Schizophrenia: Information, Symptoms, Treatment and More

Schizophrenia is a severe and long-term mental health condition characterised by a range of symptoms, normally revolving around a difficulty in understanding reality, due to changes in the way someone thinks, feels and acts.

The condition usually involves a breakdown in the connection between thoughts, emotions and behaviour – leading to symptoms of psychosis appearing.

While the exact symptoms range from case to case, generally delusions, hallucinations, disorganised speech, catatonia, poor concentration and a lack of interest may be displayed. This leads to a person not being able to distinguish their own thoughts from reality.

Schizophrenia is considered to be part of a spectrum of disorders known as the “Schizophrenic Spectrum” – having moved away from a previous approach which involved different sub-types of the condition.

Unfortunately, Schizophrenia is a highly-misunderstood condition. With the right treatment, support and lifestyle, it is possible for symptoms to be controlled more, hopefully leading to an improvement in quality of life. Sometimes, recovery is possible.

What are the symptoms of Schizophrenia?

In general, someone with Schizophrenia struggles with the way they think, feels and acts.

Symptoms of Schizophrenia can normally be classed as either positive or negative. Essentially, positive symptoms refer to the symptoms that ‘add’ a behaviour, thought or feeling, while negative symptoms are ones that will ‘take away’ a behaviour, thought or feeling.

You can read more about the differences in these symptoms at this article here. Moreover, cognitive symptoms also exist.

Positive symptoms

Positive symptoms refer to those that involve any change in the behaviour or thoughts of an individual – such as hallucinations or delusions. These positive symptoms are often associated with psychosis.

Hallucinations: This is where a person sees or hears something that doesn’t exist outside of their mind. It is also possible to smell, feel or even taste something too while hallucinating. A common hallucination is hearing voices. When someone hears voices, they may believe they are being ordered to do something by the voice, or sometimes the voice may be critical, or abusive. One of the most damaging parts of a hallucination is that the person who is hallucinating believes fully that what they are experiencing is real.

Delusions: A delusion is where an individual has a belief that they believe steadfastly in, though isn’t true. The person involved will be adamant that their belief is true. In the majority of cases however, they will not be correct. Delusions can take on a wide array of forms. An example of a delusion is paranoia – such as the feeling an individual is being spied on. As such, the delusion can have a marked effect on the day-to-day life of the individual.

Disorganised Speech: This is where an individual will struggle with their speech. They may make up words, struggle to concentrate on one topic, repeatedly chant words, or switch between topics rapidly. Sometimes, it can be impossible to understand what the person is saying.

Disorganised Behaviour: Someone exhibiting disorganised behaviour may act impulsively and unpredictably. A person may behave in a somewhat inappropriate way – having forgotten how a suitable way is to act. For instance, a person may swear loudly in public. Some people believe their movements and actions are being dictated by someone else, leading to their disorganised behaviour.

Catatonia: In cases that involve catatonia, an individual will normally appear immobile – sometimes not speaking nor moving. The individual will often be in a state of stupor – where they appear near-unconscious. The person will often be mute – offering little in the way of interaction. They often appear agitated, and may make repetitive movements. It is also possible for the other extreme of this behaviour to arise, such as excessive movements and excitement.

Unusual motor behaviour: Sometimes, an individual will exhibit unusual motor behaviour – such as pacing up and down, or making the same, repetitive movements. This can also act as a compulsion – similar to those seen in Obsessive-Compulsive Disorder.

Depersonalisation: This refers to the state where someone feels separated from their own body sensations, thoughts, feelings, emotions and behaviour. The person may believe they aren’t connected to their body, and as such, may feel away from reality.

Derealisation: This is the feeling or sense that what is happening around an individual isn’t real. A person may feel they are in a dream. This can cause an individual to feel alienated from those close to them.

Negative symptoms

These symptoms of Schizophrenia may appear before positive symptoms – which generally appear for the first time during a maiden schizophrenic episode. The negative symptoms are often referred to as the prodromal period of Schizophrenia. These symptoms will often worsen over time, though start off relatively mild.

Blunted Affect: Affect refers to the emotions of an individual. Someone with a Schizophrenic spectrum condition will often exhibit a blunted affect. This is where the individual shows little or no emotion, emphasised by a rigid facial expression. This can extend to tone of voice and mannerisms – both of which will tend to be limited. On occasions that seem to provoke happiness in most people, someone with a blunted affect will normally remain unmoved. Moreover, they can sometimes abandon the blunted affect and act inappropriately – such as laughing at a serious matter.

Poverty of Speech: This is where an individual may struggle to speak, or only give short, empty answers to questions. They may struggle to hold down a conversation with someone. The individual may struggle with social skills.

