disrupts hormonal balance.”
The notion that schizophrenia patients are violent is also a misconception. Professor Lee stated, “It varies depending on the tendencies or temperaments of the patients.”
For example, a patient who is originally timid and fearful tends to shrink back or avoid contact with others due to paranoid delusions. Such patients may fear that people will harm them, and thus are unable to go outside. On the other hand, patients who are originally hot-tempered and impulsive may react aggressively in paranoid situations, Professor Lee explained.
With advancements in schizophrenia treatment, treatment effectiveness is greatly improving. Professor Lee stated, “In the past, patients were treated under the rehabilitation concept long after the onset of schizophrenia; now, with the advancement of treatment agents, if treatment is started quickly and consistently, there are good prognoses that allow for normal work life.”
The most important factors in schizophrenia treatment are early intervention and medication. Professor Lee explained, “Since schizophrenia is a biological disease that arises from an imbalance in hormones in the brain, medication that restores this balance is key” and emphasized that “finding the right medication for patients at an early stage can yield sufficient treatment effects.”
The treatment goals of healthcare professionals for schizophrenia are broadly twofold. First, it is to reduce the intensity of symptoms like hallucinations and delusions, and second, to support the return to daily life. Professor Lee noted, “The main treatment objective for schizophrenia is to prevent relapse with continuous medication and help the patient return to daily life while the symptoms are reduced.”
Professor Lee asserted that medications for schizophrenia should not be arbitrarily discontinued due to the high risk of relapse. He stated, “Every time a relapse occurs, brain cells are damaged and do not recover, which can lead to cognitive decline or worsening of symptoms,” stressing that “arbitrarily stopping treatment increases the risk of relapse, and symptoms such as hallucinations or delusions may reappear.”
Antipsychotic medications are classified into first-generation and second-generation. First-generation drugs, developed in the 1950s, include haloperidol, chlorpromazine, and fluphenazine, which primarily block dopamine receptor D2. While they act quickly, they have side effects such as movement disorders and muscle rigidity.
To improve these side effects, second-generation drugs developed since the 1970s work by blocking not only dopamine D2 receptors but also serotonin 5-HT2A receptors to alleviate symptoms. These include risperidone, paliperidone, olanzapine, quetiapine, and aripiprazole. Second-generation medications generally have fewer movement side effects and reduce depression and anxiety, though they may cause weight gain.
In addition to oral medications, injections are also available. Oral medications have limitations as patients often refuse to take them or arbitrarily discontinue them, in which case injections can be substituted. Professor Lee noted, “Isn’t it challenging to take cold medication regularly?” and explained that “schizophrenia patients may skip doses or arbitrarily stop taking medication due to side effects and other reasons.” According to Professor Lee, it was found that less than half of patients consistently took their prescribed medication for a year.
Long-acting injectable medications used in schizophrenia treatment are administered as muscle injections and must be given by healthcare workers at the hospital. Depending on the dosage, their effects can last from one month to three months or six months. They can be given on a set schedule, similar to a vaccination, helping to prevent patients from missing their doses, whether intentionally or unintentionally.
Professor Lee explained, “Research shows that when using injectable medications, the likelihood of hospitalization can be reduced to one-third of the original level.” According to a paper published last year by researchers from Zucker School of Medicine in the journal of the American Medical Association (JAMA), if patients receive the latest six-month injectable formulation for three years, 95.9% maintain a state without relapse.
On 25th of last month, the Ministry of Health and Welfare announced that it would add schizophrenia patients to the list of those exempt from out-of-pocket costs for outpatient services as part of a policy to strengthen support for vulnerable groups. Until now, only oral medications were included in the exemption for outpatient costs for medical aid recipients, but starting January 2026, all outpatient costs, including long-acting injectable medications, will be exempted.
Professor Lee noted, “Schizophrenia patients often have difficulty finding employment due to their symptoms, resulting in a relatively high number of individuals receiving basic living benefits and medical aid,” and expressed that “it was unfortunate that there are many cases where injections are hesitated or given up due to the higher medical expenses compared to oral medications, but I am glad that they will now receive insurance benefits.”
References
JAMA(2024), DOI: https://doi.org/10.1001/jamanetworkopen.2024.21495