Schizophrenia

Topic Overview

What is schizophrenia?

Schizophrenia is an illness that can affect your ability to think clearly, manage your emotions, and interact with others. It affects each person differently.

The way other people react to schizophrenia can make a difference in how schizophrenia affects you. It can make it easier or harder for you to cope with the illness.

Most people who have schizophrenia:

• Hear and sometimes see things that aren't there (hallucinations).
• Often believe some things that aren't true (delusions).
• May think that some people are trying to harm them (paranoia).

With treatment, they may come to understand that these experiences aren't real but are a problem with how their brains work.

Some people with schizophrenia have paranoid thinking, which causes them to have frightening thoughts, to believe that people or forces are trying to harm them, and to hear voices. Some people think that schizophrenia is the same as a "split personality" (dissociative identity disorder), but that is a different mental health problem.

Living with schizophrenia can cause many challenges. It's a difficult disease. It changes your life and the lives of your family. But you can live a full and meaningful life if:

• You are willing to work at helping yourself.
• You get professional help.
• You have the support and understanding of your family.

What causes schizophrenia?

Experts don't know what causes schizophrenia. It may have different causes for different people.

• In some people, brain chemistry and brain structure aren't normal.
• Family history may play a role.
• Problems that harm a baby's brain during pregnancy may help cause it.

It is not caused by anything you did, by personal weakness, or by the way your parents raised you.

What are the symptoms?

Symptoms of schizophrenia include:

• Negative symptoms. "Negative" doesn't mean "bad." Negative symptoms are things that are "lost" from your personality or how you experience life. You may:
  • Not care about things.
  • Have no interest or drive to do things.
  • Not take care of yourself, such as not bathing or not eating regularly.
  • Find it hard to say how you feel.
  • Become angry with strangers for no reason and react to others in other harmful ways.
• Positive symptoms. "Positive" doesn't mean "good." Positive symptoms are things "added" or "new" to your personality or how you experience life. They include:
  • Hallucinations.
  • Delusions.
  • Thoughts and speech that are confusing.
• Cognitive symptoms. These symptoms have to do with how you think. They often aren't obvious to you or others. They can include:
  • Memory loss.
  • Not being able to understand things well enough to make decisions.
  • Having trouble talking clearly to others.

Symptoms usually start when you are a teen or a young adult, but they may start later in life. They may appear suddenly or may develop slowly. You may not be aware of your symptoms.

Negative symptoms usually appear first. They may be hard to recognize as schizophrenia, because they are similar to symptoms of other problems, such as depression. Positive symptoms can start days, months, or years after the negative symptoms.

Early signs of schizophrenia may include doing worse in school, thinking that people are trying to harm you, or having changes in your personality, such as not wanting to see people.

These signs don't mean you have schizophrenia. But if you notice these signs, see a doctor.

How is schizophrenia diagnosed?

Your doctor will ask you questions about your health and about any odd experiences you may have had, such as hearing voices or having confusing thoughts. You will have a physical exam. Your doctor also may suggest tests, such as blood tests or imaging tests, to see if your symptoms may be caused by another health problem.

How is it treated?

Medicines help your symptoms, and counseling and therapy help you change how you think about things and deal with the illness. Treatment may last a long time.

When you have your symptoms under control, you are in recovery. Recovery usually is a lifelong process. In the recovery process, you learn to cope with your symptoms and challenges, find and meet your goals, and get the support you need. Your recovery depends upon a partnership between you, your doctors, and others who are important in your life.

People who have schizophrenia often stop treatment. This may be because they don't understand that they have an illness or because the medicines cause side effects. When treatment stops, symptoms usually come back (relapse) or get worse. A relapse might happen right after treatment is stopped or months later. A later relapse makes it hard to see that stopping the medicine was the cause. During a relapse, some people who have schizophrenia may need to spend time in a hospital.

How can family and friends help?

Having schizophrenia can be a scary experience, and knowing that someone you love has this illness changes your life. Show love, and learn as much as you can about the illness. Understand that the behavior you may see is caused by the illness and is not the person you love.

If you think that someone you love has schizophrenia, help that person get to a doctor. The sooner the illness is diagnosed and the person begins treatment, the more successful treatment and recovery may be.

