Schizophrenia
Schizophrenia is a serious mental health condition that changes how people think, feel, and behave, affecting approximately 1 in 345 people worldwide. While living with this condition can be challenging, effective treatments including medication and therapy can help many people manage their symptoms and lead fulfilling lives.
Table of contents
- What is schizophrenia?
- Symptoms and how they affect daily life
- Causes and risk factors
- How common is schizophrenia?
- Diagnosis
- Treatment options
- Recovery and long-term outlook
- Living with schizophrenia
What is schizophrenia?
Schizophrenia is a chronic mental health condition that affects how a person thinks, feels, and behaves. It can make it very hard to tell what is real and what is not[2][10]. People with schizophrenia often experience a disconnect from reality, which can make daily living very difficult[2].
This condition is one of several psychotic disorders – mental health conditions where people have difficulty recognizing reality. Psychosis refers to symptoms that make it hard to know what is real, such as believing things that are not true or sensing things that are not there[4].
Schizophrenia is the most common psychotic disease, although it is not as common as many other mental health conditions[4][11]. It affects people of all ethnicities and is slightly more common in men[11].
Symptoms and how they affect daily life
Schizophrenia involves a range of problems in how people think, feel, and behave. Healthcare professionals often describe symptoms as either positive, negative, or cognitive[4][6].
Positive symptoms are things that appear in a person’s life that were not there before. These include[2][3]:
- Delusions: Strong beliefs in things that are not real or true, even when there is clear evidence otherwise. For example, a person might believe they are being harmed or harassed when they are not, or that others are reading their minds or controlling their thoughts[2][6].
- Hallucinations: Sensing things that are not really there. This most commonly means hearing voices that others cannot hear, but can also include seeing, smelling, touching, or feeling things that do not exist[2][3].
- Disorganized speech: Trouble organizing thoughts while speaking, making it hard to stay on topic or be understood. Speech may seem jumbled or irrelevant[2][3].
- Disorganized or unusual behavior: Moving or acting in ways others might not expect, such as doing things that appear bizarre or purposeless, or having unpredictable emotional responses[3].
Negative symptoms refer to abilities that are reduced or lost. These include[4][3]:
- Very limited speech
- Restricted experience and expression of emotions, or speaking in a flat tone
- Inability to experience interest or pleasure
- Loss of motivation to engage in life’s activities
- Social withdrawal
- Not caring about personal hygiene and appearance[10]
Cognitive symptoms involve difficulties with thinking skills, such as problems with memory, attention, working memory, or the ability to plan and organize activities[4][3]. These problems can be very subtle, but may account for why a person with schizophrenia has such a hard time managing day-to-day life[4].
Many people with schizophrenia do not know they have symptoms or may not believe they need treatment[2]. This is often due to a biological condition called anosognosia, where someone with a severe mental illness cannot recognize that they have one[16].
Causes and risk factors
The exact cause of schizophrenia is not known. Experts believe it happens for different reasons and involves a combination of factors[4][10].
Several factors may contribute to the development of schizophrenia[11]:
- Genetics: Having a biological parent or sibling with schizophrenia increases risk. If an immediate family member (a parent or sibling) has the illness, the chance of developing it is about 10%. For those who have an identical twin with schizophrenia, the risk is as high as 65%[4].
- Brain chemistry: Problems with chemical messengers in the brain called neurotransmitters (especially dopamine and glutamate) may play a role[9][10].
- Brain development and structure: Problems with how the brain develops before birth or differences in brain structure may contribute[10].
- Environmental factors: Exposure to viruses or poor nutrition before birth, being born and raised in an urban area, central nervous system infection in early childhood, and advanced paternal age (older than 55 years) may increase risk[11].
- Substance use: Using certain substances, especially cannabis, during the teen and young adult years can increase risk[10][11].
How common is schizophrenia?
Schizophrenia affects approximately 23 million people worldwide, or about 1 in 345 people (0.29%)[3]. Among adults specifically, the rate is 1 in 233 people (0.43%)[3]. In the United States, the global prevalence is estimated between 0.3% to 0.7%[11].
The condition affects all ethnicities. Although there is no significant difference between sexes, a slight predominance is noted in men[11].
Symptoms usually begin between late adolescence and the mid-30s. The onset tends to happen earlier among men (typically between 18 and 25 years of age) than among women (typically between 25 years and the mid-30s, with a second peak after 40 years of age)[10][11]. Cases involving children as young as five years have been reported, but these are rare[11].
Diagnosis
A healthcare provider can diagnose schizophrenia by learning about a person’s symptoms and observing their behavior. There are no specific diagnostic tests for schizophrenia itself[10][15].
Finding a diagnosis may include[7][15]:
- Physical exam: To rule out other problems that could cause similar symptoms and check for any related complications.
