Treatment Of Phobia's

Simple or specific phobias have been quite effectively treated with behavior therapy (Marks, 1987). The behaviorists involved in classical conditioning techniques believe that the response of phobic fear is a reaction acquired to non-dangerous stimuli. The normal fear to a dangerous stimulus, such as a poisonous snake, has unfortunately been generalized over to non-poisonous ones as well. If the person were to be exposed to the non-dangerous stimulus time after time without any harm being experienced, the phobic response would gradually extinguish itself. Also, this assumes that the person does not also experience the dangerous stimulus during that same extended period of time. In other words, one would have to come across ONLY non-poisonous snakes for a prolonged period of time for such extinction to occur. This is not likely to occur naturally, so behavior therapy sets up phobic treatment involving exposure to the phobic stimulus in a safe and controlled setting. Foa and Kozak (1986) call this exposure treatment, so called because the patient is exposed to the phobic stimulus as part of the therapeutic process.

One simple form of exposure treatment is that of flooding, where the person is immersed in the fear reflex until the fear itself fades away. Some phobic reactions are so strong that flooding must be done through one's imagining the phobic stimulus, rather than engaging the phobic stimulus itself.

Some patients cannot handle flooding in any form, so an alternative classical conditioning technique is used called counter-conditioning (Watson, 1924). In this form, one is trained to substitute a relaxation response for the fear response in the presence of the phobic stimulus. Relaxation is incompatible with feeling fearful or having anxiety, so it is said that the relaxation response counters the fear response. This counter-conditioning is most often used in a systematic way to very gradually introduce the feared stimulus in a step-by-step fashion known as systematic desensitization, first used by Joseph Wolpe (1958). 

This desensitization involves three steps:

 (1) training the patient to physically relax, 

(2) establishing an anxiety hierarchy of the stimuli involved, and 

(3) counter-conditioning relaxation as a response to each feared stimulus beginning first with the least anxiety-provoking stimulus and moving then to the next least anxiety-provoking stimulus until all of the items listed in the anxiety hierarchy have been dealt with successfully.

Biofeedback instrumentation has often been used to ensure that the patient is truly well-relaxed before going the next higher item in the anxiety hierarchy. Several indexes have been used in this adjunctive approach, including pulse rate, respiration rate, and electrodermal responses.

Also, systematic desensitization can be paired with modeling, an application suggested by social learning theorists. In modeling, the patient observes others (the "models") in the presence of the phobic stimulus who are responding with relaxation rather than fear. In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia. Combining live modeling with personal imitation is sometimes called participant modeling (Bernstein, 1997).

Stress Management

STRESS MANAGEMENT

The word stress is derived from the Latin word "stringi", which means, "to be drawn tight". Stress can be defined as follows:

Definition of Stress:

In medical terms stress is described as, "a physical or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness." When you are under stress, your adrenal gland releases corticosteroids, which are converted to cortisol in the blood stream. Cortisol have an immune suppressive effect in your body.

Another Definition of Stress:

According to Richard S Lazarus, stress is a feeling experienced when a person thinks that "the demands exceed the personal and social resources the individual is able to mobilize."

Your body tries to adjust to different circumstances or continually changing environment around you. In this process, the body is put to extra work resulting in "wear and tear". In other words, your body is stressed. Stress disturbs the body's normal way of functioning.

Most of us experience stress at one time or another. Without stress, there would be no life. However, excessive or prolonged stress can be harmful. Stress is unique and personal. A situation may be stressful for someone but the same situation may be challenging for others. For example, arranging a world level symposium may be challenging for one person but stressful to another. Some persons have habit of worrying unnecessarily.

Stress is not always necessarily harmful. Hans Selye said in 1956, "stress is not necessarily something bad – it all depends on how you take it. The stress of exhilarating, creative successful work is beneficial, while that of failure, humiliation or infection is detrimental." Stress can be therefore negative, positive or neutral. Passing in an examination can be just stressful as failing.

Sometime we know in advance that doing a certain thing will be stressful, but we are willing to doing that. For example, while planning a vacation to a hill station you know that it would be stressful at certain times. But you are willing to face those challenges.