You can help by talking to your loved one and helping him or her continue treatment. You also can help your loved one deal with fear and other feelings about the illness and with the negative attitudes that some people have toward schizophrenia.

What Happens

Symptoms of schizophrenia usually start in the late teens to mid-20s for men and the late 20s to 30s for women. The symptoms may start suddenly or happen gradually.

Childhood schizophrenia is rare.

There are four stages of schizophrenia: prodromal phase, active or acute phase, remission, and relapse.

Prodromal phase

Schizophrenia usually starts with this phase, when symptoms are vague and easy to miss. They are often the same as symptoms of other mental health problems, such as depression or other anxiety disorders. They may not seem unusual for teens or young adults. In fact, schizophrenia is rarely diagnosed at this time.

Symptoms are sometimes triggered by stress or changes, such as going away to school, starting to use drugs or alcohol, or going through a severe illness or a death in the family.

These first symptoms often include being withdrawn, outbursts of anger, or odd behavior. For more information, see Symptoms.

This phase can last for days, months, or years.

Active, or acute, phase

At some point you start to have symptoms such as hallucinations, delusions, or confusing thoughts and speech.

These symptoms may appear suddenly or slowly over time. They can be severe and can cause a psychotic episode, which means you can't tell the difference between what is real and what isn't real.

You may need to go to the hospital. You probably won't be able to make many decisions about your care.

This phase usually lasts 4 to 8 weeks. This is when schizophrenia usually is diagnosed.

Remission and relapse

After an active phase, symptoms get better, especially with treatment, and life may be more "normal." This is called remission. But symptoms may get worse again, which is called a relapse. You may have this cycle of symptoms that get severe and then improve.

In each cycle, symptoms such as hallucinations and delusions may become less intense, but other symptoms, such as feeling less interested in caring for yourself, may get worse. You may have few or many cycles before you are able to stay in remission.

Within 5 to 10 years, you may develop a unique pattern of illness that often stays the same throughout your life. It also is possible that you will have fewer relapses as you get older and may even not have symptoms.

Tips for avoiding relapse

• Learn how to recognize the first signs of relapse, such as not wanting to do things with others, and have a plan to deal with it and get help right away.
  • If you need help deciding whether to see your doctor, read about some of the reasons people don't get help and how to overcome them.
• Take your medicine, even if you're feeling better. This makes a relapse less likely. Learn some ways to help you remember to take your medicine.
• If side effects are making your life hard, talk with your doctor to see whether you can try a different medicine.
• Stay in counseling or therapy, and continue with your recovery plan.

Special concerns

Watch these areas for problems:

• Thoughts of suicide or thoughts about harming yourself or others. If you think about these things, call your doctor or 911 right away. Tell family and friends how to recognize the warning signs of suicide, such as threatening to harm yourself and being preoccupied with death or suicide, and warning signs of violence toward others, such as thinking or talking about harming someone or becoming aggressive.
• Social concerns, such as other people's attitudes. People who don't understand schizophrenia or other mental health problems may treat you differently. Find family and friends who want to support you and help you with relationships. Help them understand schizophrenia.
• Smoking. Many people who have schizophrenia smoke cigarettes. This may be because smoking helps with some of the symptoms. But smoking makes other illnesses, such as cancer and heart disease, more likely.
• Having a baby . If you have schizophrenia and want to have a baby, talk to your doctor. Medicines that you take for schizophrenia can cause birth defects, and not taking your medicine puts you at risk for a relapse. Your doctor can help you plan your pregnancy so there will be as little risk as possible to you and your baby.
• Substance abuse. Many people who have schizophrenia abuse alcohol or drugs. When you have schizophrenia and a substance abuse problem, it's called a dual diagnosis. Talk with your doctor or another trusted person about getting help for substance abuse.
• Other health problems. Obesity, substance abuse, type 2 diabetes, and heart and lung problems may occur along with schizophrenia.

What Increases Your Risk

Schizophrenia is a complex illness. Experts don't know what causes it or why some people get it and others don't. But some things increase your chances of getting it. These are called risk factors.

