Schizophrenia

Overview

Schizophrenia is a serious mental illness characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling.

Fortunately, effective treatments are available. These can help people with schizophrenia stay in school, keep working, be independent, and enjoy relationships.

Signs and Symptoms

Schizophrenia symptoms generally fall into three main categories: psychotic, negative, and cognitive.

Psychotic Symptoms

Psychotic symptoms include changes in the way a person thinks, acts, and experiences the world. A person experiencing psychotic symptoms often has disrupted thoughts and perceptions. They may have difficulty recognizing what is real and what is not. For some, these symptoms come and go. For others, the symptoms become stable over time.  Psychotic symptoms include:

• Hallucinations. When a person sees, hears, smells, tastes, or feels things that are not there. Hearing voices is common among people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
• Delusions. When a person has strong beliefs that are not objectively true and may seem irrational to others. For example, a person experiencing delusions may believe that people on the radio and television are sending special messages that require a certain response, or they may believe that others are trying to hurt them.
• Thought disorder. When a person has ways of thinking that are unusual or illogical. People with thought disorder may have trouble organizing their thoughts and speech. They may stop talking in the middle of a thought, jump from topic to topic, or make up words that have no meaning.

Negative Symptoms

Negative symptoms include loss of motivation, loss of interest or enjoyment in daily activities, withdrawal from social life, difficulty showing emotions, and difficulty functioning normally. These symptoms are sometimes mistaken for symptoms of depression or other mental illnesses. Negative symptoms include:

• Having trouble planning and sticking with routine activities, such as grocery shopping
• Having trouble anticipating and being motivated by pleasure in everyday
• Talking in a dull voice and showing limited facial expression
• Avoiding social interaction or interacting in socially awkward ways
• Having very low energy and spending a lot of time in passive activities (In extreme cases, a person might stop moving or talking for periods of time. This rare condition is called catatonia.)

Cognitive Symptoms

Cognitive symptoms include problems with attention, concentration, and memory. These symptoms can make it hard to follow a conversation, learn new things, or remember appointments. A person’s level of cognitive functioning is one of the best predictors of their day-to-day functioning. Cognitive symptoms include:

• Having trouble processing information to make decisions
• Having trouble using information immediately after learning it
• Having trouble focusing or paying attention

Related Health Effects

Schizophrenia can bring significant health, social, and economic concerns.

• People with schizophrenia have an increased risk of death at a younger age than the general population.
• The increased risk of early death in people with schizophrenia may be because of medical conditions that often co-occur with schizophrenia, such as heart disease, liver disease, and diabetes. These conditions may be less likely to be detected and treated in people with schizophrenia.
• Higher rates of premature death among people with schizophrenia are also related to the fact that death by suicide is much more common in people with schizophrenia than in the general population. The highest risk is in the early stages of illness.
• About half of those with schizophrenia have other mental and/or behavioral health disorders as well.
• Financial costs associated with schizophrenia tend to be higher than other chronic mental and physical health conditions. This reflects both the costs of health care and other costs such as lost productivity, criminal justice involvement, and social service needs.
• Left untreated, psychotic symptoms can lead to disruptions in school and work, strained family relationships, and separation from friends. The longer symptoms go untreated, the greater the risk of a person developing a substance use disorder, injuring themselves, and becoming homeless or unemployed.

Most people with schizophrenia are not violent. However, the risk of self-harm and violence to others is elevated when the illness is untreated or co-occurs with alcohol or substance misuse. Also, people with schizophrenia are more likely than those without schizophrenia to be harmed by others.

Causes and Risk Factors

Research suggests that a combination of genetic factors and aspects of a person’s environment and life experiences may play a role in the development of schizophrenia.

Genes

Schizophrenia sometimes runs in families. However, just because one family member has schizophrenia, it does not mean that other members of the family will also have it. Studies suggest that a combination of genetic factors may affect a person’s chances of developing schizophrenia, and that no single gene causes the disorder by itself.

Environment

Research suggests that various aspects of a person’s environment and life experiences can play a role in the development of schizophrenia. These environmental factors may include poverty, stressful or dangerous surroundings, and exposure to viruses or nutritional problems before birth.

Brain Structure and Function

Research shows that people with schizophrenia may be more likely to have subtle differences in the size of certain brain areas and in connections between brain areas. Some of these brain differences may develop before birth or early in life.

Diagnosis

People with schizophrenia are usually first diagnosed between the ages of 16 and 30 after they experience their first episode of psychosis. The condition tends to emerge in males in late adolescence to early twenties. Females are more often diagnosed in their early twenties to early thirties. Schizophrenia is rare in younger children.

More subtle changes in cognition and social relationships may precede the actual diagnosis, often by years. Identifying these subtle changes and connecting people with treatment early could have long-term benefits.

A qualified mental health professional, such as a psychologist, psychiatrist, or social worker, can provide a thorough assessment and accurate diagnosis. As part of the process of diagnosing schizophrenia, health care providers will determine whether other factors, such as sleep deprivation, certain prescription medicine, or misuse of alcohol or drugs, might be causing the psychotic symptoms.

Early diagnosis and appropriate treatment make it possible to recover from psychosis. Some people who receive early treatment never have another psychotic episode. For other people, recovery means the ability to live a fulfilling and productive life, even if psychotic symptoms sometimes return.

