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Hallucination, delusions, disorganized thinking, lack of motivation, slow movement, change in sleep patterns, poor grooming or hygiene, changes in body language and emotions

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What are the signs and symptoms of schizophrenia?

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This page covers what schizophrenia is, what the symptoms are and how you can get treatment.

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(No exact causes lead to schizophrenia but research shows it may be linked to…)

genetic/physical

environmental

psychological

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The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition.
Some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it's not known why some people develop symptoms while others do not.

Increased risk

Genetics

Schizophrenia tends to run in families, but no single gene is thought to be responsible.

It's more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes does not necessarily mean you'll develop schizophrenia.

Evidence that the disorder is partly inherited comes from studies of twins. Identical twins share the same genes.

In identical twins, if a twin develops schizophrenia, the other twin has a 1 in 2 chance of developing it, too. This is true even if they're raised separately.

In non-identical twins, who have different genetic make-ups, when a twin develops schizophrenia, the other only has a 1 in 8 chance of developing the condition.

While this is higher than in the general population, where the chance is about 1 in 100, it suggests genes are not the only factor influencing the development of schizophrenia.

Brain development

Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains.

These changes are not seen in everyone with schizophrenia and can occur in people who do not have a mental illness. But they suggest schizophrenia may partly be a disorder of the brain.

Neurotransmitters

Neurotransmitters are chemicals that carry messages between brain cells.

There's a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia.

Research suggests schizophrenia may be caused by a change in the level of 2 neurotransmitters: dopamine and serotonin.

Some studies indicate an imbalance between the 2 may be the basis of the problem. Others have found a change in the body's sensitivity to the neurotransmitters is part of the cause of schizophrenia.

Pregnancy and birth complications

Research has shown people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as:

a low birthweight

premature labour

a lack of oxygen (asphyxia) during birth

It may be that these things have a subtle effect on brain development.

Triggers

Triggers are things that can cause schizophrenia to develop in people who are at risk.

These include:

Stress

The main psychological triggers of schizophrenia are stressful life events, such as:

bereavement

losing your job or home

divorce

the end of a relationship

physical, sexual or emotional abuse

These kinds of experiences, although stressful, do not cause schizophrenia. However, they can trigger its development in someone already vulnerable to it.

Drug abuse

Drugs do not directly cause schizophrenia, but studies have shown drug misuse increases the risk of developing schizophrenia or a similar illness.

Certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may trigger symptoms of schizophrenia in people who are susceptible.

Using amphetamines or cocaine can lead to psychosis, and can cause a relapse in people recovering from an earlier episode.

Research has shown that teenagers and young adults who use cannabis regularly are more likely to develop schizophrenia in later adulthood.

Want to know more?

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The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition. Some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode.

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How effective is it?

It relieves anxiety and aggression in a few hours but takes a few weeks to stop hallucinations.

Negative side effects:

Shaking, muscle twitches, drowsiness, weight gain, blurred vision, dry mouth, constipation

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Introduction

Schizophrenia is a long-term mental health condition that causes a range of different psychological symptoms, including:

hallucinations - hearing or seeing things that do not exist

delusions - unusual beliefs not based on reality that often contradict the evidence

muddled thoughts based on hallucinations or delusions

changes in behaviour

Doctors often describe schizophrenia as a psychotic illness. This means sometimes a person may not be able to distinguish their own thoughts and ideas from reality.

Read more about the symptoms of schizophrenia.

Why does schizophrenia happen?

The exact cause of schizophrenia is unknown. However, most experts believe the condition is caused by a combination of genetic and environmental factors.

It is thought certain things make you more vulnerable to developing schizophrenia, and certain situations can trigger the condition.

Read more about the causes of schizophrenia.

Who is affected?

Schizophrenia is one of the most common serious mental health conditions. About 1 in 100 people will experience schizophrenia in their lifetime, with many continuing to lead normal lives.

Schizophrenia is most often diagnosed between the ages of 15 and 35. Men and women are affected equally.

There is no single test for schizophrenia. It is most often diagnosed after an assessment by a mental health care professional, such as a psychiatrist.