You may be at risk for schizophrenia if:

• Your mother, father, brother, or sister has schizophrenia.
• Your mother had certain problems while she was pregnant with you. For example, if your mother didn't get enough to eat (malnutrition), had a viral infection, or took certain medicines for high blood pressure, you may be at increased risk.
• You or a family member have another disorder that is like schizophrenia. An example of this is a delusional disorder, which means you believe things that you know are false.
• You have a problem with alcohol or drugs. Experts don't know whether substance abuse triggers schizophrenia or whether schizophrenia makes a person more likely to have this problem.

When to Call a Doctor

Call 911 or other emergency services if you (or a loved one with schizophrenia):

• Are thinking about suicide or are threatening suicide.
• Hear voices that tell you to hurt yourself or someone else or to do something illegal, such as destroy property or steal.
• Notice warning signs of violence toward others, such as thinking or talking about harming someone or becoming aggressive.

Call a doctor if you (or a loved one with schizophrenia):

• Have a sudden change in behavior, such as refusing to eat because you think someone has poisoned your food.
• Have experiences that don't usually occur, such as hearing someone calling your name when no one is there.
• Have a hard time taking care of basic needs, such as grooming, or become confused doing simple chores or tasks.
• Show signs of schizophrenia, such as talking to people who aren't present or believing things that you know are false.
• Show the first signs of relapse, such as finding it hard to focus or withdrawing from other people.

Who can treat schizophrenia?

Health professionals who can help diagnose schizophrenia or who may work together with other health professionals to treat schizophrenia include:

• General practitioners.
• Family medicine physicians.
• Internists.
• Neurologists.
• Psychiatrists.
• Psychologists.
• Physician assistants.
• Nurse practitioners.
• Social workers.

Exams and Tests

Your doctor will ask you questions about your medical history and your mental health and about any odd experiences you may have had, such as hearing voices or having confusing thoughts. You also will have a physical exam.

Your doctor also may suggest tests to rule out other conditions with similar symptoms or to diagnose other schizophrenia disorders. These tests may include blood tests and a CT scan or MRI. The CT scan or MRI will check the size, structure, and function of your brain.

If your doctor thinks you are depressed or are thinking about suicide, a suicide assessment also may be done.

Schizophrenia is diagnosed when:^{footnote 1}

• You have had at least two of the following symptoms and they lasted for at least 1 month. One of your symptoms must be hallucinations, delusions, or disorganized speech.
  • Hallucinations
  • Delusions
  • Disorganized speech, such as not making sense to others when you talk
  • Very disorganized or catatonic behavior, such as sitting or standing in unusual positions for a long time
  • Negative symptoms, such as having no emotion, not being able to feel pleasure, or having a hard time focusing
• You have had milder symptoms, such as odd beliefs or confusion, for at least 6 months.
• You have problems doing your job right or dealing with other people or problems in other areas of your life.
• Your symptoms aren't caused by other mental or physical health problems, a medicine you're taking, or substance abuse problems.

Treatment Overview

Finding out that you have schizophrenia can be scary and hard to deal with. But you can treat it.

The goals of treatment and recovery are to:

• Reduce or stop symptoms.
• Reduce the number of relapses.
• Develop a personal plan for your recovery by setting and meeting goals for home, work, and relationships.

Medicines help your symptoms. And counseling and therapy help you change how you think about things and deal with the illness.

If medicine and therapy aren't helping you, your doctor may suggest electroconvulsive therapy (ECT). In this procedure, your doctor uses electricity to create a brief and mild seizure. This may change your brain chemistry and help your symptoms.

If you struggle with alcohol, drugs, or tobacco or have other mental health problems, such as depression, you need to treat these problems too.

Treatment may last a long time, and the need to follow a recovery plan usually lasts for your lifetime. Your treatment and recovery plan may change as your experience of schizophrenia and your life change.

Most people with schizophrenia qualify for health care programs such as Medicare or Medicaid. To find out whether you qualify, check with your local health and welfare agency.

When schizophrenia is not treated, the risks are higher for suicide, a hospital stay, and other problems. Early treatment called coordinated specialty care (CSC) may help a person who is having his or her first episode of psychotic thoughts. Ask your doctor about CSC.

Medicines

Medicines are the treatment that works best for schizophrenia, and you may be taking more than one at a time. They may be used for positive or negative symptoms, but they don't work as well for negative symptoms as they do for positive symptoms.