People often work well under certain stress leading to increased productivity. Many times you do not know in advance and the stress periods may be sudden. The situation may not be under your control. Too much stress is harmful. You should know your level of stress that allows you to perform optimally in your life.

Types of Stress:

Eustress

Eustress is one of the helpful types of stress. It is the type of stress you experience right before you have the need to exert physical force. Eustress prepares the muscles, heart, and mind for the strength needed for whatever is about to occur.

Eustress can also apply to creative endeavors. When a person needs to have some extra energy or creativity, eustress kicks in to bring them the inspiration they need. An athlete will experience the strength that comes form eustress right before they play a big game or enter a big competition. Because of the eustress, they immediately receive the strength that they need to perform.

When the body enters the fight or flight response, it will experience eustress. The eustress prepares the body to fight with or flee from an imposing danger. This type of stress will cause the blood to pump to the major muscle groups, and will increase the heart rate and blood pressure to increase. If the event or danger passes, the body will eventually return to its normal state.

Neustress

 It is a sensory stimuli that have no consequential effect; it is consider neither good nor bad. For example news of an earthquake in remote corner of the world.

Distress

Distress is one of the negative types of stress. This is one of the types of stress that the mind and body undergoes when the normal routine is constantly adjusted and altered. The mind is not comfortable with this routine, and craves the familiarity of a common routine. There are actually two types of distress: acute stress and chronic stress.

Types of distress:

Acute Stress

 Acute stress is the type of stress that comes immediately with a change of routine. It is an intense type of stress, but it passes quickly. Acute stress is common in people who take too many responsibilities and are overloaded or overworked, disorganized, always in a hurry and never in time. These people are generally in positions of importance at their workplace and stressful lifestyle is inherent in them.

Symptoms of this type of stress are prolonged tension headaches, hypertension, migraines, chest pain and heart disease.

Chronic Stress

This type of stress is the most serious of all the  stress types. Chronic stress is a prolonged stress that exists for weeks, months, or even years. This stress is due to poverty, broken or stressed families and marriages, chronic illness and successive failures in life. People suffering from this type of stress get used to it and may even not realize that they are under chronic stress. It is very harmful to their health.

General causes of stress:

Threat

A perceived threat will lead a person to feel stressed. This can include physical threats, social threats, financial threat, and so on. In particular it will be worse when the person feels they have no response that can reduce the threat, as this affects the need for a sense of control.

Generally speaking, any threat to needs is likely to lead to stress being experienced.

Fear

Threat can lead to fear, which again leads to stress. Fear leads to imagined outcomes, which are the real source of stress.

Uncertainty

When we are not certain, we are unable to predict, and hence feel we are not in control, and hence may feel fear or feel threatened by that which is causing the uncertainty.

Cognitive dissonance

When there is a gap between what we do and what we think, then we experience cognitive dissonance, which is felt as stress. Thus, if I think I am a nice person then do something that hurts someone else, I will experience dissonance and stress.

Dissonance also occurs when we cannot meet our commitments. We believe we are honest and committed, but when circumstances prevent us from meeting our promises we are faced with the possibility of being perceived as dishonest or incapable (i.e. a social threat).

Life causes:

There are many causes of stress in life including:

Death: of spouse, family, and friend

Health: injury, illness, pregnancy

Crime: Sexual molestation, mugging, burglary, pick-pocketed

Self-abuse: drug abuse, alcoholism, self-harm

Family change: separation, divorce, new baby, marriage

Sexual problems: getting partner, with partner

Argument: with spouse, family, friends, co-workers, boss

Physical changes: lack of sleep, new work hours

New location: vacation, moving house

Money: lack of it, owing it, investing it

Environment change: in school, job, house, town, jail

Responsibility increase: new dependent, new job  

Stress signs and symptoms:

Cognitive Symptoms

• Memory problems
• Inability to concentrate
• Poor judgment
• Seeing only the negative
• Anxious or racing thoughts
• Constant worrying

Emotional Symptoms

• Moodiness

• Irritability or short temper
• Agitation, inability to relax
• Feeling overwhelmed
• Sense of loneliness and isolation
• Depression or general unhappiness

