Schizophrenia

There are different presentations of schizophrenia, and each person's experience with the disorder can be unique. Symptoms often appear in one’s late teens through mid-30s but can also emerge during childhood or later in life. 

For a diagnosis of schizophrenia, two or more of the following symptoms must be present for a considerable amount of time during one month. One or more of the exhibited symptoms must be hallucinations, delusions, or disorganized speech. In addition, episodes must not be attributable to the physical symptoms of another medical condition or the effects of medications, drugs, or alcohol.

Positive symptoms

Positive symptoms involve an emergence of changes in thoughts and behaviors. The positive symptoms required for a schizophrenia diagnosis include the following: 

• Delusions: Delusions are firmly held false beliefs that are not grounded in reality. These beliefs can be bizarre or implausible, such as thinking that one has special powers or external forces control them.
• Hallucinations: Hallucinations are sensory perceptions that are not real. They are most commonly auditory hallucinations (hearing voices) but can also involve seeing, feeling, tasting, or smelling stimuli that are not present.
• Disorganized thinking and speech: Individuals with schizophrenia may have difficulty organizing and expressing their thoughts. Their speech may become jumbled or incoherent.
• Grossly disorganized or abnormal motor behavior: This behavior may manifest as unpredictable or agitated behavior, catatonia (lack of movement or response), or other unusual mannerisms.

Negative symptoms 

Negative symptoms cause diminishment in affect or participation in daily life. Negative symptoms include the following:

• Blunted affect: Diminished ability to express emotions through tone of voice, facial expressions, or physical behaviors
• Alogia: The reduction of quality and quantity of vocabulary and speech
• Avolition: Significant and uncharacteristic lack of motivation or an inability to complete tasks in daily life
• Asociality: Aversion of or reluctance to participate in social interaction
• Anhedonia: A reduced or lack of ability to experience pleasure

Schizophrenia stages 

People with mental health conditions like schizophrenia often experience symptoms in phases. Schizophrenic episodes present in three phases of symptoms, including the following: 

• The prodromal stage: This stage occurs before more intense psychotic symptoms emerge. Typically, the symptoms during this stage are non-specific and can be attributable to another mental disorder, such as depression or anxiety. It is often challenging to tell when an individual is in the prodromal stage of an episode.
• Active stage: The characteristic symptoms of psychosis emerge during this phase, including delusions, hallucinations, paranoia, and confused or disorganized thought patterns.
• Residual stage: According to the DSM-5, this phase is not necessary for diagnostic purposes but may occur for some individuals in the long term after an episode. Symptoms similar to the prodromal stage may emerge at this point, including a reduced display of affect, social withdrawal, and apathy.

The exact cause of schizophrenia has not been identified, but it is believed that a complex interplay of genetic, environmental, and neurobiological factors causes schizophrenia. Brain structure and chemistry differences and neurotransmitter imbalances (particularly involving dopamine) have been implicated in symptoms like hallucinations, which may cause hearing voices or seeing stimuli that aren’t present. 

Genetic factors

Current identical twin studies indicate that as much as 79% of an individual's risk in order to develop schizophrenia lies in genetics. Through wide-scale global collaboration in 2022, scientists identified mutations in ten genes that significantly increase the risk of developing schizophrenia. Still, more studies are required to understand the connections between these specific genes and their effect on emergence and symptoms for developing newer, more effective treatments. 

Neurobiological factors

Neurological activity seems to significantly affect schizophrenia, particularly concerning dysfunction in the activity of dopamine neurons. Neuroanatomical changes occur over time in individuals with schizophrenia, including in the gray and white matter of the brain. However, brain dysfunction in patients with schizophrenia is thought to result from changes in several brain networks rather than specific regions. 

Environmental factors

While genetics and neurobiological factors can be significant risk factors for schizophrenia and psychotic disorders, some experts surmise that environmental elements may work in tandem with them to cause or worsen schizophrenia symptoms. Environmental factors can include:

• Trauma⁴ during childhood or adulthood
• Severe difficulties in interpersonal relationships
• Socioeconomic status and isolation
• Urbanicity or living in a migrant group
• Living with family members with severe mental health conditions

Specific factors may also incite a schizophrenic episode, including stressful or emotional life events, perceived threats, and substance use. 

Treatment plans for schizophrenia often involve a combination of health care approaches focused on managing symptoms, managing relationships, improving functioning in daily life, and enhancing overall well-being. Treatment plans can vary based on individual needs and responses, but psychoeducation is the cornerstone for helping individuals with schizophrenia and their families understand the illness and learn productive ways to cope. 

Individuals experiencing symptoms of schizophrenia may benefit from seeking support and schizophrenia treatment from a qualified mental health professional or via mental health services as soon as symptoms arise. Early intervention and treatment can make a significant difference in managing the condition.

Medication

Pharmaceutical treatments are often considered an important element of schizophrenia treatment, with antipsychotics being the most frequently prescribed. Antipsychotics help alleviate schizophrenia symptoms by regulating neurotransmitters in the brain, reducing hallucinations and delusions. 

There are two main classes of antipsychotics, including: 

• Typical (first-generation) antipsychotics: First-generation antipsychotics may include haloperidol and chlorpromazine. These medications treat symptoms of conditions like schizophrenia by primarily blocking dopamine receptors in the brain, helping to reduce hallucinations, delusions, and disorganized thinking. First-generation antipsychotics mainly target dopamine receptors and can be associated with more movement side effects. 
• Atypical (second-generation) antipsychotics: Examples of these medications include risperidone, olanzapine, and quetiapine.  Second-generation antipsychotics affect both dopamine and serotonin receptors, often with fewer movement side effects but possibly more metabolic side effects like weight gain.

