Burden is measured by years lived with a disability and by calculating how much of that could be alleviated with best available treatment.
Dr Carr said: “The treatment is really quite unsatisfactory at the present time, as is suggested by the fact that there’s considerable amount of burden remaining after best available treatment. And that’s because we haven’t really had a significant advance in treatment since the early-to-mid 1950s, which is when anti psychotic medications were introduced. “When they were introduced they were terribly effective in enabling large lunatic asylums to be emptied of patients, because they helped to control the delusions and hallucinations. As it turns out, they’re only partially effective for that. Probably about 30-40 per cent of people discharged from hospital continue to have delusions and hallucinations.
“But [the anti-psychotic drugs] were good enough to get people out of hospital and living marginalised lives in substandard accommodation, boarding houses, and making up a significant percentage of the homeless. But the fact is, there’s been no medical advances in treatment since that time. All of the new drugs that have come onto the market have been variations on that same theme of the medications that were introduced in the early ‘50s. Psychosocial treatments are effective, cognitive therapy, rehabilitation treatments, family interventions and so forth. But I can tell you most people don’t get it because staff aren’t, in the public sector, trained to deliver them. They’re trained for case management and nothing else. And they’re very expensive. So people don’t get them. But as I said, even if they did, it would still only make a small mark.”
Researchers are looking in two directions for solutions:
1. Doing better with what is already known. This involves identifying people earlier in the course of the illness, intervening earlier and more effectively and addressing drug and alcohol use problems.
2. Fundamental basic discovery-orientated research, which is the only stream of research that will eventually identify the means to prevent or cure the disorder. There are three key components to the fundamental discovery-orientated research.
The first involves the establishment of large-scale studies of the genetics of schizophrenia, on large samples with 2000 regarded as a minimum. These require collaborative efforts of multi-centre investigators to draw together the samples.
The second strand of discovery-oriented research that needs to be undertaken is neurobiological research – the sort of stuff that takes place in laboratories looking at human tissue and animal models.