Speak the word “schizophrenia” and you’ll likely receive reactions peppered with misunderstanding and fear. The disorder is largely shrouded in myths, stereotypes, and stigma. For instance, many equate schizophrenia with violence and criminals. But schizophrenia sufferers aren’t more likely to be violent than others, unless they have a criminal history before becoming sick or unless they abuse alcohol and drugs (see schizophrenia and violence). Also, despite its etymology and its portrayal in movies, schizophrenia isn’t a split personality: It literally means “split mind.”
Schizophrenia is a chronic, debilitating disorder characterized by an inability to distinguish between what is real and what isn’t. A person with schizophrenia experiences hallucinations and delusional thoughts and is unable to think rationally, communicate properly, make decisions or remember information. To the public, a sufferer’s behavior might seem odd or outrageous. Not surprisingly, the disorder can ruin relationships and negatively affect work, school, and everyday activities.
About one-third of individuals with schizophrenia attempt suicide. Fortunately, however, schizophrenia is treatable with both medication and therapy, making it imperative to recognize the symptoms and receive the correct diagnosis. The earlier a person is accurately diagnosed, the sooner he or she can start an effective treatment plan.
As with other psychological disorders, it’s believed that schizophrenia is a complex interplay of genetics, biology (brain chemistry and structure), and environment.
- Genetics: Schizophrenia typically runs in families, so it’s likely the disorder is inherited. If an identical twin has schizophrenia, the other twin is 50 percent more likely to have the disorder. That also points out the likelihood of other causes: If schizophrenia were purely genetic, both identical twins always would have the disorder.
- Brain chemistry and structure: Neurotransmitters—chemicals in the brain, including dopamine and glutamate, that communicate between neurons—are believed to play a role. There also is evidence to suggest that the brains of individuals with schizophrenia are different from those of healthy individuals (for details, see Keshavan, Tandon, Boutros & Nasrallah, 2008).
- Environment: Some research points to child abuse, early traumatic events, severe stress, negative life events and living in an urban environment as contributing factors. Additional causes include physical and psychological complications during pregnancy, such as viral infection, malnutrition, and the mother’s stress.
- Paranoid schizophrenia is characterized by auditory hallucinations and delusions about persecution or conspiracy. However, unlike those who have other subtypes of the disease, these individuals show relatively normal cognitive functioning.
- Disorganized schizophrenia is a disruption of thought processes, so much so that daily activities (e.g., showering, brushing teeth) are impaired. Sufferers frequently exhibit inappropriate or erratic emotions. For instance, they might laugh at a sad occasion. Also, their speech becomes disorganized and nonsensical.
- Catatonic schizophrenia involves a disturbance in movement. Some might stop moving (catatonic stupor) or experience radically increased movement (catatonic excitement). Also, these individuals might assume odd positions, continuously repeat what others are saying (echolalia) or imitate another person’s movement (echopraxia).
- Undifferentiated schizophrenia includes several symptoms from the above types, but the symptoms don’t exactly fit the criteria for the other kinds of schizophrenia.
- Residual schizophrenia is diagnosed when a person no longer exhibits symptoms or these symptoms aren’t as severe.
According to Simeone et al., 2015, “Among 21 studies reporting 12-month prevalence, the median estimate was 0.33 percent with a [range of between] 0.26 – 0.51 percent.
The median estimate of lifetime prevalence among 29 studies was 0.48 percent [with a range of between] 0.34 – 0.85 percent.” The American Psychiatric Association places the lifetime prevalence rate of schizophrenia to “be approximately 0.3% – 0.7%”.
Recent research identified five risk factors for teens, which are similar in adults:
- Schizophrenia in the family
- Unusual thoughts
- Paranoia or suspicion
- Social impairment
- Substance abuse
There are three types of symptoms in schizophrenia: positive, negative, and cognitive.
- Positive (symptoms that should not be present)
- Hallucinations (something a person sees, smells, hears, and feels that isn’t really there). The most common hallucination in schizophrenia is hearing voices.
- Delusions (a false belief that isn’t true)
- Negative (symptoms that should be present)
- Flat (individuals show no emotion) or inappropriate affect (e.g., giggling at a funeral)
- Avolition (little interest or drive). This can mean little interest in daily activities, such as personal hygiene.
These symptoms often are harder to recognize, because they’re so subtle.
