Schizophrenia is a type of psychotic disorder. Psychotic disorders are types of mental illness. These disorders affect people’s thinking, perceptions, behaviours and emotions.
People who experience schizophrenia can experience any of the following:
Delusions are unusual and false beliefs.
Hallucinations are when someone sees, hears or feels things that are not there.
Trouble with thinking and concentration. For example, people’s thinking can get muddled or jumbled up.
Lack of motivation.
You can read more about the symptoms of schizophrenia below.
Often, people with schizophrenia don’t recognise that they are unwell. This can make treatment difficult on occasions. With treatment, many people with schizophrenia improve. It is possible to recover from schizophrenia.
Anyone can get schizophrenia. Over 1 out of every 100 people develop schizophrenia at some point in their life.
Schizophrenia can happen at any age. Usually, symptoms of schizophrenia appear in the late teens or early adulthood.
Symptoms of schizophrenia differ from person to person. Like all illnesses, the severity, duration and number of symptoms can vary over time.
Symptoms of schizophrenia fall into 3 main groups:
Positive symptoms. Here, the word positive means the presence of an experience that a person wouldn’t normally have. In schizophrenia, these are unwanted experiences. They can be upsetting for the person.
Negative symptoms. Here, the word negative means the loss of a skill or behavior. It can also refer to changes in how someone manages in their day-to-day life.
Cognitive symptoms. These are changes in someone’s thinking and their ability to process
We will look at each of these in turn.
Positive symptoms of schizophrenia
When talking about symptoms of schizophrenia the word ‘positive’ refers to the presence of certain thoughts and beliefs. It does not mean that the symptoms are good.
Hallucinations and delusions are the two main positive symptoms of schizophrenia.
Hallucinations are when someone sees, feels or senses things that are not there. They can involve any of the 5 senses:
Hearing. When someone hears sounds or voices that are not there. These are called auditory hallucinations.
Seeing. When someone sees things (objects, people or images) that are not there. These are called visual hallucinations.
Taste. When someone tastes things that they have not eaten. These are called gustatory hallucinations.
Touch. When someone senses someone or something touching them when nothing is near them. These are called haptic hallucinations.
Smell. When someone smells something that is not around. These are called olfactory hallucinations.
Hallucinations seem very real to the person experiencing them.
Delusions are false beliefs a person holds with strongconviction.
When someone has a delusion, it’s hard to convince them their beliefs are not true. They hold onto the belief even when there is no evidence to support it. There are lots of false beliefs people can have. Some examples include when a person believes:
That people are against them or wish to harm them
They have extra special powers that no one else has
They are being spied on in their home
Another force is trying to control them
Negative symptoms of schizophrenia
In schizophrenia, negative symptoms refers to the absence of behaviours and skills that a person once had. It can also refer to changes in how someone functions in their day-to-day life.
These symptoms can involve a person experiencing the following:
They can have low energy and may not be motivated to do anything. When they have no motivation, it is called avolition.
They may lose pleasure in things they used to enjoy. This is called anhedonia.
Their speech may slow down. They might struggle to express themselves.
They may not experience joy and pleasure as they did before.
How they feel and express their emotions could change. They may lose their ability to express their emotions. They may seem emotionally flat. This is called having blunted affect.
They may lose interest in looking after themselves.
They may not function as well as they used to in their day-to-day life.
Cognitive symptoms of schizophrenia
Cognitive symptoms refer to negative changes in how a person processes information. This can include changes in someone’s:
Focus and attention
People with schizophrenia may lose their ability to concentrate. They may struggle to learn things as well as they did before. They may find it hard to make decisions. Their speech may become disorganised or confused.
Below is a video of someone talking about what it is like to experience schizophrenia:
No one knows exactly what causes schizophrenia. Research suggests that it is not caused by one thing. There are many things that increase a person’s risk of developing schizophrenia. These are called risk factors.
Risk factors for schizophrenia include:
Genetic vulnerability. People with a parent or close relative with schizophrenia are at higher risk of developing schizophrenia. Researchers believe that something related to genetics may partly explain this. Everyone is born with traits passed down through genes from their parents. No one has found a gene that is specific to schizophrenia. But, researchers still think that there may be a genetic risk in schizophrenia.
Experiences of stress and trauma. Early stressful life experiences can put people at higher risk of developing schizophrenia. They can include:
Complications during pregnancy and birth
Childhood abuse and neglect
Growing up in poverty
Not living in safe communities or environments
Traumatic life experiences
Experiences of victimization or exclusion
Stress and trauma are also risk factors for other mental disorders. No one yet knows how to explain differences in the mental health of people with similar risk factors.
Some brain injuries can cause people to develop psychosis. This can depend on the area of the brain that has been damaged.
Certain drugs are associated with higher risk of psychosis. Cannabis is has been found to increase people’s risk of psychosis. Drug use during adolescence is particularly problematic.
