Schizophrenia (mate wairua tuakoi) is a mental health condition characterised by recurring episodes of psychosis. This affects your perception, thoughts, mood and behaviour.
On this page, you can find the following information:
- What is schizophrenia?
- What causes schizophrenia?
- What may be the first signs of schizophrenia?
- What are the symptoms of schizophrenia?
- How is schizophrenia diagnosed?
- What are the treatment options for schizophrenia?
- What can I do to help myself with schizophrenia?
- What support is available with schizophrenia?
Key points about schizophrenia
- Schizophrenia can affect anyone at any age but the first symptoms mostly begin between the ages of 15–30.
- The first symptoms often appear at a slightly younger age in men than women.
- If you think you have symptoms of psychosis or schizophrenia, talk to your GP or regular health professional first. They will refer you to a psychiatrist who is qualified to diagnose and treat people with mental health conditions.
- A diagnosis of schizophrenia can be made if you've been having symptoms and problems with your functioning for at least 6 months.
- It is important to get treatment as early as possible to increase the likelihood of a good recovery.
Schizophrenia is a mental health condition characterised by recurring episodes of psychosis. You have significant changes in your perception, thoughts, mood and behaviour.
During a psychotic episode, you may have trouble thinking clearly, hear voices that other people cannot hear, perceive a reality that differs from other people’s reality or experience paranoia. Other symptoms include problems with mood and motivation.
The symptoms can be very distressing and it may be difficult for you to relate to others. This means that the ability to work, study or carry on doing ordinary day to day things can be seriously affected.
It is not exactly known how or why schizophrenia develops, but it is generally accepted that a combination of factors plays a role. Some people may be more vulnerable than others.
Things that may increase the risk of developing or triggering schizophrenia include the following:
- Genetics – relatives of a person who suffers from schizophrenia may be slightly more vulnerable than others. However, most people who have a relative with schizophrenia do not develop the condition themselves.
- Life events – your childhood experience, including abuse and trauma, can be an important factor.
- Stress – it is most often during big life changes or after serious events that people experience the first signs of schizophrenia.
- Drug abuse – certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may trigger symptoms of schizophrenia in some people.
Sometimes symptoms come on quickly, but mostly people’s behaviour changes gradually. Early changes may include:
- having trouble keeping up at school or work
- isolation from friends and whānau
- giving up hobbies or activities
- hearing sounds, like voices, that others can't hear
- getting a bit paranoid.
Not everyone who has some or all of these symptoms will go on to develop schizophrenia, but these symptoms may be a warning sign. Recognising that something is not right and getting help early can help you get better faster.
The symptoms of schizophrenia vary between people and you may have different symptoms at different times. Three different types of symptoms are commonly reported:
- psychotic symptoms – also called ‘positive’ symptoms because they are new and unusual
- mood and motivation symptoms – also called ‘negative’ symptoms because they refer to the loss of normal behaviours and emotions
- thinking and memory problems – also called ‘cognitive’ symptoms.
Positive symptoms may include the following:
- Hallucinations – you may hear, see, taste, smell or feel things that are not there. Hearing voices no one else can hear is the most common hallucination. The voices may threaten, frighten or command you to do harmful acts. Some people hear reassuring or neutral voices.
- Delusions – you may develop unusual and strongly held beliefs. You may think you have special powers, that you are being watched or spied upon or that your thoughts are being shared with others. Such delusions cannot be changed by logical argument or evidence that supports a different point of view.
- Disordered thoughts – you may have trouble connecting ideas into a logical sequence or may jump rapidly from one topic to another, which makes it difficult to hold a conversation. This may also be accompanied by inappropriate emotional responses (where your words and moods do not match), and you may laugh when speaking of a serious or frightening event.
Negative symptoms may include the following:
- Lack of motivation – you may find doing ordinary tasks such as washing, cooking or planning ahead very difficult. Solving everyday problems may become a chore.
- Social withdrawal – you may find it difficult to be with other people or to communicate with others.
- Changes in mood – you may appear anxious, panicky, depressed or in an abnormally good mood. Your emotions may be flattened, eg, you may appear quite ‘wooden’.
- Loss of awareness that the experiences and difficulties you have are the result of a mental health issue.
Cognitive symptoms may include the following:
- Problems with memory or concentration – this can make it difficult to do your daily tasks, perform your job or keep up with your education.
Many people who experience an episode of psychosis recover quite quickly and will not have another episode. However, in some cases, psychosis can be a sign of an on-going or long-term mental health problem.
Some people with symptoms of psychosis may turn out to have depression, bipolar disorder or anxiety for instance. If you have had symptoms of psychosis and problems with day-to-day activities for 6 months or longer, and all other possible conditions have been ruled out, your psychiatrist may make a diagnosis of schizophrenia.
Early diagnosis and treatment
Specialised early interventions (as provided by Early Intervention in Psychosis services in New Zealand for adolescents and young adults) help you get better faster and return to your regular life sooner. Check who can provide early intervention services in your area.
Various treatments, therapies and community supports are available to help people with schizophrenia manage their condition and live their lives to the full.
