Schizophrenia

Schizophrenia is a mental health condition that greatly affects how you think, feel and behave. Psychosis is a core feature of it, which means you lose touch with reality. Delusions and hallucinations are common.

These symptoms can have a major impact on your daily life. You may have difficulty forming close relationships and working. It can affect your physical health as well.

Schizophrenia is a lifelong disorder. There’s no cure for it. But medication and talk therapy can help you manage symptoms. Continued care and support are essential.

This condition affects about 1% of people worldwide.

Symptoms of schizophrenia

People with schizophrenia often don’t realize they have symptoms. But others, like friends and family, may notice changes. Symptoms generally begin in the late teen years or early adulthood. Males typically have symptoms sooner (early 20s) than females (mid 20s to early 30s).

Schizophrenia in children is rare but possible. Diagnosis may be more difficult for teens. Some of the early symptoms may resemble typical teenage behavior, like withdrawing from family and irritability.

Symptoms may include:

• Delusions: You believe things that aren’t true, even with clear evidence that shows reality. For example, you may think someone is spying on you.
• Hallucinations: You sense things that aren’t there. Hearing voices is common. But you may also see or feel things that aren’t there.
• Disorganized speech: You have trouble organizing your thoughts while speaking. This can make it hard to stay on topic or for others to understand you.
• Disorganized or catatonic behavior: You move or act in ways others might not expect. For example, you may laugh excessively, do repetitive motions or stay very still.
• Cognitive issues: You have difficulty with mental functions, like memory, attention and decision-making.
• Reduced ability to function: You show little emotion, speak in a flat tone or lose motivation to socialize or enjoy activities.

You may hear schizophrenia symptoms referred to as “positive” or “negative.” The positive symptoms are additional mental experiences that most people don’t have, like hallucinations. The negative symptoms are the mental features people with schizophrenia lack that most people do have, like a lack of emotional expression.

Schizophrenia causes

Experts don’t know the exact cause of schizophrenia. But they think it has to do with brain changes, like:

• Imbalances of chemical messengers (neurotransmitters), like dopamine and serotonin
• Development issues before birth
• Loss of connection between certain areas

Certain factors may increase your risk of these changes.

Risk factors

Risk factors for schizophrenia include:

• Genetics: You’re more likely to develop the condition if your biological parent or sibling has it.
• Issues during fetal development: This condition is linked to severe malnutrition and exposure to the flu before birth.
• Environmental factors: Childhood trauma and social isolation may contribute to schizophrenia.
• Substance use: Substance use, like cannabis use, during your teen and young adult years can affect brain development. Especially with frequent use at a young age.

Complications of schizophrenia

Without treatment, schizophrenia impacts all aspects of your life. It can lead to several complications, including:

• Relationship issues or a lack of them, leading to loneliness
• Difficulty keeping a job and stable housing
• Other mental health conditions, like anxiety and depression
• Substance use disorders (dual diagnosis)
• Poor physical health
• Frequent hospitalizations
• Financial and legal problems
• Suicidal thoughts and behaviors

If you ever need help or someone to talk to, call or text 988 (U.S.). This is the Suicide & Crisis Lifeline. Someone can speak with you 24/7. If you need immediate medical attention, call 911 or your local emergency services number.

How doctors diagnose this condition

Healthcare providers diagnose schizophrenia by learning more about your symptoms and medical history. They also do a mental status exam. It involves observing your behavior and asking questions.

Your provider may want to rule out other possible causes of your symptoms with the following tests:

• Imaging tests: CT or MRI scans to check for stroke, brain injury, tumors or structural changes
• Lab tests: Blood, urine or cerebrospinal fluid tests to rule out infections, poisoning or chemical imbalances
• Brain activity tests: An EEG to check for disorders like epilepsy

Your provider will check if your symptoms match the schizophrenia criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

How is schizophrenia treated?

Treatment for schizophrenia involves comprehensive care. This may include:

• Medications: Several types of antipsychotics can help manage symptoms.
• Psychotherapy: Talk therapy, like cognitive behavioral therapy for psychosis (CBTp), may help you better understand how your thoughts influence your behaviors. You learn skills that may improve daily functioning and prevent complications.
• Supportive services: Resilience training, family therapy, cognitive support, and help with work or school are available. They can improve coping skills, communication, thinking abilities and long-term success.

If medications don’t improve your symptoms, your provider may recommend other options. One is electroconvulsive therapy (ECT). It’s a treatment that sends small electric signals to your brain. It causes a short, safe seizure to help your brain work differently.

You’ll need regular visits with your healthcare provider throughout your life. Follow up with them as recommended and any time you notice changes in your symptoms. They may be able to adjust your treatment or recommend other options.

Medication

Antipsychotic medications are a key part of treating schizophrenia. These may include:

• Aripiprazole (Abilify®, Aristada®)
• Brexpiprazole (Rexulti®)
• Cariprazine (Vraylar®)
• Clozapine (Clozaril®)
• Haloperidol (Haldol®)
• Lurasidone (Latuda®)
• Lumateperone (Caplyta®)
• Olanzapine (Zyprexa®, Lybalvi®, Symbyax®)
• Quetiapine (Seroquel®)
• Risperidone (Risperdal®, Perseris®, Risperdal Consta®)
• Xanomeline and trospium (Cobenfy™)

The two main types of antipsychotics are first- and second-generation antipsychotics. These medications adjust the balance of brain chemicals to help prevent delusions and hallucinations. First-generation (typical) blocks dopamine receptors. Second-generation (atypical) targets dopamine and serotonin receptors.

Emerging treatments are expanding. One example is a newly approved combination of xanomeline and trospium chloride (Cobenfy). It works through the cholinergic system. This system helps control memory, thinking and muscle movement. It doesn’t mainly target dopamine receptors the way traditional antipsychotics do. It marks the first in a new class of antipsychotic drugs.

Talk to your provider about what possible side effects to look out for if you start a new medication.

What can I expect if I have schizophrenia?

Schizophrenia varies greatly from person to person. It can affect many parts of daily life. But treatment may help you manage symptoms more effectively.

Symptoms often come in cycles. There are periods when they flare up and times when they improve, but don’t fully go away. It’s important to continue treatment as directed, even when you’re feeling better, to prevent setbacks and maintain progress.

Some people respond well to treatment but may still face ongoing challenges, like difficulty thinking clearly or staying focused. This is common. Your care team can work with you to adjust your treatment as needed.

Life expectancy

Schizophrenia isn’t deadly on its own. But without treatment, it can lead to serious problems, like a higher chance of suicide and poor physical health. Because of its complications, the life expectancy of someone with schizophrenia is about 15 years fewer than that of those without it.

That’s why ongoing care, support and open communication with your care team are essential.