It is important that schizophrenia is diagnosed as early as possible, as the chances of recovery improve the earlier it is treated.

Read more about diagnosing schizophrenia.

How is schizophrenia treated?

Schizophrenia is usually treated with a combination of medication and therapy appropriate to each individual. In most cases, this will be antipsychotic medicines and cognitive behavioural therapy (CBT).

People with schizophrenia will usually receive help from a community mental health team (CMHT), which will offer day-to-day support and treatment.

Many people recover from schizophrenia, although they may have periods when symptoms return (relapses). Support and treatment can help reduce the impact the condition has on your life.

Read more about treating schizophrenia.

Living with schizophrenia

If schizophrenia is well managed, it is possible to reduce the chances of severe relapses. This can include:

recognising the signs of an acute episode

taking medication as prescribed

talking to others about the condition

There are many charities and support groups offering help and advice on living with schizophrenia. Most people find it comforting talking to others with a similar condition.

Read more about living with schizophrenia.

Symptoms

Changes in thinking and behaviour are the most obvious signs of schizophrenia, but people can experience symptoms in different ways.

The symptoms of schizophrenia are usually classified into one of two categories - positive or negative.

positive symptoms - represent a change in behaviour or thoughts, such as hallucinations or delusions

negative symptoms - represent a withdrawal or lack of function that you would usually expect to see in a healthy person; for example, people with schizophrenia often appear emotionless, flat and apathetic

The condition may develop slowly. The first signs of schizophrenia, such as becoming socially withdrawn and unresponsive or experiencing changes in sleeping patterns, can be hard to identify. This is because the first symptoms often develop during adolescence and changes can be mistaken for an adolescent "phase".

People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no positive symptoms. This is known as acute schizophrenia.

If you are experiencing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be.

Read more information about how schizophrenia is diagnosed.

Positive symptoms of schizophrenia

Hallucinations

A hallucination is when a person experiences a sensation but there is nothing or nobody there to account for it. It can involve any of the senses, but the most common is hearing voices.

Hallucinations are very real to the person experiencing them, even though people around them cannot hear the voices or experience the sensations.

Research using brain-scanning equipment shows changes in the speech area in the brains of people with schizophrenia when they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices.

Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive or annoying. The voices might describe activities taking place, discuss the hearer's thoughts and behaviour, give instructions, or talk directly to the person. Voices may come from different places or one place in particular, such as the television.

Delusions

A delusion is a belief held with complete conviction, even though it is based on a mistaken, strange or unrealistic view. It may affect the way people behave. Delusions can begin suddenly, or may develop over weeks or months.

Some people develop a delusional idea to explain a hallucination they are having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions.

Someone experiencing a paranoid delusion may believe they are being harassed or persecuted. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend.

Some people who experience delusions find different meanings in everyday events or occurrences. They may believe people on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing on the street.

Confused thoughts (thought disorder)

People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme.

People sometimes describe their thoughts as "misty" or "hazy" when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand.

Changes in behaviour and thoughts

A person's behaviour may become more disorganised and unpredictable, and their appearance or dress may seem unusual to others. People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason.

Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else.

Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind. Some people feel their body is being taken over and someone else is directing their movements and actions.

Negative symptoms of schizophrenia

The negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia.

Symptoms during the prodromal period usually appear gradually and slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene.

It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else. Negative symptoms experienced by people living with schizophrenia include:

losing interest and motivation in life and activities, including relationships and sex

lack of concentration, not wanting to leave the house, and changes in sleeping patterns

being less likely to initiate conversations and feeling uncomfortable with people, or feeling there is nothing to say

The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes be mistaken for deliberate laziness or rudeness.

Causes

The exact causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition.

Current thinking is that some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it's not known why some people develop symptoms while others don't.

Increased risk

Things that increase the chances of schizophrenia developing include:

Genetics

Schizophrenia tends to run in families, but no one gene is thought to be responsible. It's more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes doesn't necessarily mean you will develop schizophrenia.

Evidence the disorder is partly inherited comes from studies of twins. Identical twins share the same genes. In identical twins, if one twin develops schizophrenia, the other twin has a one in two chance of developing it too. This is true even if they are raised separately.