It may take time to find which medicines are best for you. This may be frustrating. Getting support from your family, your friends, and a community-based rehabilitation program is helpful, especially while you and your doctor are trying to find the best medicines. It also may help to speak with and get support from others who have had trouble finding the right medicines.

If you stop taking your medicines, you may have a relapse. Don't stop taking your medicines until you talk with your doctor. If you and your health care team decide you should stop using medicine, you will need to be checked on a regular basis.

Medicine choices

Medicines used most often to treat schizophrenia include:

• Antipsychotic medicines, such as aripiprazole, clozapine, and haloperidol.

These medicines often are used along with the medicines listed above:

• Antianxiety medicines, such as clonazepam and diazepam.
• Antidepressants, such as amitriptyline, citalopram, desipramine, escitalopram, and fluoxetine.

Side effects

Because of side effects or the risk of side effects, you may be tempted to stop using your medicine. But if you stop using medicine, the symptoms of schizophrenia may come back or get worse.

If you have any concerns about side effects, talk to your doctor. He or she will work with you. Your doctor may give you a smaller dose of the antipsychotic medicine, have you try another antipsychotic medicine, or give you another medicine to treat the side effect.

Some side effects of antipsychotic medicines can be serious.

• Neuroleptic malignant syndrome is a rare but life-threatening side effect of antipsychotics. The first signs usually include a fever between102°F (38.9°C) and103°F (39.4°C), a fast or irregular heartbeat, rapid breathing, and severe sweating.
• Tardive dyskinesia is body movement that you can't control.
• Type 2 diabetes might develop as a result of weight gain caused by some antipsychotics. Some antipsychotics may also increase insulin resistance.

You may need regular blood tests to check for side effects. Children, teens, and older adults may need to have blood tests more often than other people.

Counseling and Therapy

Counseling and therapy are important parts of treatment. You will work with a mental health professional such as a psychologist, a licensed professional counselor, a clinical social worker, or a psychiatrist.

Find a therapist you trust and feel comfortable with. A good therapist not only provides help but gives you support and encouragement. If you don't feel good about working with one doctor or therapist, try another one.

Here are some types of therapy that may help:

• Cognitive-behavioral therapy helps you to:
  • Change the way you think about things.
  • Understand why it's important to prevent a relapse and take steps to do so.
• Counseling can take place one-on-one or in a group setting.
  • It helps you improve your relationships, deal with your symptoms, and meet your goals.
  • Group counseling also helps you make friends and learn social skills.
• Family therapy is a type of counseling that helps you and your family work out problems when they occur.
  • It usually includes education about schizophrenia and its treatment.
  • It's important, because your family can play a large role in supporting you if you have schizophrenia.

Recovery

When you have schizophrenia, you need more than medicines and counseling to move forward with your life. You need to partner with your health care team to find and meet your personal goals. This life-long partnering is known as recovery.

Recovery isn't the same as being cured, and it doesn't mean that you will be symptom-free. It is being able to live a full life and enjoy favorite activities with as little trouble as possible from your symptoms. Recovery may help you manage your symptoms so that you can be an active member of your community.

Education, support, and training in social and job skills all are important parts of your treatment and recovery. For example:

• Learning about schizophrenia can improve the quality of your life and the lives of those who care about you.
• Job training may help you find a job that interests you and that you can be successful in. This can help with finances and self-esteem.
• Social skills training can help you develop life skills such as learning to communicate, managing frustration, and coping. It may include cognitive enhancement therapy, which may help you improve how well you understand and deal with other people.
• Case management and assertive community treatment can help you organize the many different parts of treatment and recovery. You receive this kind of help at your home. You don't have to go anywhere special to get it.
• Support groups give you the chance to talk with people who are going through the same things you are.

It may be hard to understand and accept that you have an illness, and it's easy to become discouraged. You can help yourself by focusing on your recovery goals and learning to see schizophrenia as one part of your life, not your entire life. Make managing schizophrenia well one of the many successes in your life.

Support

You have schizophrenia, but like other people, you have wishes and goals for your life. You most likely want healthy relationships with your partner, family, and friends. You may want a job that gives you a sense of self-worth.