Avolition: A common symptom of many mental health conditions is avolition. This is where someone may experience a profound reduction or difficulty in starting and persisting with goal-directed behaviour – like getting a job or having a relationship. This is often seen as disinterest. As a result, someone may want to stay inside and away from the world, exhibit erratic sleeping patterns, have a low sex drive, and in general lack motivation.

One complication of negative symptoms is that many of these symptoms are similar to those seen in Depression. As a result, someone can be first diagnosed with Depression prior to developing Schizophrenia – when a positive symptom arises.

These negative symptoms will often lead to struggles with friends and families. Unfortunately, these symptoms can often be seen as being lazy or rude. Such symptoms often develop slowly during the teenage years, which means they are unfortunately often attributed to a ‘phase’.

It is common for these negative symptoms to remain after a schizophrenic episode.

Cognitive symptoms

There are then some other symptoms that are separate from positive and negative symptoms, but are associated with Schizophrenia.

Thought Disorder: Also known as disturbed thoughts – someone who has experienced psychosis will often lose touch with reality. As a result, their thought process can become distorted. They may be unable to focus on anything – losing their concentration easily. During a situation which involves disturbed thoughts, the mind of an individual can become jumbled, leading to confusion. Someone may think slowly, or have a poor memory. The person will generally struggle to match their thoughts, feelings and behaviour together.

There are a lot of potential symptoms. As such, not everyone will experience all of these symptoms, sometimes only a few symptoms are present. For someone with Schizophrenia, they can have periods of time without any symptoms.

What are the causes of Schizophrenia?

Given the complexity of Schizophrenia, the cause isn’t fully known. However, it is believed that a range of factors, such as genetics, environmental influences and trauma are all possible factors.

It is believed that genetics play a role, with Schizophrenia often running in families. One study found that heritability rates for Schizophrenia are around 80% – suggesting genetics plays a big role in the onset of the condition [1].

However, there doesn’t appear to be a certain gene that causes this. Having a parent with Schizophrenia raises the risk of an individual developing the illness. This is similar with identical twins. But this is purely a risk factor, and not always a cause – having a family history of Schizophrenia doesn’t mean the illness will always develop.

Another potential factor is a chemical imbalance in the brain. For instance, some of these chemicals, such as dopamine and serotonin, help to regulate mood and communication in the brain. When these chemicals become unbalanced, it is possible that a mental health condition can develop. Antipsychotic medication, which is used for Schizophrenia treatment, helps to restore the balance, which normally results in the lessening of symptoms – adding credence to this theory.

Loneliness, abuse, financial problems, or trauma are additional risk factors. In fact, research suggests that any traumatic event in childhood has been explicitly linked to the risk of psychosis increasing [2].

More recent research has also proposed that living in an area which is deprived and features low income is an additional risk factor [3].

Substance Abuse is also associated with an increase in the chances of Schizophrenia developing. Moreover, research suggests that those who use street drugs regularly in their teenage years have a heightened risk of developing the condition [4].

There is also some research that suggests birth complications are an additional risk factor [5]. For example, complications include premature birth, a lack of oxygen in birth, along with a low birth weight.

Finally, Schizophrenia can potentially start off as another mental health condition, like Depression, Brief Psychotic Disorder or Schizotypal Personality Disorder, before exacerbating.

Diagnosis of Schizophrenia

A person should see their doctor immediately if they believe they are suffering from Schizophrenia, or are displaying any symptoms of psychosis.

At an appointment, the doctor will try to gain an understanding of the person’s symptoms. If they deem it appropriate, an urgent referral should be made.

This is normally either through the closest Community Mental Health Team (CMHT) or an Early Intervention Team (EIT). CMHT’s and EITs are made up of a group of mental health professionals, such as psychiatrists and psychologists.

CMHT’s help people with complex mental health conditions. EITs help those who have had their first experience of psychosis. A member of one of the teams will carry out a full assessment of the symptoms of the individual.

Further questions will be based on a personal history, any past drug use, and a family history of mental illness. It is very important that the individual answers each question truthfully, as this can assist in an accurate diagnosis being made.

For Schizophrenia to be diagnosed, the patient will normally need to:

• Have experienced the following:
  • Either a delusion (e.g. paranoia), hallucination (e.g. hearing voices) or disorganised speech.
  • AND at least one of:
  • Disorganised behaviour, catatonic behaviour or a negative symptom like blunted affect, anhedonia etc.
• The symptoms have not been caused by substance abuse. If substance abuse has caused the symptoms, Substance-induced Psychosis may be diagnosed.
• The symptoms must have caused a negative impact on the life of an individual.
• The symptoms don’t fit a different mental health condition better, like Bipolar Disorder, Schizoaffective Disorder or a Personality Disorder.