In non-identical twins, who have different genetic make-ups, when one twin develops schizophrenia, the other only has a one in seven chance of developing the condition.

While this is higher than in the general population (where the chance is about 1 in a 100), it suggests genes are not the only factor influencing the development of schizophrenia.

Brain development

Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains. These changes aren't seen in everyone with schizophrenia and can occur in people who don't have a mental illness. But they suggest schizophrenia may partly be a disorder of the brain.

Neurotransmitters

These are chemicals that carry messages between brain cells. There is a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia.

Research suggests schizophrenia may be caused by a change in the level of two neurotransmitters: dopamine and serotonin. Some studies indicate an imbalance between the two may be the basis of the problem. Others have found a change in the body's sensitivity to the neurotransmitters is part of the cause of schizophrenia.

Pregnancy and birth complications

Research has shown that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as a low birth weight, premature labour, or a lack of oxygen (asphyxia) during birth. It may be that these things have a subtle effect on brain development.

Triggers

Triggers are things that can cause schizophrenia to develop in people who are at risk. These include:

Stress

The main psychological triggers of schizophrenia are stressful life events, such as a bereavement, losing your job or home, a divorce or the end of a relationship, or physical, sexual, emotional or racial abuse. These kinds of experiences, though stressful, do not cause schizophrenia, but can trigger its development in someone already vulnerable to it.

Drug abuse

Drugs do not directly cause schizophrenia, but studies have shown drug misuse increases the risk of developing schizophrenia or a similar illness.

Certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may trigger symptoms of schizophrenia in people who are susceptible. Using amphetamines or cocaine can lead to psychosis and can cause a relapse in people recovering from an earlier episode.

Three major studies have shown teenagers under 15 who use cannabis regularly, especially "skunk" and other more potent forms of the drug, are up to four times more likely to develop schizophrenia by the age of 26.

Want to know more?

Diagnosis

There is no single test for schizophrenia. The condition is usually diagnosed after assessment by a specialist in mental health.

If you are concerned you may be developing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be.

Your GP will ask about your symptoms and check they are not the result of other causes, such as recreational drug use.

Community mental health team (CMHT)

If a diagnosis of schizophrenia is suspected, your GP should refer you promptly to your local community mental health team (CMHT).

CMHTs are made up of different mental health professionals who support people with complex mental health conditions.

A member of the CMHT team, usually a psychiatrist or a specialist nurse, will carry out a more detailed assessment of your symptoms. They will also want to know your personal history and current circumstances.

To make a diagnosis, most mental healthcare professionals use a diagnostic checklist. Schizophrenia can usually be diagnosed if:

you have experienced one or more of the following symptoms most of the time for a month - delusions, hallucinations, hearing voices, incoherent speech or negative symptoms, such as a flattening of emotions

your symptoms have had a significant impact on your ability to work, study or perform daily tasks

all other possible causes, such as recreational drug use or bipolar disorder, have been ruled out

Related illnesses

Sometimes it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, a psychiatrist may have reason to believe you have a related mental illness.

There are several related mental illnesses similar to schizophrenia. Your psychiatrist will ask how your illness has affected you so they can confidently confirm you have schizophrenia and not another mental illness, such as:

bipolar disorder (manic depression) - people with bipolar disorder swing from periods of mania (elevated moods and extremely active, excited behaviour) to periods of deep depression; some people also hear voices or experience other kinds of hallucinations, or may have delusions

schizoaffective disorder - this is often described as a form of schizophrenia because its symptoms are similar to schizophrenia and bipolar disorder, but schizoaffective disorder is a mental illness in its own right; it may occur just once in a person's life or recur intermittently, often when triggered by stress.

You should also be assessed for post-traumatic stress disorder and other conditions, such as depression, anxiety and substance misuse.

Getting help for someone else

As a result of their delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe there is nothing wrong with them.

It is likely someone who has had acute schizophrenic episodes in the past will have been assigned a care co-ordinator. If this is the case, contact the person's care co-ordinator to express your concerns.

If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative or other loved one to persuade them to visit their GP.

