Schizophrenia

Schizophrenia is a disorder of your mind that affects how you think, feel and behave. The strongest feature of schizophrenia is loss of insight or awareness that the experiences and difficulties you have are the result of your illness.

Key points

  1. You may hear voices, see things that aren't there or believe that others are reading or controlling your mind. This is called psychosis.
  2. If you continue to have episodes of psychosis for more than 6 months, you will be diagnosed as having schizophrenia.
  3. Schizophrenia can affect anyone at any age but symptoms mostly begin between the ages of 15–30. Symptoms often start slightly earlier for the first time in men than women. 
  4. Schizophrenia can be effectively treated and you can recover. Recovery is defined as living well with or without symptoms, not as the complete absence of symptoms.  
  5. The earlier treatment is started, the better your chances of recovery, so see your doctor as soon as you have any symptoms.

What causes schizophrenia?

The exact cause of schizophrenia is not known. There may be a range of causes.

Some things that make it more likely that you will develop schizophrenia are:

  • Having particular genes – like many other illnesses, schizophrenia runs in families. People with a parent, brother or sister who has schizophrenia have a higher chance of developing schizophrenia. However, most people who have a family member with schizophrenia will not develop the condition. 
  • Injuries to your brain – eg, not getting enough oxygen at birth or your mother having a virus infection during the early months of pregnancy.
  • Use of recreational drugs – heavy use of cannabis seems to double the risk of developing schizophrenia and stronger forms of cannabis may increase this risk. Cannabis is more likely to trigger schizophrenia if you start using it in your early teens or have smoked it a lot (more than 50 times). Amphetamines can give you psychotic symptoms, but they usually stop when you stop taking the amphetamines.
  • Stress – symptoms often get worse just after difficult situations, such as a car accident, moving home, someone close to you dying, or even difficulties with work or studies. Long-term stress, such as family tensions, can also make it worse.
  • Difficulties in your childhood – schizophrenia is more likely if you were deprived or physically or sexually abused as a child. 

What are the first signs that schizophrenia may develop?

Before the signs of schizophrenia become obvious and it can be diagnosed, most people have early-stage symptoms. These symptoms can include:

  • changes in normal behaviour, such as work or schoolwork getting worse
  • no longer wanting to spend time with friends
  • dropping out of normal activities
  • beginning to have unusual beliefs
  • hearing sounds that other people can’t hear.

These symptoms may be a warning sign that you are at high risk of developing schizophrenia, although not everyone who has them will go on to develop schizophrenia. 

Some people with the same symptoms may go on to develop another mental illness such as bipolar disorder or anxiety, or be at increased risk of self-harm

Recognising something is not right and getting help early can help you get better faster. 

What are the symptoms of schizophrenia?

The symptoms of schizophrenia vary between people and you may have different symptoms at different times. They are often divided into 2 categories:

  • psychotic symptoms, sometimes called 'positive' symptoms because they are new and unusual
  • mood symptoms, sometimes called 'negative' symptoms because they refer to the loss of normal behaviours.

Psychotic symptoms can include one or more of 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.

Mood symptoms may include one or more of 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 seem unaware of your illness or other people’s feelings. Your concentration and memory may be poor and you may find it difficult to communicate as they would normally.
  • Changes in mood, eg, you may appear anxious, panicky, depressed or in an abnormally good mood. Your emotions may be flattened, eg, you may appear quite ‘wooden’ and unable to express joy or sorrow, or you may have a preoccupation with death.

The strongest feature of schizophrenia is loss of insight – the loss of awareness that the experiences and difficulties you have are the result of your illness.

How is schizophrenia diagnosed?

See your doctor if you are experiencing any of these symptoms. They will refer you to a psychiatrist for diagnosis. They will diagnose schizophrenia if you meet the following criteria:

1. You have 2 of the following 5 symptoms, with at least 1 of the first 3:

  • delusions
  • hallucinations
  • disorganised speech
  • disorganised or catatonic behaviour, such as a lack of movement and communication, or agitation, confusion and restlessness
  • negative symptoms, such as a flattening of emotions.

2. You have experienced symptoms for more than 6 months.

3. All other possible causes, such as recreational drug use or other health conditions such as bipolar disorder or depression have been ruled out. 

What is the treatment for schizophrenia?

The recommended treatment approaches for schizophrenia include:

  • early diagnosis and treatment
  • counselling and psychological therapy
  • social support
  • medication
  • hospital-based treatment. 

