Schizophrenia is a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior.
Contrary to popular belief, schizophrenia isn't a split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking.
Schizophrenia is a chronic condition, requiring lifelong treatment.
In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than 45.
Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. Signs and symptoms may vary, but they reflect an impaired ability to function. Symptoms may include:
- Delusions. These are false beliefs that are not based in reality. For example, you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; a major catastrophe is about to occur; or your body is not functioning properly. Delusions occur in as many as 4 out of 5 people with schizophrenia.
- Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
- Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
- Extremely disorganized or abnormal motor behavior. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to perform tasks. Abnormal motor behavior can include resistance to instructions, inappropriate and bizarre posture, a complete lack of response, or useless and excessive movement.
- Negative symptoms. This refers to reduced ability or lack of ability to function normally. For example, the person appears to lack emotion, such as not making eye contact, not changing facial expressions, speaking without inflection or monotone, or not adding hand or head movements that normally provide the emotional emphasis in speech. Also, the person may have a reduced ability to plan or carry out activities, such as decreased talking and neglect of personal hygiene, or have a loss of interest in everyday activities, social withdrawal or a lack of ability to experience pleasure.
Symptoms in teenagers
Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:
- Withdrawal from friends and family
- A drop in performance at school
- Trouble sleeping
- Irritability or depressed mood
- Lack of motivation
Compared with schizophrenia symptoms in adults, teens may be:
- Less likely to have delusions
- More likely to have visual hallucinations
When to see a doctor
People with schizophrenia often lack awareness that their difficulties stem from a mental illness that requires medical attention. So it often falls to family or friends to get them help.
Helping someone who may have schizophrenia
If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.
If your loved one poses a danger to self or others or can't provide his or her own food, clothing or shelter, you may need to call 911 or other emergency responders for help so that your loved one might be evaluated by a mental health provider. In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.
Suicidal thoughts and behavior
Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
It's not known what causes schizophrenia, but researchers believe that a combination of genetics and environment contributes to development of the disorder.
Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they support evidence that schizophrenia is a brain disease.
Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:
- Having a family history of schizophrenia
- Exposure to viruses, toxins or malnutrition while in the womb, particularly in the first and second trimesters
- Increased immune system activation, such as from inflammation or autoimmune diseases
- Older age of the father
- Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood
Left untreated, schizophrenia can result in severe emotional, behavioral and health problems, as well as legal and financial problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:
- Any type of self-injury
- Anxiety and phobias
- Abuse of alcohol, drugs or prescription medications
- Family conflicts
- Inability to work or attend school
- Social isolation
- Health problems, including those associated with antipsychotic medications, smoking and poor lifestyle choices
- Being a victim of aggressive behavior
- Aggressive behavior, although it's uncommon and typically related to lack of treatment, substance misuse or a history of violence
If you're seeking help for someone with mental illness, you may start by seeing his or her family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.
What you can do
To prepare for the appointment, make a list of:
- Any symptoms your loved one is experiencing, including any that may seem unrelated to the reason for the appointment
- Key personal information, including any major stresses or recent life changes
- Medications, vitamins, herbs and other supplements that he or she is taking, including the dosage
- Questions to ask the doctor
Go with your loved one to the appointment. Getting the information firsthand will help you know what you're facing and what you need to do for your loved one.
For schizophrenia, some basic questions to ask the doctor include:
- What's likely causing the symptoms or condition?
- What are other possible causes for the symptoms or condition?
- What kinds of tests are needed?
- Is this condition likely temporary or lifelong?
- What's the best treatment?
- What are the alternatives to the primary approach you're suggesting?
- How can I be most helpful and supportive?
- Do you have any brochures or other printed material that I can have? What websites do you recommend?
Don't hesitate to ask questions anytime during your appointment.
What to expect from the doctor
The doctor is likely to ask you a number of questions, including:
- What are your loved one's symptoms, and when did you first notice them?
- Have symptoms been continuous or occasional?
- Has your loved one talked about suicide?
- How is your loved one functioning in daily life — is he or she eating regularly, going to work or school, bathing regularly?
- Has your loved one been diagnosed with any other medical conditions?
- What medications is your loved one currently taking?
When doctors suspect someone has schizophrenia, they typically ask for medical and psychiatric histories, conduct a physical exam, and run medical and psychological tests, including:
- Tests and screenings. These may include a lab test called a complete blood count (CBC), other blood tests that may help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
- Psychological evaluation. A doctor or mental health provider will check mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance abuse, and potential for violence or suicide.