In the case of a rapidly worsening schizophrenic episode, you may need to go to the accident and emergency (A&E) department, where a duty psychiatrist will be available.

If a person who is having an acute schizophrenic episode refuses to seek help, their nearest relative can request that a mental health assessment is carried out. The social services department of your local authority can advise how to do this.

In severe cases of schizophrenia, people can be compulsorily detained in hospital for assessment and treatment under the Mental Health (Scotland) Act 2015.

After diagnosis

If you or a friend or relative are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn.

It is important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available.

Treatment

Community mental health teams

Most people with schizophrenia are treated by community mental health teams (CMHTs). The goal of the CMHT is to provide day-to-day support and treatment while ensuring you have as much independence as possible.

A CMHT can be made up of and provide access to:

social workers

community mental health nurses - a nurse with specialist training in mental health conditions

occupational therapists

pharmacists

counsellors and psychotherapists

psychologists and psychiatrists - the psychiatrist is usually the senior clinician in the team

After your first episode of schizophrenia, you should initially be referred to an early intervention team. These specialist teams provide treatment and support, and are usually made up of psychiatrists, psychologists, mental health nurses, social workers and support workers.

Care programme approach (CPA)

People with complex mental health conditions, such as schizophrenia, are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs.

There are four stages to a CPA:

assessment - your health and social needs are assessed

care plan - a care plan is created to meet your health and social needs

care co-ordinator appointed - a care co-ordinator, sometimes known as a key worker, is usually a social worker or nurse, and is your first point of contact with other members of the CMHT

reviews - your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed

Not everyone uses the CPA. Some people may be cared for by their GP, while others may be under the care of a specialist.

You will work together with your healthcare team to develop a care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency.

Your care plan should include a combined healthy eating and physical activity programme and, if you smoke, support for giving up.

Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan.

Want to know more?

Acute episodes

People who have serious psychotic symptoms as the result of an acute schizophrenic episode may require a more intensive level of care than a CMHT can provide.

These episodes are usually dealt with by antipsychotic medication and special care.

Crisis resolution teams (CRT)

One treatment option is to contact a home treatment or crisis resolution team (CRT). CRTs treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis. Without the involvement of the CRT, these people would require treatment in hospital.

The CRT aims to treat people in the least restrictive environment possible, ideally in or near their home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre.

CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis from occurring.

Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis.

Voluntary and compulsory detention

More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it is necessary.

People can also be compulsorily detained at a hospital under the Mental Health (Scotland) Act 2015. It is only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder, such as schizophrenia, and if detention is necessary:

in the interests of the person's own health and safety

to protect others

People with schizophrenia who are compulsorily detained may need to be kept in locked wards.

All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.

An independent panel will regularly review your case and progress. Once they feel you are no longer a danger to yourself and others, you will be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.

Advance statements

If it is felt there is a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement.

An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to include contact details for your care co-ordinator.

If you want to make an advance statement, talk to your care co-ordinator, psychiatrist or GP.

Antipsychotics

Antipsychotics are usually recommended as the initial treatment for the symptoms of an acute schizophrenic episode. They work by blocking the effect of the chemical dopamine on the brain.

Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but may take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts.

It's important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you.

Antipsychotics can be taken orally (as a pill) or given as an injection (known as a depot). Several slow-release antipsychotics are available. These require you to have one injection every two to four weeks.

You may only need antipsychotics until your acute schizophrenic episode has passed. However, most people take medication for one or two years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent.

There are two main types of antipsychotics:

typical antipsychotics - the first generation of antipsychotics developed during the 1950s

atypical antipsychotics - newer-generation antipsychotics developed in the 1990s

The choice of antipsychotic should be made following a discussion between you and your psychiatrist about the likely benefits and side effects.

Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and the severity will differ from person to person.

The side effects of typical antipsychotics include:

Side effects of both typical and atypical antipsychotics include:

drowsiness

weight gain, particularly with some atypical antipsychotics

blurred vision

constipation

lack of sex drive

dry mouth

Tell your care co-ordinator, psychiatrist or GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicines that will help you deal with the side effects.