Physical Symptoms

• Aches and pains
• Diarrhea or constipation
• Nausea, dizziness
• Chest pain, rapid heartbeat
• Loss of sex drive
• Frequent colds

Behavioral Symptoms

• Eating more or less
• Sleeping too much or too little
• Isolating yourself from others
• Procrastinating or neglecting responsibilities
• Using alcohol, cigarettes, or drugs to relax
• Nervous habits (e.g. nail biting, pacing)

The stress Response

The fight-or-flight response, also called the fright, fight or flight response, hyper arousal or the acute stress response, was first described by Walter Cannon in 1915. His theory states that animals react to threats with a general discharge of the sympathetic nervous system, priming the animal for fighting or fleeing. This response was later recognized as the first stage of a general adaptation syndrome that regulates stress responses among vertebrates and other organisms.

The "fight or flight response" is our body's primitive, automatic, inborn response that prepares the body to "fight" or "flee" from perceived attack, harm or threat to our survival.

There are four stages of fight or flight response:

Stage 1. Stimuli from one or more of the five senses are sent to brain.

Stage 2. The brain deciphers the stimulus as either a threat or a non threat; this is the end of response. If response is decoded as a real threat, the brain then activates the nervous and endocrine systems to quickly prepare for defense and or escape.

Stage 3. The body stays activated, aroused, until the threat is over.

Stage 4. The body returns to homeostasis, a state of physiologically calmness, once the threat is gone.

Following table explains the bodily changes that take place during stress.

Target	Sympathetic Stress, Fight/Flight	Parasympathetic Normal function (opposite of stress response)
Heart Rate	Increased	Decreased
Coronary Arteries	Dilate	Constrict
Blood Pressure	Increase	Decrease
Bronchioles	Dilate	Constrict
Respiratory Secretions	Decrease	Increase
Pupil	Dilate	Constrict
Skin Blood Flow	Decrease	Increase
Digestive Blood Flow, Secretions and Muscular Activity	Decrease	Increase
Sweating	Increase	Decrease
Blood Glucose	Increase	Decrease

General Adaptation Syndrome:

Hans Selye researched the effects of stress on rats and other animals by exposing them to unpleasant or harmful stimuli. He found that all animals presented a very similar series of reactions, broken into three stages. In 1936, he described this universal response to the stressors as the general adaptation syndrome, or GAS.

Alarm is the first stage. As you begin to experience a stressful event or perceive something to be stressful psychological changes occur in your body.  This experience or perception disrupts your body’s normal balance and immediately your body begins to respond to the stressor as effectively as possible. It describes the cannon’s fight or flight response.

Resistance is the second stage. If the stressor persists, it becomes necessary to attempt some means of coping with the stress. Although the body begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually useless.

Exhaustion is the third and final stage in the GAS model. At this point, all of the body's resources are eventually useless and the body is unable to maintain normal function. At this point the initial autonomic nervous system symptoms may reappear (sweating, raised heart rate etc.). If stage three is extended, long term damage may result as the capacity of glands, especially the adrenal gland, and the immune system is exhausted and function is impaired resulting in decompensation. The result can manifest itself in obvious illnesses such as ulcers, depression, and diabetes, trouble with the digestive system or even cardiovascular problems, along with other mental illnesses.

COPING STRATEGIES FOR STRESS:

1) Healthy diet:

• Promotes connection of mind and body.
• Recognizes control over one’s own health.

2) Spiritual Practice

The relationship between stress and human spirituality is gaining more and more attention in the aalied health fields. Prayer is perhaps one of the most common coping techniques for those stressors that seem beyond the grasp of human resources.

3) Physical activity:

• Improves self-esteem.
•  Decreases risk of diseases and disability.

4) Sleep hygiene:

• Sleep deprivation exacerbates stress.
• Unrealistic expectations about sleep can cause stress.

5) Social support

• Social support greatly reduces stress.
•  When people bond together in times of trouble, they are better able to cope with the problems at hand.

6) Setting realistic goals:

• Take small steps.
• Work on what is most important first.

