Schizophrenia is an often misunderstood chronic brain disorder. It’s characterized by thoughts or experiences that seem out of touch with reality, disorganized behavior or speech, and decreased participation in daily activities. Common symptoms include hallucinations — sensory experiences that seem real but are actually products of the mind — and delusions — fixed, false beliefs that go against reality. Schizophrenia interferes with a person’s ability to think clearly, manage their emotions, make clear decisions, and relate to others.
According to the American Psychiatric Association, schizophrenia affects less than one percent of the U.S. population. According to the World Health Organization, it affects 20 million people worldwide and is not as common as many other mental disorders.
Schizophrenia can occur in men and women of all ages. However, research shows that men often develop symptoms earlier than women, starting in their late teens or early 20s, while women most often show signs in their late 20s and early 30s.
Schizophrenia Symptoms and Behaviors
People with schizophrenia can have intense behavioral symptoms, most often confusion and disorientation, making it difficult for them to distinguish between reality and their delusions or hallucinations. It’s important to note that the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Some might have their symptoms worsen or improve unpredictably, and others might have consistent symptoms.
Schizophrenia symptoms are considered to be either positive or negative, not because they are good or bad, but based on whether or not they mark the presence or absence of symptoms. Positive symptoms, such as hallucinations, delusions, and disordered thoughts and speech represent increased activation of certain areas of the brain. The positive symptoms tend to respond well to drug therapy. Negative symptoms, on the other hand, include symptoms that halt normal functioning and don’t respond as well to drug therapy, such as a lack of desire for any social connections and lack of emotional affect.
There are five main types of schizophrenia symptoms: delusions, hallucinations, disorganized speech, disorganized behavior, and the aforementioned “negative” symptoms.
Delusions: Broadly, a delusion is a firmly-held belief that a person has despite clear and obvious evidence to the contrary.
Hallucinations: Hallucinations are sensations experienced as real even though they only exist in the mind. These can involve any of the five senses, but auditory hallucinations (hearing voices or other sounds in your head) are the most common for those with schizophrenia.
Disorganized speech: Schizophrenia can cause issues with concentrating, which can someone’s speech skills. Disorganized speech may look like someone giving partially or completely unrelated answers to questions, using made-up words or phrases that only have meaning to themselves, repeating words or statements, and/or rhyming words meaninglessly (also referred to as “clang”).
Disorganized behavior: Typically, people’s activities are goal-oriented, but those suffering with schizophrenia may not have goals connected to their actions. These individuals become unable to take care of themselves, work or interact like they used to with others. Disorganized behavior can be hard to identify, but it typically results in a lack of normal daily functioning, useless and excessive movement, lack of inhibition and impulse control, and behaviors that appear bizarre.
“Negative” symptoms: Negative symptoms can include lack of emotional expression, lack of enthusiasm, social withdrawal, and lack of awareness of one’s environment.
These symptoms are sometimes categorized in three buckets: psychotic symptoms (altered perceptions, abnormal thinking, and odd behaviors), negative symptoms (mentioned above) and cognitive symptoms (problems in attention, concentration and memory).
Regardless of symptoms, most people with schizophrenia experience them either continuously or intermittently throughout their entire life after onset and are often severely stigmatized by people who do not understand the disorder.
Schizophrenia Causes and Risk Factors
Researchers have found that there is a very strong genetic component to schizophrenia, but it’s still unknown exactly what causes some people to develop schizophrenia. Findings so far indicate that it’s likely a combination of genetic, psychological, physical, and environmental factors that can make a person more likely to develop the condition.
It is important to note that only a psychiatrist can diagnose an individual with schizophrenia, and this diagnosis can only be made after a full psychiatric assessment to rule out substance misuse or other neurological or medical illnesses whose symptoms mimic schizophrenia. However, understanding the possible causes and risk factors for schizophrenia can help clarify who might be at risk.
Genetics: There is strong evidence of a genetic predisposition to schizophrenia. Researchers have not pinpointed one single gene that leads to schizophrenia developing, but many genes are thought to play a role. According to one research study, if a sibling or parent has the illness, your chances of having schizophrenia is around 10%. It is important to note that just because someone in your family has schizophrenia, it does not mean that other members of your family will have it as well.
Environment: As with many other health conditions, there are certain environmental factors that can contribute to the development of schizophrenia. These include pre- or post-natal viral infections and exposure to toxins such as lead during gestation or childhood.
Societal factors: There has been a lot of research devoted to investigating societal issues that could potentially contribute to the onset of schizophrenia. There are many aspects being researched, but for example, there is research suggesting that people who grew up in metropolitan areas were more likely to be diagnosed with schizophrenia than those who lived in rural areas.
Lifestyle factors: There are a few lifestyle factors that put someone at a higher risk to develop schizophrenia, but these factors are more correlational than causational. All types of stress, homelessness, drug abuse, bereavement, job or home loss, divorce, the end of a relationship, or abuse are examples of this.
Although these experiences aren’t proven to directly cause schizophrenia, they can trigger its development in someone already vulnerable to it.
Structural changes in the brain: Studies of people with schizophrenia have shown that there are subtle differences in the structure of their brains compared to those without schizophrenia. For example, some studies have found that individuals with schizophrenia have less gray matter in their brains, which plays an important role in information processing, memory, and evaluating rewards and consequences.
