What is schizophrenia?
Schizophrenia is a severe, long-term mental health condition that affects a person’s thoughts, behaviour, emotions, language, and even how they see the world around them.
Schizophrenia is a misunderstood diagnosis and many people have misconceptions and false beliefs about the disease.
Although it can be frightening to have schizophrenia, proper management of the condition can help someone with schizophrenia have a better quality of life.
Schizophrenia is a complex condition that comes with a variety of symptoms and takes many different forms. It is important to learn more about schizophrenia to break the stigma associated with this condition.
What are some common false beliefs people have about schizophrenia?
False Belief: “People with schizophrenia are always violent and dangerous”
Schizophrenia is a very misunderstood condition, and it is usually associated with a lot of false beliefs. For example, many people believe that a person with schizophrenia is a violent individual, but that isn’t always true. In reality, people with schizophrenia are the ones that are more likely to suffer from abuse because of their mental health condition.12
False Belief: “People with schizophrenia cannot work and they need to be in hospital”
It is also believed that everyone with schizophrenia cannot keep a job, or that they require long-term hospital care. However, a person with schizophrenia can work normally and they can also live at home without needing long-term care.
False Belief: “People with schizophrenia cannot take care of themselves”
Many people with schizophrenia are completely capable of taking care of themselves. As schizophrenia is a life-long disorder, a person living with this condition has to learn how to manage the symptoms, and they have to try their best to surround themselves with supportive family and friends. Some people may only need help when their symptoms become very severe, or if they cannot manage their condition well on their own.
What are the symptoms of schizophrenia?
The symptoms of schizophrenia are divided into two different groups called “positive” and “negative” symptoms. These names can be misleading as they do not mean that “positive” symptoms are good and that “negative” symptoms are bad. They are just referring to different types of symptoms.
The different symptoms that people with schizophrenia can get include:
What are the positive symptoms of schizophrenia?
Positive symptoms are symptoms that are present in someone when they normally shouldn’t be. These symptoms can cause a change in someone’s behaviour, thoughts and perceptions.
Examples of positive symptoms of schizophrenia can include:
- Delusions (very strong beliefs about something that isn’t true)
- Hallucinations (seeing, thinking, hearing, smelling or tasting something that does not exist outside of that person’s mind)
- Change in behaviour
- Having confused thoughts
- Speaking in a disorganised way
- Having involuntary muscle movements
Positive symptoms tend to go away after a while, but for many people the symptoms can return.
What are the negative symptoms of schizophrenia?
Negative symptoms are symptoms that are “absent” when they should normally be there for someone. People with “negative” symptoms are usually “lacking” a feeling, an interest, or a thought that is ordinarily present in people.
Examples of negative symptoms of schizophrenia include:
- Losing interest in sex
- Having difficulty concentrating and sleeping
- Losing interest in talking to people or going out
- Having a hard time being interested in daily activities
What is psychosis?
People with schizophrenia can suffer from episodes of “psychosis”. Psychosis is a mental condition that makes it difficult for a person to tell the difference between what is real and what is not. Psychosis can include the following symptoms:
What are hallucinations?
Having hallucinations means seeing, hearing, smelling, tasting or even feeling things that are not real. For example, a person with schizophrenia who is suffering from hallucinations can see people or objects that are not present in real life.
Hearing voices is the most common type of hallucination. This can be really frightening because some people can hear voices that can be cruel and harmful. However, it’s important to understand however that these voices are not always negative or dangerous.
Hallucinations can be a scary symptom to have and can sometimes lead to violent behaviours. Although most medications try to decrease the occurrence of hallucinations, the symptoms can return for many patients.
What are delusions?
Delusions are very strong thoughts and beliefs that are not real. For example, a person suffering from a delusion can believe very strongly that someone is trying to hurt them, when in reality no one is trying to hurt them. Delusions can also make people believe that their medication is poisoning them, or they may have other similar false beliefs.
Experiencing delusions can be very frightening, and they can sometimes make people act strangely or even violently towards other people around them.
Delusions are another symptom that can get better with medication, and they can even go away completely. Seeking professional support and sticking to your doctor’s medication plan can help stop delusions from coming back.
Are people with schizophrenia dangerous?
Having schizophrenia does not mean you are dangerous. As you can imagine, the symptoms of hallucinations or delusions can be very scary, and they can sometimes cause a person to commit violent acts as a response to what they see or hear. However, there are many things besides having schizophrenia that can contribute to a person becoming violent including:
- Family history of violence
- Alcohol or drug abuse
- Economic status
So it is important to recognise that firstly, not all people with schizophrenia are violent and dangerous, and that secondly, if someone with schizophrenia is violent, that it may be due to a number of different reasons.