7) Rest:

Get a minimum of six hours of continuous rest

8) Anger management

• Learn to manage your anger
• Anger affects your health
• Anger causes you to over react to many situations

9) Forgiveness

• We get angry often because someone did not do what we thought they should
• Rethink the situation and learn to be more flexible

10) Cognitive restructuring:

The term cognitive restructuring was coined by Meichenbaum in1975 to describe a coping technique for patients diagnosed with stress related disorders. This coping style aimed to modify internal self-dialogue by tuning into the conversation within the mind. The practice of cognitive restructuring was an important step in what Meichanbaum referred to as stress inoculation, a process to build up positive thoughts when negatively perceived events encountered. Bandura in 1977 and Beck in 1976 also supported the concepts of cognitive change perceptions as a mean to effectively deal with stress.

The purpose of cognitive restructuring is to widen ones conscious perspective and thus allow room for a change in perception. Cognitive restructuring involves assuming responsibility, facing the reality of a situation, and taking the offensive to resolve the issues causing stress.

To restructure your perceptions to experience more good luck, something we can all do. Wiseman suggests adopting four attitudinal behaviors.

1.      Maximize your chances opportunities by taking a proactive stance rather than playing the role of a victim.

2.      Listen to your intuition. Go with your gut feelings and learn to listen to the voice of intuition rather than the voice of fear that tends to hold you back.

3.      Focus on the positive and take calculated risks. Meeting new people and trying new activities increase the chance of expanding your thoughts and possibly making and succeeding with new goals.

4.      Find the good in bad situation. Every situation has a good side and a bad side; at each moment you decide which is which.

Steps to initiate cognitive restructuring:

A simple four –stage process introduced by the field of behavioral medicine by Roger Allen (1983) is a model for implementing changes in lifestyles behaviors through cognition to promote health. The following model explains how cognitive restructuring can be implemented as a coping technique to reduce stress. The steps are as follows:

1.     Awareness: the awareness process has three steps. In first, stressors are identified and acknowledged. This may include writing down what is on your own mind, including all frustrations and worries. The second step of the awareness process is to identify why these situations and events are stressors and, more specifically, what emotional attitudes are associated with each. In the last step, a primary appraisal given to the main stressors and acknowledgment of the feelings associated with it. If the original perception appears to be defensive or negative, and inhibits you from resolving this issue, then the next stage is a reappraisal.

2.     Reappraisal of the situation. A secondary appraisal, or reappraisal, is a “second opinion” you generate in your mind to offer a different objective. A reappraisal is a new assembly or restructuring of the factors involved, and the openness to accept a new frame of mind.

3.     Adaptation and substitution. The most difficult part of any attitudinal change is its implementation. Once a new frame of mind is created, it must then be adopted and implemented. Humans to be creatures of habit, finding comfort in known entities even if the “known” is less than desirable. With cognitive restructuring, the new mind frame must often be substituted when the stress is encountered and repeated again and again.

4.        Evaluation. The test of any new venture is to measure its effectiveness. Did this attitude work? Initially, it may not. The first attempt to shoot a basket through the hoop may result in an embarrassing miss. Evaluate the new attitude and decide how beneficial it was. If it turns out that the new mind frame was a complete.

11) Journal writing:

Journal writing is perhaps the most effective coping skill available to provide profound internal vision and enhance the self-awareness process. Journal writing initiates the communication of self-reflection between the mind and soul, the necessary first step in the resolution and closure of perceived stress. Journaling, in its own way, is a vehicle for meditation. As a technique to clear the mind of thoughts a claming effect takes place as thoughts and feelings are transferred from the mind. Although few studies have investigated the effectiveness of expressive writing, there is consensus that when encouraged, this technique can prove meaningful on many fronts, from expressing guilt and worry, to planting and harvesting the seeds of creative problem solving. Current research suggests that journal writing is not only good for the soul, as a mode of catharsis to express the full range of emotions, but has proven to be good for the soul. The healing process of self –expression through poetry described Morris Morrison in his book, Poetry as Therapy, incorporates imagination, intuition, and the development of personal insight- three characteristics essential in the healing process. Poetry therapy is currently used as a therapeutic tool in the treatment of emotional disorders. Thus, this method of writing is encouraged as a complementary journal writing style.

