What Is Schizophrenia?

Schizophrenia is a chronic psychotic disorder. A person with schizophrenia may experience delusions or false beliefs not based on reality and hallucinations or sensory experiences that aren’t real.

Schizophrenia is also characterized by a lack of motivation, difficulty expressing emotions, and cognitive impairment.

Schizophrenia occurs less frequently than many other mental disorders but still affects approximately 1% of the population, or about 24 million people worldwide.

What Are The Types Of Schizophrenia?

Today, schizophrenia is considered to exist on a spectrum. However, in the past, schizophrenia was divided into several subtypes. These subtypes, though no longer listed in the Diagnostic and Statistical Manual of Mental Disorders subtypes, can be helpful to providers when deciding on appropriate treatment for someone with schizophrenia.

Paranoid

The most common type of schizophrenia. Paranoid schizophrenia is characterized by hallucinations and paranoid delusions. Disorganized speech and behavior may also be present. Negative symptoms aren’t as common with this type.

Disorganized

Persons with this type of schizophrenia don’t have delusions or hallucinations. Instead, they experience disorganized speech and behavior. This can result in significant trouble with daily activities.

Catatonic

This is a rare type of schizophrenia that is characterized by stupor, mutism, and confusion. A person may also have agitation or restlessness.

Residual

This specifier was used when a person once met the criteria for schizophrenia but no longer has symptoms present.

Undifferentiated

Undifferentiated schizophrenia indicates that a person has symptoms and behaviors that meet the criteria for more than one type of schizophrenia. For instance, they may have paranoid delusions along with catatonia.

Where someone falls on the spectrum can indicate how affected their daily functioning may be. For example, some people with schizophrenia can remain largely independent, holding down a job and having relationships, while others may not be able to function independently because of their symptoms and must live with family or in an assisted living home.

Who Does Schizophrenia Affect?

Schizophrenia is typically diagnosed in the early twenties to early thirties but can occur in the late teens.

Schizophrenia tends to affect males and females about equally. However, the age of onset tends to occur earlier in those assigned male at birth (AMAB). Those AMAB also tend to have more negative symptoms.

Some studies have found that schizophrenia occurs at a substantially higher rate in immigrants. This could be due to the stress of immigrating to a new country and the stigma surrounding the condition, with people with schizophrenia often experiencing high rates of discrimination and human rights violations.

What Are The Symptoms Of Schizophrenia?

Schizophrenia symptoms can vary widely from person to person and may be heightened if a person is using substances or experiencing stress. In men and AMAB, symptoms typically begin between 15-25. In women or those assigned female at birth (AFAB), symptoms start between 25 and 35 years of age.

In the DSM-5, the symptoms of schizophrenia are broken up into two main categories: positive and negative symptoms.Positive symptoms refer to the presence of symptoms not normally present. Negative symptoms refer to the absence of normal behaviors or emotions.

Research conducted by the University of Oxford and the Institute of Psychiatry, Psychology & Neuroscience, London, has found that cognitive symptoms are another distinct third category and should be considered when discussing schizophrenic disorders.

Research published by the World Psychiatric Association found that people with schizophrenia have a shortened life expectancy by as much as 15-20 years earlier than the general population. It is thought this is due to high rates of co-occurring conditions like high blood pressure, substance abuse, and heart disease.

This disease is associated with one of the highest mortality rates of all psychiatric illnesses.

Positive Symptoms

Positive symptoms refer to the presence of abnormal thoughts or behaviors. These symptoms can be quite debilitating and include:

• Hallucinations: Seeing or hearing things (such as objects, people, etc.) that aren’t there. The person may also smell or feel things that aren’t real.
• Delusions: False beliefs that are not based in reality. An example might be an egomaniac delusion, where a person believes that a person who they have never met is in love with them.
• Paranoia: Being suspicious of others. The person may believe that they are being persecuted or followed.
• Abnormal or bizarre behavior: This includes strange postures or movements. This includes catatonia, which is characterized by a lack of verbal responses and rigid postures.

When the disorder is severe, positive symptoms can cause the affected individual to be unable to discern whether or not their ideas and thoughts are real.

Negative Symptoms

Negative symptoms are the absence or reduction of normal behaviors or emotions. Examples include:

• Flat affect: A flat affect refers to a flattening of emotions. A person might not show any emotions about events around them, or they might speak in a monotone voice.
• Anhedonia: The person does not experience joy or any of life’s pleasures.
• Social isolation: The person may spend most of their time alone, withdrawing from friends and family.
• Lack of motivation: Schizophrenia may result in a decrease in motivation.

Sometimes, negative symptoms can look like depression, which can make diagnosis difficult. A greater number of negative symptoms are related to poorer functional outcomes and higher morbidity.

Cognitive Symptoms

Persons with schizophrenia may also experience cognitive symptoms.

Approximately 80% of people with schizophrenia present with some cognitive deficit.

These symptoms may make working, going to school, and staying compliant with treatment difficult. Cognitive symptoms include:

• Disorganized speech and thinking: A person with schizophrenia might have incoherent speech. Their words might not make any sense. They may also have difficulty staying on topic.
• Memory or concentration impairments: Difficulty focusing or paying attention is common in schizophrenia. People with the disorder may also have deficits in working memory.

