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Schizophrenia is a long-term mental health condition that affects the mind in many ways. It can cause varying psychological symptoms affecting how you think, feel and behave.
It is one of several mental health conditions (such as bipolar disorder) that causes psychosis in patients, which is a term used to describe delusions, or a false sense of reality. Symptoms of schizophrenia can present differently in different people; so, two people with the condition will not necessarily have the same experience.
When symptoms of the condition present more severely, it can have a large impact on day-to-day life (to the extent that hospital admission may be necessary for a period of time). This is because psychotic symptoms, such as hallucinations, feel completely real to the person experiencing them and can create risk of harm to the person and others around them in some situations.
However, many people with the condition are able to live fulfilled lives in the community, where they have recovered from their symptoms, or are managing these with community mental health support.
Data from the Royal College of Psychiatry has found that schizophrenia can affect 1 in 100 people over the course of their life. It can develop as early as adolescence in some people, but in the majority of cases, first symptoms develop in early adulthood up to the age of 35.
There is no clear causal factor that determines whether you will get schizophrenia in your lifetime, but there are a number of circumstances that can create a higher chance of you developing the condition (which will be explained further on in this guide).
Research suggests that men and women are equally affected by the condition, with men receiving diagnosis at a slightly earlier age than women. Schizophrenia is one of many health conditions that, until the last decade, tended to have a negative stigma associated with the condition in the media, health settings and with employers; causing adverse effects to those suffering with the condition.
However, since the introduction of the Equality Act 2010, mental health has been treated with more empathy, and become a protected right in law that condemns discrimination.
Some research by MIND mental health charity suggests that black people in the UK could be more likely to receive a diagnosis of schizophrenia than other ethnicities, which could be due to healthcare discrimination as opposed to black people being at higher risk of the condition biologically. You can read further information about types of discrimination in our knowledge base.
Work continues to challenge mental health discrimination, with many charities raising awareness through events to improve the lives of those affected. On 25 July 2021, National Schizophrenia Awareness Day takes place to raise awareness of the challenges faced by those affected by the condition, as well as working to eradicate the stigma and discrimination associated with the condition.
What are the signs and symptoms of schizophrenia?
There are a range of symptoms that schizophrenia can cause, but not every person with the condition will experience every symptom. Symptoms can be categorised as positive and negative symptoms, but this does not mean that some symptoms are good and other symptoms are bad.
Positive symptoms can be explained as those which are felt in addition to reality, such as psychotic symptoms (which will be explained further shortly). Negative symptoms can be described as demotivating symptoms, causing you to react less with reality and feel unable to complete daily tasks.
Positive symptoms induce a period of psychosis, which is when the brain loses touch with reality and tricks you into seeing, hearing or thinking a range of things that nobody else can experience. They make it difficult for the person to understand what is real and what isn’t because the symptoms feel completely real to the person.
These schizophrenia symptoms include:
- Hallucinations – Hallucinations occur when a person hears, sees, smells or feels something that isn’t real. Most commonly in schizophrenia, it is predominantly hearing that is affected (described as “hearing voices”), but the other forms of hallucinations can also occur. The hallucinations are completely real to the person experiencing them, as the brain tricks the person’s senses into hearing, seeing, feeling or smelling something external from the body. Commonly, people with schizophrenia will either experience hallucinations coming from different places, or regularly experience them coming from a single object, or place. When a person hears voices, the voices can talk directly to the person, or can be several voices talking among each other that the person can hear. Most of the time the voices are irritating, abusive and distracting for the person, but at times the voices can also be pleasant.
- It is initially advised for people with schizophrenia to try to ignore voices if they are hearing them. If this is not possible because they are particularly loud, some patients may try to talk or shout back at them asking them to stop. At times, voices can try to influence a person to do things that are bad, which can be additionally challenging to ignore. If this occurs you can contact a health professional for advice and support to manage the challenging symptoms to prevent the situation from escalating.
- Delusions – Delusions are beliefs or thoughts that a schizophrenia patient has that are completely unrealistic and different to reality. Other people may suggest that the patient is misunderstanding a particular situation or has mistaken something. The delusions are completely true to the patient and it can get frustrating when other people tell them that they are wrong. Often the delusions can appear out of nowhere; a patient could wake up one day and suddenly feel like they have a better understanding of the world (because of their delusion).
- Paranoia – Paranoia can be closely linked to delusions. It is the thought of feeling spoken about, threatened or harassed. A person with schizophrenia may feel like people are trying to “get them”, and may alter their behaviour to respond to their paranoia; such as avoiding particular people, or even changing locations in a false attempt to keep safe. Some common paranoid delusions include feeling like spies are watching, or loosing trust in people who you are usually close to (such as friends and family).
- Muddled thinking – Muddled thinking is also known as disorganised thinking. As the name suggests, it means that the person struggles to process their thoughts or concentrate on one thing as a time. This can make even the simplest of daily tasks challenging such as watching TV or washing clothes. It can feel like the brain is working at maximum speed, or like the brain is hazy; with some people experiencing feelings of their thoughts being controlled.
To other people, negative symptoms can appear to be more subtle, and can easily be mistaken for laziness. This is because the symptoms listed below can be difficult to explain, or can also be a result of a different mental health problem, making them harder to attribute to schizophrenia. However, for the person with schizophrenia, they are extremely draining and, at times, feel more serious than positive symptoms.
It is important that a patient’s experience is always taken seriously to avoid them failing to reach out for help in the future. Negative symptoms of schizophrenia can be likened to symptoms of depression, so it is important that the correct diagnosis and treatment is provided to ensure thorough management of the condition.
