Schizophrenia

What is schizophrenia?

Schizophrenia is a psychiatric condition that has severe effects on your physical and mental well-being. It disrupts how your brain works, interfering with things like your thoughts, memory, senses and behaviors. As a result, you may struggle in many parts of your day-to-day life. Untreated schizophrenia often disrupts your relationships (professional, social, romantic and otherwise). It can also cause you to have trouble organizing your thoughts, and you might behave in ways that put you at risk for injuries or other illnesses.

What are the types of schizophrenia?

Psychiatrists once referred to different types of schizophrenia, like paranoid schizophrenia and catatonic schizophrenia. But the types weren’t very useful in diagnosing or treating schizophrenia. Instead, experts now view schizophrenia as a spectrum of conditions, including:

• Schizotypal personality disorder (which also falls under the category of personality disorders).
• Delusional disorder.
• Brief psychotic disorder.
• Schizophreniform disorder.
• Schizoaffective disorder.
• Other schizophrenia spectrum disorders (specified or unspecified). This diagnosis allows healthcare providers to diagnose unusual variations of schizophrenia.

Who does it affect?

Schizophrenia starts between ages 15 and 25 for men and between 25 and 35 for women. About 20% of new schizophrenia cases occur in people over age 45. These cases tend to happen more in men.

Schizophrenia in children is rare but possible. When schizophrenia does start in childhood, it’s usually more severe and harder to treat.

How common is schizophrenia?

Schizophrenia is a somewhat common condition. Worldwide, it affects 221 in every 100,000 people.

What are the five symptoms of schizophrenia?

Many people with schizophrenia can’t recognize that they have symptoms of schizophrenia. But those around you might. These are the five main symptoms of schizophrenia

1. Delusions: These are false beliefs that you hold even when there’s plenty of evidence that those beliefs are wrong. For example, you might think that someone is controlling what you think, say or do.
2. Hallucinations: You still think you can see, hear, smell, touch or taste things that don’t exist, like hearing voices.
3. Disorganized or incoherent speaking: You may have trouble organizing your thoughts while speaking. This might look like trouble staying on topic, or your thoughts might be so jumbled that people can’t understand you.
4. Disorganized or unusual movements: You might move differently than people around you expect. For example, you may turn around a lot for no clear reason, or you might not move much at all.
5. Negative symptoms: These refer to a reduction or loss of your ability to do things as expected. For example, you might stop making facial expressions, or speak with a flat, emotionless voice. Negative symptoms also include a lack of motivation, especially when you don’t want to socialize or do things you ordinarily enjoy.

Because of these symptoms, you might:

• Feel suspicious, paranoid or scared.
• Not care about your hygiene and appearance.
• Experience depression, anxiety and suicidal thoughts.
• Use alcohol, nicotine, prescription medications or recreational drugs to try to ease your symptoms.

What causes schizophrenia?

There’s no one single cause of schizophrenia. Experts suspect schizophrenia happens for different reasons. The three main reasons include:

• Imbalances in chemical signals your brain uses for cell-to-cell communication.
• Brain development problems before birth.
• Loss of connections between different areas of your brain.

What are the risk factors of schizophrenia?

While there aren’t any confirmed causes of schizophrenia, there are risk factors for developing the condition:

• Environment: Many factors in the world around you can increase your risk of developing schizophrenia. Being born during the winter increases your risk slightly. Certain illnesses that affect your brain, including infections and autoimmune diseases (where your immune system attacks part of your body), can also increase your risk. Extreme stress for long periods can also play a role in developing it.
• Development and birth circumstances: How you developed before you were born plays a role in schizophrenia. The risk of having schizophrenia goes up if your mother had gestational diabetes, preeclampsia, malnutrition or a vitamin D deficiency while pregnant with you. The risk also increases if you were underweight at birth or if there were complications during your birth (like if you were born via an emergency cesarean section).
• Recreational drug use: Schizophrenia is linked with the use of certain recreational drugs, especially in larger amounts and earlier in life. The connection between heavy marijuana (cannabis) use as a teenager is one of the best-studied of these links. But experts aren’t sure if marijuana use is a direct cause of schizophrenia or if it’s just a contributing factor.

Is schizophrenia genetic?

Experts haven’t found one specific cause of schizophrenia, so they can’t say for sure if genetics cause schizophrenia. But if you have a family history of schizophrenia — especially a parent or sibling with it — you have a much higher risk of developing this condition.

How is schizophrenia diagnosed?

Your (or your loved one’s) healthcare provider can diagnose schizophrenia or its related disorders based on a combination of questions they ask, the symptoms you describe or by observing your actions. They’ll also ask questions to rule out other potential causes of your symptoms. They then compare what they find to the criteria required for a schizophrenia diagnosis.

According to the DSM-5, a schizophrenia diagnosis requires the following:

• At least two of the five main symptoms.
• You’ve had symptoms for at least one month.
• Your symptoms impact your ability to work or your relationships (friendly, romantic, professional or otherwise).

What tests will be done to diagnose this condition?

There aren’t any diagnostic tests for schizophrenia. But healthcare providers may run tests to rule out other conditions before diagnosing schizophrenia. The most likely types of tests include:

• Imaging tests. Healthcare providers will often use computerized tomography (CT), magnetic resonance imaging (MRI) and other imaging tests to rule out problems like stroke, brain injuries, tumors and other changes to your brain structure.
• Blood, urine and cerebrospinal fluid (spinal tap) tests. These tests look for chemical changes in bodily fluids that might explain changes in your behavior. They can rule out heavy metal toxicity or other causes of poisoning, infections and more.
• Brain activity testing. An electroencephalogram (EEG) detects and records the electrical activity in your brain. This test can help rule out conditions like epilepsy.

