What is schizophrenia?

Schizophrenia is a complex disorder of the mind that results in a person having mixed-up thoughts and feelings. Anyone can develop schizophrenia, but it generally appears in the late teenage years, or in early adulthood. The main symptoms include delusions and hallucinations. People with schizophrenia may also become withdrawn, depressed, confused and agitated and may behave strangely. While someone with schizophrenia may find their symptoms scary, there are treatments available that can help an affected person lead a normal life. 

Signs and symptoms

There are many different symptoms that are associated with schizophrenia. They generally start to appear during the later teenage years or early adulthood. The symptoms of schizophrenia can be grouped into three different categories: positive, negative and cognitive symptoms.

Positive symptoms

Positive symptoms are also known as psychotic symptoms. They include behaviours and feelings that are not normally present in healthy people. Positive symptoms include delusions, hallucinations, disordered thoughts and disorganised behaviour.

Delusions

A person with schizophrenia may have delusions, which are very strong beliefs in things that are clearly not true. For example, a person with schizophrenia may believe that aliens are trying to control their thoughts, or that the government is plotting against them. Delusions are very common in people with schizophrenia.

Hallucinations

Some people with schizophrenia may experience hallucinations, which are experiencing sensations of things that are not real. The most common hallucination is hearing voices, but some people see or sense things that are not really there.

Thought disorder

People with schizophrenia often have mixed-up thoughts and feelings. This can appear as jumbled speech, or random comments about different topics that are not logically connected.

Disorganised behaviour

Disorganised behaviour may appear as though the affected person is behaving like a child, or acting silly or agitated. 

Negative symptoms

People with schizophrenia may also have difficulty showing emotion, or may not behave normally in social situations. These are sometimes referred to as negative symptoms. People with negative symptoms may not take care of themselves, or have lack of motivation.

Cognitive symptoms

A person with schizophrenia may also experience problems with their thought processes, which are referred to as cognitive symptoms. These include:

  • Difficulty paying attention or understanding simple things;
  • Problems with memory, and;
  • Difficulty processing information.

Not everyone who is affected by schizophrenia experiences all of these symptoms. Some of the symptoms may appear and disappear over time.

Types

Schizophrenia can be grouped into different types, depending on the displayed symptoms and behaviours. The most common types of schizophrenia include:

Paranoid schizophrenia

People with paranoid schizophrenia may experience delusions or have hallucinations, such as hearing voices. People with this type of schizophrenia may be very suspicious and argumentative, or feel anxious. With treatment, this type of schizophrenia usually offers the best hope for improvement.

Disorganised schizophrenia

People with disorganised schizophrenia have very mixed-up thoughts and may not be able to express their emotions properly. This type of behaviour can make everyday life difficult and is harder to manage than paranoid schizophrenia.

Catatonic schizophrenia

People with catatonic schizophrenia may show extreme behaviours, ranging from being completely still and not speaking for hours, which is known as catatonia, or being very hyperactive. This is not a very common type of schizophrenia. In severe cases, people with this type of schizophrenia may need help to take care of themselves.

Undifferentiated schizophrenia

People with undifferentiated schizophrenia display symptoms of the other types of schizophrenia. This is the most common type of schizophrenia, as many people who have the schizophrenia tend to experience a range of symptoms, which can change over time.

Causes and risk factors

The exact cause of schizophrenia is not known. While anyone can develop schizophrenia, you are more likely to develop the condition if you:

  • Have a close family member with the condition;
  • Have older parents;
  • Are exposed to certain viruses or malnutrition before birth, and;
  • Use drugs such as cannabis and lysergic acid diethylamide (LSD).

Lysergic acid diethylamide

A recreational drug, also known as acid, that causes vivid thoughts and sensations, and changes in behaviour.

Methods for diagnosis

The diagnosis of schizophrenia will usually be made by a psychiatrist after asking specific questions and from your medical history. If your doctor suspects that you have schizophrenia, they may conduct some tests to rule out other conditions that could be causing your symptoms. This may include a blood test, or take images of your brain using magnetic resonance imaging (MRI) or a computerised tomography (CT) scan.

As there is no specific test that can confirm schizophrenia, a diagnosis is usually made on the basis of symptoms. People diagnosed with schizophrenia will typically have at least two of the following symptoms that last for a period of six months or longer:

  • Delusions;
  • Hallucinations;
  • Disorganised behaviour;
  • Disorganised speech;
  • Social withdrawal;
  • Memory problems, and;
  • Suicidal thoughts and self-harm.