- Tests and screenings: Blood tests, screening for alcohol and drug use, and sometimes imaging studies such as an MRI or CT scan to rule out other conditions.
- Mental health evaluation: A healthcare professional checks mental status by noting how a person looks and behaves, and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. This evaluation includes family and personal history.
The healthcare provider will compare the symptoms with criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)[10].
A diagnosis usually happens during the late teen years or early adulthood[10]. Patients presenting with psychosis should be urgently referred for psychiatric evaluation[11].
Treatment options
People with schizophrenia need lifelong treatment[2]. While there is no cure, treatment with medication and psychosocial therapy can help manage the condition[7][15]. Early treatment often helps control symptoms before serious complications arise, making the long-term outlook better[2].
Antipsychotic medications are the main treatment for schizophrenia. They help control symptoms mainly by affecting brain receptors for different neurotransmitters (chemical messengers)[7][15]. Antipsychotic drugs should be started as soon as possible after schizophrenia is diagnosed[11].
It is important to take medication as prescribed, even when symptoms start to improve. Continuous medication can help prevent relapses (return of symptoms)[13]. However, antipsychotic medications can cause side effects. People receiving these medications, especially second-generation (or atypical) antipsychotics, should be monitored at least annually for metabolic changes and cardiovascular risk factors[11].
Psychosocial therapies are also important. Patients with schizophrenia should be offered psychosocial therapies in addition to medical treatment. These can include[11]:
- Cognitive behavior therapy
- Family interventions
- Social skills training
People who undergo psychosocial therapy in addition to medical therapy have better outcomes[11].
Treatment is usually guided by a psychiatrist experienced in treating schizophrenia. The treatment team may also include a psychologist, social worker, psychiatric nurse, and case manager to coordinate care[7][15].
Most people with schizophrenia are treated by community mental health teams, which provide day-to-day support and treatment while helping maintain as much independence as possible[8]. During severe episodes, some people may need to stay in a hospital[7][8][15].
Recovery and long-term outlook
Most people with schizophrenia make a recovery, although many will experience the occasional return of symptoms[13]. At least one third of people with schizophrenia experience complete remission of symptoms[3]. A range of effective care options exists, and at least one in three people with schizophrenia will be able to fully recover[3].
Some people with schizophrenia experience worsening and remission of symptoms periodically throughout their lives, while others experience a gradual worsening of symptoms over time[3].
People who have untreated psychosis often have more severe symptoms, more stays in a hospital, poorer thinking and processing skills and social outcomes, injuries, and even death[2]. This is why early treatment is so important.
Patients diagnosed with schizophrenia have a higher overall mortality rate than the general public, partly because of the increased suicide risk associated with schizophrenia[11]. People with schizophrenia attempt suicide more often than people in the general population, and estimates are that up to 10 percent of people with schizophrenia will complete a suicide in the first 10 years of the illness, particularly young men with schizophrenia[6].
Living with schizophrenia
Support and treatment can help manage the condition and its impact on daily life. Caring for your own health can make treating the condition easier and help reduce anxiety, depression, and fatigue[13].
Taking medication as prescribed is critical. It is important to take medicine as prescribed, even when feeling better, as continuous medication can help prevent relapses[13]. If there are questions or concerns about medication or side effects, talk to a healthcare provider[13].
Recognizing warning signs of worsening symptoms can help prevent a crisis. Learning to recognize signs of becoming unwell can help manage the illness. Signs can include losing appetite, feeling anxious or stressed, disturbed sleep, feeling suspicious or fearful, worrying about people’s motivations, hearing quiet voices, or finding it difficult to concentrate[13].
Maintaining physical health is important. A healthy lifestyle, including having a balanced diet with lots of fruit and vegetables and taking regular exercise, is good for overall health and can reduce the risk of developing cardiovascular disease or diabetes[13][16]. Regular exercise can help prevent or treat metabolic syndrome and also serves as a healthy coping mechanism for stress[16].
Avoiding alcohol and drugs is strongly recommended. Regularly drinking more than the recommended amount of alcohol or using illegal drugs can trigger psychosis and make symptoms of schizophrenia worse. Alcohol and drug use can also cause other mental health problems and damage physical health[13].
Managing stress through relaxation techniques, mindfulness, meditation, and other forms of breathwork can help minimize its impact on symptoms[16].
Finding community support is one of the best things a person can do. Having a support network helps individuals with schizophrenia cope with their illness[16]. Having a good relationship with the healthcare team means symptoms or concerns can be easily discussed[13].
More than two out of three people with psychosis in the world do not receive specialist mental health care[3]. Stigma, discrimination, and violation of human rights of people with schizophrenia are common[3]. However, with proper treatment and support, many people with schizophrenia can manage their symptoms and lead fulfilling lives.