Cognitive symptoms are usually present during the first episode of psychosis.

What Causes Schizophrenia?

While no single cause of schizophrenia has been identified, several factors have been found to play a role, including:

Genetics

Schizophrenia is thought to have a strong genetic component, though there has not been a single gene identified that causes schizophrenia. However, the disorder does run in families. A 2020 study found that people who have a close relative with schizophrenia are eight times as likely to develop the condition compared to those without a close family connection. People with two close relatives with the disorder were 11 times more likely to develop the disorder during their lifetime.

Environment

Pregnancy complications and family environment have been linked with the later development of schizophrenia. Exposure to viruses, toxins, and lead may also play a role.

Biology

Differences in brain development have been noticed in those with schizophrenia. Researchers have noted both functional and structural brain abnormalities in some people with schizophrenia. It is believed that something goes wrong during the development of the brain, resulting in these changes.

Chemical Imbalances

People with schizophrenia have been found to have different amounts of neurotransmitters, including dopamine and serotonin. These are chemicals in the brain that are linked with emotion and behavior.

What Are The Risk Factors Of Schizophrenia?

The risk factors of schizophrenia include:

• Cannabis use: There may be a link between schizophrenia and cannabis use. It is believed that cannabis use might worsen schizophrenia in those diagnosed with the disorder and trigger symptoms in those who haven’t been diagnosed. Those who use cannabis regularly have twice the risk of experiencing psychosis. They also have higher rates of relapse and hospitalization.
• Smoking: There is an association between tobacco use and schizophrenia. There is double the risk of a psychotic episode among those who smoke. Smokers who develop schizophrenia tend to have an earlier age of onset.
• Vitamin D: Studies have found a link between vitamin D deficiency and the development of schizophrenia, particularly vitamin D deficiency during the neonatal and infancy periods.
• Childhood trauma: Childhood trauma, including both psychological and physical abuse, is a risk factor for the development of schizophrenia later in life. Those who have experienced childhood sexual abuse, childhood poverty, and parental divorce also have higher rates of schizophrenia.
• Social factors: Those who have experienced human rights violations, discrimination, social exclusion, and poverty are at a higher risk of developing schizophrenia. It is believed that the trauma of these issues can trigger schizophrenia in those predisposed.
• Heavy drug use: Research has shown that abusing drugs, especially amphetamines, LSD, or cocaine, can increase the risk of developing schizophrenia.
• Stressful life events: Experiencing extreme stress is a risk factor for schizophrenia symptoms. Examples include becoming homeless or being the victim of a crime.

Risk factors cannot predict with certainty whether someone will develop schizophrenia. However, the more risk factors you have, the more likely you are to develop the condition.

How Is Schizophrenia Diagnosed?

Many people with schizophrenia aren’t aware that they have it. They may not even realize that anything is wrong with them. But, family members may notice and urge them to see a doctor.

There is no single test for diagnosing the disorder. Instead, diagnosis is usually made by evaluating the symptoms and ruling out a medical cause. The healthcare provider will also ensure that the symptoms aren’t due to substance abuse.

A schizophrenia diagnosis requires the following criteria, according to the DSM-5:

• The presence of two of the following five key symptoms: hallucinations, delusions, disorganized behavior, disorganized speech, and negative symptoms.
• The symptoms must be present for one month.
• The symptoms interfere with work, school, relationships, or other key areas of life.

What Tests Will Be Done to Diagnose Schizophrenia?

Your doctor or healthcare provider may perform several tests during an evaluation for schizophrenia, including:

• Mental health evaluation: This assessment typically covers questions about mood, thoughts, behaviors, and symptoms like delusions. You may be asked about suicidal thoughts or behaviors.
• Imaging studies: These may include an MRI or CT scan. The purpose is to rule out other medical conditions, such as a stroke, that may be causing the symptoms.
• Physical exam: A physical exam may also be preformed to rule out other medical conditions, as well.
• Urine and blood tests: These tests are used to determine if a medical condition (such as an infection or poisoning) could be the cause of your symptoms or behavioral changes.

After medical tests are conducted, the person may be referred to a psychiatrist — a medical doctor who specializes in mental health. The psychiatrist will perform a comprehensive psychiatric evaluation and suggest appropriate treatment.

Can Schizophrenia Be Cured?

There is no cure for schizophrenia. However, it can be effectively managed with mental health treatment. In some cases, people experience a decrease in symptoms, but they aren’t considered to be cured, as symptoms can re-occur at any time, especially during times of extreme stress.

How Is Schizophrenia Treated?

Most people with schizophrenia require treatment that includes a combination of therapies, such as medications and psychosocial therapy. Treatments can reduce symptoms and may help prevent them from recurring. It’s important to continue with treatment, even when symptoms stabilize.

Schizophrenia may be treated using a team-based approach. The treatment team may include a psychiatrist, nurse, therapist, and case manager and may include several options.