This can be used to reduce the intensity of distressing experiences. Medication can also be used to help you stay well after the signs of psychosis have reduced or gone away.
Antipsychotic medicines are the main group of medications used to treat schizophrenia. The goal of treatment with antipsychotics is to effectively manage your symptoms at the lowest possible dose.
It is difficult to predict how well a particular person will respond to a particular antipsychotic medicine. You and your psychiatrist may need to try different medicines, doses or combinations over time. Read more about antipsychotics.
Talking therapies, such as psychology sessions or counselling, can help you learn coping strategies, address problems with motivation, regain confidence or cope with stress.
The focus of psychological therapy or counselling is on education and support for you to understand what is happening to you, to learn coping strategies and to pursue a path of recovery. Sessions help you gain the confidence and belief in yourself that is critical to recovery.
Examples of talking therapies are:
- Cognitive-behavioural therapy (CBT) teaches how behaviours, thoughts and mood influence each other. Sessions may be held on a one-to-one basis, sometimes include partners or family or are held in a group.
- Relapse prevention – to help you identify early warning signs of relapse and prolong periods of remission.
- Family therapy can help both you and your family.
- Social skills training focuses on improving your communication and social interactions and your ability to fully participate in daily activities.
- Vocational support programmes can help people with schizophrenia complete training, find a job and obtain self-sufficiency.
- Support from whānau and friends can be very important for the health and wellbeing of people with schizophrenia. It is important for families to be well informed and supported themselves.
- Social and life skills support – occupational therapists or social workers can help with day-to-day issues or connect you with useful community services. They can also help you prepare for, find and keep jobs.
- Peer support groups – being around other people who've had similar experiences can help you feel less alone and better understood.
- Certain complimentary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all shown to have some effect in alleviating mental distress.
Occasionally there may be times when a stay in hospital will be helpful. This may be when you need a place away from stresses, your medications need a major review or you need other treatments that can only be delivered in hospital. A stay in hospital may be the best way to keep you safe, get proper nutrition and adequate sleep.
The Mental Health Act
In some cases, if you do not agree to receive treatment, but your doctors consider your treatment crucial for your wellbeing and safety, they may make an application to have you assessed under the Mental Health (Compulsory Assessment and Treatment) Act 1992. Read about the compulsory assessment process.
You always have the right to be treated with respect and to have things explained to you in a way and language that you understand. You can ask for family, whānau or friends to support you while you are assessed and during your treatment. Read more about your rights as a mental health patient.
It's really important to look after your physical wellbeing. Being in good physical health will also help your mental health. Make sure to be physically active, remain or become fit, and eat a healthy diet.
You can also help yourself by:
- having a plan for who to contact if you start to feel unwell
- asking your friends and whānau to support you
- explaining to friends and whānau what you may need from them, don’t assume they know what to do
- learning about schizophrenia, treatment options, and coping skills
- checking out the links on this page
- taking medicines as agreed with your doctor
- getting enough sleep
- keeping in touch with family and friends
- avoiding illegal drugs or alcohol
- avoiding stressful events and situations and learning how to cope with stress
- keeping up with your normal activities as much as you are able to.
Read more about self-care.
For ongoing support, see your family doctor, your contact person at community mental health services or your psychiatrist or psychotherapist. There are also support groups around the country. See also Mental health support for families – Yellow Brick Road, who help families and whānau to provide the best possible support for their loved one and look after their own wellbeing.
If you need urgent help:
- free call or text 1737 any time, 24 hours a day to speak to a trained counsellor
- contact your nearest crisis team: Crisis contact details Mental Health Foundation, NZ
- Schizophrenia Mental Health Foundation, NZ, 2014
- Why early intervention? Early Psychosis Intervention Ontario Network, Canada, 2018
- Schizophrenia – your guide The Royal Australian and NZ College of Psychiatrists, 2017
- The New DSM-5 – schizophrenia spectrum and other psychotic disorders Mentalhelp.net, US
- Schizophrenia – NZ treatment guide for consumers and carers The Royal Australian and New Zealand College of Psychiatrists, 2005
- Mental health compulsory assessment treatment act 2002 Mental Health and the Law, NZ
- Schizophrenia Royal College of Psychiatrists, UK
- Transforming understanding and treatment of mental illness National Institute of Mental Health
- Genetic risk – diseases that run in families Learn Genetics (Genetic Science Learning Centre), University of Utah, US, 2015
Information for healthcare providers
Typically, there is a prodromal period before the psychotic event, lasting from a few days to about 18 months and often characterised by some deterioration in personal functioning. For diagnosis of schizophrenia, the episode should have lasted for 6 months or longer and include 1 month or more of active psychotic symptoms.
See Psychosis in adults at Auckland Regional HealthPathways for full assessment and management pathway.
Australian clinical guidelines for early psychosis – a brief summary for clinical practitioners Orygen Youth Health Centre, Australia, 2011
RANZCP clinical practice guidelines for schizophrenia Royal Australian and NZ College of Psychiatrists, 2016
Curtis J, Newall H, Samaras K. Positive cardiometabolic health – an early intervention framework for patients on psychotropic medication Health Education and Training, NSW, Australia