What is schizophrenia?

It is a condition which affects thinking, feeling and behaviour and causes people to have abnormal experiences. It is most likely to startbetween the ages of 15 to 35 and will affect about 1 in every 100 people during their lifetime.

What schizophrenia is not

Schizophrenia is not a split personality.

Many people think that schizophrenia makes people violent. This is the exception, not the rule. People with schizophrenia are more likely to be victims of violence by others.

Hospital admission is often not needed and many people with schizophrenia live a stable life, work, and have relationships.

What causes schizophrenia?

It seems to be a combination of factors. Genes, perhaps slight brain damage at birth or during pregnancy, childhood abuse. Street drugs (ecstasy, LSD, amphetamines and crack) seem to trigger it. Stress and family tensions make it worse.

What are the symptoms of schizophrenia?

“Positive” symptoms include:

  • Hallucinations - hearing, smelling, feeling or seeing something that isn’t there. Hearing voices is the most common problem. These can seem utterly real. The voices can be pleasant, but they are more often rude, critical, abusive or annoying.
  • Delusions - believing something completely even though others find your ideas strange and can't work out how you've come to believe them.
  • Difficulty thinking – you find it hard to concentrate and tend to drift from one idea to another. Other people can find it hard to understand you.
  • Feeling controlled – you may feel that your thoughts are vanishing, or that they are not your own, or that your body is being taken over and controlled by someone else.

“Negative” symptoms include:

  • Loss of interest, energy and emotions.
  • You may not bother to get up or go out of the house.
  • You don't get round to routine jobs like washing, tidying, or looking after your clothes.
  • You may feel uncomfortable with other people.

Most people have a mixture of positive and negative symptoms. If someone just has negative symptoms. the problem may not be recognised for years.

Treatments that can helpCan treatment help?

The earlier you get help, the better the outlook - and there is less need for hospital treatment.

Antipsychotic Medication

This helps to weaken any delusions and hallucinations. It should also help you to think more clearly and to look after yourself better. It can help in around 4 out of 5 people. It works best when taken regularly, even when you have felt better for some time. We are not sure how they work, but most of them reduce the action of a chemical in the brain called 'dopamine'. Like all medicines, they do have side-effects, especially at higher doses:

  • They can all cause tiredness and sexual difficulties.
  • One group (eg. chlorpromazine, haloperidol and zuclopenthixol) can also cause stiffness, shakes and restlessness.
  • A different group (eg. olanzapine, risperidone and quetiapine) have less effect on the muscles, but they can cause weight gain and diabetes.
Psychological Treatments
  • Cognitive Behavioural Therapy can help you to cope with your experiences and to work out if there are things you do, or habits of thinking that make you unwell. You can then find new ways of thinking or behaving that help you to stay well.
  • Family therapy can help you and your family cope better with the illness. In the sessions, you learn about the condition, ways to support someone with schizophrenia, and how to solve some of the practical problems that can arise.
Social Support and Recovery
  • Day centres - offer classes, advice about education and employment, and a place to spend time with other people.
  • Work projects - they will support you in getting back to work.
  • Art therapies - to help you express yourself.
  • Supported accommodation – staff on-site or visiting, it can help you gain confidence in living independently.
  • A community mental health team or key-worker can support you, both with practical advice and with treatment. Occupational therapists can help you develop skills for living, working and getting on with other people.
How to help yourself
  • Learn to recognise the signs that you are getting unwell – these signs might be going off your food, feeling anxious or sleeping badly. Someone you trust may be able to warn you if they see you becoming unwell.
  • Try to avoid getting too stressed, or using alcohol to feel better. Make sure you are able to do things that you enjoy.
  • Try to keep healthy - eat well, don't smoke and keep fit.
  • Street drugs should be avoided. However much you might like them, they will make you worse.
Helping someone else

It can be hard to understand what is happening. The person you know starts to behave differently, avoids other people and become less active. If they have delusions, they won't always talk about them. If they are hearing voices, they may suddenly look away from you as they listen to the voice. When you speak to them, they may say little, or be difficult to understand.

A person with schizophrenia can be more sensitive to stress, so you can help by avoiding arguments and keeping calm.

Can I talk to the mental health team?

If you are caring for your relative, you should be able to get information from healthcare professionals. They can advise on psychological treatments, drugs and side-effects, and can suggest ways to help recovery.

For more in-depth information see our main leaflet: Schizophrenia

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Dr Michael Yousif

© February 2014. Due for review: February 2016. Royal College of Psychiatrists.