Schizophrenia

• What is schizophrenia?
• Who gets schizophrenia?
• When people first become unwell
• Different types of schizophrenia
• Treatment
• Physical health problems
• Living with schizophrenia

What is schizophrenia?

People with schizophrenia experience the symptoms of psychosis – delusions, hallucinations and disordered thinking. Mental health professionals describe these as the 'positive symptoms' of schizophrenia.

People with schizophrenia also experience what mental health professionals call ‘negative symptoms’. People may have no energy and lose the motivation to do anything; they may lose interest in friends, family members and activities they previously enjoyed. They may also have memory problems and find it very hard to concentrate. They may no longer care about their personal appearance and become isolated and withdrawn.

Schizophrenia is a serious mental illness, but people may not feel unwell or think that they have a problem. They may not want to ask for help or treatment.

The experiences and symptoms each person has will differ and last for different periods of time. Some people are unwell for only a short period. Others experience negative symptoms for months, or even years. A few people have just one episode of psychosis in their lives. Many people have episodes of psychosis that come and go over time.

People with schizophrenia may also experience depression and anxiety. 

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Who gets schizophrenia?

About one in every 200 people currently has a diagnosis of schizophrenia.

People can develop schizophrenia at any age, but the illness usually starts for men when they are in their late teens or early 20s. Women tend to develop schizophrenia when they are slightly older, in their late 20s. A small number of people develop schizophrenia in middle age.

Anyone can get schizophrenia, though children of a parent who has the illness are slightly more likely to become unwell. Even though genes play a part in the development of schizophrenia, there is no single cause and many contributing factors (see What causes psychosis? page). Just because one person in the family has schizophrenia doesn’t mean that other family members will inevitably develop the illness.

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When people first become unwell

Sometimes the illness starts suddenly with an acute, and often frightening, episode of psychosis.

However, a first episode of psychosis is often preceded by what health professionals call a ‘prodromal period’ when people’s behaviour begins to change.

People are often depressed or anxious, may find it difficult to concentrate or have problems remembering things, stop seeing their friends, act in a strange and uncharacteristic way, be less interested in study, work or hobbies and care less about how they look. They may become socially withdrawn and spend much more time alone.

They also sometimes have experiences resembling the symptoms of psychosis – hearing voices every now and then, being occasionally suspicious and paranoid for example (see Paranoia page). However, not everyone who has these sort of experiences will go on to have a first episode of psychosis (see Psychotic-like experiences page).

A large proportion of people who experience psychosis for the first time will get better with treatment. Others will improve but may have further episodes.

Research has shown that the quicker treatment is given, the better people recover from the symptoms. People who don’t access mental health services when they first get symptoms may get better slower, or be less likely to get completely better, and have an increased risk of relapse in the future (see Early intervention services page).

When people experience the symptoms of psychosis for the first time, it may not always be clear if they have schizophrenia, bipolar disorder or schizoaffective disorder. Therefore, a diagnosis will not necessarily be given after a first episode.

It is not unusual for a diagnosis to change. Different diagnoses are given in response to symptoms an individual has at any particular time. 

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Different types of schizophrenia

There are different 'sub-types' of schizophrenia. The kind of symptoms people experience are used to make a sub-type diagnosis. If someone is diagnosed with paranoid schizophrenia, for example, it means the symptoms they experience most are delusions, paranoia and voices. 'Paranoid schizophrenia' is the most common sub-type.

The sub-types of schizophrenia are described in two guides that are used by psychiatrists to help them make a diagnosis. One of them is called the Diagnostic and Statistical Manual of Mental Disorder (DSM) and is published by the American Psychiatric Association. The other is called the International Classification of Diseases (ICD). It includes a special section on psychiatric illness and is published by the World Health Organisation (see Specific diagnoses page).

A new updated version of the DSM is to be published in May 2013. One of the proposed changes is to abolish the sub-types of schizophrenia.

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Treatment

People who are experiencing an episode of psychosis will be prescribed antipsychotic medication.

The National Institute of Clinical Excellence (NICE) also recommends people with schizophrenia should be offered cognitive behaviour therapy and family therapy, and that mental health professionals should consider offering arts therapies. However, talking therapies and arts therapies are not available everywhere.

After an acute episode of psychosis, people will be encouraged to take antipsychotic medication for some time. If they stop taking the drugs too soon, symptoms may return. Some people with schizophrenia will continue to take antipsychotics for many years, even for life.

The symptoms of psychosis mostly diminish and often disappear following treatment with antipsychotic drugs and talking therapies.

However, antipsychotic drugs don’t work for some people. Mental health professionals call their illness ‘treatment-resistant’, or ‘refractory’ schizophrenia.

The antipsychotic clozapine can suppress the symptoms of psychosis in people who have not got better after taking other antipsychotics. However, clozapine can damage white blood cells, so people who take it need to be monitored and have regular blood tests. The NICE guidance says people with a diagnosis of schizophrenia should be offered clozapine after trying at least two other drugs, including one of the newer atypical antipsychotics.

Sometimes, antipsychotic medication controls the symptoms of psychosis, but people still experience the negative symptoms of schizophrenia, and these may last for some time.

If people experience depression and anxiety, they may be prescribed antidepressants or drugs that tackle anxiety.

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Physical health problems

People with schizophrenia are more at risk of physical health problems, including weight gain, high blood pressure, heart disease and diabetes. These problems are caused by changes in lifestyle as a result of the symptoms of the illness – research has shown that people with schizophrenia and other serious mental health conditions tend to look after themselves less well, are more likely to smoke, less likely to eat healthy food and take regular exercise. Long-term use of antipsychotics can lead to weight gain and also increase the risk of cardiovascular disease and diabetes.

Research has shown that people who have a serious mental health problem like schizophrenia have shorter lives compared to the national average and these physical health problems contribute to premature death.

GPs should check the physical health of people with schizophrenia once a year, including their weight, blood pressure, blood sugar and cholesterol levels. People should be given treatment for any physical health problems and encouraged to raise any such problems with their GP.

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Living with schizophrenia

Schizophrenia can severely affect people’s lives and the lives of their families. In addition to the distressing and often frightening symptoms, people with schizophrenia may find it difficult to get jobs, make friends and have relationships. Other people’s fear and misunderstanding of the illness often leads to discriminatory practices that leave people with schizophrenia even more socially isolated (see Discrimination and stigma page).

People with schizophrenia may need support from social services as well as health care and mental health professionals should help organise this (see Services and support page).