If you do not benefit from one antipsychotic medication after taking it regularly for several weeks, an alternative can be tried. It is important that you work with your treatment team to find the right one for you.

Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP. If you stop taking them, you could have a relapse of symptoms.

Your medication should be reviewed at least once a year.

Want to know more?

Psychological treatment

Psychological treatment can help people with schizophrenia cope with the symptoms of hallucinations or delusions better. They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment.

Psychological treatments for schizophrenia work best when they are combined with antipsychotic medication. Common psychological treatments include:

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to replace this thinking with more realistic and useful thoughts.

For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts.

Most people will require between 8 and 20 sessions of CBT over the space of 6 to 12 months. CBT sessions usually last for about an hour.

Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist.

Family therapy

Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family.

Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetings over a period of around six months. Meetings may include:

discussing information about schizophrenia

exploring ways of supporting somebody with schizophrenia

deciding how to solve practical problems that can be caused by the symptoms of schizophrenia

If you think you and your family could benefit from family therapy, speak to your care co-ordinator or GP.

Arts therapy

Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia.

Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others.

Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people.

NICE recommends that arts therapies are provided by an arts therapist registered with the Health and Care Professions Council who has experience of working with people with schizophrenia.

Want to know more?

Living with

As well as monitoring your mental health, your healthcare team and GP should monitor your physical health.

A healthy lifestyle, including a balanced diet with lots of fruits and vegetables and regular exercise, is good for you and can reduce your risk of developing cardiovascular disease or diabetes. You should also try to avoid too much stress and get a proper amount of sleep.

You should have a check-up with your GP at least once a year to monitor your risk of developing cardiovascular disease or diabetes. This will include recording your weight, checking your blood pressure, and any appropriate blood tests.

Stop smoking

Rates of smoking in people with schizophrenia are three times higher than in the general population. If you are a smoker, you are at a higher risk of developing cancer, heart disease and stroke.

Stopping smoking has clear physical health benefits but it has also been shown to improve the mental health of people with schizophrenia.

Research has shown you are up to four times more likely to quit smoking if you use NHS support as well as stop-smoking medicines, such as patches, gum or inhalators. Ask your doctor about this or phone Quit Your Way Scotland on 0800 84 84 84.

If you take antipsychotic medicines and want to stop smoking it's very important that you talk to your GP and/or psychiatrist before you stop as the dosage of your prescription drugs may need to be monitored and the amount you have to take could be reduced.

Want to know more?

Who is available to help me?

In the course of your treatment for schizophrenia, you will be involved with many different services. Some are accessed through referral from your GP, others through your local authority. These services may include the following:

community mental health teams (CMHTs) - these provide the main part of local specialist mental health services, and offer assessment, treatment and social care to people living with schizophrenia and other mental illnesses

trained peer support - this involves the support of someone who has had schizophrenia themselves and is now stable, and may be available through your CMHT

early intervention teams - these provide early identification and treatment for people with the first symptoms of psychosis; your GP may be able to refer you directly to an early intervention team

crisis services - specialist mental health teams that help with crises that occur outside normal office hours and allow people to be treated at home for an acute episode of illness instead of in hospital

acute day hospitals - an alternative to inpatient care in a hospital, where you can visit every day or as often as necessary

assertive outreach teams - deliver intensive treatment and rehabilitation in the community for people with severe mental health problems and provide rapid help in a crisis situation; staff often visit people at home, act as advocates, liaise with other services (such as your GP or social services), and can also help with practical problems (such as helping to find housing and work), and daily tasks (such as shopping and cooking)

advocates - trained and experienced workers who help people communicate their needs or wishes, get impartial information, and represent their views to other people; they can be based in your hospital or mental health support groups, or you can find an independent advocate to act on your behalf

Want to know more?

Employment and financial support

Avoid too much stress, including work-related stress. If you are employed, you may be able to work shorter hours or in a more flexible way.

Under the Equality Act 2010, all employers must make reasonable adjustments for people with disabilities, including people diagnosed with schizophrenia or other mental illnesses.

Several organisations provide support, training and advice for people with schizophrenia who wish to continue working.