As with all mental disorders, the reason people develop schizophrenia is complicated. Everyone’s experience is unique.
The goal of treatment for people with schizophrenia is for the person to recover. Recovery can mean different things to different people. The most important thing in recovery is that a person’s life is meaningful and fulfilling to them. For most people, recovery also means:
Reducing the intensity and frequency of their symptoms
Reducing the distress they feel
Being able to concentrate, learn and focus
Being able to stay in education or work
Stay connected to people and things that matter to them
Mental health teams
Most people who have schizophrenia will get treatment from a team of professionals.
Treatment for schizophrenia usually involves a combination of two or more of the following:
Medication is often an important part of treatment for people with schizophrenia. It can help manage symptoms and support recovery
Medications called antipsychotics are used to treat the main symptoms of schizophrenia
Some people may also be prescribed other medications. For example, they may be prescribed anti-depressant medications if their mood is low
Most people with schizophrenia need to take some type of medication for the rest of their lives
Medication for schizophrenia works best when it is taken consistently. That means taking it every day as prescribed
The psychiatrist involved in the person’s care will track their medication closely. They will recommend what medication to take and how long to take it for.
There are lots of different medications that can help. Some medications have side-effects. Some medications don’t work for some people. If that happens, a psychiatrist will recommend trying a different medication.
Some medications by injection (every few weeks)
Psychoeducation is when people learn about an illness from someone else. It is an important part of supporting people with schizophrenia and their families.
Understanding and acceptance help people to manage their illness. It also makes it easier for them to get professional support. Sometimes, this is hard for people with schizophrenia. That’s because their thinking can get very mixed up and they may not believe there is anything wrong with them.
Families are often offered psychoeducation. It’s helpful for family members to understand schizophrenia. It can help them to cope. It can also help them to support their family member who has schizophrenia.
Sometimes, people with schizophrenia meet together in groups to talk and offer each other support. Within mental health services, there is usually a professional there too.
Family members may also be invited to support groups. There, they can meet other people who have a family member with schizophrenia. These kind of groups often combine psychoeducation and emotional support.
Outside of the mental health services, there are groups around Ireland where people who hear voices meet together.
In occupational therapy, people can be supported in many ways.
They may do activities to help with their focus and concentration.
They may be supported in relation to their social skills.
They might work on identifying early warning signs of relapse.
They may also be supported in relation to their education or work goals.
It is upsetting for family members when someone they love and care about has schizophrenia.
Supporting families is an important part of treatment, where this is possible.
Rehabilitation involves social and vocational training. The goal is to help people with schizophrenia manage as well as they can in their day-to-day lives.
It can include job training.
It can also support people with their social and workplace communication skills.
Talking therapy means getting counselling support from someone. There are many kinds of talking therapy that can be offered to people and their families.
Cognitive behavioural therapy is one type of talking therapy for people with schizophrenia. It’s known as CBT for short. CBT helps people to manage their distress and to improve their emotional well-being. It focuses on the connection between people’s thoughts, beliefs, emotions and behaviours. For people with schizophrenia, CBT can help to reduce stress, anxiety and depression. It can be very helpful for people who hear voices. People can do CBT individually or as part of a group.
The kind of talking therapy offered to someone with schizophrenia may depend on the issues they are struggling with. There may be times when a person’s symptoms can make it very hard for them to talk or listen. In those times, they might not be able to engage in talking therapy.
Researchers are exploring therapies for people with psychosis who have experienced trauma. If they are shown to be helpful, they may offer support to people with a history of trauma.
All of the support offered to people with schizophrenia aims to:
Offer emotional support for the person living with schizophrenia
Help the person develop coping strategies to manage their psychotic symptoms
Support the person as they adjust to living with a serious illness
What is insight?
Sometimes, a person with schizophrenia believes there is nothing wrong with them at all. That is because the symptoms of schizophrenia make it hard for people to have something called insight. Insight is about having awareness of something. With schizophrenia, a person has insight when:
They are aware that they are unwell
They recognise their hallucinations or delusions are psychotic symptoms
They are aware that they need treatment and support
It is very common for people with schizophrenia not to have insight. This is particularly the case when they have intense symptoms. Hallucinations and delusions can feel so real to the person that they don’t realise those experiences are not real.
A lack of insight may lead to a refusal of treatment. This can cause family and friends to become very distressed. It can also mean that a person’s symptoms get worse because they stop taking medication or don’t get the support they need.
Sometimes, people who refuse treatment get admitted to a psychiatric hospital against their will. Under Irish law (the Mental Health Act 2001), that can only happen where, because of their illness:
The person is at risk of immediate and serious harm to themselves or others
They need treatment that they can only get in a hospital
Their condition could get worse if they don’t get treatment that could help their mental health
Being brought to a psychiatric hospital against your will is distressing for the person and their family. That is why people are supported to develop as much awareness as they can about the illness and their symptoms.