Diagnostic criteria for schizophrenia
To be diagnosed with schizophrenia, a person must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health providers to diagnose mental conditions.
Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms aren't due to substance abuse, medication or a medical condition. In addition, a person must have at least two of the following symptoms most of the time during a one-month period, with some level of disturbance being present over six months:
- Disorganized speech (indicating disorganized thinking)
- Extremely disorganized behavior
- Catatonic behavior, which can ranges from a coma-like daze to bizarre, hyperactive behavior
- Negative symptoms, which relate to reduced ability or lack of ability to function normally
At least one of the symptoms must be delusions, hallucinations or disorganized speech.
The person shows a significant decrease in the ability to work, attend school or perform normal daily tasks most of the time.
The American Psychiatric Association eliminated the previous subtypes of schizophrenia — paranoid, disorganized, catatonic, undifferentiated and residual — because of poor reliability. These subtypes weren't shown to be valid and didn't help in determining which treatment might be best for a specific subtype.
Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.
A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.
Medications are the cornerstone of schizophrenia treatment. However, because medications for schizophrenia can cause serious but rare side effects, people with schizophrenia may be reluctant to take them.
Antipsychotic medications are the most commonly prescribed drugs to treat schizophrenia. They're thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin.
Willingness to cooperate with treatment may affect medication choice. Someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill. Someone who is agitated may need to be calmed initially with a benzodiazepine such as lorazepam (Ativan), which may be combined with an antipsychotic.
These newer, second-generation medications are generally preferred because they pose a lower risk of serious side effects than do conventional medications. They include:
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Clozapine (Clozaril)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Olanzapine (Zyprexa)
- Paliperidone (Invega)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
Ask your doctor about the benefits and side effects of any medication that's prescribed.
Conventional, or typical, antipsychotics
These first-generation medications have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. This group of medications includes:
- Haloperidol (Haldol)
These antipsychotics are often cheaper than newer counterparts, especially the generic versions, which can be an important consideration when long-term treatment is necessary.
It can take several weeks after first starting a medication to notice an improvement in symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. The psychiatrist may try different medications, different dosages or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety medications.
Once psychosis recedes, psychological and social (psychosocial) interventions are important — in addition to continuing on medication. These may include:
- Individual therapy. Learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.
- Social skills training. This focuses on improving communication and social interactions.
- Family therapy. This provides support and education to families dealing with schizophrenia.
- Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.
Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their condition.
Coping with a mental disorder as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. Here are some ways to cope:
- Learn about schizophrenia. Education about the condition can help motivate the person with the disease to stick to the treatment plan. Education can help friends and family understand the condition and be more compassionate with the person who has it.
- Join a support group. Support groups for people with schizophrenia can help them reach out to others facing similar challenges. Support groups may also help family and friends cope.
- Stay focused on goals. Managing schizophrenia is an ongoing process. Keeping treatment goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the illness and working toward goals.
- Learn relaxation and stress management. The person with schizophrenia and loved ones may benefit from stress-reduction techniques such as meditation, yoga or tai chi.
There's no sure way to prevent schizophrenia. However, early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook.
Sticking with the treatment plan can help prevent relapses or worsening of schizophrenia symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.
Jan. 24, 2014
- Schizophrenia spectrum and other psychotic disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed July 12, 2013.
- Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Washington, D.C.: American Psychiatric Publishing; 2008. http://www.psychiatryonline.com/resourceToc.aspx?resourceID=5. Accessed May 8, 2013.
- Schizophrenia. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/schizophrenia/complete-index.shtml. Accessed May 8, 2013.
- Fischer BA, et al. Schizophrenia: Clinical manifestations, course, assessment, and diagnosis. http://www.uptodate.com/home. Accessed May 8, 2013.
- Fischer BA, et al. Schizophrenia: Epidemiology and pathogenesis. http://www.uptodate.com/home. Accessed May 8, 2013.
- Stroup TS, et al. Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment. http://www.uptodate.com/home. Accessed May 8, 2013.
- Mental illness and the family: Recognizing warning signs and how to cope. Mental Health America. http://www.nmha.org/go/information/get-info/mi-and-the-family/recognizing-warning-signs-and-how-to-cope. Accessed May 16, 2013.
- Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Association. http://www.dsm5.org/Pages/Default.aspx. Accessed May 17, 2013.
- Schak KM (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 13, 2013.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 18, 2013.