Treatment and Management

Starting treatment for schizophrenia as soon as possible is an important step toward recovery. Current treatments focus on helping people manage their symptoms, improve day-to-day functioning, and achieve personal life goals, such as completing education, pursuing a career, and having fulfilling lives.

There is no “one-size-fits-all” treatment. To find one that works best, a person may need to talk to a few health care providers and try several different treatments or a combination of treatments.

Coordinated Specialty Care

Coordinated specialty care programs are recovery-focused programs for people with first-episode psychosis, an early stage of schizophrenia. Health professionals and specialists work together as a team to provide care, which includes psychotherapy, medicine, case management, employment and education services, and family education and support. The treatment team works collaboratively with the patient to make treatment decisions. They also involve family members as much as possible.

Compared with typical care, coordinated specialty care is more effective in reducing symptoms, improving quality of life, and increasing involvement in work or school. Coordinated specialty care is now the standard of care for early psychosis, according to The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.

Antipsychotic Medicine

Antipsychotic medicine can help make psychotic symptoms less intense and less frequent. This type of medicine is usually taken every day in a pill or liquid form. Some forms may be given as an injection once or twice a month.

If a person’s symptoms don’t improve with usual antipsychotic medicine, they may be prescribed clozapine. While clozapine is generally recognized as the strongest antipsychotic medicine, the risk of serious side effects, particularly a dangerous reduction in white blood cell count, discourages its use as a first-line treatment. People who take clozapine must have regular blood tests to check for this side effect, which occurs in 1% to 2% of patients.

People respond to antipsychotic medicine in different ways. Many who start taking antipsychotic medicine have side effects such as weight gain, dry mouth, restlessness, and drowsiness. Some of these may go away over time, while others may last. People may need to try several medicines before finding the one that works best. Do not stop taking a medicine without first talking to a health care provider. Read the most up-to-date information on medicines, side effects, and warnings on the U.S. Food and Drug Administration (FDA) website.

Family Education and Support

Educational programs can help family and friends learn about symptoms of schizophrenia, treatment options, and strategies for helping loved ones with the illness. These programs can help friends and family manage their own distress, boost their coping skills, and strengthen their ability to provide support.

Assertive Community Treatment

Assertive community treatment is designed to help people with schizophrenia who are likely to experience multiple hospitalizations or homelessness. This type of treatment is usually delivered by a team of health care providers who work together to provide care to patients in the community.

Psychosocial Treatments

Psychosocial treatments help people find solutions to everyday challenges and manage symptoms while attending school, working, and forming relationships. These treatments are often used together with antipsychotic medicine. People who participate in regular psychosocial treatment are less likely to have symptoms recur or to be hospitalized.

Examples of these treatments include cognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions.

Substance Abuse Interventions

People with schizophrenia may also have problems with drugs and alcohol. A treatment program that includes treatment for both schizophrenia and substance use is important for recovery, because substance use can interfere with treatment for schizophrenia.

How Can I Help a Loved One with Schizophrenia?

Aside from helping a loved one access treatment, it can be difficult to know how to help someone who is experiencing psychosis. Here are some things you can do:

• Encourage them to stay in treatment.
• Remember that their beliefs or hallucinations seem very real to them.
• Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior.
• Look for support groups and family education programs.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on schizophrenia.

Find Treatment

If you have concerns about your or your loved one’s mental health, talk to a primary care provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help you figure out the next steps.

You can learn about finding support and locating mental health services in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) websites.

The following organizations can also help you find treatment programs and support:

• Early Psychosis Intervention Network’s (EPINET): Early Psychosis Intervention Network Clinics provide treatment and services to individuals with early psychosis across 17 states.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) has an Early Serious Mental Illness Treatment Locator for finding mental health treatment facilities and programs.

Community Support

Additional resources are available to learn more about schizophrenia:

• The National Alliance on Mental Illness (NAMI) offers support groups and family education programs for people with schizophrenia and their loved ones. The NAMI HelpLine can connect you with the NAMI office in your state and help you find programs close to home.
• Mental Health America supports individuals with lived experience of mental health conditions through public education, advocacy, and screening.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research to understand the origins of schizophrenia and clarify how symptoms develop over time. Researchers are studying ways to identify people who are likely to develop schizophrenia before psychosis and other symptoms emerge. They are also trying to find better ways to evaluate a person’s symptoms and functioning and to predict how they will change over time.

NIH-supported research explores new treatment approaches that target the disorder’s specific cognitive, emotional, or interpersonal aspects. Researchers are working to improve and expand Coordinated Specialty Care, a recovery-oriented approach to treating early psychosis that emphasizes shared decision-making among specialists, the person experiencing psychosis, and family members.

NIH also supports the Early Psychosis Intervention Network (EPINET). EPINET funded awards to establish regional scientific hubs connected to multiple coordinated specialty care programs and a national data coordinating center. The initiative now includes eight regional hubs in 17 states with more than 100 clinics that provide coordinated specialty care.

In addition, NIH supports the Accelerating Medicines Partnership® Program for Schizophrenia, a public-private partnership that aims to identify new and better treatment targets for schizophrenia and related mental health conditions.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.