An Overview of Schizophrenia

In This Article

Schizophrenia is a type of mental illness that affects how the brain works. This leads to chronic problems with disordered thoughts and behaviors. It usually requires lifelong care and treatment.

Researchers estimate that schizophrenia affects approximately 0.3 percent to 0.7 percent of people (between 3 in 1000 and 7 in 1000). Schizophrenia affects people from all racial backgrounds and ethnicities. Schizophrenia is slightly more common in men than women.

overview of schizophrenia
Verywell / Cindy Chung

Symptoms

Two of the major categories of schizophrenia symptoms are “positive” or “negative" symptoms. These terms don't refer to whether the symptoms are good or bad as some people might think, but rather to the way symptoms present.

Positive Symptoms

Positive symptoms are active problems that shouldn’t be present (like hallucinations). They are "positive" in the sense that they represent an addition to someone's typical day-to-day experience.

Some of the positive symptoms of schizophrenia include:

Hallucinations: During a hallucination, a person hears, sees, feels, or smells something that is not actually present. Most often this occurs in the form of hearing voices that others do not hear. These voices may be reassuring, threatening, or anything in between. Sometimes a person experiences these only as intrusive thoughts, but often they seem to come from outside the self.

Delusions: Delusions are false beliefs held by a person that are not shared by other people. Someone with a delusion has a very fixed view of a situation and cannot be talked out of it with reason. For example, someone with schizophrenia might believe he is the subject of a government conspiracy, or that aliens are trying to monitor his activities.

Disorganized Speech: People with disorganized speech may be difficult to understand because their sentences are unconnected or because the person is frequently switching topics in a way that doesn’t make sense to the listener. However, the speech may have meaning for the individual in a way that is connected to their internal experience.

Negative Symptoms

Characteristics that seem to be absent or diminished in someone with schizophrenia are called negative symptoms. Negative symptoms of schizophrenia can include:

People may also have additional cognitive symptoms like difficulty concentrating, remembering, or planning activities. People with schizophrenia may also have poor self-care and poor interpersonal, school, or career functioning. The illness also makes it more challenging for the individual to join in social events, and participate in meaningful relationships.

Fluctuation of Symptoms

Symptoms may have periods of worsening, and periods of improvement. Periods of worsening symptoms are called flares or relapses. With treatment, most of these symptoms may diminish or go away (especially "positive" symptoms). Disease remission refers to periods of six months or longer in which a person experiences no symptoms or only mild symptoms.

On the whole, negative symptoms tend to be harder to treat than positive ones.

In the traditional biomedical model of schizophrenia, these symptoms are purely pathological. However, people in the hearing voices movement argue that hearing voices is sometimes a meaningful human experience and that it shouldn't be seen purely as a sign of illness.

Age of Onset

The early symptoms of schizophrenia often start to appear gradually and then become more severe and obvious to others. Typically, symptoms of schizophrenia first appear sometime between adolescence and a person’s mid-30s. However, sometimes symptoms appear earlier or later. In women, symptoms tend to begin at a later age than in men.

Changes in the Brain

Scientists are continuing to learn about how schizophrenia affects the brain, as the condition is associated with a number of alterations in how the brain functions. These brain changes reflect the specific symptoms of the disease. The following are some of the brain regions thought to have disordered functioning in schizophrenia:

  • Medial temporal lobe (causing problems with working memory)
  • Superior temporal lobe (causing problems processing auditory information)
  • Prefrontal lobe (causing problems with decision-making and inhibition)

Diagnosis

There isn’t a simple blood test or brain scan that health providers can use to diagnose schizophrenia. To diagnose schizophrenia, a physician takes a thorough medical history and performs a medical exam. A clinician will need to rule out other psychiatric conditions that can cause hallucinations or delusions. People with schizoaffective disorder, for instance, have many of the same symptoms of schizophrenia, but they also have specific problems with their mood and emotions.