Steps to initiate Journal Writing:

Only three essential elements re needed for effective journal writing: (1) a notebook dedicated solely to the journal, (2) a pen or pencil, and, perhaps most important, (3) a quiet, uninterrupted environment to collect your thoughts and then put them down on paper.    

Although there is no specific formula for successful journal writing, some criteria aid the writer to use this coping strategy to deal more effectively with perceived stress. These include the following:

1.      Try to identify those concerns and problems that cause the most frustration, grief and tensions.

2.      Ask yourself what emotions are elicited when these stressors are encountered.

3.      Allow the writing process to augment your creative process to further resolution.

 12)Humor&Laughter:

besides respite care, humor may reduce caregiver stress.  Humor therapy is defined as the use of humor for the relief of physical or emotional pain and stress.  Humor is a coping mechanism that a caregiver may use repeatedly or in the ‘heat of the moment’.  When a situation with the care receiver has gone awry, laughter may be the best medicine.

Humor:

• Is a complementary method to promote health and cope with illness?
• Is generally used to improve quality of life, provide some pain relief, encourage relaxation and reduce stress. 
• May allow people to feel in control of their situations and make the situation seem more manageable. 
• Allows people to release fears, anger and stress, all which harm the body over time.

Laughter:

• Appears to change brain chemistry and may boost the immune system. 
• Appears to increase breathing, increase heart rate and increase oxygen use within the body.
• Allows more oxygen to be used by your body which stimulates the circulatory system.
• Exercises the same muscles and organs used for breathing.
• May release endorphins (neurotransmitters in the brain) which help to control pain.

13) Communication skills:

Good communication skills can relieve a stressful situation. A communication skill lesson plan can help build effective communication. You can communicate your feelings by a putting a frown on your face. Or you could wave across the street to someone. This is known as body language or "non-verbal" communication. Or you could communicate by speaking. Sometimes our verbal communication does not match our non-verbal gestures.

"Interpersonal communication is the process where meaning is exchanged."

"A meaning is exchanged through the sending and receiving of messages."

Meanings are your ideas and feelings. When you communicate your ideas and feelings to someone else you are using both verbal and nonverbal elements. When you are listening you are processing both the words and nonverbal cues and add meaning to them. Effective communication skills: Effective communicators use skills such as paraphrasing and questioning skills what the other person was saying to clarify if they understood the message as the person intended.

Effective Communication Helps to Relieve Stress and Remove Tension: Effective communication is an important technique for stress management and build to a health work and personal life. People who cope with stress well use their communication skills to calmly reach a solution. They are able to talk about their feelings and listen to the other person until the problem is solved. Both parties consider each others position and viewpoint until a happy medium can be found, or until they agree on something.

14) Creative Problem Solving:

Going beyond the traditional process for creating and implementing solutions to problems, this course will: Equip participants with skills to evaluate underlying purposes for solving problems Teach the process of formulating solutions that compel participants to probe “solutions after next” to understand the dynamics of future solutions or system requirements Create powerful in-class exercises and problem-solving activities tailored to specific needs of individuals or groups.

Participants will discover:

• A process for identifying challenges and potential solutions
• How to look beyond problems to the potential challenges ahead
• How to utilize problem solving to reach organizational goals and vision
• A visual model for problem solving (return to top)

15) Time Management: Optimizing Performance:

In an effort to be more productive and efficient, organizations must realize the value of using time wisely. Misspent time is lost opportunity and profit. This interactive course will teach: Critical skills for monitoring and scheduling time Tools for monitoring the quality of how time is spent Processes for determining and setting priorities Innovative in-class exercises and examples to emphasize concepts.

• Participants will discover:
• How to prioritize
• Time management tools and techniques in the work environment
• How to be proactive rather than reactive (“putting out fires”) at work.