Your community mental health team is a good first point of contact to find out what services and support are available for you.

Mental health charities such as Mind or Rethink Mental Illness are also an excellent source of information on training and employment.

If you are unable to work as a result of your mental illness, you are entitled to financial support, such as Incapacity Benefit.

Want to know more?

Talk to others

Many people find it helpful to meet other people with the same experiences for mutual support and to share ideas. It is also an important reminder that you are not alone.

Charities and support groups allow individuals and families to share experiences and coping strategies, campaign for better services, and provide support. Useful charities, support groups and associations include:

There are also other places that offer support to people with schizophrenia and other mental illnesses.

Day centres

Even if you do not have a job or are unable to work, it is still important to go out and do everyday things and give a structure to your week.

Many people regularly go to a day hospital, day centre or community mental health centre. These offer a range of activities that allow you to get active again and spend some time in the company of other people.

Work projects

These provide training to help you develop your work skills and support you back into work. They often have contacts with local employers.

Supported accommodation

This could be a bedsit or flat where there is someone around who is trained to support you and help you deal with day-to-day problems.

Peer support

You may be offered the chance to meet regularly with a trained peer support worker who has recovered from psychosis or schizophrenia themselves.

Want to know more?

What can family, friends and partners do to help?

Friends, relatives and partners have a vital role in helping people with schizophrenia recover and make a relapse less likely.

It is very important not to blame the person with schizophrenia or tell them to "pull themselves together", or to blame other people. It is important to stay positive and supportive when dealing with a friend or loved one's mental illness.

As well as supporting the person with schizophrenia, you may want to get support to cope with your own feelings. Several voluntary organisations provide help and support for carers.

Friends and family should try to understand what schizophrenia is, how it affects people, and how they can help. You can provide emotional and practical support, and encourage people to seek appropriate support and treatment.

As part of someone's treatment, you may be offered family therapy. This can provide information and support for the person with schizophrenia and their family.

Friends and family can play a major role by monitoring the person's mental state, watching out for any signs of relapse, and encouraging them to take their medication and attend medical appointments.

If you are the nearest relative of a person who has schizophrenia, you have certain rights that can be used to protect the patient's interests. These include requesting that the local social services authority ask an approved mental health professional to consider whether the person with schizophrenia should be detained in hospital.

Want to know more?

Depression and suicide

Many people with schizophrenia experience periods of depression. Do not ignore these symptoms. If depression is not treated, it can worsen and lead to suicidal thoughts.

Studies have shown that people with schizophrenia have a higher chance of committing suicide. If you have been feeling particularly down over the last month and no longer take pleasure in the things you used to enjoy, you may be depressed. See your GP for advice and treatment.

Immediately report any suicidal thoughts to your GP or care co-ordinator.

The warning signs of suicide

The warning signs that people with depression and schizophrenia may be considering suicide include:

making final arrangements - such as giving away possessions, making a will or saying goodbye to friends

talking about death or suicide - this may be a direct statement such as, "I wish I was dead", or indirect phrases such as, "I think that dead people must be happier than us", or "Wouldn't it be nice to go to sleep and never wake up?"

self-harm - such as cutting their arms or legs, or burning themselves with cigarettes

a sudden lifting of mood - this could mean a person has decided to commit suicide and feels better because of their decision

Helping a suicidal friend or relative

If you see any of these warning signs:

get professional help for the person, such as from a crisis resolution team (CRT) or the duty psychiatrist at your local A&E department

let them know they are not alone and you care about them

offer your support in finding other solutions to their problems

If you feel there is an immediate danger of the person committing suicide, stay with them or have someone else stay with them. Remove all available means of suicide, such as sharp objects and medication.

Want to know more?

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Schizophrenia is a long-term mental health condition often described as a psychotic illness. Learn about its symptoms and treatments.

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4. Treatment- Cognitive behavioral therapy (CBT)

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4. Treatment- Cognitive behavioral therapy (CBT)

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How effective is it?