Can schizophrenia be cured?

Schizophrenia isn’t curable, but it’s often treatable. In a small percentage of cases, people can recover from schizophrenia entirely. But this isn’t a cure because there’s no way of knowing who will relapse and who won’t. Because of that, experts consider those who recover from this condition “in remission.”

How is schizophrenia treated?

Treating schizophrenia usually involves a combination of medication, therapy and self-management techniques. These include:

• First- and second-generation antipsychotics. These medications, including haloperidol (Haldol®), aripiprazole (Abilify®, Aristada®), olanzapine (Zyprexa®, Lyablvi®, Symbyax® and quetiapine (Seroquel®), block how your brain uses certain chemicals for cell-to-cell communication. But they can cause side effects like drowsiness, weight gain and tremors, among others.
• Next-generation antipsychotics. The FDA recently approved xanomeline and trospium chloride (Cobenfy™), which is a new type of antipsychotic that acts on cholinergic receptors instead of dopamine receptors. In clinical trials, this new treatment reduced symptoms of schizophrenia with a different side effect profile. Side effects include nausea, stomach upset, urinary retention, increased heart rate and constipation.
• Psychotherapy. Talk therapy methods like cognitive behavioral therapy (CBT) can help you cope with and manage your condition. Long-term therapy can also help with secondary problems alongside schizophrenia, such as anxiety, depression or substance use issues.
• Electroconvulsive therapy (ECT). If other treatments don’t work, your provider may recommend ECT. This treatment involves using an electrical current applied to your scalp, which then stimulates certain parts of your brain. The stimulation causes a brief seizure, which can help improve brain function if you have severe depression, agitation and other problems. If you have ECT, you receive anesthesia. You’ll be asleep for this procedure and won’t feel any pain.

How soon after treatment will I feel better?

Your healthcare provider is the best person to tell you how long it’ll take for medication and therapy to work, as different medications take different amounts of time before their effects are noticeable. Your provider can also tell you about other treatment options that might help if the first treatments don’t work well.

What can I expect if I have this condition?

Schizophrenia is a condition that varies greatly from person to person. You may struggle with work, relationships and self-care. But with treatment, you may be able to work, care for yourself and have fulfilling relationships.

This condition also often affects people in cycles. That means you can go through periods when the condition flares up and your symptoms get much worse. Then, you may have a time when your symptoms improve but don’t completely go away.

Despite how serious this condition is, treatment does make it possible to live with the condition and minimize how it affects your life.

What’s the outlook for this condition?

Schizophrenia itself isn’t a deadly condition. But its effects can lead to dangerous or harmful behaviors. About one-third of people with schizophrenia have symptoms that worsen over time. That can happen because your symptoms don’t respond to treatment, or you have trouble following treatment plans closely enough to manage the condition. About 10% of people with schizophrenia die by suicide.

Other people respond to treatment. But they still have periods where symptoms return and worsen. They might also have lingering problems, like trouble focusing or thinking, because of earlier episodes of this condition.

How can I reduce my risk or prevent this condition?

Because experts still don’t know why schizophrenia happens, it’s impossible to prevent it or reduce your risk of it happening.

How do I take care of myself?

If you have schizophrenia, you should do the following to help care for yourself and manage your condition:

• Take medications as prescribed. One of the most critical things you can do is take your medications. If you have schizophrenia, you shouldn’t stop your medication without talking to your healthcare provider. Discuss any concerns or side effects with your provider to find one that both works well for you and has minimal or no side effects.
• See your healthcare provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your condition.
• Don’t ignore or avoid symptoms. You’re more likely to respond to treatment and have a good outcome with early diagnosis and medical care.
• Avoid alcohol and recreational drug use. Alcohol and drug use can make schizophrenia symptoms worse and can lead to other issues. This includes using prescription medications in a way other than prescribed.
• Consider seeking support. Organizations like the National Alliance on Mental Illness can offer resources and information that can help.

When should I see my healthcare provider?

You should see your healthcare provider as recommended. You should also see them if you notice a change in your symptoms, like if they get worse even if you’re taking your medication. You can see your provider if the side effects of your medication cause disruptions in your life, as well. Your healthcare provider can sometimes recommend alternative medications or treatments that might better treat your condition without causing those same effects.

When should I go to the ER?

If you have thoughts of harming yourself or others, call the 988 Suicide and Crisis Lifeline (U.S.). If you feel like you’re in immediate danger of harming yourself, call 911, your local emergency services number or go to the nearest emergency room.

What can I do if a loved one shows signs of schizophrenia?

If you notice a loved one showing signs of schizophrenia or a related condition, you can try helping them by doing the following:

• Ask how you can help. Listening and offering your help keeps a line of communication open and helps them feel connected to others.
• Encourage them to see someone who can help. Treatment for schizophrenia, especially medication, can improve a person’s symptoms and help them recognize what’s real and what isn’t.
• Don’t judge or argue. Avoid judging them or arguing with them about what’s real and what isn’t, even if you have evidence. People experiencing hallucinations or delusions usually don’t respond to evidence because they can’t tell what’s real and what isn’t.
• Stay calm. If they’re agitated or angry, don’t raise your voice, and try to make the area around you as calm and quiet as possible. You should also make sure they don’t feel trapped or otherwise threatened.
• Get help in emergencies. People with schizophrenia are much more likely to die by suicide. Call for help if they talk about thoughts of harming themselves or others.