Schizophrenia

Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling.

People with schizophrenia require lifelong treatment. Early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook.

Schizophrenia is a chronic psychiatric disorder. People with this disorder experience distortions of reality, often experiencing delusions or hallucinations.

Although exact estimates are difficulty to obtain, it’s estimated to affect about 1 percent of the population.

Misconceptions about this disorder are common. For example, some people think it creates a “split personality.” In fact, schizophrenia and split personality — properly termed dissociative identity disorder — are two different disorders.

Schizophrenia can occur in men and women of all ages. Men often develop symptoms in their late teens or early 20s. Women tend to show signs in their late 20s and early 30s. Here’s what you need to know.

re common. For example, some people think it creates a “split personality.” In fact, schizophrenia and split personality — properly termed dissociative identity disorder — are two different disorders.

Symptoms of schizophrenia

Symptoms of schizophrenia may include the following:

Early symptoms

Symptoms of this disorder commonly show up in the teenage years and early 20s. At these ages, the earliest signs may get overlooked because of typical adolescent behaviors.

Early symptoms include:

isolating oneself from friends and family
changing friends or social groups
a change in focus and concentration
sleep problems
irritability and agitation
difficulties with schoolwork, or poor academic performance

Positive symptoms

“Positive” symptoms of schizophrenia are behaviors that aren’t typical in otherwise healthy individuals. These behaviors include:

Hallucinations. Hallucinations are experiences that appear real but are created by your mind. They include seeing things, hearing voices, or smelling things others around you don’t experience.
Delusions. A delusion occurs when you believe something despite evidence or facts to the contrary.
Thought disorders. These are unusual ways of thinking or processing information.
Movement disorders. These include agitated body movements or strange postures.

Negative symptoms

Negative symptoms of schizophrenia interrupt a person’s typical emotions, behaviors, and abilities. These symptoms include:

disorganized thinking or speech, where the person changes topics rapidly when speaking or uses made-up words or phrases
trouble controlling impulses
odd emotional responses to situations
a lack of emotion or expressions
loss of interest or excitement for life
social isolation
trouble experiencing pleasure
difficulty beginning or following through with plans
difficulty completing normal everyday activities

Cognitive symptoms

Cognitive symptoms of schizophrenia are sometimes subtle and may be difficult to detect. However, the disorder can affect memory and thinking.

These symptoms include:

disorganized thinking, such as trouble focusing or paying attention
poor “executive functioning,” or understanding information and using it to make decisions
problems learning information and using it
lack of insight or being unaware of their symptoms

Schizophrenia causes

The exact cause of schizophrenia is unknown. Medical researchers believe several factors can contribute, including:

biological
genetic
environmental

Recent studies have suggested that imaging tests completed on people with schizophrenia may show abnormalities in certain brain structures. Ongoing research in this area continues. Chemical abnormalities in the brain are believed to be responsible for many of the symptoms seen in schizophrenia.

Researchers also believe low levels of certain brain chemicals that affect emotions and behavior may contribute to this psychiatric disorder.

Genetics may also play a role. People with a family history of schizophrenia have a higher risk of developing this disorder.

Other risk factors for schizophrenia may include:

exposure to toxins or a virus before birth or during infancy
having an inflammatory or an autoimmune disease
using mind-altering drugs
high stress levels

It’s not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Subtypes of schizophrenia

Although the subtypes don’t exist as separate clinical disorders anymore, they can still be helpful as specifiers and for treatment planning. There are five classical subtypes:

paranoid
hebephrenic
undifferentiated
residual
catatonic

Paranoid schizophrenia

Paranoid schizophrenia used to be the most common form of schizophrenia. In 2013, the American Psychiatric Association determined that paranoia was a positive symptom of the disorder, so paranoid schizophrenia wasn’t a separate condition. Hence, it was then just changed to schizophrenia.

The subtype description is still used though, because of how common it is. Symptoms include:

delusions
hallucinations
disorganized speech (word salad, echolalia)
trouble concentrating
behavioral impairment (impulse control, emotional lability)
flat affect

Did you know?
Word salad is a verbal symptom where random words are strung together in no logical order.

Hebephrenic/disorganized schizophrenia

Hebephrenic or disorganized schizophrenia is still recognized by the International Statistical Classification of Diseases and Related Health Problems (ICD-10), although it’s been removed from the DSM-5.

In this variation of schizophrenia, the individual doesn’t have hallucinations or delusions. Instead, they experience disorganized behavior and speech. This can include:

flat affect
speech disturbances
disorganized thinking
inappropriate emotions or facial reactions
trouble with daily activities

Undifferentiated schizophrenia

Undifferentiated schizophrenia was the term used to describe when an individual displayed behaviors that were applicable to more than one type of schizophrenia. For instance, an individual who had catatonic behavior but also had delusions or hallucinations, with word salad, might have been diagnosed with undifferentiated schizophrenia.

With the new diagnostic criteria, this merely signifies to the clinician that a variety of symptoms are present.

Residual schizophrenia

This “subtype” is a bit tricky. It’s been used when a person has a previous diagnosis of schizophrenia but no longer has any prominent symptoms of the disorder. The symptoms have generally lessened in intensity.

