Schizophrenia

Overview

Schizophrenia is a serious mental health condition that affects how people think, feel and behave. It may result in a mix of hallucinations, delusions, and disorganized thinking and behavior. Hallucinations involve seeing things or hearing voices that aren't observed by others. Delusions involve firm beliefs about things that are not true. People with schizophrenia can seem to lose touch with reality, which can make daily living very hard.

People with schizophrenia need lifelong treatment. This includes medicine, talk therapy and help in learning how to manage daily life activities.

Because many people with schizophrenia don't know they have a mental health condition and may not believe they need treatment, many research studies have examined the results of untreated psychosis. People who have psychosis that is not treated often have more-severe symptoms, more stays in a hospital, poorer thinking and processing skills and social outcomes, injuries, and even death. On the other hand, early treatment often helps control symptoms before serious complications arise, making the long-term outlook better.

Symptoms

Schizophrenia involves a range of problems in how people think, feel and behave. Symptoms may include:

• Delusions. This is when people believe in things that aren't real or true. For example, people with schizophrenia could think that they're being harmed or harassed when they aren't. They could think that they're the target for certain gestures or comments when they aren't. They may think they're very famous or have great ability when that's not the case. Or they could feel that a major disaster is about to occur when that's not true. Most people with schizophrenia have delusions.
• Hallucinations. These usually involve seeing or hearing things that other people don't observe. For people with schizophrenia, these things seem real. Hallucinations can occur with any of the senses, but hearing voices is most common.
• Disorganized speech and thinking. Disorganized speech causes disorganized thinking. It can be hard for people with schizophrenia to talk with other people. The answers people with schizophrenia give to questions may not be related to what's being asked. Or questions may not be answered fully. Rarely, speech may include putting together unrelated words in a way that can't be understood. Sometimes this is called word salad.
• Extremely disorganized or unusual motor behavior. This may show in several ways, from childlike silliness to being agitated for no reason. Behavior isn't focused on a goal, so it's hard to do tasks. People with schizophrenia may not want to follow instructions. They may move in ways that are not typical or not appropriate to the social setting. Or they may not move much or respond at all.
• Negative symptoms. People with schizophrenia may not be able to function in the way they could before their illness started. For example, they may not bathe, make eye contact or show emotions. They may speak in a monotone voice and not be able to feel pleasure. Also, they may lose interest in everyday activities, socially withdraw and have a hard time planning ahead.

Symptoms can vary in type and how severe they are. At times, symptoms may get better or worse. Some symptoms may be present at all times.

People with schizophrenia usually are diagnosed in the late teen years to early 30s. In men, schizophrenia symptoms usually start in the late teens to early 20s. In women, symptoms usually begin in the late 20s to early 30s. There also is a group of people — usually women — who are diagnosed later in life. It isn't common for children to be diagnosed with schizophrenia.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are like those in adults, but the condition may be harder to pinpoint. That's because some early symptoms of schizophrenia — those that occur before hallucinations, delusions and disorganization — are commonly seen in many teens, such as:

• Withdrawing from friends and family.
• Not doing well in school.
• Having trouble sleeping.
• Feeling irritable or depressed.
• Lacking motivation.

Also, the use of recreational drugs, such as marijuana, stimulants like cocaine and methamphetamines, or hallucinogens, can cause similar symptoms. Compared with adults with schizophrenia, teens with the condition may be less likely to have delusions and more likely to have hallucinations.

When to see a doctor

People with schizophrenia often don't know that they have a mental condition that needs medical attention. As a result, family or friends often need to get them help.

Helping someone who may have schizophrenia

If people you know have symptoms of schizophrenia, talk to them about your concerns. While you can't force them to seek help, you can offer encouragement and support. You also can help them find a healthcare professional or mental health professional.

If people are a danger to themselves or others, or they don't have food, clothing or shelter, you may need to call 911 in the U.S. or other emergency responders for help. A mental health professional needs to evaluate them.

Some people may need an emergency stay in a hospital. Laws on mental health treatment against a person's will vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts and behavior

Suicidal thoughts and attempts are much higher than average in people with schizophrenia. If a person is in danger of suicide or has made a suicide attempt, make sure that someone stays with that person. Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

Proper treatment of schizophrenia can reduce the risk of suicide.

Causes

It isn't known what causes schizophrenia. But researchers believe that a mix of genetics, brain chemistry and environment can play a part.

Changes in certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may play a part in schizophrenia. Neuroimaging studies show changes in the brain structure and central nervous systems of people with schizophrenia. While researchers haven't yet been able to apply these findings to new treatments, the findings show that schizophrenia is a brain disease.

Risk factors

Although the cause of schizophrenia is not known, these factors seem to make schizophrenia more likely:

• A family history of schizophrenia.
• Life experiences, such as living in poverty, stress or danger.
• Some pregnancy and birth issues, such as not getting enough nutrition before or after birth, low birth weight, or exposure to toxins or viruses before birth that may affect brain development.
• Taking mind-altering — also called psychoactive or psychotropic — drugs as a teen or young adult.

Complications

Left untreated, schizophrenia can lead to severe problems that affect every area of life.

Complications that schizophrenia may cause or be related to include:

• Suicide, suicide attempts and thoughts of suicide.
• Anxiety disorders and obsessive-compulsive disorder, also known as OCD.
• Depression.
• Misuse of alcohol or other drugs, including nicotine.
• Not being able to work or attend school.
• Money problems and homelessness.
• Social isolation.
• Health and medical problems.
• Being victimized.
• Aggressive or violent behavior, though people with schizophrenia are more likely to be assaulted rather than assault others.

Prevention

There's no sure way to prevent schizophrenia. But staying with your treatment plan can help stop symptoms from returning or getting worse. Researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.