What are the different types of schizophrenia?
Important Note: Before 2013, doctors used various different subtypes of schizophrenia to diagnose people depending on their symptoms. These subtypes have been listed below, however please bear in mind that since 2013, doctors have been using a different approach to diagnose schizophrenia, and so you may not come across these terms in current practice.
Paranoid schizophrenia, also known as type 1 schizophrenia, is the most common type of schizophrenia. People with paranoid schizophrenia can experience symptoms such as hallucinations and delusions.
A person with paranoid schizophrenia can believe that someone is following them, watching them, or even trying to hurt them. Although this belief is not based in reality, a person with paranoia can feel genuine fear or confusion.
Hebephrenic schizophrenia is also known as “disorganised schizophrenia” or type 2 schizophrenia. People with this type of schizophrenia have an unusual way of thinking or acting. They can have trouble speaking normally because they mix up sentences (for example instead of saying “I need help” they might say “need I help”).
A person with this type of schizophrenia can also have inappropriate reactions, such as laughing in sad situations, or not showing any emotions at all.
A person with schizoaffective disorder has both schizophrenia and another mental health condition that also affects their mood. For example, they may have a mood disorder such as bipolar disorder and schizophrenia (this would be called bipolar or manic schizophrenia), or they may have depression and schizophrenia (this would be called depressive schizophrenia).
Residual schizophrenia is a more stable form of schizophrenia which can be reached if the condition is managed properly. People are considered to have residual schizophrenia if:
- They have previously had psychosis and their symptoms are now less severe
- They only suffer from negative symptoms of schizophrenia
However, emotional stress can cause a person to go from having residual schizophrenia to having a more severe form of the condition.
Catatonic schizophrenia develops when someone with schizophrenia starts to develop catatonic behaviour. This behaviour involves sudden or unusual movements and activities.
For example, a person with catatonic schizophrenia can be very active and talkative one minute, and then suddenly very still and quiet. Other types of catatonic behaviour includes copying sounds or other people in a random manner.
This form of schizophrenia can be difficult to diagnose because the strange behaviour could be caused by other problems.
Cenesthopathic schizophrenia develops when someone with schizophrenia starts to feel strange things on their body. This is a very rare type of schizophrenia symptom, and so very little is written about it. A study in India found that 25% of patients with Cenesthopathic schizophrenia had strange feelings in their arms or legs. These feelings include things like:
- Feeling the arms and legs shrinking or enlarging
Undifferentiated schizophrenia is diagnosed when someone has signs of paranoid, disorganised or catatonic schizophrenia.
Because of the many different symptoms, it is difficult to diagnose a specific type. Undifferentiated schizophrenia is treated on a case by case basis with emphasis on helping someone with their specific symptoms.
Unspecified schizophrenia is when a person is diagnosed with schizophrenia but has a unique characteristic which makes it difficult to classify it as any of the above types.
Like undifferentiated schizophrenia, the diagnosis is given for unique cases.
Treatment of unspecified schizophrenia is the same as any of the other forms of schizophrenia.
Early onset schizophrenia is also known as childhood onset schizophrenia. Symptoms of schizophrenia normally appear in adulthood, but in early onset schizophrenia, the symptoms start to develop before the age of 13.
Children with childhood onset schizophrenia can develop any of the same symptoms as adults. However, early onset schizophrenia tends to be more severe. For example, children can have even more trouble speaking than adults do, or they are more socially distant.
The management plans of early onset schizophrenia is similar to those done for adults with schizophrenia.
Who can get schizophrenia?
Schizophrenia affects 1% of the world population. Normally people are diagnosed between the late teenage years to early thirties. Both men and women can develop schizophrenia. However, men tend to show symptoms earlier than women (between 18 years and early 20’s). Women normally show symptoms later on in life (between 20 to 30 years).
Other than the differences in age onset, both genders are equally likely to develop the disorder, and there is little data to suggest that they are affected differently by the type of symptoms.
Although it is rare, children can also develop schizophrenia.
Who has a higher risk of developing schizophrenia?
Studies in twins show that schizophrenia is a hereditary (genetic) disease. This means that if both your parents have schizophrenia , you have a 40% risk of developing it also.
However, a person’s environment can also affect the onset of schizophrenia in people who have a higher risk of developing it.
Life experiences such as:
can trigger schizophrenia to develop.
What causes schizophrenia?
The exact cause of schizophrenia is not known. Brain chemicals, brain structure, and the environment are factors that may play a role in the development of this condition.
