Schizophrenia: The Cost of Silence and the Value of Action
by José Luis Cárdenas Tomažič / Dr. Guillermo Maligne
Adapted from the Spanish column originally published in El Economista on June 13th, 2026 (Esquizofrenia: el costo del silencio y el valor de actuar)
A few days ago, on May 24, the calendar reminded us of a reality that rarely makes headlines, but should: World Schizophrenia Day. Behind that clinical diagnosis lie millions of human, family, and social stories that deserve to be told, understood, and, above all, addressed. This is particularly relevant as mental health has historically been overlooked, as I noted in a previous column.
Schizophrenia is a severe mental disorder that affects how a person thinks, feels, and behaves. It manifests through delusions and hallucinations—its most characteristic symptoms—along with disorganized thinking and negative symptoms such as social withdrawal or flattened affect. These negative symptoms, being more subtle and less noticeable, may go undetected and delay diagnosis by up to 15 years.
According to the WHO, schizophrenia affects more than 24 million people worldwide—about 1 in 300—and is one of the leading causes of global disability. Although there is no definitive cure, schizophrenia can be effectively treated. Paradoxically, despite its prevalence among people with epilepsy or bipolar disorder reaching up to half of those populations, schizophrenia receives perhaps only one-third of the attention and visibility in society compared to other disorders. This invites reflection on stigma, lack of awareness, and the need for greater collective consciousness.
Various studies show that a significant proportion of patients—in some cases close to one-third—can achieve functional or complete remission if they receive timely and adequate care, especially during the early years following symptom onset. This includes access to community services, continuous pharmacological treatment, and psychosocial support. Early diagnosis is key: detecting initial symptoms and acting quickly can make the difference between a functional life and one marked by disability.
This is particularly important as evidence shows that people with schizophrenia may live 10 to 20 years less than the general population, due to a combination of factors such as suicide, cardiovascular diseases, adverse effects of treatment, and barriers to accessing physical healthcare services. In addition, quality of life is compromised by persistent symptoms, social stigma, unemployment, and isolation.
The Contribution of the New INTEGRATE Guideline and a Broader Approach
The INTEGRATE guideline, recently hpublished in The Lancet Psychiatry (2025), represents a significant advancement over previous clinical recommendations. Unlike traditional approaches focused solely on disease stages, INTEGRATE proposes an algorithmic model that incorporates predominant symptom domains: positive symptoms (such as delusions and hallucinations), negative symptoms (such as social withdrawal), cognitive, and affective domains. This classification allows for more precise personalization of treatment, including psychological therapies, cognitive rehabilitation, and social reintegration programs.
In addition, the guideline emphasizes the need to address physical comorbidities from the outset, particularly metabolic risks associated with antipsychotic treatment, such as obesity, diabetes, and dyslipidemia. Comprehensive treatment of schizophrenia cannot be limited to controlling psychiatric symptoms; it must also include the prevention and management of associated physical illnesses.
Compliance, Adherence, and Quality of Life: The Role of Long-Acting Injectables (LAIs)
One of the greatest challenges is treatment adherence, as I have noted in another column. This is a broader concept than mere compliance. It implies an active attitude from the patient and their environment, whereas compliance may be limited to simply taking medication.
Understanding this difference helps explain why up to 50% of patients discontinue medication during the first year, increasing the risk of relapse, hospitalization, and functional deterioration. This is where long-acting injectable antipsychotics (LAIs) offer an effective alternative compared to oral therapies.
The INTEGRATE international guidelines recommend the early use of LAIs, even from the first psychotic episode. These treatments improve adherence, reduce hospitalizations, and enable more stable clinical follow-up.
A recent study published in Molecular Psychiatry evaluated more than 12,000 patients with schizophrenia treated with LAIs in France. The results showed a significant reduction in hospitalizations and psychiatric emergency visits, especially among previously non-adherent patients.
Are LAIs Sustainable? Pharmacoeconomic Evidence
LAIs have a higher upfront cost than oral antipsychotics, so it is reasonable to question whether healthcare systems should cover them as recommended by INTEGRATE.
Strong support for the economic sustainability of LAIs comes from a systematic review published in Applied Health Economics and Health Policy. The study, conducted by Achilla and McCrone, analyzed 28 full economic evaluations of long-acting antipsychotics and concluded that, in general, these treatments are cost-effective compared to oral or typical injectable formulations. The review highlights that LAIs significantly reduce relapses and hospitalizations, translating into substantial savings for healthcare systems, including shorter hospital stays in non-adherent patients.
Community Participation and Psychosocial Support
Beyond pharmacological treatment, the social and community environment plays a decisive role in recovery.
Building community support networks—including patients, families, professionals, and public policies—is essential for the humanization of treatment, a topic I have emphasized in other columns.
In conclusion, schizophrenia is a complex condition that requires a comprehensive and multidimensional approach. The INTEGRATE guideline offers a valuable framework to personalize and improve treatment, but it is essential to also address physical comorbidities and strengthen community and psychosocial support. Only then can we move toward more humane and effective care for those living with this condition.
As a society, we have the responsibility to break the silence and act decisively.