If the above symptoms have been present for under a month, the individual may be diagnosed initially with Schizophreniform Disorder, rather than Schizophrenia.

In the past, people would have been diagnosed with a specific sub-type of Schizophrenia. For example, these included Paranoid Schizophrenia, Disorganised Schizophrenia, and Residual Schizophrenia among others.

However, since moving to a “spectrum” approach – these sub-types have been removed, leaving purely Schizophrenia as its own condition.

Once an accurate diagnosis has been made, a treatment plan can be drawn up. This will have the aim of helping the patient to improve their quality of life and cope with symptoms in a healthy way.

How is Schizophrenia treated?

It is vital for someone with Schizophrenia to seek treatment. Treatment for the condition generally involves a combination of therapy and medication.

Treatment is organised by Community Mental Health Teams. CMHT’s will normally provide the patient with a key worker, who will act as the first point of contact for any enquiries during treatment.

A care plan, which will involve therapy and medication, is normally created. The care plan takes into account living needs like housing arrangements, financial arrangements and more, if the patient requires help. The purpose is essentially to ensure the patient has support wherever necessary to enter treatment without external pressures.

As mentioned, treatment will normally include:

Talking Therapy

Talking therapy is an important component in the treatment of Schizophrenia. There are several different types of therapy that are used. Therapy often helps in making symptoms have less of an impact on an individual’s life.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.

Arts Therapy: Arts and creative therapy (also known as expressive arts therapy, creative arts therapy, expressive therapies etc) can help people find a way to express their thoughts and feelings in an easier way. This type of therapy involves an individual creating art, an object or piece of music, which can normally be used by a therapist to link to certain problems. Arts therapy can be a good alternative to talking therapy if needed.

There are a range of other types of talking therapies available. There are many ways that talking therapy can help. We have more information on our Therapy section.

Medication

The use of medication is crucial in the management of Schizophrenia. The primary medication class used is Antipsychotics. Antipsychotics can help lessen the severity of the symptoms of Schizophrenia. They will normally need to be taken on a long-term basis.

Antipsychotics: Antipsychotics (also known as neuroleptics) block the effect of dopamine – a chemical in the brain that is heavily linked to psychotic symptoms like hallucinations. They can also be useful for stabilising mood, and treating anxiety. They are not suitable for everyone however, and are often associated with many side effects like weight gain, dizziness and dry mouth.

In cases where an individual is in crisis, needs rapid sedation, or another feasible reason, a benzodiazepine could be prescribed on a short-term basis.

Benzodiazepines: Benzodiazepines are fast-acting sedatives, which can relax an individual and improve their mood. Any anxiety should fade rapidly upon consumption. The individual should therefore have an improved level of functioning. Benzodiazepines cannot be taken for more than a few weeks, due to acute risk of both physical and psychological dependence.

Other

Sometimes, in very severe cases of Schizophrenia, psychotic symptoms can cause what is known as an Acute Schizophrenic Episode. This involves a worsening of symptoms to the extent where the individual may pose a danger to themselves or others.

This will commonly require additional care. Additional care can sometimes be provided by Crisis Resolution Teams (CRT). CRT’s aid individuals who in normal circumstances would need to be treated in hospital. CRT’s try and stop admission to hospital wherever possible.

For instance, treatment may take place at a Day Care centre. If treatment of the acute episode is successful, the CRT’s can help with future prevention of further episodes.

Unfortunately however, in cases where CRT’s are unable to help those having an acute schizophrenic episode, admission to a psychiatric ward or secure hospital will be necessary. This will often involve an individual being kept in a locked ward. Sometimes, this will involve sectioning.

This is only reserved for instances where someone may be a danger to themselves or others. An individual can also self-admit to hospital if necessary. This should only be a temporary measure.

If a range of measures have failed to gain an adequate response, or if a person is in a severe state of catatonia, Electroconvulsive Therapy can be used:

Electroconvulsive Therapy (ECT): Electroconvulsive Therapy (commonly referred to as shock treatment) is a treatment that sees an electric current sent through the brain of an individual. The aim is to trigger an epileptic seizure, with the ultimate objective to relieve symptoms of a mental health problem. The human body is fully restrained during the procedure, which also involves a general anaesthetic. Electroconvulsive therapy is normally a last resort. Despite this, ECT actually has an impressive efficacy rate, with many people finding it helps immeasurably.

Summary

Schizophrenia is certainly a debilitating mental health condition. There a vast range of symptoms and potential causes. Getting a diagnosis is very important.

Treatment can improve the quality of life of someone with the condition and potentially even lead them to recovery. For more information, our website has plenty of information to assist you.

See Also

• Schizophrenic Spectrum Section
• What is the Prognosis for Schizophrenic Spectrum Disorders?
• Therapy Homepage
• Medicine Homepage