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Schizophrenia is a complex psychiatric disorder in which a person has episodes of psychosis (loss of contact with reality) along with other symptoms that have an adverse effect on thoughts, feelings, and behaviors. Contrary to portrayals in popular culture, schizophrenia is not associated with having multiple personalities.

Who develops schizophrenia?

Schizophrenia can affect anyone. Roughly twelve million males and nine million females around the world have the disorder. Men are most often diagnosed in their late teens to early 20s. Women are most often diagnosed in their late twenties to early thirties, although some have their first episode around menopause. The diagnosis is almost never made in children, although researchers believe that some symptoms can begin to develop in childhood.

What causes schizophrenia?

Most cases of schizophrenia are believed to be a result of both genetic and environmental causes. Some risk factors are: Having a close relative with schizophrenia. Exposure to viruses before birth. Older age of the father. Living in a city environment. Complications during the pregnancy or delivery. Abnormalities in brain chemistry or structure (not caused by trauma).

Schizophrenia is not caused by trauma to the brain, ‘bad’ parenting, evil spirits, or witchcraft.

What are the symptoms of schizophrenia?


Everyone with schizophrenia is affected by at least one form of psychosis, along with a few or many of the other symptoms that characterize schizophrenia. There are three forms of psychosis:

  • Hallucinations
  • Delusions
  • Disorganized thoughts and behaviors

Other, non-psychotic symptoms can be categorized as:

  • Negative symptoms
  • Cognitive impairment
  • Mood and anxiety symptoms

Forms of psychosis

Hallucinations: Hallucinations are ‘sensory’, meaning they affect one or more of our senses.

  • Auditory: hearing voices or other sounds that are not present. Auditory hallucinations are the most common type of hallucination
  • Visual: seeing objects or abstract shapes or lights that are not actually there
  • Somatic: the feeling of being touched, although nothing is touching the affected area
  • Olfactory (smell) and Gustatory (taste) hallucinations exist but are uncommon

Delusions: Delusions are beliefs that a person holds onto even when the belief is objectively impossible. For example, a person might believe that space aliens implanted a transmitter in their brain.

Disorganization: Disorganization can be demonstrated by speech or behavior. Disorganized speech can be a sign of disorganized thoughts. Examples of disorganized speech include:

    • Circumstantial speech, in which the person only gets to the point after numerous detours
    • Derailment, in which the person switches topic for no apparent reason
    • Neologisms, in which a person makes up words with no clear meaning
    • Word salad, in which the person randomly tosses words together

Disorganized behavior affects a person’s ability to start or finish a task.

Negative symptoms

Negative symptoms involve a reduction in normal activity, including a decline in expression, interest, movement, energy, and/or speech. Consequences of negative symptoms can include poor hygiene, job loss, and social isolation.

Negative symptoms can be mistaken for clinical depression.

Cognitive impairment


Cognitive impairment in schizophrenia involves a reduction in thought, understanding, and ‘executive function’. Abilities that are commonly affected include:

  • Attention
  • Understanding the meaning of a word
  • Interacting with other people
  • Learning and memory – visual and/or verbal
  • Problem-solving

Mood and anxiety symptoms

People with schizophrenia experience high rates of anxiety and depression.

Associated physical symptoms

  • Neurological: Symptoms are similar to those caused by antipsychotic medications.
    • Tremor
    • Slow movements
    • Feeling of restlessness
    • Uncontrolled movements such as lip smacking
  • Catatonia/catatonic excitement:
    • Catatonia is the term for a state of resistance to movement
    • Catatonic excitement is the term for excessive movement without a purpose
  • Metabolic disturbances such as weight gain and diabetes. Antipsychotic medications can cause weight gain and diabetes. However, even before the development of the medications, people with schizophrenia were affected at higher-than-average rates.

How is schizophrenia diagnosed?

Different countries allow different types of health care providers to diagnose schizophrenia. Because there are no laboratory tests that can confirm the presence of schizophrenia, the diagnostic process involves taking a detailed and complete medical history and ruling out conditions with similar symptoms. It can be useful for the healthcare provider to interview family members because many people with schizophrenia lack awareness of their condition.