Develop better social and problem-solving skills, reduce the severity of symptoms, and lower the risk of relapse

Negative side effects:

Impairment manifesting, social withdrawal, and emotional disorders

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Cognitive Behavioral Therapy for Schizophrenia

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Specialists at NYU Langone offer cognitive behavioral therapy to people who have schizophrenia. Learn more.

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U.S.- 1.2%

Worldwide- 1%

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Schizophrenia Symptoms, Patterns And Statistics And Patterns

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Schizophrenia is not a terribly common disease but it can be a serious and chronic one. Worldwide about 1 percent of the population is diagnosed with

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-stress

-trauma

-drug abuse

-genetics/family history

-social isolation

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Schizophrenia is a complex illness that can evolve in different ways over time. Researchers have not identified a single cause that explains or is present in all people with schizophrenia.

Scientists think a complex interaction between genetics, early development, environment, and biological factors causes schizophrenia. People are more likely to develop the condition if a parent or sibling has the disease.

Research also suggests that certain diseases and negative life experiences may be risk factors for schizophrenia. Despite this, they do not know the exact role these environmental factors play.

Read on to learn more about the different potential causes of schizophrenia.

Schizophrenia does not have a single cause. Instead, several risk factors appear to increase the likelihood of a person developing the disease.

Doctors do not yet fully understand how these risk factors interact. It is also unclear why some people with many risk factors do not get schizophrenia while others with few or no risk factors do. Both genetics and environmental factors likely play a role.

Numerous studies have found that genetics play a significant role in the development of schizophrenia. Doctors have not identified a single gene or group of genes that explains all cases of the condition. However, they have found that having an immediate relative with schizophrenia greatly increases the risk.

According to a , a person has a 40% likelihood of developing schizophrenia if both biological parents have it.

When looking at twins, researchers found that if one identical twin has schizophrenia, there is a 46% chance the other will also have it. Identical twins share the same genes, meaning that while there is a strong genetic component to schizophrenia, other factors must play a role.

A large Danish study of 31,524 pairs of twins suggests that schizophrenia has a heritability rate of 79%. Heritability measures how genes explain the difference in symptoms. This heritability rate means that 79% of the differences between people with and without schizophrenia are because of genetics.

Epigenetics is the study of how various triggers, including environmental exposures, such as life experiences or infections, change the behavior of genes.

Epigenetic factors likely play an important role in schizophrenia. In genetically vulnerable people, environmental factors may increase the risk and trigger schizophrenia.

Some environmental factors that may increase the risk include:

Maternal behavior and health: A birthing parent's health during pregnancy may affect the infant's development, increasing the risk of schizophrenia. Childbirth complications, infections, and conditions, such as preeclampsia, may play a role in the condition.

Family environment: The place where a person lives and grows up may increase the likelihood of schizophrenia. People living in urban areas are more vulnerable.

Early trauma: Childhood trauma, such as abuse, unstable home life, living in poverty, or exposure to racism, can increase the risk.

Substance misuse: Substance misuse may trigger brain changes that increase the risk of schizophrenia. Research has found an especially robust correlation between cannabis use and the condition.

Infections: Exposure to certain infections, either when developing during pregnancy or later in life, may be a trigger for schizophrenia. For example, individuals with a history of toxoplasmosis have higher rates of psychosis and schizophrenia.

Many different risk factors increase the likelihood of developing schizophrenia. They include:

complications during birth

malnourishment in a person's birth parent

being born in winter

a family history of schizophrenia

using cannabis

living in an urban area

a birthing parent having the flu during pregnancy

childhood trauma such as poverty or abuse

social isolation

exposure to certain infections, such as toxoplasmosis

Race may also be a risk factor for schizophrenia. Although the direct cause is unclear, health experts believe exposure to racial bias in healthcare may contribute.

However, some research also suggests that doctors overdiagnose schizophrenia in Black individuals.

For example, a 2018 study found that doctors were more likely to disregard mood symptoms of depression and diagnose schizophrenia in Black patients. This means that doctors may misdiagnose psychosis or improperly label other diagnoses as schizophrenia.

No blood or lab test can diagnose schizophrenia. However, a doctor may recommend certain tests to rule out other potential causes of schizophrenia symptoms.