Medications

Antipsychotic medications are most often prescribed for schizophrenia. These schizophrenia medications treat both positive symptoms, like delusions and hallucinations, as well as negative symptoms. Common antipsychotic medications include:

• First-generation antipsychotics: These are older medications and include Haloperidol (Haldol), molindone (Moban), and chlorprothixene (Truxal).
• Second-generation antipsychotics: Second-generation antipsychotics, also known as atypical antipsychotics include aripiprazole (Abilify), quetiapine (Seroquel), Clozapine (Clozaril), and paliperidone (Invega).

Some schizophrenia medications, especially first-generation ones, have the potential for serious side effects, including movement disorders like tardive dyskinesia. These may be permanent in some cases.

Psychosocial Treatments

If you have schizophrenia, it’s important to take medication even after symptoms improve. However, it’s also important to participate in psychosocial treatments, as these can lead to better outcomes. Treatments include:

• Cognitive behavioral therapy (CBT): CBT can help people with schizophrenia manage symptoms and improve their overall quality of life. CBT is a type of talk therapy that uses various techniques to change maladaptive thinking and teach problem-solving and coping skills.
• Family interventions: Family therapy and other family interventions have been found to reduce relapse in schizophrenia significantly. This type of therapy can help reduce stress and teach families how to support a loved one diagnosed with schizophrenia.
• Social skills training: Because of their symptoms, especially negative ones, people with schizophrenia may have difficulty communicating effectively with others. This treatment enhances social skills and communication.
• Supported employment or vocational rehab: This type of support helps people with schizophrenia obtain and maintain employment or educational training.

Psychosocial treatments can help a person diagnosed with schizophrenia improve relationships with family members, obtain gainful employment, and learn how to better manage crisis situations.

Lifestyle Changes

Lifestyle changes that support overall health and mental well-being, when used in conjunction with medication and therapy, can help reduce symptoms. Examples include:

• A healthy diet
• Exercise and movement
• Relaxation exercises
• Healthy sleep practices

These changes can’t solely treat symptoms but are helpful in conjunction with other treatments.

Electroconvulsive Therapy (ECT)

ECT may be used in cases where medication has not improved symptoms. Electroconvulsive therapy generates a minor seizure using electric currents. This changes electrical signaling in the brain, which improves symptoms.

Some side effects of ECT include confusion, memory loss, and minor pain or headache. In addition, ECT is performed under general anesthesia, so it’s usually performed in a clinic or hospital setting.

Transcranial Magnetic Stimulation (TMS)

TMS is another intervention that is used for treatment-resistant schizophrenia. With TMS, nerve cells in the brain are stimulated using short electromagnetic pulses. This relieves symptoms, specifically auditory hallucinations. Unlike ECT, TMS doesn’t require anesthesia. There are minimal side effects, as well.

Hospitalization

During periods of severe symptoms or crisis, a person with schizophrenia may require hospitalization. In some cases, the person may be involuntarily hospitalized or put into a hospital even if they don’t want to go. The laws surrounding involuntary hospitalization vary by state, but it generally occurs when the person is considered a danger to themself or others or is gravely disabled.

How Can I Reduce My Risk Or Prevent Schizophrenia?

Schizophrenia can’t be prevented. Some of the causes, like birth complications and genetics, are not under your control. However, you can take steps to reduce the risk:

• Don’t abuse substances: Recreational drug use, including marijuana and excessive alcohol use, are all linked with schizophrenia. Therefore, if you use misuse drugs or alcohol, get help to stop.
• If you’re in an abusive situation, get help: Trauma and abuse are also linked to schizophrenia. If you’re in an abusive relationship, reach out to your doctor or therapist for help. You can also contact the National Domestic Violence Hotline at 1.800.799.SAFE.
• Get help early: If you are experiencing symptoms of schizophrenia, don’t wait to get help. Those at a high risk of developing the disorder may be able to prevent or delay symptoms with early intervention. The earlier a person gets treatment, the better the outcome.

When Should I See My Healthcare Provider?

If you have symptoms of schizophrenia, it’s not always easy to know when to call the doctor, especially if you have paranoia and believe that others are out to get you. However, it’s important to contact your doctor or a mental health provider right away if you are experiencing symptoms, as early treatment is vital for managing symptoms.

If you have a schizophrenia diagnosis and you notice a change in symptoms or behaviors, you should also contact your provider. Examples of notable changes include:

• Noticeable increase in symptoms
• Sleeping changes
• Changes in eating habits
• Thoughts of harming yourself or someone else

A healthcare professional will ask about symptoms. They may perform blood, imaging, or other tests. They may also want to talk to family members about your symptoms.

How To Live Well With Schizophrenia

Schizophrenia is a serious brain disorder that affects how a person thinks, feels, and acts. However, despite the stigma surrounding it, people can live full, happy lives with the disorder.

If you suspect that you are experiencing schizophrenia symptoms, reach out to a mental health professional for an evaluation. Treatment can help you manage symptoms and improve your overall quality of life.

If a loved one is struggling with symptoms of schizophrenia, encourage them to get help. Proper diagnosis and treatment can help a person manage the condition so they can live a normal life.