Schizophrenia is a psychotic disorder that affects about 20 million people worldwide. It affects the way a person thinks about and perceives reality. Medications and therapies can help manage schizophrenia symptoms. 

What are the signs of schizophrenia?

People who have schizophrenia experience periods of psychosis. During psychosis, a person is unable to tell the difference between life events that are real and those that are imaginary. 

There are three categories for schizophrenia symptoms:

• Psychotic symptoms include delusions (false beliefs) and hallucinations (seeing or hearing things that don’t exist).

• Negative symptoms affect daily functioning. A person may show signs of depression, lack motivation, be disinterested in activities that once brought joy, and appear numb to emotional situations.

• Cognitive symptoms cause disordered thinking, difficulty focusing or following conversations, incoherent or nonsensical speech, and unusual or inappropriate behaviors.

At what age does schizophrenia occur?

Signs of schizophrenia typically appear for the first time between the late teens and early 20s for males. Symptoms often appear later in females, usually between the early 20s and 30s. During the tween years, there may be some noticeable changes in thinking or moodiness that affect relationships.

From the community: “…With my experiences with the disorder it started in my teens. i started hearing voices. i don't really experience the visual hallucinations, but i do experience the voices. i was scared to take the drugs once it got bad. i heard stories from friends about them and how they could numb your feelings.I luckily lived in a home where i had a good support system in place. My family got educated on the disorder, and also some people in my family in the past have had the disorder or symptoms of it at least. the voices would say that i'm worthless, and such. i did have suicidal thoughts at one point when it got more serious and consumed a lot of my life. some people didn't take what i said seriously and invalidated my feelings that were in my life.i'm glad that over time it has gotten better and im not in rock bottom anymore. schizophrenia is a newer concept and still misunderstood a lot by society. it still has a lot of stigma behind it, due to people not knowing what it is. i hope there is more awareness in the future of what it is, instead of people who have it getting the "crazy" label which invalidates us further.” – Inspire member 

What causes schizophrenia? 

There isn’t one particular cause of schizophrenia. Instead, many factors seem to play a role in the development of this mental disorder. These include:

• Genetics: A family history of schizophrenia may slightly raise the risk of schizophrenia, but most people who have relatives with schizophrenia don’t develop the disorder.

• Environmental factors: Someone who is genetically predisposed to schizophrenia and also exposed to poverty, physical abuse, substance abuse, or stressful situations may be more likely to develop schizophrenia.

• Brain chemistry: Changes to nerve cells in the brain that make dopamine (a chemical called a neurotransmitter) may bring on schizophrenia.

What is schizoaffective disorder?

Some people have both schizophrenia and a mood disorder like depression or bipolar disorder. This condition is called schizoaffective disorder. With this disorder, episodes of psychosis tend to get worse when a person is experiencing depression or mania. 

Schizoaffective disorder is rare, affecting 3 out of every 1,000 people. Using psychoactive drugs like LSD may cause this disorder. But genetics, brain chemistry, and life stressors also play a role, just as they do in schizophrenia.

People with schizoaffective disorder have psychotic symptoms (hallucinations and delusions), in addition to:

• manic symptoms like increased energy, restlessness, irritability, compulsive talking, insomnia, mood swings, and reckless behaviors

• depressive symptoms like low energy, feeling hopeless, lack of motivation, and an inability to complete tasks

From the community: “Schizoaffective disorder is an episode of major depression, mania, or a mix of the two which occurs along with the symptoms of schizophrenia. No two people with schizophrenia will have exactly the same symptoms, it all depends on how the disease if effecting that person and their life.” – Inspire member

How is schizophrenia diagnosed?

Psychiatrists diagnose mental health disorders like schizophrenia and schizoaffective disorder. These medical doctors refer to criteria established by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

Criteria for a schizophrenia diagnosis include:

• psychotic episodes that persist for at least six months

• onset of symptoms between the late teens and early 30s

How is schizophrenia treated?

There isn’t a cure for schizophrenia, but medication and other therapies can keep symptoms in check. Treatment involves a combination of:

• antipsychotic medications

• talk therapy (psychotherapy)

Antipsychotic medications

Antipsychotic medicines (also known as tranquilizers or neuroleptic drugs) minimize the frequency and severity of psychotic episodes. They work by lowering the amount of dopamine in the body. Taking this medicine daily and consistently may prevent psychosis altogether.

People with schizoaffective disorder may take antipsychotic medicines in combination with:

• antidepressants

• anti-anxiety medicines

• mood stabilizers like lithium

Talk therapy (psychotherapy)

People with schizophrenia see more improvement when they take antipsychotic medicines and also talk to a mental health counselor like a psychologist. This is psychotherapy. 

Talk therapies include the following:

• Cognitive behavioral therapy (CBT) helps a person change the way they think about and respond to delusions and hallucinations. Over time, CBT can make psychosis less disrupting and distressing.

• Family counseling helps everyone affected by the disorder learn how to better communicate and manage symptoms. Family counseling sessions provide a way for loved ones to create a supportive environment for the person with the mental disorder.

• Peer support groups bring people with schizophrenia together. Mental Health America’s online support group on Inspire is one way to meet others.

What are the side effects of antipsychotic medications?

An estimated 1 in 4 people who take antipsychotic medications develop a medication side effect called tardive dyskinesia. It causes uncontrollable facial or body movements, including symptoms like tongue thrusting, rapid eye blinking, lip smacking, and grimacing. 

Nearly all (95% of) antipsychotics prescribed today are second-generation antipsychotics (SGAs). These medicines are less likely to cause tardive dyskinesia than first-generation (conventional) antipsychotics.

Some SGAs may increase the risk of metabolic syndrome. This group of conditions — high blood pressure, abdominal fat, abnormal cholesterol levels, and high blood sugar — raises the risk of heart attack, stroke, and diabetes.

Doctors closely monitor people taking antipsychotic medicines for signs of tardive dyskinesia and metabolic syndrome.

What’s the prognosis for someone with schizophrenia?

Schizophrenia is a challenging disease, but it is possible to manage symptoms and enjoy life with proper treatment.

Schizophrenia is associated with:

• Other mental health disorders: More than half of those with schizophrenia also experience anxiety or depression.

• Poor health and shorter life span: Many people with schizophrenia also have heart disease, liver disease, or diabetes, which can shorten one’s life.

• Suicides: Close to 5% of people with schizophrenia commit suicide every year. 

• Workplace disability: Schizophrenia is among the top 15 causes of disability in the world.

Sources

• About DSM-5. American Psychiatric Association.

• What is schizophrenia? American Psychiatric Association. August 2020.

• How does CBT help people with psychosis? Child Mind Institute.

• Tardive dyskinesia. Mental Health America.

• Therapy. Mental Health America.

• Schizoaffective disorder. MedlinePlus. August 2020.

• Antipsychotic drugs. Merck Manual (Consumer Version). May 2020.

• Schizoaffective disorder. National Alliance on Mental Illness. 

• Tardive dyskinesia. National Alliance on Mental Illness. March 2019.

• Schizophrenia: Definition. National Institute of Mental Health. May 2018.

• Schizophrenia: Overview. National Institute of Mental Health. May 2020.

• Schizophrenia. World Health Organization. October 2019.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.