Schizophrenia can be similar to symptoms of other conditions, such as biploar disorder, psychotic depression, substance abuse, personality disorder, and adult ADHD.

Computerised tomography

A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.

Magnetic resonance imaging

A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.

Personality disorder

A lasting pattern of thoughts and behaviour that tend to be extreme, difficult to change and cause distress to the person with the personality disorder and those around them.

Psychotic depression

A type of depression that is accompanied by symptoms of psychosis, such as vivid thoughts and sensations.

Types of treatment

If you have schizophrenia, it is likely that you will need lifelong treatment to keep your symptoms under control. The most effective treatment is usually a combination of medication, psychosocial treatments and self-help resources.

Medication

Some antipsychotic medications, such as haloperidol and chlorpromazine, may be prescribed if you are experiencing delusions or hallucinations, while other antipsychotics, such as clozapine or amisulpride, may be prescribed to treat symptoms including social withdrawal and difficulty expressing emotions. Other commonly used antipsychotic medications include risperidone and quetiapine. 

Antipsychotic medications may also be prescribed to manage the condition in the long-term and prevent symptoms from returning. For individuals with symptoms that are particularly difficult to manage and/or have suicidal thoughts, a particular antipsychotic medication called clozapine may be trialed.

All antipsychotics are used cautiously, given the potential for side effects. These include movement disorders resembling Parkinson's disease (known as extrapyramidal symptoms), weight gain and metabolic syndrome, and heart disease (which is further increased by the high incidence of cigarette smoking among individuals with schizophrenia). Clozapine has the potential for other side effects, such as lowering the white cell count and increasing the risk of serious infections (known as agranulocytosis), and causing heart failure. Prior to commencing antipsychotic medications, and as part of ongoing monitoring, your doctor will conduct various tests, such as weight and waist circumference measurements, examination of the nerves, blood tests, electrocardiography (ECG) and occasionally echocardiography. These tests are used to identify side effects early and allow change in medication to prevent long-term complications. 

Psychosocial treatments

In addition to taking medication, some people with schizophrenia may benefit from psychosocial treatments to help them overcome problems with motivation, day-to-day activities, relationships and communicating. Psychosocial treatments for schizophrenia include:

Individual psychotherapy

Individual psychotherapy, which is sometimes referred to as 'talking therapy', involves meeting regularly with a therapist to discuss your thoughts and feelings and any problems that you may be having. Talking about your symptoms may help in telling the difference between what is real and what is not.

A young woman in a session with a therapist.Talking therapy can provide ways of managing the symptoms of schizophrenia. 

Rehabilitation

There are rehabilitation programs available for people with schizophrenia. These programs are designed to help people affected by the condition to find a job, manage their money and teach them how to interact with people.

Family education

People with schizophrenia generally make a better recovery with support from family or friends. There are services available to support and educate family and friends caring for someone with schizophrenia. For example, these services may teach family members why it is important that their loved one takes their prescribed medications and how to provide a safe and caring environment.

Echocardiography

The procedure in which ultrasound waves are used to create an image of the heart, to allow assessment of the heart's function as it beats.

Heart failure

A condition in which the heart is too weak to effectively pump blood throughout the body.

Electrocardiography

A test that uses electrodes placed on the chest and limbs to record the electrical impulses causing the contractions of the heart.

Extrapyramidal symptoms

Drug-induced movement disorders, such as muscle spasms, restlessness and jerky movements, that can be side effects of antipsychotic medications.

Agranulocytosis

A condition in which the bone marrow does not make enough of certain white blood cells that fend off serious infections.

Metabolic syndrome

The combination of abdominal obesity, high blood-sugar level, abnormal cholesterol level and high blood pressure that is associated with an increased risk of developing type 2 diabetes, heart disease and stroke.

Prognosis

If left untreated, schizophrenia can affect many aspects of everyday life and make it difficult to function normally. People with schizophrenia may also develop violent behaviour and depression, which can often lead to family conflicts and difficulty with keeping a job.  

The outlook for people with schizophrenia is improving. Although there is no cure, there are treatments available that are effective at reducing the symptoms. Generally, the earlier the condition is diagnosed and treated, the better the outcome. Many people with the disease improve enough to lead normal lives in their communities.

Prevention

There is no exact way to prevent schizophrenia. Recognising the condition and getting treatment early may help to control the symptoms before they become too serious. If you have an increased risk of schizophrenia, avoiding illegal drug use, reducing stress, getting enough sleep and starting treatment as soon as possible may help minimise symptoms, or prevent them from becoming worse.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.