The following list are examples of negative schizophrenia symptoms:
- Lack of motivation – This can extend to all areas of a patient’s life. A patient can lack motivation to get out of bed in the morning, to prepare food, to speak to people, or to groom themselves. These symptoms can also be attributed to depression, and many people with schizophrenia have a high risk of developing depression at some point during their lives. This makes it crucial for signs of reduced motivation to be properly acknowledged and supported.
- Change to sleeping habits – Sleeping habit changes can vary between patients. A person may feel tired all of the time and want too much sleep, whereas another person may not want to sleep at all (which could be an impact from a positive symptom such as muddled thinking).
- Lack of concentration – A patient may lack concentration to complete any task because they do not care about completing anything, or feel consumed by other symptoms.
- No social desires – This means that a patient does not want to talk to anybody. They may feel afraid, or have a lack of desire to be around other people. This negative symptom can often be influenced by other positive symptoms, such as paranoia.
- Not leaving the house – A lack of motivation, among other symptoms, can cause a person with schizophrenia to be afraid of leaving the house, or have no desire to leave the house. They may feel more comfortable in their own surroundings at home, and may want to avoid reality.
- Lack of hygiene routine – Lack of motivation can extend to looking after yourself. When a person with schizophrenia lacks motivation, they often don’t care about the things that they used to care about. It is common for personal hygiene to be a main thing that is neglected. A dishevelled appearance in a patient who is usually well maintained is a high indicator of them experiencing negative schizophrenia symptoms.
How is schizophrenia diagnosed?
Schizophrenia can be difficult to diagnose because there is no medical test that can be completed to obtain diagnosis. Doctors must be specially trained in psychiatry to diagnose and treat patients with schizophrenia due to the complexities of the mental health condition. In many first cases of schizophrenia, signs begin with negative symptoms, which can often delay diagnosis until positive symptoms arise.
To be assessed by a psychiatrist who can identify or attribute your symptoms to a particular condition, you will need to have experienced symptoms for a number of weeks prior to a diagnosis.
This means that psychiatric assessments are completed over a period of time, rather than a single doctor’s visit like most physical health conditions. The NHS advise that positive symptoms must be experienced for one month before a diagnosis of schizophrenia can be given.
What are the causes of schizophrenia?
There is no single thing that causes schizophrenia to develop in people. It is a combination of different genetic issues, health issues and traumas that can cause the condition to develop. However, just because a person can identify with one of the factors that contribute to schizophrenia, it does not automatically mean that they will develop the condition; it just makes the condition more likely to develop than in other people.
Below are some of the factors that can contribute to schizophrenia developing in some people:
- Genetics – If you have a parent with schizophrenia, the chances of you developing the condition are 1 in 10. This risk increases further if a sibling has the illness. The Royal College of Psychiatry advise that there is a 1 in 8 chance of you developing the condition if your non-identical twin suffers with the illness, and this increases to a 1 in 2 chance if you have an identical twin who has the illness.
- Substance misuse – Taking drugs and alcohol has adverse effects on the body, and can even induce schizophrenia. Drugs and alcohol can alter the brain functioning and create psychotic symptoms, like the positive symptoms of schizophrenia. It is thought that these symptoms have a chance of triggering long-term symptoms; even when you stop taking drugs and alcohol. Some patients with schizophrenia also turn to drugs and alcohol as a form of self-medicating, which places them at further risk of harm. Abusing substances only causes symptoms to worsen, adding further complications to the condition. Patients who use drugs and alcohol also risk complications with their medication if they are taking this in conjunction with drugs and alcohol.
- Brain damage – If there is an issue with brain development during pregnancy and birth, there can be a higher risk of schizophrenia developing in the child’s later life.
- Stress – Stress can be a gateway to many conditions developing; one of which is schizophrenia. Stress has a huge impact on the body’s functioning, and can trigger more symptoms that can lead to schizophrenia.
- Trauma – If you have experienced childhood trauma, such as abuse or neglect, there is a higher chance that schizophrenia may develop later in life. Abuse and neglect, and insecure avoidant attachment, has an impact on childhood development, which can translate into mental illness in later life.
What are the types of schizophrenia?
Schizophrenia can vary in each patient. Some patients have episodic symptoms which means that symptoms will come and go, whereas other patients will have continuous symptoms that require management. This can vary depending on the type of schizophrenia diagnosed.
We have included the types of schizophrenia below:
This is the most common form of schizophrenia and has main symptoms of delusions and paranoia that can also involve hallucinations. The hallucinations experienced are predominantly hearing voices that can create further paranoia.
Hebephrenic schizophrenia can create active changes to a person’s behaviour, thoughts and speech. After onset of positive symptoms, there can be rapid development of negative symptoms. This form of schizophrenia is mainly diagnosed in young adults and is characterised by self-isolation, where the person would rather be in their own company.
Catatonic schizophrenia influences the person to display unusual behaviour, such as extreme movements followed by periods of stillness. This can also be accompanied by intense hallucinations. This form of schizophrenia is less common than other types.
Simple schizophrenia develops over time with a decline in overall performance compared to the usual self. Psychotic symptoms are uncommon in this type of schizophrenia as it is predominantly focused on negative symptoms. A person with simple schizophrenia may feel increasingly unable to meet the demands of society which can lead to their symptoms developing quicker.
There is an ample amount of support for people living with schizophrenia in contemporary society to allow them to live independently in the community without being excluded from day-to-day life. The treatment for people with schizophrenia can vary depending on the type of schizophrenia symptoms experienced, but treatment will often include medication, therapy, self-help groups and support from a community mental health team.
Even if schizophrenia symptoms continue for a patient, they are still able to aim for greater insight and understanding of their condition, to allow them to manage their own symptoms and recognise when further help is required. Staying healthy and avoiding potential triggering situations, can help to prevent schizophrenia symptoms from redeveloping, to help patients enjoy a fulfilled meaningful life.