Concluding remarks

Traditionally, psychiatry has not always given to schizophrenia the attention that its complexities and chronicity merit. Views about what really helps in such a disorder are not, at the end of the day, based solely on research evidence, but are informed by personal experience—and, no doubt, personal prejudice. The distinction between theoretical and pragmatic psychiatry is nowhere more evident than in psychiatrists' actions in regard to schizophrenia. As a result, an element of variability in treatment and management recommendations is inevitable. What is often perceived as lacking, however, is less a consistency in practice recommendations than a consistency of personnel. One element sufferers and their families appreciate most is accessible care by experienced professionals, who, by being involved over the long years of illness, know the disorder, the patient, and the families—and are able to attempt some understanding of all three. Combining such an essentially 'primary care' function with rapidly expanding knowledge of pathophysiological mechanisms and a wide, and evolving, array of therapeutic tools, schizophrenia can increasingly be seen as a legitimate and rewarding area for specialist psychiatric practice in which, contrary to widespread belief, the skilled doctor can make a difference.

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