Your family and community can support you and help you meet your goals.

• Your family can help you get the right treatment, deal with your symptoms, and get along in your community. Family therapy is an important part of this.
• Social support and support groups give you the chance to talk with people who are going through the same things you are.
• Case management and assertive community treatment can help you deal with the many different parts of treatment and recovery. If you feel overwhelmed, ask your doctor or therapist about these programs.
• Your local or state health department may have programs to help you. The National Alliance on Mental Illness (NAMI) provides contact information for support organizations nationwide. For more information, go to www.nami.org.

Relapse

If your symptoms come back, it's called a relapse. Anyone with schizophrenia can have a relapse, but it may happen much more often when you don't take your medicine.

You can help prevent a relapse by taking your medicine, going to your counseling sessions, being active in your own recovery, and not drinking alcohol or using illegal drugs.

If you are having trouble taking your medicine or feel that you don't need to, talk to your doctor or another trusted person. Your doctor may be able to change the medicine or how much you take. A partner or spouse may help you find ways to remember to take the medicine.

A healthy lifestyle

The symptoms of schizophrenia can make it easy to forget some of the basics of good health. But it's important to try to have a healthy lifestyle.

Here are some things to do:

• Don't abuse drugs or alcohol. Having a substance abuse problem makes treating schizophrenia harder. If you have a substance abuse problem, you need to treat both problems to help your recovery.
• Exercise and be active . Exercise can help relieve anxiety, depression, and stress. Exercise and activity also make other diseases, such as heart disease or diabetes, less likely.
• Relieve stress . Reducing stress may mean fewer relapses.
• Get enough sleep . This is very important. Sleep can help your mood and make you feel less stressed.
• Eat a balanced diet . This helps your body deal with tension and stress.
• Stop smoking,if you smoke. Smoking increases the risk for other diseases, such as cancer and heart disease. For information on how to stop smoking, see the topic Quitting Smoking.

For Family and Friends

Schizophrenia affects everyone around the person who has the illness. It can be hard to watch a family member or friend develop symptoms and perhaps act in very different ways.

You may feel helpless, but you play an important role in the life and treatment of a loved one who has schizophrenia.

What you can do

• Learn about schizophrenia. Understand what happens in schizophrenia and how you and your loved one can cope with it. This may make it easier for you and your loved one to work together on treatment.
• Work together as a family . You and your family may benefit from therapy even if your loved one doesn't want to participate.
• Help during hallucinations and paranoia . Call for help if you think the situation could become dangerous.
  • Deal with symptoms.
• Encourage the person to take medicines .
• Be aware of your own and other people's negative attitudes toward the illness and your loved one.

You can also help the person with good health habits, like getting enough sleep and avoiding alcohol and drugs.

Sometimes people who have schizophrenia are too sick to seek treatment on their own. If the symptoms are severe, you may have to force the person to get treatment. Talk with your health care providers and/or local law enforcement officials about the laws and procedures in your area for getting treatment in this situation. If you have this information before you need it, it will reduce your fears and concerns and may make it easier for you.

Emergency help

Some people who have schizophrenia may become aggressive or violent at times. Call 911 or other emergency help if you notice:

• Warning signs of suicide, such as the person threatening to harm himself or herself and being preoccupied with death or suicide.
• Warning signs of violence toward others, such as thinking or talking about harming someone or becoming aggressive.

Helping yourself

Supporting or caring for someone who has schizophrenia isn't easy. Finding your own support can help you deal with the illness and the sense of loss you may feel.

• Take care of yourself . Do things you enjoy, such as seeing family or going to movies.
• Don't feel that you need to do everything possible to help a loved one who has schizophrenia. Remember that you need to respect the wishes and choices of your loved one, unless those wishes and choices are dangerous. Everyone learns from a wrong choice or mistake. Recovery may be faster if your loved one believes that family members trust him or her with decision making.
• Don't do it alone. Ask others to help you, or join a support group. The more support you have, the more help you can give.
• Get help from a local organization. Your city or state may have programs to help you. Ask at your local or state health department. The National Alliance on Mental Illness (NAMI) provides contact information for support organizations nationwide. For more information, go to www.nami.org.