Schizophrenia affects approximately 24 million people around the world, according to the World Health Organization (WHO). This means that one in every 300 people (0.32%) worldwide are affected by the mental disorder and this rate is 1 in every 222 people (0.45%) among adults. In India alone, around 3.5 million people had this disorder in 2017, showed a Lancet study.

Psychosis, which is caused by Schizophrenia, affects even more people and, according to the WHO, more than two out of three people with psychosis do not receive specialist mental health care. The global health agency also found that people with schizophrenia are 2-3 times more likely to succumb to a premature death than people without it.

Schizophrenia is a serious mental illness characterised by incoherent or illogical thoughts, bizarre behaviour and speech, and delusions or hallucinations. The onset is most often during late adolescence, and onset tends to happen earlier among men than women.

Psychosis and schizophrenia, though closely related, are not the same. Psychosis is a grouping of symptoms that involve a person's disconnection from reality and the world around them. Such symptoms may include hallucinations or delusions. Schizophrenia is a mental health disorder that includes bouts of psychosis along with other symptoms.

FactChecker spoke to psychiatrists and busted some common myths about the disorder that are rooted in stigma.

Myth 1: Schizophrenia patients have split personality

Fact: Schizophrenia is often confused with Dissociative Identity Disorder (DID). However, the Diagnostic and Statistical Manual of mental disorders, published by American Psychiatric Association, classifies DID as a dissociative disorder and schizophrenia under psychotic disorders.

The manual states that the core criteria for diagnosis of DID includes having "two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self".

Patients of schizophrenia, on the other hand, do not have multiple personas. Instead, they may experience hallucinations such as voices in their head or act on delusional beliefs which they may think to be true. The split therefore, is not in the patient's personality but in their perception of reality.

Myth 2: People with schizophrenia must be institutionalised or hospitalised

Fact: Institutional care always depends on the severity of symptoms. Many patients of schizophrenia can be enabled to live independently with family or in supportive housing by preventing substance misuse, facilitating adherence to medication taking, and overall reducing the duration of untreated psychosis.

Dr Shyam Lulla, Psychiatrist at PD Hinduja Hospital, Mumbai told FactChecker that not all patients of schizophrenia need to be institutionalised or kept in hospitals. "They might require temporary institutionalisation… Once they respond to treatment and come back to the initial stage, modern medication can provide very good symptomatic relief, and then counselling can give additional support," said Dr Lulla.

Myth 3: Schizophrenia patients are dangerous and violent

Fact: People with schizophrenia are wrongly portrayed as dangerous in popular media. A 2012 study, which looked at movies produced from 1990-2010, found that 80% of those films involving schizophrenic characters had portrayed them as violent.

No more than 10% of patients with schizophrenia or other psychotic disorders behave violently, showed a research conducted by psychiatrists from All India Institute of Medical Sciences (AIIMS). Among them, a higher prevalence of violence is seen in patients who have been involuntarily confined.

Outpatient settings have generally low rate of people acting out (2%-13%). Co-morbid substance abuse, neurological impairment, or social burdens also pose an increased risk for aggressive behaviour.

There are various ways in which schizophrenia manifests in people. "Some people become quiet and withdrawn and retreat into a world of their own. There are some people who are also violent, different patients present with different symptoms," Dr Lulla clarified.

Myth 4: Schizophrenia is untreatable

Fact: Schizophrenia is frequently associated with significant distress and impairment in personal, family, social, educational, occupational, and other important areas of life. "A lot of people with schizophrenia can lead comparatively normal lives, can work, teach, be good parents and children, provided they take their medication," said Dr Kersi Chavda, consultant psychiatrist at PD Hinduja Hospital, Mahim.

The experts also mentioned that the first anti-psychotic drug was invented 69 years ago and there have been progressively more effective drugs since then. By understanding the psychodynamics of the patient, limiting their stress levels and giving them a balanced lifestyle, chances of relapse in the long run can be reduced, said Dr Lulla.

Myth 5: Schizophrenia is hereditary

Fact: There is a considerable underlying genetic component to one's risk of developing schizophrenia, but that is only one of the many factors. "A lot of people with schizophrenia actually do not have a family history," said Dr Chavda.

Schizophrenia isn't caused by just one genetic variation, but a complex interplay of genetics and environmental influences. Exposure to viruses or malnutrition before birth, particularly in the first and second trimesters has been shown to increase the risk of schizophrenia. A 2019 research also suggested that there exists a positive relationship between autoimmune diseases and the risk of developing psychosis.

Myth 6: Schizophrenia always sets in with a sudden episode of psychosis

Fact: Researchers from Mysuru's JSS Academy of Higher Education & Research found that 75% of people who develop schizophrenia experience some initial symptoms, which could last anywhere between several weeks to a year, before they lose their touch with reality.

These early signs, also known as the prodromal stage, include social withdrawal, having odd beliefs, impairment in functioning, and vague or over-elaborate speech, among others. The onset of psychosis in schizophrenia or otherwise, is therefore not sudden but marked by a trajectory of symptoms.

Elaborating on early signs, Dr Chavda said schizophrenic patients may begin feeling suspicious of people around them or question their loyalty. "There is generally an increase in anxiety and change in sleep patterns," he added.