Schizophrenia, a serious psychiatric disorder, is one of the most disabling mental health conditions. It can cause delusions and hallucinations, affecting how a person feels, thinks, and behaves.
There are treatments available to help reduce the symptoms of schizophrenia, but it has no cure. Nonetheless, it’s possible for people with schizophrenia to live full and satisfying lives.
Types of Schizophrenia
In the past, doctors split schizophrenia diagnoses into five subtypes depending on their dominant symptoms. In 2013, the American Psychiatric Association (APA) eliminated these schizophrenia subtypes and changed its guidelines to reflect a broader definition of schizophrenia, since schizophrenia symptoms can change over time and may overlap within subtypes.
These subtypes were formerly characterized in the following ways:
Paranoid Schizophrenia This subtype was said to involve preoccupation with at least one delusion or frequent auditory hallucination. However, symptoms like disorganized speech and behavior, catatonia, or inappropriate or flat emotional expression were not present.
Disorganized Schizophrenia This subtype was said to involve symptoms including disorganized speech and behavior, as well as inappropriate or flat emotional expression. However, symptoms like catatonia were not present.
Catatonic Schizophrenia This subtype was said to involve catatonia, or appearing unresponsive to one’s surroundings while awake. This could involve symptoms such as staring into space, repeating seemingly purposeless movements, or maintaining a rigid or unusual posture, among others.
Undifferentiated Schizophrenia This subtype was said to involve multiple symptoms of schizophrenia that didn’t align with the criteria for any of the subtypes named above.
Residual Schizophrenia This subtype was said to involve an absence of noticeable hallucinations, delusions, disorganized speech or behavior, and catatonia, as well as the presence of negative symptoms, or an absence of usual and expected ways for someone to interact with their environment.
Schizophrenia symptoms usually first appear during a person’s late teen years through their early thirties. Some people go through a “prodromal period” during which they do not display symptoms of schizophrenia but may have mood symptoms, withdraw socially, or be irritable. People with schizophrenia may display unusual behaviors and symptoms that can be upsetting for friends and family. These symptoms include:
Hallucinations (when a person sees, hears, smells, or feels things that aren’t there)
Delusions (illogical or false beliefs)
Disorganized thinking and speaking, “word salad” (words thrown together without sensible meaning)
Unusual body movements
Problems with memory, attention, and concentration
Social withdrawal
Absent or inappropriate reactions or emotional responses
Neglecting personal appearance or hygiene
Profound lack of energy
The hallucinations and delusions of schizophrenia are symptoms of psychosis, a state of mind in which there is some loss of contact with reality. Schizophrenia can cause psychosis.
According to the APA, symptoms of schizophrenia generally fall into four categories:
Positive Symptoms This category refers to symptoms that are abnormally present: hearing voices, paranoia, distorted perceptions, and unusual behaviors.
Negative Symptoms Here the symptoms involve things that abnormally absent: a flattened affect (or impaired emotional expression), decreased speech, reduced desire to be social, a lowered drive to engage in purposeful activities, and a decrease in the ability to experience pleasure.
Disorganized Symptoms These include things symptoms such as confused thinking and speech, abnormal movements, and difficulty with logical thinking.
Cognitive Symptoms These include issues with memory, concentration, and attention.
Misconceptions about schizophrenia and its symptoms persist. One of the biggest myths about schizophrenia is that people with schizophrenia have split, or multiple, personalities. This is actually a symptom of a different mental illness called dissociative identity disorder.
The notion that people with schizophrenia are dangerous and violent is also misleading. Some people with schizophrenia may have violent outbursts — especially those who are acutely psychotic, experiencing paranoia or other delusions involving people potentially harming them in some way — but most people with schizophrenia are not dangerous to others. In fact, people with schizophrenia are more likely to be victims of violence as opposed to perpetrators, and the vast majority of people with schizophrenia tend to withdraw from society when they are experiencing symptoms.
Experts have long debated the causes of schizophrenia, including whether schizophrenia is hereditary. There doesn’t appear to be just one cause of schizophrenia.
Risk factors for schizophrenia may include the following:
Genetics
Certain genes have been linked to an increased risk of schizophrenia, but no single gene appears to be responsible for the disease.
Defects in those genes may increase the risk of schizophrenia by causing disturbances in the connections between brain cells.
In 2014, more than 300 scientists from around the world compared the genomes of 37,000 people with schizophrenia with more than 113,000 people without the disease in the biggest-ever genetic schizophrenia study. They found 128 distinct gene variants that were associated with schizophrenia. They reported their findings in the journal Nature.