                                  

Prevalence of Schizophrenia

Schizophrenia: 

  

Prevalence of Schizophrenia: 

The global prevalence of schizophrenia: 

 There is no doubt that the global burden of schizophrenia, a chronic serious mental illness, is massive. It is therefore essential that any intervention is appropriate, cost-effective, and efficacious. The prevalence rates of schizophrenia depend upon a whole range of factors, such as the availability of and response to treatment. The prevalence of schizophrenia, as with other mental disorders, can be calculated from a number of sources—from case registers to field surveys. The latter lend themselves more readily to estimation of period prevalence than point prevalence, while case register data can provide point prevalence more readily. The denominator can be the whole population or only a small defined population. Saha et al. quite rightly differentiate between traditional prevalence, or “core”, studies (these generate an estimate based on the population residing within a defined catchment area), and studies in specific sub-groups (which they divide into migrant studies and studies in other special groups). Using sequential filters they were able to isolate discrete data from multiple studies, and they used other strategies to ensure that the largest groups were counted. The authors had hypothesised that prevalence estimates would differ between lifetime, period, and point prevalence and that lifetime prevalence would be higher than lifetime estimates (estimates are calculated as a proportion by dividing the total number of individuals who manifest a disorder [the numerator] by the total population at risk including those with the disorder [the denominator]). They also predicted that the estimates would be higher for males, those from urban areas, and migrants. Case ascertainment methods and sample selection do influence prevalence rates, so Saha et al. chose studies that used comprehensive case ascertainment methods. Of the 132 core studies, 21 studies reported point prevalence, 34 reported period prevalence, and 24 reported lifetime prevalence. The median prevalence of schizophrenia was 4.6/1,000 for point prevalence, 3.3/1,000 for period prevalence, 4.0 for lifetime prevalence, and 7.2 for lifetime morbid risk. 

Point prevalence: The proportion of individuals who manifest a disorder at a given point in time. 

Period prevalence: The proportion of individuals who manifest a disorder over a specific period of time (e.g., over one year). 

Lifetime prevalence: The proportion of individuals in the population who have ever manifested a disorder, who are alive on a given day. 

Lifetime morbid risk: The probability of a person developing the disorder during a specified period of their life or up to a specified age (lifetime morbid risk differs from lifetime prevalence in that it attempts to include the entire lifetime of a birth cohort both past and future, and includes those deceased at the time of the survey). 

There were no significant differences between males and females, nor between urban, rural, and mixed sites, although migrants and homeless people had higher rates of schizophrenia and, not surprisingly, developing countries had lower prevalence rates (the lower prevalence of schizophrenia in developing countries has been previously documented). It is well known from other studies that migrants have higher than expected rates of schizophrenia, although definitions of migrants in these studies have been variable and the studies have suffered from a series of other methodological problems. 

Several important findings emerge from Saha and colleagues' analysis. For clinicians, the analysis indicates clearly that lifetime prevalence is 4.0/1,000 and not 1%, as reported in the Diagnostic and Statistic Manual of Mental Disorders, fourth edition, and other textbooks. The study also challenges the widely held view that schizophrenia is much more common in men. Saha et al.'s finding that schizophrenia was just as common in women has clear implications for developing services, since it means that not only must we develop and provide culturally appropriate services but also services that are gender sensitive (as the number of cases in women are higher than expected, gender becomes a more important factor). 

 Detailed economic measures must be included in analyses of the prevalence of schizophrenia to determine whether countries are developed or developing. Saha et al. themselves acknowledge that they have used a single measure of World Bank definitions relying on per capita income (whereas in any country there will be marked geographical variation in social and economic classes) for assessing a complex and multi-dimensional concept, which is a weak point of their systematic review. The impact of urbanization must be studied especially, as in many developing or low-income countries the migration into urban areas adds a tremendous amount of variation that must be taken into account in future ecological studies. 

Schizophrenia across Cultures: 

Studies have shown that the outcome of schizophrenia is better in developing countries, and therefore the point prevalence in these countries should be lower. Despite this clear difference in the course of schizophrenia in different cultures, cross-cultural research in psychiatry focuses on similarities rather than differences.