Cultural or religious beliefs can affect the way a person perceives their symptoms and treatment. It can be helpful to have a health care provider who understands and respects the persons cultural or religious background.

How is schizophrenia treated?

The most effective treatment plans incorporate medication with psychotherapy and psychosocial support, family counseling, and community-based assistance if needed.

Medication

If the first sign of schizophrenia is a psychotic episode, the priority is to stabilize the person.  This might require short-term hospitalization.  Once they have been stabilized, the first line of treatment is an antipsychotic medication. At least one person on the healthcare team should be experienced in prescribing medication for schizophrenia. It is not unusual to try different medications or doses before finding one that is effective with tolerable side effects.    

Side effects of antipsychotics include:

  • Involuntary movements
  • Stiff muscles
  • Sedation
  • Dry mouth

Newer medications, known as “atypical” antipsychotics, cause fewer movement disorders. However, they increase the risk of weight gain and diabetes.

In order to make an accurate diagnosis and to safely prescribe medications, the prescriber must be informed of every medication that the person takes, including over-the-counter medications, vitamins, and other supplements. Using a smartphone app with a medication management feature can help to provide an accurate list to healthcare providers.

Complementary or alternative therapies should never be used as a substitute for medication.

Multidisciplinary approaches


Medication alone is insufficient for managing schizophrenia. The most effective approaches incorporate medication along with 

  • Psychotherapy or psychosocial therapy. Forms of therapy might include:
    • Cognitive behavioral therapy 
    • Supportive psychotherapy
    • Education about schizophrenia
    • Peer support groups
    • Community-based assistance. This provides social skills training, as well as housing and job placement if needed.

Family psychoeducation to help the family support their loved one. Education and recommended strategies should include:

    • How to help the loved one avoid stressful situations
    • Understanding that schizophrenia is a medical condition for which no one is at fault
    • How to help keep their loved ones safe, get to appointments, and consistently take their medication
    • How to stay calm when feeling angry or frustrated
    • Understanding that their loved one might not believe that they have schizophrenia
    • How to help the loved one avoid drugs or alcohol – both of which can worsen symptoms
    • Making sure the family knows how to (and is willing to) get emergency help if they feel that the loved one is a danger to themselves or to others

Are people with schizophrenia more likely to have other conditions?

People with schizophrenia are more likely to have certain other conditions. These include:

  • Substance abuse
  • Post-traumatic stress disorder
  • Obsessive compulsive disorder
  • Major depressive disorder

Treating schizophrenia typically results in improvement in these disorders as well.

What is the prognosis for a person with schizophrenia?


Around half of all people with schizophrenia are eventually able to function in society with only mild symptoms. However, it typically takes a minimum of five years to reach that point.

Several factors influence how the disease progresses. These include:

  • If symptoms began suddenly or over time
  • If symptoms began in adolescence or childhood
  • If symptoms are continual or occasional
  • If treatment was obtained early in the illness
  • If the person participates in multidisciplinary treatment (such as medication, psychotherapy, and psychosocial support)
  • If stressful events occur during the illness
  • If the person is prescribed the appropriate medication and takes it as prescribed

Misunderstandings about schizophrenia can cause people with the disorder to feel stigmatized, which in turn creates stress and exacerbates symptoms.

It is true that the challenges of schizophrenia can lead to self-medication, but most people with schizophrenia do not abuse illegal substances. And although people with schizophrenia are not inherently violent, some do become aggressive during a psychotic crisis in an attempt to protect themselves or someone else from a perceived threat. And although most people with schizophrenia are not homeless, symptoms and treatment can make it difficult to hold a steady job, thereby limiting housing options.

If you are concerned that you or a loved one might have schizophrenia, it is important that you or they start treatment as soon as possible, preferably with a multidisciplinary team of professionals, with patience in finding the best medication and dose, and with love, support and understanding from friends and family.

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