Some other medical conditions that can cause some similar symptoms to schizophrenia include:

  • Substance-related disorders
  • Dementia
  • Endocrine and inflammatory conditions
  • Brain tumor
  • Delirium

In some cases, an individual might need additional tests to rule out other conditions like these.

Time Matters

The time period of symptoms is also important in diagnosis. To be diagnosed with schizophrenia, a person must display at least a six-month period of symptoms. If you or a loved one have had symptoms for less than a month, the diagnosis may instead be what is called a brief psychotic disorder.

Someone who has had symptoms for more than a month but less than six months might be diagnosed with something called schizophreniform disorder. Sometimes people with these conditions have persistent symptoms and are later officially diagnosed with schizophrenia.

Subtypes

You may have heard of various types of schizophrenia, such as paranoid schizophrenia or catatonic schizophrenia. Mental health providers used to diagnose people with these different subtypes based on their different symptoms. However, in 2013, psychiatrists decided to stop classifying people with schizophrenia in this way. They concluded that these categories didn’t really help them understand schizophrenia any better, and they didn’t help clinicians provide better care to patients.

Causes

The causes of schizophrenia are complex and not completely understood, though research does indicate certain risk factors.

Genetics

Genetics seem to play a role in those who have schizophrenia. You are more likely to have schizophrenia if you inherited variations of certain genes (portions of DNA) from your parents.

People who have a relative with schizophrenia have a somewhat increased risk of also having schizophrenia or a related disorder, like schizoaffective disorder.

Identical twins (who share identical DNA) are more likely to have schizophrenia than fraternal twins (who do not). This implies that genetics play a role in triggering schizophrenia, probably through several different genes.

Other Risk Factors

Schizophrenia can occur in people who have no history of it in their family. And just because you have schizophrenia in your family, doesn’t mean you will have it yourself.

Various environmental factors have been linked to an increased risk of schizophrenia. Some of these include:

  • Obstetric complications at your birth
  • Infection of the central nervous system in early childhood
  • Childhood trauma
  • Social stressors, such as economic adversity

However, many people with schizophrenia have none of these risk factors.

Schizophrenia likely emerges as a complex result of a variety of genetic, environmental, social, and psychological factors that are not yet well understood.

Treatment

Ideally, treatment for schizophrenia combines a multidisciplinary approach from a collaborative team of health professionals. Early treatment can help improve the chances of a fuller recovery.

Elements of treatment should include:

  • Psychiatric medication
  • Psychological treatment
  • Social support

Many people with schizophrenia will need to initially be hospitalized for psychiatric treatment so that doctors can stabilize their condition.

Medications

Antipsychotic medications form a very important part of treatment for schizophrenia. These medications help reduce the symptoms of schizophrenia and help prevent relapse. First generation antipsychotic medications describe a class of drugs that were developed in the 1950s. These are also called typical antipsychotics. Some of these include:

  • Haldol (haloperidol)
  • Thorazine (chlorpromazine)

This group of antipsychotics tend to have similar side effects like problems with movement (known as extrapyramidal symptoms), drowsiness, and dry mouth.

Scientists later developed a newer group of antipsychotics, often called second-generation antipsychotics or atypical antipsychotics. Some of these antipsychotic drugs include the following:

  • Abilify (aripiprazole)
  • Clozaril (clozapine)
  • Zyprexa (olazapine)
  • Seroquel (quetiapine)
  • INVEGA (paliperidone)

These drugs don’t usually cause the movement problems of typical antipsychotic drugs. However, they are more likely to cause weight gain and other problems with metabolism, among other side effects.

Therapy

Increasingly, mental health providers are realizing the important role of psychological treatment in addressing schizophrenia. For example, various forms of psychotherapy can be very helpful. One form of psychotherapy called cognitive behavioral therapy helps patients learn to identify and change their dysfunctional emotions, behaviors, and thoughts.

No matter the type of therapy one pursues, it's best to be as honest as possible with your doctor or mental health professional. This way he/she can help you to the full extent in managing and coping with your symptoms.