- Cognitive symptoms (associated with thinking)
- Disorganized speech (the person isn’t making any sense)
- Grossly disorganized or catatonic (unresponsive) behavior
- Inability to remember things
- Poor executive functioning (a person is unable to process information and make decisions)
Learn more: Symptoms of Schizophrenia
To diagnose schizophrenia, a trained mental health professional conducts a face-to-face clinical interview, asking detailed questions about family health history and the individual’s symptoms.
Though there isn’t a medical exam for schizophrenia, doctors typically order medical tests to rule out any health conditions or substance abuse that might mimic schizophrenia symptoms.
According to the DSM-IV-TR, the standard reference book mental health professionals use to help make diagnoses, medical conditions that can imitate symptoms of schizophrenia include: neurological conditions (e.g., Huntington’s disease, epilepsy, auditory nerve injury); endocrine conditions (e.g., hyper- or hypothyroidism); metabolic conditions (e.g., hypoglycemia); and renal (kidney) diseases.
Schizophrenia can be successfully managed with medication and psychotherapy. For the majority of schizophrenia sufferers, medication is highly effective in controlling symptoms. However, finding the right medication can take time; each medication affects each person differently. Patients typically try several medications before finding the best one for them.
It’s important to discuss the details of each medication’s risks and benefits with your doctor, take the medication as prescribed, and never stop taking your medication without first talking to your doctor.
What Kinds of Medications Are Used for Schizophrenia?
- Typical antipsychotics. Available since the mid-1950s, these older antipsychotics used to be the first line of treatment, because they successfully reduced hallucinations and delusions. These include: haloperidol (Haldol), chlorpromazine (Thorazine), perphenazine (Etrafon, Trilafon) and fluphenzine (Prolixin). Many patients stop taking their medication because of its extrapyramidal side effects. “Extrapyramidal” actions are those that affect movement, such as muscle spasms, cramps, fidgeting, and pacing. Taking typical antipsychotics long-term can cause tardive dyskinesia—involuntary, random movements of the body, such as facial grimacing and movements of the mouth, tongue, and legs. Because of these side effects, atypical antipsychotics largely have replaced traditional antipsychotics.
- Atypical antipsychotics. Developed in the 1990s, these medications have become the standard treatment for schizophrenia. That’s because they effectively control positive symptoms and help treat negative symptoms without the same side effects as traditional antipsychotics. They include: aripiprazole (Abilify), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), clozapine (Clozaril), olanzapine/fluoxetine (Symbyax), and ziprasidone (Geodon). Though they rarely cause extrapyramidal complications, each atypical antipsychotic comes with its own side effects. For instance, though effective and much cheaper than other atypicals, clozapine can cause agranulocytosis — a condition that leaves the bone marrow unable to produce enough white blood cells to fight off infection. The newer antipsychotics don’t cause agranulocytosis, but they do cause significant weight gain and increase the risk for diabetes, which can have serious health complications.
When combined with medication, psychotherapy can be a valuable tool in managing schizophrenia. Therapy facilitates medication adherence, social skills, goal setting, support, and everyday functioning. Different types of psychotherapy benefit patients in different ways.
Illness management helps patients become an expert on their disorder, so they learn more about their symptoms, the warning signs of a potential relapse, various treatment options, and coping strategies. The goal is for patients to be actively involved in their treatment.
Rehabilitation gives patients the tools to be independent and navigate everyday life by teaching them social, vocational, and financial skills. Patients learn how to manage money, cook, and communicate better. There are many different types of rehabilitation programs.
Cognitive-behavioral therapy helps patients develop techniques to challenge their thoughts, ignore the voices in their heads, and overcome apathy.
Family education provides families with the tools to help and support their loved one. Families gain a deeper understanding of schizophrenia and learn coping strategies and other skills to prevent relapses and bolster treatment adherence.
Family therapy aims to reduce familial stress by teaching relatives how to discuss problems immediately, brainstorm solutions and pick the best one. Families who participate in therapy significantly decrease the chances of their loved one relapsing.
Group therapy offers a supportive environment that fosters discussion of real-life problems and their solutions, encourages social interaction, and minimizes isolation.
A person with schizophrenia might require hospitalization if he or she is experiencing severe delusions or hallucinations, suicidal thoughts, problems with substance abuse or any other potentially dangerous or self-harmful issues.
Learn more: Schizophrenia Treatment
Learning about schizophrenia is an important first step in finding help. If you would like to learn more about schizophrenia, check out Psych Central’s guide to the disorder.
If you think you have schizophrenia (or your loved one might), the next step is to seek an evaluation by a trained mental health professional. To find a therapist near you, use Psych Central’s therapist locator, ask your physician or consult a community mental health clinic for a referral.