It is believed that schizophrenia is caused by abnormal communication between brain cells.
Our brain cells release chemicals such as dopamine to try to communicate with one another. When the brain starts to release an abnormal amount of these chemicals, schizophrenic symptoms can start to develop.
Schizophrenia can also be caused by an abnormal brain structure.
Doctors have noticed differences in the prefrontal cortex in people who develop schizophrenia. The prefrontal cortex is a part of the brain that is associated with memory and decision making.
Other parts of the brain can also have a different structure in people with schizophrenia.
The environment can also affect the chances of developing schizophrenia. Some environmental factors that can increase the risk of developing this condition include:
- Advanced parental age
- Childhood trauma
- Pregnancy and birth complications
- Cannabis and alcohol use
How does schizophrenia affect quality of life?
Having schizophrenia can affect people’s lives in many ways.
Schizophrenia can be very debilitating, especially with the social exclusion and prejudice associated with the diagnosis. The symptoms of schizophrenia can be really scary to experience, and may cause someone to have trouble sleeping, or have trouble maintaining normal social relationships.
Often, people with poorly treated schizophrenia are at risk of suffering with discrimination, and at risk of being shamed by those around them.
Schizophrenia has a huge association with disability. This in turn affects people’s education and employment opportunities.
Unemployment is as high as 80-90% in people with schizophrenia.
The daily stress of having schizophrenia can lead to depression. People with schizophrenia have an increased rate of suicide (1 in 10 people with schizophrenia die by suicide)1. The majority of people with schizophrenia are less likely to seek treatment and care when compared to the general population.
It is important for people with schizophrenia to try to practice self-care by cutting down on stress, and maintaining healthy relationships with supportive family members, friends and community members.
The medication taken by people with schizophrenia can also have severe side effects that can impact them socially, potentially leading them towards isolation.
A high percentage of patients with schizophrenia also die from cardiovascular disease (mostly due to the medication) therefore they are strongly encouraged to exercise and maintain a healthy diet.
Understanding the needs of someone with schizophrenia
Managing schizophrenia can be difficult. Therefore, part of therapy includes group efforts to help an individual with schizophrenia manage their daily lives.
Community-based therapy also helps family and friends better understand the needs of the person who is affected.
Which other conditions have similar symptoms to schizophrenia?
Schizophrenia is a very misunderstood disease in society, and people can confuse schizophrenia for many other conditions. This is why it is very important to see a doctor if you have symptoms, so that they can five you a professional diagnosis and treatment.
Psychosis is a condition that develops when a person cannot tell the difference between what is real and what is not. Different illnesses can cause a psychotic episode including:
- Bipolar disorder
- Severe depression
Asperger’s syndrome is a condition where a person has problems with social interaction and communication. Normally symptoms develop during early childhood. Asperger’s syndrome is also a form of autism.
Bipolar disorder is when a person has sudden changes in energy and emotions. People with bipolar disorder have a hard time concentrating on one task, and they may find it difficult to do a task from day-to-day. Diagnosis usually occurs in the teenage years, but symptoms can develop in children as well.
Attention-Deficit Hyperactivity Disorder (ADHD) is a condition that develops when a person has a difficult time focusing on one task. People with ADHD can be very active, constantly moving, or restless.
Post-Traumatic Stress Disorder (PTSD) is a condition that sometimes develops when someone has been through a traumatic experience.
A person can re-experience the traumatic event through flashbacks or nightmares. They may also be angry or anxious, easily scared and can sometimes focus on certain problems.
These thoughts or obsessions cannot be controlled. People with OCD can also have a tic, a sudden, involuntary repetitive and temporary movement of the face or limbs.
Dissociative Identity Disorder (DID), also known as split personality or multiple personality disorder, is a condition that is caused by a traumatic event in early childhood that makes it difficult to develop a healthy, self-aware identity. People with DID have memory loss and can experience “blackout” moments, or lost time and can at times, seem like a different person or personality.
It is important to emphasise that this is a completely different condition to schizophrenia, and people with schizophrenia do not have “a split personality”.
How is schizophrenia diagnosed?
Schizophrenia is diagnosed by a psychiatrist. A psychiatrist is a doctor who specialises in mental health conditions and management.
There is no specific test that will diagnose schizophrenia, so a psychiatrist may need to do the following tests to help them diagnose schizophrenia:
- Various mental status exams
- Brain scans (although these are not needed commonly)
If you are worried about any symptoms it is best to seek medical help as soon as possible because the sooner schizophrenia is treated, the better it is for you.
