Schizophrenia 

About Schizophrenia

Schizophrenia is a complicated mental illness that can transform the way we understand ourselves and the world around us. And it may feel like nothing will be the same again. 

Schizophrenia is a serious brain disorder that can affect your thoughts, feelings, and actions, according to the National Institutes of Mental Health. People with schizophrenia may also have problems with memory, attention, and concentration, notes the American Psychological Association.

But there are things that can help. A combination of medicine and other kinds of support can help control some symptoms.

What Causes Schizophrenia?

It’s not known exactly what causes schizophrenia.

For some people, schizophrenia may be hereditary. Having a parent or sibling with schizophrenia may slightly increase a person's risk of developing it. Researchers have found several genetic changes that may lead to an increased risk of the condition, according to the U.S. National Library of Medicine. (3)

Symptoms of schizophrenia may be severe or even disabling — and schizophrenia can be tricky to diagnose. But many of the symptoms can be controlled over time with proper treatment.

What schizophrenia may feel like

Schizophrenia is a very diverse category, so there is no universal answer, but most people who suffer from the most common form, paranoid schizophrenia, say it feels like being tortured. They hear voices that seem to be artificially injected in their heads, feel thoughts that seem to come from outside their own minds, and experience a range of unpleasant physical symptoms such as constant banging or buzzing noises, pinpricks, flashes of hot or cold, etc. William James once described the world that a baby experiences as a “blooming, buzzing confusion”. That’s probably not a very good description of a baby’s world, but as a description of schizophrenia it isn’t too bad. Underlying everything is a deep anxiety and a deep sense of malevolence, a feeling that all of this is being secretly inflicted by hostile forces, perhaps government agents, perhaps extraterrestrials, perhaps witches.

Schizophrenia Signs and Symptoms

Schizophrenia symptoms vary in type and severity, and can change over time. People with schizophrenia typically show a number of symptoms.

They usually first appear in a person's late teens through early thirties.

People with schizophrenia may display psychotic symptoms, which can be particularly troubling for friends and family. Doctors call these symptoms "positive" symptoms.

Positive symptoms of schizophrenia include:

• Hallucinations

This is when a person sees, hears, smells, or feels things that aren't really there.

Auditory hallucinations — hearing sounds that are not really there — are the most common type of hallucination in people with schizophrenia.

An estimated 60 to 80 percent of people with schizophrenia may experience auditory hallucinations, noted an article published in October 2019 in Schizophrenia Research. 

Hearing voices is the most common type of auditory hallucination in schizophrenia. This could come in the form of hearing a clear voice or hearing many less clear voices, like the noise found on a busy subway. Other less common types of auditory hallucinations include music, body noises, or machinery. 

People with schizophrenia also may feel sensations of pain or invisible fingers touching their bodies when no one is nearby, according to a study published in December 2016 in Scientific Reports. 

Visual hallucinations, which are uncommon in schizophrenia and tend to be found more in neurologic illnesses, like certain forms of dementia, tend to be vivid and colorful, and may include scenes with family members, religious figures, or animals, past research has noted. (6)

• Delusions

These are beliefs — sometimes bizarre — that are illogical or untrue. For example, a person with schizophrenia may believe he or she is being watched by another person or animal who’s not there, followed by the government for not paying taxes, or even controlled by aliens.

The majority of people with schizophrenia experience delusions, per Stat Pearls. 

People with schizophrenia may have paranoid delusions, believing that others are trying to harm, spy on, or plot against them.

Paranoid delusions are important because they can make it difficult for a person with schizophrenia to cooperate with treatment. Poor compliance with treatment can increase the likelihood of social problems, such as joblessness or homelessness, for people with schizophrenia, according to the National Alliance on Mental Illness.

Disorganized Thinking and Speaking

People with schizophrenia may have trouble organizing their thoughts in a logical pattern. They may talk in a jumbled way that's difficult to understand.

One severe thought disorder is referred to as “word salad.”