Schizophrenia tends to run in families, though not everyone who has a parent with schizophrenia will get the disease. People who have a parent or sibling with schizophrenia have about a 6 times higher risk of developing schizophrenia than the general population.
Among people with schizophrenia, most of the risk of developing the disorder (80 percent) seems to be related to genetic factors (which include particular genotypes, variations in genomes, and family history), according to a study of Danish twins.
The family link is most evident in identical twins. If one twin is diagnosed with schizophrenia, the other has as much as a 46 percent chance of developing the disease.
Brain Chemicals
Neurotransmitters help brain cells in different parts of the brain communicate with one another and abnormal or disrupted signaling of the neurotransmitters dopamine and glutamate may contribute to schizophrenia.
Uterine Environment
Researchers have linked exposure to certain viruses or malnutrition in the womb to schizophrenia.
Drug Use
Some scientific studies suggest that using mind-altering drugs like marijuana or methamphetamine, especially during the teenage years and early adulthood, can increase the risk of schizophrenia.
Schizophrenia can be difficult to diagnose. That’s partially because people with schizophrenia symptoms may not realize they have it and may not take themselves to a doctor for treatment.
Schizophrenia Testing and Diagnosis
No single definitive test exists for schizophrenia. Thorough clinical interviews are used to diagnose the disease. A doctor will test for — or diagnose — schizophrenia by ruling out other medical conditions that may be causing symptoms.
Other conditions that can be associated with psychotic symptoms include:
Legal or illegal drug use, including marijuana and alcohol
Overuse of stimulants — including methamphetamine (meth) and amphetamine and dextroamphetamine (Adderall, used to treat ADHD) — can cause drug-induced psychosis and schizophrenia-like symptoms
The process of testing and diagnosis will include:
Psychological Evaluation A doctor or mental health worker will ask you a range of questions about your thoughts, moods, delusions, hallucinations, and substance use. This evaluation is considered a critical part of the diagnostic assessment.
Medical Tests A health worker may draw your blood for tests that can help rule out other conditions.
These tests will also screen for any alcohol or drugs in your system that may be contributing to your symptoms.
A diagnosis of schizophrenia requires that two or more of the following symptoms are persistent for at least six months:
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
First Episode Psychosis
As mentioned, psychosis is defined as a break with reality. It can involve hearing voices, experiencing hallucinations, or having paranoia and other delusional thoughts.
Research estimates that between 15 and 100 people out of 100,000 develop psychosis each year.
Not everyone who experiences a psychotic episode has a mental health condition. Sleep deprivation, certain prescription medications, and disordered use of alcohol or drugs can cause psychosis. But it can also be caused by mental illnesses like schizophrenia.
Psychosis can make it difficult for someone to tell what’s real and what isn’t. The changes in thoughts and perceptions can be gradual. People experiencing psychotic symptoms for the first time may not understand what’s happening. They may feel confused or distressed.
In these cases, friends, family members, or others in the community, including police officers, may be the first to spot psychotic behaviors.
It’s best to seek medical treatment immediately if you or someone you know might be experiencing signs of psychosis or schizophrenia. Early diagnosis — and prompt treatment — can greatly increase the chances that medication and other schizophrenia treatments will work effectively.
While many of the symptoms can be managed over time with proper treatment, there is no cure for schizophrenia.
Most people with schizophrenia will require medication, psychotherapy, and social services long term. In most cases, schizophrenia requires ongoing treatment, even after symptoms subside.
Can Schizophrenia Be Cured?
Schizophrenia cannot be cured, but the symptoms can be managed effectively with various treatments. Over the past 30 years, researchers have begun making discoveries that may help identify new targets for drug therapy.
As with many diseases that can be managed but not cured, early detection and treatment for schizophrenia are important. Treatment options include the following:
Medication Options
Antipsychotic drugs are the main treatment for schizophrenia. They help relieve hallucinations, delusions, and difficulty forming thoughts. These drugs work by changing the way that certain brain chemicals, or neurotransmitters, function, which can help relieve symptoms of schizophrenia.
Psychosocial Interventions
Psychosocial interventions for schizophrenia include individual and family therapy, social skills training, and rehabilitation programs that stress skills that can help people with schizophrenia maintain employment and function in their communities
Coordinated Specialty Care: A Team Approach to Treatment
A team approach called Coordinated Specialty Care (CSC) has been shown to be effective. CSC involves early intervention after the onset of a first episode of psychosis with a coordinated, team-based approach and low doses of antipsychotic medication.
