What is schizophrenia?
Schizophrenia—one of the most complex mental disorders—involves a severe, chronic and disabling disturbance in the brain. People with schizophrenia have trouble thinking and behaving normally, and have a hard time determining what is real and what is not real.
Schizophrenia affects about one in every 100 people and can happen to anyone, though it is more severe in men and usually occurs in people under age 45.
Symptoms of schizophrenia get worse over time. At first, you may just feel tense, isolated or withdrawn. You may have trouble acting normally in social situations, and you may have trouble sleeping. As the disease progresses, you can develop psychotic symptoms, such as loss of emotion, catatonia (unresponsiveness to the setting or environment), delusions, hallucinations, and paranoia.
Treatment for schizophrenia depends on the severity of your symptoms. For very severe symptoms, hospitalization may be necessary to keep you and those around you safe. Other treatments include antipsychotic medications and social and behavioral therapy. While there is no cure for schizophrenia, treatment is usually effective at managing the symptoms.
Seek immediate medical care (call 911) if you hear voices or see things that are not there (hallucinations), if you have thoughts of hurting yourself or others, or if you cannot take care of yourself.
Seek prompt medical care if you are being treated for schizophrenia but symptoms recur or are persistent.
What are the types of schizophrenia?
Because of the overlap of symptoms among the different types of schizophrenia, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer specifies distinct subtypes of schizophrenia. Instead, the DSM-5 refers to the “schizophrenia spectrum.”
Previously, schizophrenia had been categorized into these fives types:
- Catatonic schizophrenia, indicated by times when a person shuts down physically, mentally and emotionally. Periods of catatonia can last for hours, during which the person has no urge to eat, drink, or even use the bathroom.
- Disorganized schizophrenia, also known as hebephrenic schizophrenia, in which someone has trouble organizing their thoughts or feelings. A person with disorganized schizophrenia may also have confusing speech patterns, sometimes called “word salad,” that are difficult for other people to understand.
- Paranoid schizophrenia, the most common type of schizophrenia. Symptoms include hallucinations (seeing or hearing something that is not there) or delusions (believing something that is not rational or real). Paranoia can take the form of people believing they are being followed, that they are being controlled by outside forces, or that someone is out to “get” them.
- Residual schizophrenia, used to describe people with a past history of schizophrenia but who currently do not exhibit any “positive” symptoms, such as active hallucinations or delusions. However, they may still show “negative” symptoms, including a lack of interest, poor verbal and nonverbal communication, and minimal eye contact.
- Undifferentiated schizophrenia, in which someone has a mix of vague symptoms of all types of schizophrenia, but does not meet the criteria of one specific subtype.
Each case of schizophrenia is unique to the individual who has it. By identifying predominant traits of schizophrenia subtypes, doctors can better understand symptoms and develop more effective treatment plans.
What are the symptoms of schizophrenia?
Symptoms of schizophrenia get worse over time. They start with mild feelings of tension, disrupted sleep, and isolation. As the disease progresses, you may start to experience things that are not real. It may become difficult to tell the difference between what is real and what is not real. These later symptoms of the disease are known as psychotic symptoms.
The symptoms of schizophrenia in children are similar to adults; however, children more often experience auditory hallucinations and typically do not experience delusions or formal thought disorders until mid-adolescence or older.
The symptoms of schizophrenia may resemble other problems or psychiatric conditions. Always consult a psychiatrist for a diagnosis.
Early symptoms of schizophrenia
You may experience schizophrenia symptoms daily or just once in a while. At times, any of these schizophrenia symptoms can be severe:
- Difficulty sleeping
- Feeling tense
- Isolation or withdrawal
- Social problems
Psychotic symptoms of schizophrenia
The later symptoms of schizophrenia depend on the type of schizophrenia (paranoid, disorganized, catatonic, undifferentiated, or residual). As schizophrenia progresses, symptoms may become worse and develop into psychotic symptoms such as:
- Catatonia (unresponsiveness to the setting or environment)
- Delusions (believing things that are not real)
- Feelings of hopelessness
- Flat affect (lack of emotion)
- Grimacing or odd facial expressions
- Hallucinations (unreal sensations)
- Inability to participate normally in activities
- Lack of focus
- Nonsensical speech
Serious symptoms that might indicate a life-threatening condition
In some cases, schizophrenia can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Being a danger to yourself or others, including threatening, irrational or suicidal behavior
- Hearing voices or seeing things that are not there (hallucinations)
- Inability to take care of yourself
What causes schizophrenia?