Disorganized thinking (which manifests as disorganized speech) exists on a spectrum, anywhere from tangentiality, to loosening of associations between sentences and words, to loss of any coherent meaning.

Unusual Body Movements
People with schizophrenia may make agitated or repetitive movements.

Memory, Attention, and Other Cognitive Problems
Cognitive symptoms are very common in schizophrenia. These symptoms include difficulties with memory, attention, executive function, and processing speed.

Other Symptoms

Other schizophrenia symptoms — sometimes referred to as "negative" symptoms — can include:

Speaking little, even when forced to interact
Lack of emotional expression when talking (face may not move, voice may be dull and monotonous)
Lack of pleasure in everyday activities
Difficulty focusing or paying attention
Difficulty using information to make decisions
Neglecting physical appearance or hygiene
Severe lack of energy
People with schizophrenia may also enter a state in which they don't move at all, don't respond to others, and seem to be in a trance. This coma-like daze is called catatonia.

While catatonia typically involves limited spontaneous movement or speech, patients in this state often respond abnormally, for example, repeating words or movements back to the examiner.

What Is Paranoid Schizophrenia?

People with paranoid delusions are often said to have paranoid schizophrenia.

Paranoid schizophrenia used to be classified as a subtype of schizophrenia. Today, health professionals no longer recognize paranoid schizophrenia as a separate subtype. The classification changed in 2013 when the American Psychiatric Association stopped recognizing schizophrenia subtypes.

Paranoid schizophrenia and other subtypes weren’t very helpful to doctors, because schizophrenia symptoms can change over time, and symptoms of different subtypes can overlap.

Schizophrenia Treatment

With treatment, many people with schizophrenia live relatively normal lives.
There’s no cure for schizophrenia, but medications can help minimize symptoms. Stocksy
Treatments for schizophrenia are aimed at reducing or eliminating symptoms of schizophrenia, including hallucinations (seeing or hearing things that aren’t there), delusions (false beliefs not based on reality), and jumbled speech.

Most people with the disease will require a combination of medications and psychotherapy (talking with a trained therapist), and social services.

Getting Schizophrenia Symptoms Under Control
Your doctor may suggest that you be admitted to a hospital at first to help get your symptoms under control.

The Prevalence of Schizophrenia: How Common Is the Disease?

Approximately 100,000 young people in the United States experience an episode of psychosis each year, according to the National Alliance on Mental Illness (NAMI). Psychosis is a break with reality that can involve paranoia, hearing voices, or having other hallucinations or delusional thoughts.

Not everyone who experiences psychosis has a mental illness. Psychosis is a symptom, not a disease: It is characteristic of schizophrenia, but psychosis can also be caused by other psychiatric disorders, substances, and a variety of medical conditions.

Seek medical treatment immediately if you or someone you know might be experiencing signs of psychosis or schizophrenia. Early diagnosis — and treatment — can improve the chances of a successful recovery. 

With proper treatment, it's possible to improve your quality of life by minimizing the symptoms of schizophrenia. Some people have a harder time controlling their symptoms than others do.

For most people, schizophrenia will require ongoing treatment, even after symptoms have subsided.

Medications for Schizophrenia Treatment

Antipsychotic drugs are often used to treat schizophrenia. These medications help relieve hallucinations, delusions, and thinking problems.

Antipsychotics work by changing the way certain chemicals, called neurotransmitters, act in the brain. Antipsychotics help control the function of brain circuits involved in thinking, mood, and perception. 

There are many different antipsychotic drugs on the market. You may hear your doctor refer to first-generation (“typical”) or second-generation (“atypical”) antipsychotics.

Newer drugs aren't necessarily better drugs. Several reviews and studies in adults and children have found that the differences between the classes are relatively small and difficult to predict. Both classes may be about as effective at reducing so-called "positive" schizophrenia symptoms, such as hallucinations or delusions, though second-generation antipsychotics may be better at treating so-called "negative" symptoms, such as depressed mood and social withdrawal. Not every drug will work for every person.

Side Effects of Drugs Used to Treat Schizophrenia

Both older and newer antipsychotics can cause serious side effects.

