background Clinical experience shows that feelings of hopelessness quite often arise in patients with schizophrenia.
aim To describe these feelings of hopelessness, obtain insight into interrelated factors, distinguish hopelessness from depression, study the influence of hopelessness on suicidal behaviour and find out how feelings of hopelessness can influence the treatment that is provided.
method We searched the literature via medline and Psycinfo using the key words 'schizophrenia', 'hopelessness', 'demoralization', and 'disappointment'.
results Demoralization is a broader term than hopelessness and is used quite often. Positive correlations are found between hopelessness and: (1) awareness of illness; (2) engulfment; and (3) depressive symptoms. Negative correlations are found between hopelessness and: (1) cognitive disorders; and (2) an avoidant coping style. Hopelessness and demoralisation cannot be equalled with depression. Hopelessness clearly heightens suicidal tendencies. Feelings of hopelessness in a patient suffering from schizophrenia signal that closer attention should be given to that patient.
conclusion Feelings of hopelessness in patients with schizophrenia are not necessarily a sign of pathology but may point to existential suffering. This needs to be recognised by those dealing with persons suffering from schizophrenia,