The underlying cause of schizophrenia is not known. Schizophrenia is related to abnormalities in the brain that may involve injury, infection, or chemical imbalance.
Schizophrenia is considered to be multifactorially inherited. Multifactorial inheritance means many factors are involved. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to unknown environmental factors, produce the trait or condition.
Stress may also be a trigger for schizophrenia symptoms, although it does not cause the condition itself.
What are the risk factors for schizophrenia?
A number of factors increase the risk of developing schizophrenia. Not all people with risk factors will get schizophrenia.
Risk factors for schizophrenia include:
- Age under 45 years
- Developmental disorder such as autism
- Family history of schizophrenia
- Personal history of mental illness
- Recent head injury or infection
- Recent stressful experience
- Stressful childhood experience
Statistics indicate that schizophrenia affects 2.7 million Americans. Schizophrenia affects men and women equally. But symptoms in men generally begin earlier than in women. In most cases, schizophrenia first appears in men during their late teens or early 20s. In women, schizophrenia often first appears during their 20s or early 30s. Other schizophrenia risk factors include complications at childbirth, living in an urban area, and being born around late winter or early spring (suggesting an association with prenatal influenza exposure).
A child born into a family with a schizophrenic family member has a greater chance of developing the disorder than a child born into a family with no history of schizophrenia. After a person has been diagnosed with schizophrenia, the chance for a sibling to also be diagnosed with it is 7 to 8%. If a parent has schizophrenia, the chance for a child to have the disorder is 10 to 15%. Risk increases with the number of affected family members.
How do doctors diagnose schizophrenia?
There is no specific test for schizophrenia. A psychiatrist typically diagnoses schizophrenia by evaluating a patient’s medical history, behaviors, and symptoms with the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A family history of schizophrenia and other known risk factors may also inform a new schizophrenia diagnosis.
What are the treatments for schizophrenia?
Treatment for schizophrenia is complex, and there is no cure for schizophrenia. A combination of therapies is often necessary. Treatment is aimed at reducing the symptoms associated with the disorder. Types of treatment that may be helpful to an individual with schizophrenia may include antipsychotic medications and neuroleptics, individual and family psychotherapy (including cognitive and behavioral therapy), and support groups.
Typically, doctors treat schizophrenia with medication but psychotherapy may also be part of the overall treatment plan. Medications for schizophrenia often include some kind of antipsychotic drug.
Medications for schizophrenia
Most schizophrenia symptoms are treated with antipsychotic drugs including:
- Atypical antipsychotics, such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), or paliperidone (Invega)
- Clozapine (Clozaril), which is often the most effective antipsychotic, but can have serious side effects
- Conventional antipsychotics, such as chlorpromazine (Thorazine), haloperidol (Haldol), perphenazine (Etrafon or Trilafon), and fluphenazine (Prolixin)
If you develop unwelcome side effects from your schizophrenia medicine, talk with your doctor before you stop taking it. Together, you and your doctor can discuss other treatment options to find the right one for you.
Other therapy for schizophrenia
In addition to medication, a variety of psychotherapies and social therapies may be helpful for people with schizophrenia. Therapies include:
- Cognitive behavioral therapy, or “talk therapy”
- Family therapy
- Illness management education
- Psychosocial treatment
- Support groups
- Support groups for both the patient and the family
What you can do to improve your schizophrenia
In addition to following the treatment plan developed by your healthcare provider, you may be able to improve your schizophrenia by:
- Avoiding alcohol and drugs
- Enrolling in a self-help group
- Seeking support from family members and friends
What are the potential complications of schizophrenia?
Schizophrenia is often a lifelong condition, though treatment can help control the symptoms. Because schizophrenia is a complicated illness, it can be difficult to tell how the disease will progress or what complications will arise.
Complications of untreated or poorly controlled schizophrenia can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you.
Complications of schizophrenia include:
- Absenteeism from work or school
- Alcohol abuse
- Harm to yourself or others
- Inability to participate normally in activities
- Increased risk of illness or hospitalization
- Nicotine abuse
- Social isolation
- Withdrawal or depression