First-generation antipsychotics, which began to be developed in the 1950s, can cause restless movements or muscle spasms as a side effect. While some of the movements or changes in muscle tone are treatable, in some cases people can develop long-term or even permanent abnormal movements. This side effect is typically related to the duration of treatment and is more common in older people.

Second-generation antipsychotics were developed later and don't cause as many movement problems. They are, however, more likely to cause other side effects, such as weight gain, as well as the development of related issues, such as diabetes and high cholesterol.

Some commonly used first-generation antipsychotics:

Haldol (haloperidol)
Chlorpromazine
Perphenazine
Fluphenazine
Commonly used second-generation antipsychotics:

Risperdal (risperidone)
Abilify (aripiprazole)
Clozaril (clozapine)
Seroquel (quetiapine)
Zyprexa (olanzapine)
Geodon (ziprasidone)
Invega (paliperidone)
Latuda (lurasidone)
Rexulti (brexpiprazole)
Vraylar (cariprazine)
Fanapt (iloperidone)

Antipsychotic Drugs and Possible Side Effects

Older and newer antipsychotic drugs can cause side effects, including the following:

Uncontrollable movements, such as tics, tremors, or muscle spasms (this risk is higher with first-generation antipsychotics)
Weight gain (this risk is higher with second-generation antipsychotics) and other metabolic effects like development of diabetes and high cholesterol
Drowsiness
Restlessness
Different antipsychotics have different possible side effects; it is important to speak with your doctor about the potential side effects from your particular medication. 

Antipsychotics can also cause interactions with certain medications and supplements.

Discuss all other medications or supplements that you take with your doctor before starting on an antipsychotic.

This includes over-the-counter (OTC) drugs, supplements, and illegal and recreational drugs, including marijuana, which has been shown to worsen psychotic symptoms in those with and susceptible to schizophrenia.

Medication Adherence and Schizophrenia Treatment
Taking medications correctly can be a problem for people with schizophrenia. An estimated one-third of people with schizophrenia use their meds incorrectly or skip them altogether, according to research published in the journal Patient Related Outcome Measures. (9)

That may be due in part to the nature of the illness itself. Psychosis can make it difficult for someone to tell what’s real and what isn’t, so people with schizophrenia may believe they do not need medications or may forget to take them. They may not understand what’s happening or may feel confused or distressed.

Nondrug Therapies for Schizophrenia Treatment

In addition to medication, your doctor may recommend other therapies to help you cope with the everyday challenges of schizophrenia.

In 2009, the National Institute of Mental Health funded a series of clinical trials known as the RAISE Initiative to improve schizophrenia treatment. (10) 

What Is Coordinated Specialty Care for Schizophrenia?
A 2016 RAISE study, published in the American Journal of Psychiatry, found that early intervention after the onset of a first episode of psychosis with a coordinated, team-based approach and low doses of antipsychotic medication resulted in more effective treatment for people with schizophrenia. (11)

This team approach is known as coordinated specialty care.

A coordinated specialty care team may include clinicians, therapists, and case workers with experience in the following areas:

Psychotherapy
Family support
Medication management
Work or education support

Other therapies for schizophrenia may include these options:

Cognitive behavioral therapy You'll meet with a therapist to work on your thinking and behavior.

The therapist may teach you how to test the reality of your thoughts or perceptions, and help you develop ways to ignore the voices in your head.

Peer support groups These are safe places where you can meet people who are going through the same things as you. Professional therapists are usually not involved.

Family therapy This involves seeing a therapist along with members of your family.

It's important that your family knows as much about your schizophrenia as possible. Therapists can help your family develop coping strategies and problem-solving skills.

Rehabilitation These programs can include job counseling, money management, and communications training.

Rehabilitation emphasizes skills that can help people with schizophrenia function better in their communities.

Integrated substance abuse treatment Some people with schizophrenia also have substance abuse problems. They often get better results when drug and alcohol treatment are part of their schizophrenia treatment program.