Early diagnosis and treatment

Specialised early intervention helps you get better much faster and return to your regular life sooner. Delaying treatment may lead to slower and less complete recovery. 

Early intervention is particularly important for teenagers and young adults, as psychosis can seriously disrupt the development of your personal identity and your ability to form relationships and keep up with work or study. 

If you have the symptoms, contact your GP as soon as possible. 

Counselling and psychological therapy

Psychological treatment can help reduce the intensity and anxiety caused by schizophrenia.

  • Cognitive-behavioural therapy (CBT)teaches how behaviours, thoughts and mood influence each other.
  • Family therapy is a way of helping both you and your family cope with your condition.
  • Social skills training – this focuses on improving your communication and social interactions and your ability to fully participate in daily activities. 

Social support

  • Social and life skills support – Occupational therapists or social workers can help with day-to-day issues or connect you with community services that can. They can also help you prepare for, find and keep jobs.
  • Support groups – being around other people who've had similar experiences can help you feel less alone and better understood.  

Medication

Medicines can help to control symptoms but they do not get rid of them. Medicines can reduce the effects of symptoms on your life such as weaken delusions and hallucinations gradually, over a period of a few weeks and help your thoughts to be clearer. They can also increase your motivation and ability to look after yourself.

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’s illness will respond to a particular antipsychotic medicine. Your psychiatrist may need to try different medicines, doses or combinations over time. Read more about antipsychotics.

Hospital-based treatment

Where possible, you will be treated at home. However, there may be times when a stay in hospital will be helpful. This may be when you need a place away from major stresses, your medications need a major review or you need other treatments that can only be delivered in hospital. 

It may also be that during crisis periods or times of severe symptoms you may need to say in hospital for your safety, proper nutrition and adequate sleep and hygiene. 

If you do not agree to this, the Mental Health (Compulsory Assessment and Treatment) Act 1992 means you can be assessed to see whether you pose a serious risk of harm to yourself or others due to a mental disorder. If this is found to be the case, you can be required to have compulsory treatment in hospital. 

If this happens, you have a 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 stay with you while you are admitted and visit you while you are staying there.  

What can I do to help myself?

You can help yourself by:

  • having a plan for who to contact if you start to feel unwell and so others know what you need from them
  • asking your friends and family to support you
  • learning about what schizophrenia is, treatment options, coping skills, how to avoid relapse and how to access services – check out the links on this page
  • taking medicines as agreed with your doctor
  • looking after yourself by eating well, getting enough sleep and keeping in touch with family and friends
  • avoiding illegal drugs or alcohol
  • avoiding stressful events and situations and learning how to cope with stress
  • getting plenty of sleep and eating well
  • keeping up with your normal activities as much as you are able to.

Read more about self-care

What support is available?

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 Supporting Families, who provide support for families and whānau to provide the best possible quality of life and recovery to their loved one who has a mental illness and to their own self-care.

If you need urgent help:

  • Free call or text 1737 any time, 24 hours a day to speak to a trained counsellor
  • In crisis? Crisis contact details Mental Health Foundation, NZ 

Learn more

Schizophrenia diagnosis NHS, UK
Schizophrenia Medline Plus, National Institute of Health, US
How antidepressants and antipsychotics work Here To Help
Mental Help Net Schizophrenia Useful website and information on schizophrenia and related disorders
Early Psychosis Prevention and Intervention Centre (EPPIC), Victoria, Australia  Australian treatment centre that provides useful information on different types of psychosis-spectrum disorders, phases of assessment, treatment and recovery.

References

  1. Schizophrenia Mental Health Foundation, NZ, 2014
  2. Why early intervention? Early Psychosis Intervention Ontario Network, Canada, 2018
  3. Schizophrenia – your guide The Royal Australian and New Zealand College of Psychiatrists, 2017
  4. The New DSM-5 – schizophrenia spectrum and other psychotic disorders  Mentalhelp.net, US
  5. Schizophrenia – New Zealand treatment guide for consumers and carers The Royal Australian and New Zealand College of Psychiatrists, 2005
  6. Mental Health Compulsory Assessment Treatment Act 2002 Mental Health and the Law, NZ
  7. Schizophrenia Royal College of Psychiatrists, UK
  8. Transforming understanding and treatment of mental illness National Institute of Mental Health
  9. Genetic risk – diseases that run in families Learn Genetics (Genetic Science Learning Centre), University of Utah, USA, 2015 
Credits: Health Navigator Editorial Team.