An MRI scan can help rule out a traumatic brain injury, while HIV and syphilis testing can determine whether an infectious disease has damaged the brain. If no other cause explains the symptoms, a doctor may diagnose the condition according to a person's symptoms.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision, requires that a person must have two or more of the following for a diagnosis:

The symptoms must be present for at least 1 month, affect daily functioning, and be unexplainable by another diagnosis.

A person can contact a doctor if:

loved ones have expressed concerns about their mental health or worry they may have schizophrenia

they see or hear things others do not

they experience significant difficulties with daily functions, such as keeping a job

they have concerns that they may have schizophrenia symptoms

Schizophrenia is not contagious, but it tends to cluster together in families. Moreover, some contagious illnesses may elevate the risk of the diagnosis or mimic schizophrenia symptoms.

Researchers have not identified a single cause of the condition. Instead, interactions between many different factors may help explain the development of schizophrenia.

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What causes schizophrenia? Environmental triggers, genetics, and more

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Although researchers do not fully understand the causes underlying schizophrenia, they think that genetics and environmental factors play a role. Learn more.

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-high expressed emotion

-emotional over-involvement

-critical comments

-hostilitaly

-dstress

-guilt

-shame

-anxiety

-increase subject of burden

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A diagnosis of schizophrenia can have a large impact not only on the affected individuals, but also on the people closest to them. This topic considers the impact of schizophrenia on family members, and on the family as a unit.

Sometimes the family of a person with schizophrenia may experience different types of burden, particularly during acute phases of the illness. Burden is considered in terms of objective effects, such as illness severity or financial output, but also in terms of subjective effects, such as the emotional impact of the illness on family members.
What is the evidence for the impact of schizophrenia on families?
Moderate to low quality evidence suggests caregiving can have both negative and positive impacts. Coping, appraisal/attribution, and interpersonal response styles account for most of the variation in caregiver distress, with a strong association between emotional over-involvement and caregiver distress. High expressed emotion is common in families with around 50% of families reporting this trait. Emotional over-involvement, critical comments, hostility, and distress are reported in around 30% of families.

Siblings experience increased subjective burden, including feelings of guilt, shame, hurt and anxiety. Burden is highest in younger, female or more educated siblings, and the levels of burden is associated with patients' symptom severity. Siblings have expressed a need for more information regarding the illness and its treatment, and would generally like to be involved in family support groups.

Family members often have difficulty recognising that an illness is developing in their relative and that the person is in need of help, resulting in delays in timing and type of help sought. Predominant barriers to seeking help by relatives are the perceived stigma of having a family member with a mental illness and reluctance of the ill relative to participate in the help-seeking process. The ill individuals' wider social context and informal networks may inhibit help-seeking. Crises, or overt psychotic symptoms, are the main promoters of active help-seeking and facilitators to accessing services. Relatives' informal networks often serve to assist in this process.

Moderate to high quality evidence finds carer psychoeducation improves carers' perceived burden and depression, their knowledge of psychosis, negative caregiving experiences, and overall morbidities. Moderate quality evidence also shows family psychoeducation has a medium-sized benefit for reducing familial expressed emotion. Family intervention, which can include psychoeducation or mutual support, improves long-term family functioning, while also reducing long-term carer support service use. Home-based crisis intervention reduces family disruption and burden, and increases patients' and relatives' overall satisfaction levels.

Moderate quality evidence finds babies of mothers with schizophrenia in the peri-natal and post-natal periods show a two- to three-fold increase in the risk of mortality or congenital malformation. Lower quality evidence is unclear about the risk of mortality in older children. Moderate to high quality evidence suggests a two-fold increased risk of foetal mortality among pregnant mothers with a psychotic disorder, though the absolute risk of stillbirth in offspring of mothers with schizophrenia is <2%. This evidence does not take into account any effects of other contributing factors such as medical conditions, medications or substance use.

March 2022

Image: ©highwaystarz - stock.adobe.com

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How does schizophrenia impact on families? A diagnosis of schizophrenia can have a large impact not only on the affected individuals, but also on the people closest to them. This topic considers the impact of schizophrenia on family members, and on the family as a unit. Sometimes the family of a...