A diagnosis of schizophrenia should only be made by a professional physician or psychiatrist. Self-diagnosis can be harmful. Proper diagnosis can help people receive the right management and treatment for this life-long condition.
Why might some people not want to see a doctor?
Many people experiencing symptoms for the first time may be reluctant to seek medical help as their thoughts and beliefs might be altered, and they might believe there is nothing wrong with them.
If you are concerned about someone you know who may be experiencing symptoms described above, please encourage them to visit a doctor for an assessment.
What should you do after you have been diagnosed?
After diagnosis, you may feel anxious and nervous about the future. This is normal and it is a stepping stone to getting the treatment and information you need to manage your condition.
Having knowledge of your condition is important, especially being aware of triggers that may cause your symptoms to get worse at certain times. Being aware of your triggers can help you prevent them and live a better quality of life.
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How do you treat schizophrenia?
Treatment of schizophrenia includes both taking medication and engaging in talking therapies to help manage symptoms.
Antipsychotic medications are one of the main medications used to treat schizophrenia. Some people may need only one medication, whilst others need a combination of medications.
First-generation, also known as ‘typical antipsychotics’ are taken by mouth as pills and tablets. Examples include:
- Chlorpromazine hydrochloride
- Fluphenazine hydrochloride
- Promazine hydrochloride
- Sulpiride, Trifluoperazine
- Zuclopenthixol acetate
- Zuclopenthixol dihydrochloride
What are the side effects of first-generation antipsychotics?
First-generation antipsychotics can have broad side effects which can include:
- Extreme tiredness
- Weight gain
- Problems with sexual function
- Conditions that cause problems with movement (e.g. parkinsonism, akathisia, dystonia)
- Menstrual problems in women
- Reduced bone mineral density
- Involuntary movement of lips, jaws, tongue and facial muscles, limbs and trunk (tardive dyskinesia)
Second-generation antipsychotics, also known as ‘atypical antipsychotics’ are also taken by mouth as pills or tablets. Examples include:
What are the side effects of second-generation antipsychotics?
Second-generation antipsychotics were developed in an attempt to decrease the severe side-effects of first-generation antipsychotics.
However, second-generation antipsychotics do have some side effects including:
- Weight gain
- Metabolic problems that can increase the risk of type-2 diabetes and cardiovascular disease
Sometimes, none of the above treatments work. In this case, the person is considered to have treatment resistant schizophrenia and can be prescribed a medication called clozapine.
Clozapine is a medication that is taken by mouth. It has shown to be able to treat severe cases of schizophrenia, but it does have many side effects.
Side effects of clozapine include:
- Dizziness/ lightheadedness
- Vision problems (blurred vision)
- Weight gain
- Bowel movement problems
- Increase blood sugar levels
- Swelling of the arms/legs
- Stomach pains
- Skin/eyes become yellow
- Difficulty breathing when exercising
Giving an injection of an antipsychotic medication can be more efficient and more effective than taking the medication by mouth.
The benefit of injections is that it allows doctors to track if their patient is taking the medication on a regular basis. It also allows doctors to regularly follow up with their patients.
However, the disadvantage is that there is only one medication (Risperidone) that is currently available as an injection.
Psychological & Psychosocial Therapy
The different symptoms of schizophrenia can be very difficult to manage. In order to properly treat this condition, people usually also need to have psychological and psychosocial therapy. This therapy can help those with schizophrenia learn how to live with their diagnosis, and it can also help family members and friends understand how they can help support their loved one.
These therapies can include:
- Social skills training
- Family interventions
- Cognitive behaviour therapy
- Cognitive remediation therapy
- Counselling and supportive therapy
- Arts therapy
Psychiatric Outpatient Clinics
There are some clinics that are specialised in helping people who have active symptoms of schizophrenia.
These clinics help promote recovery and also aim to teach people how to manage their condition.
Can you prevent schizophrenia?
As of yet, we do not know how to prevent schizophrenia. As both environmental and genetic factors play a role in the development of schizophrenia, it is possible that decreasing these risk factors can delay the onset of the condition.
Although you may not be able to prevent schizophrenia from developing, you can try to be more aware of certain triggers that bring back your symptoms or make them worse.
It is also important to try to maintain close relationships with others, so that people around you can also help you pick up on times when your symptoms may be getting worse.
Recognising these signs is important because treating them early or receiving extra support early can prevent someone from having to be admitted to hospital.
Is there a cure for schizophrenia?
Unfortunately not. There is no cure for schizophrenia. However, proper therapy and medication can help people manage their symptoms.
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