Residual schizophrenia usually includes more “negative” symptoms, such as:

flattened affect
psychomotor difficulties
slowed speech
poor hygiene

Many people with schizophrenia go through periods where their symptoms wax and wane and vary in frequency and intensity. Therefore, this designation is rarely used anymore.

Catatonic schizophrenia

Although catatonic schizophrenia was a subtype in the previous edition of the DSM, it’s been argued in the past that catatonia should be more of a specifier. This is because it occurs in a variety of psychiatric conditions and general medical conditions.

It generally presents itself as immobility, but can also look like:

mimicking behavior
mutism
a stupor-like condition

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Childhood schizophrenia

Childhood schizophrenia isn’t a subtype, but rather used to refer to the time of diagnosis. A diagnosis in children is fairly uncommon.

When it does occur, it can be severe. Early-onset schizophrenia typically occurs between the ages of 13 and 18. A diagnosis under the age of 13 is considered very early-onset, and is extremely rare.

Symptoms in very young children are similar to those of developmental disorders, such as autism and attention-deficit hyperactivity disorder (ADHD). These symptoms can include:

language delays
late or unusual crawling or walking
abnormal motor movements

It’s important to rule out developmental issues when considering a very early-onset schizophrenia diagnosis.

Symptoms in older children and teens include:

social withdrawal
sleep disruptions
impaired school performance
irritability
odd behavior
substance use

Younger individuals are less likely to have delusions, but they’re more likely to have hallucinations. As teens get older, more typical symptoms of schizophrenia like those in adults usually emerge.

Symptoms

Schizophrenia involves a range of problems with thinking (cognition), behavior and emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. Symptoms may include:

Delusions. These are false beliefs that are not based in reality. For example, you think that you’re being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
Hallucinations. These usually involve seeing or hearing things that don’t exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.
Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn’t focused on a goal, so it’s hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact, doesn’t change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.

In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It’s uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

Withdrawal from friends and family
A drop in performance at school
Trouble sleeping
Irritability or depressed mood
Lack of motivation

Also, recreational substance use, such as marijuana, methamphetamines or LSD, can sometimes cause similar signs and symptoms.

Compared with schizophrenia symptoms in adults, teens may be:

Less likely to have delusions
More likely to have visual hallucinations

When to see a doctor

People with schizophrenia often lack awareness that their difficulties stem from a mental disorder that requires medical attention. So it often falls to family or friends to get them help.

Helping someone who may have schizophrenia

If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can’t force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health professional.

If your loved one poses a danger to self or others or can’t provide his or her own food, clothing, or shelter, you may need to call 911 or other emergency responders for help so that your loved one can be evaluated by a mental health professional.

In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

chizophrenia diagnosis and tests

There isn’t a single test to diagnose schizophrenia. A complete psychiatric exam can help your doctor make a diagnosis. You’ll need to see a psychiatrist or a mental health professional.

At your appointment, expect to answer questions about:

your medical history
your mental health
your family medical history

Your doctor may conduct the following:

a physical exam
blood work
imaging tests, including magnetic resonance imaging (MRI) or computed tomography (CT) scan

Sometimes, there can be other reasons for your symptoms, even though they may be similar to those of schizophrenia. These reasons may include:

substance use
certain medications
other mental illnesses

Your doctor may diagnose schizophrenia if you’ve had at least two symptoms for a one-month period. These symptoms must include:

hallucinations
delusions
disorganized speech

Risk factors

Although the precise cause of schizophrenia isn’t known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

Having a family history of schizophrenia
Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood

Complications

Left untreated, schizophrenia can result in severe problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

Suicide, suicide attempts and thoughts of suicide
Anxiety disorders and obsessive-compulsive disorder (OCD)
Depression
Abuse of alcohol or other drugs, including nicotine
Inability to work or attend school
Financial problems and homelessness
Social isolation
Health and medical problems
Being victimized
Aggressive behavior, although it’s uncommon

Prevention

There’s no sure way to prevent schizophrenia, but sticking with the treatment plan can help prevent relapses or worsening of symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.

Schizophrenia treatments

There’s no cure for schizophrenia. If you’re diagnosed with this disorder, you’ll need lifelong treatment. Treatments can control or reduce the severity of symptoms.

It’s important to get treatment from a psychiatrist or mental health professional who has experience treating people with this disorder. You may also work with a social worker or a case manager, too.

Possible treatments include the following:

Medications

Antipsychotic medication is the most common treatment for schizophrenia. Medication can help stop:

hallucinations
delusions
symptoms of psychosis

If psychosis occurs, you may be hospitalized and receive treatment under close medical supervision.

Psychosocial intervention

Another treatment option for schizophrenia is psychosocial intervention. This includes individual therapy to help you cope with stress and your illness.

Social training can improve your social and communication skills.

Vocational rehabilitation

Vocational rehabilitation can provide you with the skills you need to return to work. It may make maintaining a regular job easier.

Alternative treatments for schizophrenia

Medication is important for treating schizophrenia. However, some individuals with the disorder may want to consider complementary medicine. If you choose to use these alternative treatments, work with your doctor to make sure the treatment is safe.

Types of alternative treatments used for schizophrenia include:

vitamin treatment
fish oil supplements
glycine supplements
diet management