Schizophrenia

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Introduction

What is schizophrenia?

Schizophrenia is a complicated mental illness in which a person has a hard time telling between what is real and what is not real. People with schizophrenia have trouble thinking and behaving normally. 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 (Source: PubMedHealth).

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 At first, you may just feel tense, isolated, or withdrawn.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.

There are five different types of schizophrenia, including paranoid, disorganized, catatonic, undifferentiated, and residual. While nobody with schizophrenia behaves normally, the exact symptoms depend on the exact type of schizophrenia. The cause of schizophrenia is not known, but it may be a combination of stress, environment, and hereditary factors.

Treatment for schizophrenia depends on the severity of your symptoms. For very severe symptoms, hospitalization may be required. 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.

Symptoms

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. Later symptoms of the disease are known as psychotic symptoms.

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:

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)
  • Disorganization
  • 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
  • Paranoia
  • Restlessness

Serious symptoms that might indicate a life-threatening condition

In some cases, schizophrenia can be life threatening. Seek imm ediate 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
Causes

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. Heredity and environment probably both play a role in the development of the disease. Stress may also be a trigger for schizophrenia, although it does not cause the condition.

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
Treatments

How is schizophrenia treated?

There is no cure for schizophrenia. Treatment for schizophrenia is aimed at managing and controlling symptoms. Usually, schizophrenia is treated with medication. Psychotherapy may also be used. Medications for schizophrenia usually 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) may be the most effective antipsychotic, though it has serious side effects

  • Conventional antipsychotics such as chlorpromazine (Thorazine), haloperidol (Haldol), perphenazine (Etrafon orTrilafon), and fluphenazine (Prolixin)

Other therapy for schizophrenia

In addition to medication, a variety of psychotherapies and social therapies may be helpful including:

  • Cognitive behavioral therapy

  • Family therapy

  • Illness management education

  • Psychosocial treatment

  • Rehabilitation

  • 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 health care 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 cannot be cured. It is usually 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 health care professional design specifically for you. Complications of schizophrenia include:

  • Absenteeism from work or school

  • Alcohol abuse

  • Drug abuse

  • Harm to yourself or others

  • Inability to participate normally in activities

  • Increased risk of illness or hospitalization

  • Insomnia

  • Nicotine abuse

  • Social isolation

  • Withdrawal or depression

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 18
  1. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
  2. Schizophrenia. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/schizophrenia/complete-index.shtml
  3. Schizophrenia. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001925/
  4. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.
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