Schizophrenia Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Mind Doc Guide

Family therapy can also help both patients and family members learn better how to cope with the condition. Many people with schizophrenia also need social skills training, which can help teach basic self-care and social skills.

Additional Support

Support groups can also be helpful, both for people with the condition and for family members. People with schizophrenia may also need help finding work, housing, or certain other types of assistance.

Goals of Treatment

The goal of treatment is to help patients achieve remission. Some people have long periods of remission with a quite stable disease and minimal impairment. Other people have worsening symptoms and functioning and do not have a good response to available therapies.

It is hard to know how a specific person will do after diagnosis. But the outlook for people with schizophrenia has improved over recent years, with better psychiatric medications and more comprehensive psychological and social support.

Coping

People diagnosed with schizophrenia can face a variety of challenges. Learning how to navigate these potential obstacles is an important part of living fully and keeping symptoms manageable.

Emotional Coping

Living with schizophrenia may feel overwhelming at times, especially as you learn of your new diagnosis and begin the treatment process. Emotional challenges are to be expected and it is important to allow yourself time to learn how to effectively regulate your emotions. Through counseling and peer support, you can learn ways to manage your emotional experiences in healthy ways.

Social coping

Social support from peers, family, and friends is important as you learn how to successfully navigate the journey of living with schizophrenia. There may be times when it is difficult to tell others about your condition, especially if you feel you may be judged by others. Learning about your condition, and being open about your experiences, can help others understand what you need, and how they might be able to help.

Debunking myths

Some people don't understand the condition of schizophrenia. You might find yourself explaining things about your condition to others. Some common misconceptions or myths about schizophrenia include things like:

  • It means having multiple personalities
  • The diagnosis is very rare
  • The condition leads to violent behavior
  • It always becomes worse over time

The reality is that each person's experience with schizophrenia is unique. Although there are specific clinical criteria that need to be met in order to be diagnosed, each person can have different experiences with the types of symptoms they have, the degree to which symptoms progress over time or go into remission, and how they respond to treatment methods.

In Children

Although rare, the onset of schizophrenia can occur in children 13 years old or younger. It is estimated that childhood schizophrenia impacts about one percent of the American population. Being able to identify the condition in children can be quite difficult, as children can have a hard time understanding and describing their experiences to others. For this reason, asking your child questions about symptoms may not be very helpful. You may want to consult your child's doctor if you notice things like:

  • Strange eating rituals
  • Unusual behaviors
  • Bizarre ideas
  • Social isolation
  • Drastic change in academic performance

Since the onset of schizophrenia symptoms typically takes place in the late teens into the early thirties, keep in mind these symptoms are likely related to something other than schizophrenia.

For Caregivers

Caring for a loved one with schizophrenia can feel challenging. One of the most important things that can help is to educate yourself on the condition and the experiences that those with schizophrenia often face. Gathering information can help us learn what to expect along the way, what our loved one might need in the process and how we can best help.

Support can be as important for caregivers as it is for the person living with the condition. Group support environments offer opportunities to connect with others who can relate to challenges and join you in celebrating victories. You may also find that people share helpful information about new or progressive treatment methods and other resources that can help your loved one.

Don't be afraid to ask for help. Caregivers can feel overwhelmed with responsibilities and spend so much time caring for others that they neglect caring for themselves. Reaching out to a support group, a mental health provider or other resources can allow you space to share your experiences and process emotions.

A Word From Verywell

Schizophrenia is often a difficult illness to fully treat, but there is hope. Through multifaceted and consistent treatment, many individuals diagnosed with schizophrenia can recover from many disease symptoms. People with schizophrenia need support from their family and community members to have the best chance of living full and active lives.

If you or your family member has been diagnosed with schizophrenia, know that it isn’t your fault. Also, know that there are many people to help affected individuals recover and regain control of their lives.

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Article Sources

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