In the International Pilot Study of Schizophrenia and the Determinants of Outcome of Severe Mental Disorders study , catatonia (a form of schizophrenia characterized by a tendency to remain in a fixed stuporous state for long periods) was diagnosed in 10% of cases in developing countries compared with less than 1% in developed countries. Hebephrenia (a form of schizophrenia characterized by severe disintegration of personality) was present in 13% of cases in developed countries and 4% in developing countries. These differences in the disease in developed versus developing countries indicate that there is more to the prevalence of schizophrenia than simple epidemiological data. Better prognosis in developing countries may indicate different sets of etiological and perpetuating factors. 

 Cohen argued that although the case-finding method in both these studies was accurate, the vast majority of cases were identified in Western-type facilities, and therefore the numbers of true cases of schizophrenia may be an underestimate. He also pointed out that in developing countries the proportion of cases with acute onset schizophrenia was twice as high as in developed countries. Such variations may indicate a real difference in the cross-cultural manifestations of schizophrenia—hospital-based data collection reflects cultural processes that have little to do with the true prevalence and incidence rates of schizophrenia. 

While prevalence studies can help contribute to an understanding of the etiology of schizophrenia, psychodynamic issues—such as cultural identity and attachment—must also be studied, especially among migrant groups, as cultural congruity and ethnic density may influence the presentation of suffering individuals to psychiatric services. 

The Prevalance Rate for schizophrenia is approximately 1.1% of the population over the age of 18 (source: NIMH) or, in other words, at any one time as many as 51 million people worldwide suffer from schizophrenia, including;

•  6 to 12 million people in China (a rough estimate based on the population) 
•  4.3 to 8.7 million people in India (a rough estimate based on the population) 
• 2.2 million people in USA 285,000 people in Australia 
•  Over 280,000 people in Canada Over 250,000 diagnosed cases in britian. 

Global Schizophrenia Prevalence May Have Been Overstated:

Although previous studies have led to the common wisdom that schizophrenia affects 1 out of every 100 individuals, new data indicate that this prevalence may be too high. 

Schizophrenia may not be as prevalent as generally believed, according to a review of a whopping amount of data from 46 countries.

 The study that arrived at this conclusion was conducted by John McGrath, M.D., a professor of psychiatry at the University of Queensland in Australia, and coworkers. Results were published in the May Public Library of Science Medicine. 

 McGrath and his colleagues systematically reviewed the medical literature on schizophrenia prevalence—that is, the number of people experiencing the illness at a given time or within a time interval—in hopes of coming up with firm figures regarding such prevalence.

 This meant that they analyzed 188 studies conducted in 46 countries and published between 1965 and 2002. 

For those studies that reported on lifetime prevalence, the mean lifetime prevalence of schizophrenia (the proportion of individuals in the population who have ever manifested the illness and who are alive on a given day) was 4 per 1,000. DSM-IV-TR states that the lifetime prevalence of schizophrenia is often reported to be 5 to15 per 1,000. For those studies that reported on point prevalence of schizophrenia, the mean point prevalence was 4.6 per 1,000. Key policy documents have estimated the point prevalence of schizophrenia to be similar, about 4 per 1,000. 

 They likewise learned that the lifetime morbid risk of schizophrenia was 7 per 1,000. This estimate corresponds to findings from two other review studies. Moreover, it raises questions about the statement that people often make that "schizophrenia affects about one person in 100," McGrath and his coworkers pointed out in their report, because the statement is usually based on lifetime morbid risk figures. "If we wish to provide the general public with a measure of the likelihood that individuals will develop schizophrenia during their lifetime, then a more accurate statement would be that `about seven to eight individuals per 1,000 will be affected.

'" The researchers concluded, "While there is substantial variation between sites, generally the prevalence of schizophrenia ranges from 4 to 7 per 1,000 persons, depending on the type of prevalence estimate used." The review also suggests, in keeping with some previous studies, that schizophrenia is more prevalent in migrant groups than in native-born populations, adding weight to the argument that migrant status is an important risk factor for the illness. 

 Yet contrary to some previous findings, the review implies that schizophrenia is about as prevalent among women as among men and that it is not more widespread in urban areas than in rural ones. However, another recent study tends to bolster their gender-related findings: it found a greater prevalence of schizophrenia among females than among males in china.