3. “The other set of problems that sit under the delusions and hallucinations is the subtle intellectual impairment. It’s not like dementia, which wipes out large tracts of memory. It’s more subtle than that and it attacks sustained attention and concentration, working memory – the memory that you use to hold a telephone number in your head long enough to dial the number, and then you forget about it.

Working memory is very significantly impaired in schizophrenia, along with some other intellectual problems such as impaired verbal memory, and a decrease in what we call executive functions. These are the capacity to plan ahead, to enable forethought to occur, to initiate a set of actions and plan for them, and carry them out with flexibility and so on. Now those may not sound terribly severe either, but you put them together with the negative symptoms and these are the core phenomena of schizophrenia and these are the core phenomena that cause life-long disability and incapacity. And they’re the phenomena that account for the loss of capacity for work, and education. The loss of the ability to establish relationships during adolescence and to complete schooling and do all those developmental tasks that are important in young people establishing themselves independent of their parents, establishing relationships, establishing career path and so on. All of that gets blown out of the water by these core fundamental symptoms.”

Dr Carr said that 85 per cent of schizophrenics were on Social Security benefits, very few being able to work, although suitable rehabilitation can get some into the workforce.

“It sits there amongst the top 10 of the leading causes of disablement in the world. As I said, it’s life long, there are high rates of drug and alcohol abuse that are associated with it. Alcohol in particular, but also marijuana, amphetamines and so on. Probably about 30–40 per cent of people with schizophrenia have concurrent drug or alcohol problems as well. And of course they’re prodigious smokers.

“It’s a costly condition as well. It accounts for probably 40 –50 per cent of admissions to psychiatric facilities and about 55 per cent of bed days in hospitals because of the longer stay of people with schizophrenia compared to other conditions. “And currently we alleviate probably about 12 -13 per cent of the burden of this condition with our currently available treatments. And if we did the best we possibly could with psycho socio treatments of rehabilitation and so forth and lots of effort and there were unlimited resources, we’d still only alleviate about 20-22 per cent of the burden.”

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