Regular follow-ups with a psychiatrist or healthcare provider are essential to monitor medication effectiveness and manage any side effects. Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Other treatment options 

Other treatment options for schizophrenia can include the following: 

• Hospitalization: In severe cases, hospitalization may be recommended to ensure safety and stabilize acute symptoms.
• Rehabilitation programs: These programs offer various services, including vocational training, housing assistance, and social support, to help individuals reintegrate into the community.
• Peer support groups: Support groups provide a space for individuals with schizophrenia to connect, share experiences, and offer mutual support.
• Social skills training: Social skills training can help individuals develop and enhance social skills, improving relationships and community interactions.
• Supported employment and education: These options are programs that help individuals find and maintain meaningful employment or educational opportunities.
• Service dog organizations: In some cases, an individual with a mental illness may benefit from a service dog that performs tasks like medication reminders, grounding, and reality checks during hallucinations. 
• Electroconvulsive therapy (ECT): In severe cases of schizophrenia, schizophrenia treatment might involve electroconvulsive therapy (ECT). Electroconvulsive therapy sends small waves of electric current through the brain under anesthesia and may be helpful for treatment-resistant conditions. This procedure often has limited side effects and is supported by clinical trials.

Individuals with schizophrenia often benefit from a comprehensive treatment plan that combines medical and psychosocial interventions, such as community mental health services, supported employment programs, support groups, and medications like antipsychotic medications. Treatment is often ongoing, and adjustments may be necessary over time. 

Regular communication with a healthcare provider and a supportive network of family and friends can contribute to the long-term management of schizophrenia. Early intervention and consistent treatment adherence can lead to better outcomes and improved quality of life for individuals with schizophrenia.

Self-care 

Negative symptoms of schizophrenia, like social withdrawal and a lack of motivation, can make it difficult for some people with schizophrenia to care for their hygiene and daily needs. Having a caregiver or implementing reminders for tasks like brushing one’s teeth, showering, or making meals may be helpful. 

People with severe schizophrenia might live in an assisted care facility to receive more frequent support with self-care and hygiene. For those who are managing symptoms, self-care practices may reduce severity. Below are techniques to try: 

• Nutritious eating: Consider talking to a nutritionist or meal planner to receive support in planning and eating foods that nourish your body.
• Exercise: Some people may benefit from regular physical movement and exercise, such as walking, going to the gym, or swimming. 
• Meditation and mindfulness: Meditation and mindfulness have been proven to reduce stress, anxiety, and depression, which may be common in individuals with schizophrenia. 
• Hobbies: Partaking in hobbies that incite happiness and offer a fun way to distract oneself may reduce symptom severity. Hobbies could include activities like creating art, singing, running, biking, writing, or creating DIY projects. 

The symptoms of schizophrenia can be challenging to cope with and can significantly impact a person's ability to function in daily life, maintain relationships, and pursue employment and education. However, with treatment, individuals with schizophrenia often experience significant improvement in their symptoms and quality of life.

There are various resources available to learn more about therapeutic options and to find a mental health professional, including but not limited to the following: 

• Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA offers a behavioral health treatment services locator that may be helpful when looking for a provider. 
• National Institute of Mental Health (NIMH): The National Institute of Mental Health (NIMH) offers educational material on schizophrenia and other mental illnesses, as well as a treatment provider locator. 
• Schizophrenia and Psychosis Action Alliance (SPAA): For specialized support, the Schizophrenia & Psychosis Action Alliance website offers a wealth of resources for people with schizophrenia and their families, including information on community involvement, peer and family support groups, educational materials, and a crisis helpline. 

Therapy can be beneficial for families seeking help in supporting a loved one with schizophrenia. If you're caring for someone with schizophrenia, the above resources may help you find a support group or individual therapy. Online platforms like BetterHelp can also provide telehealth services where clients can speak with a therapist from home. 

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

The body of research on schizophrenia is increasing. As a result, professionals are learning new facts about the disorder at an increased rate. In the 21st century, a more robust exploration into the condition has yielded essential information on the relationship between schizophrenia and genetics, brain structure, and environmental factors. 

For example, researchers at the University of Pennsylvania Perelman School of Medicine analyzed the brain scans of 300 patients with schizophrenia. They uncovered previously undetected differences in brain structure between two subject groups. Through these differences, specialists hope to identify previously unknown subtypes of schizophrenia and develop more successful personalized treatments. 

Another 2017 study published in the scientific journal Schizophrenia Research found that roughly 30% of schizophrenic patients may gradually discontinue treatment with antipsychotics without psychosis relapse after ten years of living with the condition. 

While still a minority of patients, there may be a significant number of individuals who can manage the disorder with psychotherapy, discontinue their medications, and still experience remission of psychosis. While more research is needed, the data may provide hope for people with schizophrenia who have difficulty tolerating the often uncomfortable side effects of medication. 

24 million people experience schizophrenia

According to 2022 statistics, the WHO reports that “Schizophrenia affects approximately 24 million people or 1 in 300 people (0.32%) worldwide.” Although its symptoms are unique, and it isn’t as common as many other mental health disorders, schizophrenia can be managed by working with a therapist.¹

¹WHO

With the growing amount of advocacy and studies on schizophrenia, facts and statistics about the disease and treatment success are ever-evolving. Below are a few statistics on this condition: 

• Schizophrenia is one of the top 15 leading causes of disability worldwide.
• About three-fourths of individuals with a high risk for psychosis, including those with schizophrenia, have comorbid mental disorders.
• Recent studies suggest that with treatment, 70% of patients experience functional remission and improvement in quality of life within one year. Early detection, medical intervention, psychotherapy, and community and family support are cited as vital for successfully treating schizophrenia.