Chemical changes in the brain: Research also indicates that people with schizophrenia have irregularities in the chemicals of the brain that allow brain cells to communicate with each other. For example, it has been shown that dopamine levels aren’t regulated properly in the brains of people who have schizophrenia. While the exact mechanism of how this happens is still being studied, it may account for certain schizophrenia symptoms.
Pregnancy or birth complications: Complications before and during birth may increase the likelihood that a person will develop schizophrenia. These complications include: infection during pregnancy, low birth weight, premature labor, maternal obesity diagnosis during pregnancy, and infection during pregnancy.
Teenagers and adults are also more likely to develop schizophrenia if they experience the death or permanent separation of one or both parents as children.
While these are a few identified causes and risks, there is no single precipitating event identified that leads to the onset of schizophrenia.
Schizophrenia Treatment Options
Being diagnosed with schizophrenia doesn’t mean you can’t live a full and meaningful life. Although there is no cure for schizophrenia, it is treatable with a combination of antipsychotic medications and supportive counseling.
Schizophrenia requires lifelong treatment through medication, therapy, or a combination of both. Remember that treatment shouldn’t be halted, even when symptoms have subsided. A psychiatrist experienced in treating schizophrenia will be able to best guide individualized treatment plans. If you or someone you know is experiencing symptoms of schizophrenia, make sure you look into treatment options as soon as symptoms start showing, as early detection can reduce the severity of symptoms.
There are a variety of treatment options for schizophrenia, including several types of therapy and medication.
While psychotherapeutic interventions can be helpful in managing symptoms of schizophrenia that persist despite medication, it’s important to note there’s more than one kind of therapy to help treat this type of disorder. Therapy options for people with schizophrenia include:
- Individual psychotherapy: Individual psychotherapy for schizophrenia patients involves regularly scheduled talks between the patient and a mental health professional such as a psychiatrist, psychologist, psychiatric social worker, or nurse. The sessions (most effective if held on a regular basis) may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a trained, licensed mental health professional, individuals with schizophrenia may gradually come to understand more about themselves and their problems. They can also learn to sort out the real from the unreal and distorted world that their disorder fosters.
- Cognitive behavior therapy (CBT): In CBT, a psychotherapist helps a person change potentially harmful or destructive beliefs and behaviors — actions and thoughts that may have developed as early as childhood and early adolescence. Cognition refers to thought patterns, and a therapist can help people with schizophrenia transform their harmful or negative cognitive patterns into healthier and more positive beliefs. CBT hinges itself on initially setting goals, meeting them, and obtaining a measure of self-awareness and confidence in order to progress and succeed in therapy. CBT looks at how our thoughts impact our feelings, which impact our behaviors. So if we can change our thoughts, we can then change how we feel and what we do.
- Cognitive enhancement therapy (CET): CET teaches people how to better recognize triggers or social cues that cause schizophrenia symptoms to appear and helps improve an individual’s ability to organize their thoughts.
- Psychosocial therapy: Psychosocial therapy helps an individual feel comfortable being in a community. This method of therapy can include social skills training, rehabilitation, family education, and self-help groups. These methods can help individuals manage their symptoms, develop the support they need, and create a satisfying, purpose-driven life.
- Support groups: Support groups help people with schizophrenia and their families feel less alone. Members of the group offer each other emotional support, acceptance, and advice. Some groups also get involved in advocacy efforts that fight stigma and work to improve the lives of all people who have mental illness. By speaking to other people with schizophrenia about one’s symptoms, and participating in dialogue about mental illness aids, one can see their own problems in the experience of others — and perhaps gain further understanding and perspective on their illness.
Further, self-help in other forms is important. Pursuing self-help strategies such as changing your diet, relieving stress, and seeking social support may not seem like effective tools against such a challenging disorder as schizophrenia, but they can have a profound effect on the frequency and severity of symptoms, as well as improve your mood and increase your self-esteem.
- Social skills training (SST): SST uses the principles of behavior therapy to teach communication skills, assertiveness skills, and other skills related to disease management and independent living. Skills are broken down into several discrete steps. After reviewing the steps, the therapist models the skill by demonstrating them. SST is often done in small groups, led by two co-therapists who then do role-plays to learn and practice skill. Therapists and group members provide constructive feedback to the individual after each role play and each participant is given an opportunity to practice the skill several times. Repeated practice and over-learning of skills are important aspects of SST.
Medication is known to be the cornerstone of schizophrenia treatment, and antipsychotic medications are one of the most commonly prescribed type of drugs.
Antipsychotics help reduce psychotic symptoms such as hallucinations, delusions, paranoia and disordered thinking. However, they may be less helpful for treating behavioral symptoms such as social withdrawal, lack of motivation and lack of emotional expressiveness. There are a wide variety of medications that can be used to treat schizophrenia symptoms, but a doctor will be able to help select the one that works best for each person.
If someone is in crisis or experiencing severe schizophrenia symptoms, hospitalization may be necessary to ensure their safety. Once they are stabilized, they can leave the hospital with a treatment plan in place. Research shows that a comprehensive treatment plan combining therapy with medication and supportive services is the most effective approach. But, it can vary case by case, and a treatment plan should only be created by a licensed professional.
Further, pursuing self-help strategies such as monitoring your diet, relieving stress and seeking social support alongside conventional treatment can also have a profound effect on the frequency and severity of symptoms. The most important thing for someone experiencing schizophrenia is to get professional help to monitor and manage their symptoms.