Carl R. Darnall Army Medical Center - Health Library

Schizophrenia

Definition

Schizophrenia is a chronic, severe, disabling brain disorder. It interferes with the way a person interprets reality. People with schizophrenia may:

  • Hear voices or see things that others do not
  • Become paranoid that people are plotting against them
  • Experience cognitive deficits—may include forgetfulness, or difficulty with concentration or paying attention
  • Withdraw socially

These and other symptoms make it difficult for people with schizophrenia to have meaningful relationships with others or maintain a productive lifestyle.

Regions of the Brain
Colored brain segments

Schizophrenia affects many different areas of the brain causing a wide range of behavioral, emotional, and intellectual symptoms.

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Causes  ^

The cause of schizophrenia is unknown but it is associated with problems in brain structure and chemistry. Genetics may be a factor.

Schizophrenia does not develop because of one factor. You may have a combination of changes in your genetic background that could increase your chances of schizophrenia. This alone doesn't mean you'll develop the disease. Outside environmental factors such as stress, infection, or trauma may also increase this risk. However, there is no clear evidence that any one single environmental factor leads to schizophrenia.

Risk Factors  ^

Factors that may increase the chances of schizophrenia:

  • Having a parent or sibling with schizophrenia
  • Marijuana or other drug use
  • Father being of older age
  • Other factors such as problems during pregnancy or birth

Symptoms  ^

Men typically develop symptoms in their late teens or early twenties. Schizophrenia in women tends to occur in their twenties or thirties. In rare cases, schizophrenia starts in childhood.

Symptoms often appear slowly. Early signs may include difficulty with relationships, school, or work. The symptoms may occur in a matter of weeks, but most of the time they tend to become more disturbing or bizarre over a period of 6 months or longer.

Positive symptoms are behaviors that are not generally seen in healthy people. They may lose touch with reality with:

  • Hallucinations—seeing or hearing things/voices that are not there
  • Delusions—strong but false personal beliefs that are not based in reality
  • Thought disorders
  • Movement disorders

Negative symptoms are associated with breaks in normal emotions and behaviors such as:

  • Emotional flatness—flat speech, lack of facial expression, and general disinterest and withdrawal
  • Reduced feelings of pleasure
  • Difficulty starting and continuing activities
  • Reduced speaking

Cognitive symptoms are changes in memory and thinking such as:

  • Poor ability to understand information and make decisions based on it
  • Difficulty focusing
  • Difficulty using information immediately after learning it

Diagnosis  ^

You, or a loved one or caregiver, will be asked about your symptoms and medical and mental health history. A physical exam will be done. A psychological exam may also be done.

It will take some time to confirm a schizophrenia diagnosis. Tests may be done to rule out other conditions or lifestyle habits such as substance misuse that can cause similar symptoms. Schizophrenia is diagnosed when 2 or more of the following symptoms occur and reduce ability of day to day life:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
  • Symptoms that disrupt normal emotions and behaviors—also known as negative symptoms

Treatment  ^

Schizophrenia is not curable, but symptoms can be reduced through treatment. Early, aggressive treatment can lead to better outcomes and may delay progression of schizophrenia to psychosis.

Hospitalization may be required during acute episodes. Symptoms are usually controlled with antipsychotic medications. Talk to your doctor about the best treatment plan for you. Options may include one or more of the following:

Antipsychotic Medications

Antipsychotics work by blocking certain chemicals in the brain. This helps control the abnormal thinking that occurs in people with schizophrenia. Determining a drug plan can be a complicated process. Often medications or dosages need to be changed until the right balance is found. This can take months or even years. The right balance of medication will have the least amount of side effects possible with the greatest benefit.

It is important to continue taking the medication even if you are feeling better. Symptoms will return once the medication has been stopped. A long-acting injection instead of daily pills may be used if you have difficulty taking regular medication.

Antipsychotics also have side effects that may make it difficult to stick to a medication routine. Common side effects include:

  • Slow and stiff movements
  • Restlessness
  • Facial tics
  • Protruding tongue

Medications called atypical antipsychotics have fewer side effects and are better tolerated over long periods of time. However, these medications may cause significant weight gain, high blood sugar, and high cholesterol.

Medications for Coexisting Conditions

Depression and anxiety can often occur with schizophrenia. They may be treated with:

  • Antidepressants
  • Anti-anxiety medications
  • Mood stabilizers
  • Anticonvulsants

Supportive Therapy

Schizophrenia is a lifelong condition. It can be confusing and frightening for the person with the disease and for family members. Individual and family therapy can address:

  • Social skills
  • Vocational guidance
  • Community resources
  • Family issues
  • Living arrangements
  • Emotional support

Prevention  ^

There are no current guidelines to prevent schizophrenia because the cause is unknown.

RESOURCES:

National Institute of Mental Health
https://www.nimh.nih.gov

National Alliance on Mental Illness
https://www.nami.org

CANADIAN RESOURCES:

Canadian Psychiatric Association
https://www.cpa-apc.org

Mental Health Canada
http://www.mentalhealthcanada.com

REFERENCES:

Counseling therapies for shizophrenia. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T903876/Counseling-therapies-for-schizophrenia. Updated July 19, 2016. Accessed April 18, 2018.

Medications for shizophrenia. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T905976/Medications-for-schizophrenia. Updated March 13, 2018. Accessed April 18, 2018.

Schizophrenia. American Psychiatric Association website. Available at: https://www.psychiatry.org/patients-families/schizophrenia. Updated July 2015. Accessed April 18, 2018.

Schizophrenia. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115234/Schizophrenia. Updated March 26, 2018. Accessed April 18, 2018.

Schizophrenia. National Institute of Mental Health website. Available at: https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. Updated February 26, 2016. Accessed april 18, 2018.

4/29/2016 DynaMed Plus Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Stafford MR, Jackson H, Mayo-Wilson E, Morrison AP, Kendall T. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ. 2013;346:f185.

Last reviewed March 2018 by EBSCO Medical Review Board Adrian Preda, MD  Last Updated: 4/17/2018