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What is schizophrenia?
Schizophrenia is a mental illness that causes people to lose touch with reality (called psychosis). People with schizophrenia may have hallucinations (like hearing voices) and delusions (fixed beliefs that aren’t true). They may have trouble keeping their thoughts straight, feel a lack of motivation, and not express much emotion. These symptoms greatly impact work and relationships.
Schizophrenia affects roughly 1% of the population. It occurs equally in men and women but tends to appear earlier—usually in the teen years—in men. It is often diagnosed between teen years and early 30s.
Schizophrenia is a lifelong illness that requires medication. Symptoms come and go over time. Early diagnosis and treatment can lead to greater improvements in symptoms.
Symptoms of schizophrenia
Schizophrenia can include a range of symptoms. It can vary from person to person and can even change in one person over time. Usually, though, reality is distorted in some way. This can include hearing voices, thinking you or others have special powers, or fearing certain people are out to harm you.
People with schizophrenia can have psychotic episodes, where symptoms are more severe (hallucinations and delusions that are frightening and can affect daily life). They may have periods between episodes with no symptoms at all. Others may have symptoms all the time.
To be diagnosed with schizophrenia, someone has to experience symptoms for at least 6 months. Many people with schizophrenia have little awareness that they are experiencing symptoms. This makes it more difficult to get an early diagnosis and get treated.
Other conditions, such as drug use, bipolar disorder, and brain tumors, can cause symptoms similar to schizophrenia. A psychiatrist will rule out other conditions.
People with schizophrenia may “feel crazy.” You are not crazy—it’s a chemical issue that can be treated with medication. Your neurotransmitters are firing in a different way that make you potentially see and hear things that aren’t there. Or that affect how you perceive reality. —Dr. Bobbi Wegner
- Delusions are false beliefs that a person clings to despite evidence to the contrary. There are many types of delusions. The most common are persecutory delusions, which are paranoid beliefs that they are going to be harmed or harassed. Referential delusions are beliefs that someone is sending them messages. Grandiose delusions are beliefs that they have extraordinary abilities. Somatic delusions are false beliefs about physical health.
- Hallucinations are hearing, seeing, or smelling things that no one else does. Hearing voices is the most common one. Voices may comment on what a person is doing or make insulting remarks.
- Disorganized speech is when a person often switches topics, making it tough for others to follow what they are saying.
- Disorganized behavior includes inappropriate laughing, and dressing or acting inappropriately.
- Catatonia is an extreme type of disorganized behavior, in which someone maintains a rigid posture (like a statue), stares, or refuses to eat or drink.
- Negative symptoms include showing little emotion, avoiding eye contact, speaking in one- or two-word statements, and having little interest in activities and social contact.
- Ability to complete tasks on a day-to-day basis declines. This may be a drop in school grades or not being able to complete work that used to be manageable.
Other symptoms you may have
- Irregular sleep patterns.
- Lack of interest in eating.
- Problems with memory, language, and thinking, and slow processing of information.
- Limited self-control.
- Poor coordination.
- Poor attention.
- Difficulty understanding other people.
- Finding meaning in events or objects that others would find irrelevant.
- Suicidal thoughts and behaviors—20% of people with schizophrenia attempt suicide and many more have thoughts about suicide.
Researchers are still trying to understand what causes schizophrenia. Studies show that people with schizophrenia have differences in brain structures and the way the brain functions. There are also differences in levels of brain chemicals, such as dopamine and glutamate, and how they function.
Schizophrenia probably develops because of a combination of genetic, environmental, and biological factors. Although stress, trauma, and substance use can also contribute to the disorder.
People with schizophrenia often have a flat affect and other mental health conditions like depression, anxiety, and substance abuse. Sometimes people with schizophrenia attempt to manage their symptoms through substance use (like marijuana). —Dr. Wegner
A number of factors may increase the likelihood of developing schizophrenia. However, most people with these factors do not get schizophrenia.
- Genetics: Having a family member with schizophrenia.
- Environment: Early childhood trauma or environmental factors such as lead exposure.
- Birth conditions: Low birth weight, premature birth, not getting enough oxygen during birth can increase risk. Having an older father, or having a mother who was malnourished or experienced a serious infection during pregnancy.
- Substance use: Using substances as a teenager, especially in those with a family history of schizophrenia.
Many people with schizophrenia don’t realize they are having symptoms. If you are worried that a friend or family member is showing symptoms, talk to them about your concerns and encourage them to speak with a doctor. It’s important to not try to convince someone having hallucinations or delusions that those thoughts aren’t real.
Schizophrenia can become a medical emergency when delusions or psychosis may harm a person or others. If someone you know has any of the following symptoms, call 911 or take them to the nearest emergency department to be evaluated by a psychiatrist:
- Intentionally injuring themselves.
- Talking about killing themselves or someone else.
- Is confused or not making sense.
- Is not able to take care of themselves on a day-to-day basis.
Schizophrenia requires lifelong treatment that often includes medication, therapy, and family support. People do best when they start treatment early.
Most treatment occurs in outpatient clinics, with a treatment team that includes a psychiatrist, social workers, psychologists, and other specialists.
If someone is having a severe episode or is in danger of hurting themselves or others, they may be hospitalized until symptoms are more manageable.
Finding the right treatment might take a little time. Although certain drugs (antipsychotics) are prescribed to treat schizophrenia, each person is unique. Be patient, work with a trusted psychiatrist, and be honest about your experience. —Dr. Wegner
Antipsychotic medications can reduce symptoms of schizophrenia (including hallucinations, delusions, and disorganization). They can also reduce the risk of serious episodes. They usually do not help negative symptoms.
There are many effective antipsychotic medications, but most have side effects, like drowsiness, involuntary movements, dizziness, and weight gain. It can take weeks or months for you and your healthcare team to find the right combination of medications that reduce symptoms with the fewest side effects.
Individual therapy, family therapy, group-based treatments, and skill-based programs are all used to help people learn how to live with schizophrenia. Treatment may change over time.
- Individual therapy. Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people examine their psychotic experiences and develop strategies for coping with them.
- Family psychoeducation teaches families how to help a family member with schizophrenia.
- Vocational rehabilitation helps people prepare for a job, conduct a job search, and maintain a job.
- Social skills training focuses on improving communication skills.
- Cognitive enhancement therapy uses computer- and group-based exercises to improve cognitive (thinking) function.
- Peer support provides emotional support and information about community resources. Peers can help show that living a satisfying life is possible.
Ways to prevent episodes
People with schizophrenia can lower their chances of having a psychotic episode if they:
- Take medications regularly.
- Follow up regularly with the treatment team, as symptoms and the treatment plan may change over time.
- Avoid alcohol and drugs, as these can worsen symptoms.
- Minimize stress.
- Maintain social support—having friends and family involved in treatment can improve the chances of recovery. The National Alliance on Mental Illness offers information and support to individuals and families. Support groups, such as the Hearing Voices Network can be a helpful source of peer support.
Dr. Becker is a psychiatry resident at the Mount Sinai Hospital. He received his undergraduate degree in Urban & Regional Studies from Cornell University (2012) and completed his medical degree at the Perelman School of Medicine at the University of Pennsylvania (2018). Prior to medical school, he worked as a pre-medical teaching assistant at Weill Cornell Medicine-Qatar, where he received an Excellence in Teaching Award. His research has focused on global health (including explanatory models of mental illness in Botswana, epidemiology of head trauma, and psychosocial aspects of HIV), adolescent and young adult mental health, and quality improvement. He enjoys communicating health-related science through writing and teaching and joined Buoy Health as a writer in 2018. In his free time he enjoys running, hiking, and exploring new places.