A CSC approach may involve support from people trained in psychotherapy, family support, medication management, as well as work or education support.
Other therapies for schizophrenia include cognitive behavioral therapy, peer support groups, and rehabilitation programs that stress skills that can help patients function in their communities.
Hospitalization
If you’re having severe symptoms or are in a crisis, you may need to be hospitalized temporarily until your symptoms stabilize. This will help you stay safe, as well as keep up with daily tasks like eating, sleeping, and bathing.
Electroconvulsive Therapy
If your symptoms aren’t sufficiently relieved with drug therapy, your doctor may recommend electroconvulsive therapy (ECT). An ECT session is performed while you’re asleep under general anesthesia. Your doctor will pass electrical currents through your brain to induce a brief, therapeutic seizure for one to two minutes. This is believed to cause changes in the brain that help relieve the symptoms of schizophrenia.
Your doctor may recommend certain lifestyle changes alongside medical treatment. These may include:
The rate of suicide is approximately 4.5 times higher among people with schizophrenia than in the general U.S. population, according to research.
Studies suggest that those with schizophrenia are at higher risk of developing cardiometabolic diseases, particularly diabetes. Part of the increased risk is related to medication, research shows, but some is related to the disease itself.
The exact prevalence of schizophrenia is hard to measure, but NAMI estimates that schizophrenia affects between 0.25 and 0.64 percent of U.S. adults.
Men typically start to show symptoms of schizophrenia in their late teens or early twenties. Women tend to show symptoms a bit later, usually in their late twenties or early thirties.
Men are about 1.4 times more likely to be diagnosed with schizophrenia than women.
Schizophrenia can occur at any age, but it’s less commonly diagnosed for the first time in a person older than 40 or younger than 12.
Studies have found that Black men are up to 2.4 times more likely to be diagnosed with schizophrenia, but more research is needed to determine if their incidence of disease is actually higher or if other factors, such as racial or testing biases, are contributing to the disparity. One study found that Black youth were more likely to be diagnosed with a psychotic disorder and less likely to receive early treatment in the first year following a diagnosis of first episode psychosis.
Schizoaffective disorder is closely related to schizophrenia. It acts like a combination of schizophrenia and either depression or bipolar disorder.
What Is Schizoaffective Disorder?
People with schizoaffective disorder typically show symptoms of a mood disorder, such as mania (periods of being extremely elated, energized, or “up”) or depression, alongside schizophrenia symptoms.
Because the symptoms can overlap, it is not always clear whether a person has bipolar disorder or depression with psychotic features, or a schizophrenia-like illness, such as schizophrenia or schizoaffective disorder. And it can be challenging to distinguish between schizophrenia with mood episodes and schizoaffective disorder.
Schizophrenia in Children
When schizophrenia develops in children younger than 13, it’s called childhood-onset or pediatric schizophrenia.
Pediatric schizophrenia is a very rare — and often very severe — form of the disorder. An estimate from the NIMH notes the incidence is less than 0.04 percent.
Schizophrenia is difficult to diagnose in young children. Many of its typical symptoms resemble those of more common childhood disorders, including autism and attention deficit hyperactivity disorder (ADHD). Another key difficulty in making the diagnosis in kids is distinguishing between true hallucinations or delusions and normal childhood imaginative play — having an imaginary friend, for instance.
NAMI is the largest national grassroots mental health organization in the United States. It provides advocacy, education, support, and public awareness to better the lives of all individuals and families affected by mental illness. Whether you have schizophrenia or you’re helping a loved one with the disorder, NAMI offers resources and support. Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org.
S&PAA is a nonprofit that aims to advance systemic change for people with schizophrenia and pave the way to recovery and an eventual cure for schizophrenia through research, education, care, advocacy, and public policy. S&PAA offers support groups for people with schizophrenia, as well as for caregivers and families.
First started as a club at Penn State University, Students With Psychosis is now a nonprofit with a goal of empowering students with psychosis and their advocates through collaboration and community-building. Students With Psychosis offers various opportunities to stay up to date with the organization and connect with others, including a yearly conference, podcasts, and a monthly newsletter.
Schizophrenia is a serious mental health disorder that affects less than 1 percent of adults in the United States.
People with this condition often experience symptoms such as hallucinations, delusions, and disorganized thinking, which significantly impact their daily lives.
If you or someone you know shows signs of schizophrenia, seeking early medical intervention can greatly improve treatment outcomes.
