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Schizophrenia

Schizophrenia is a mental health condition that affects how the brain normally functions, which in turn can affect how someone thinks, feels, speaks and behaves.

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About schizophrenia 

Around one in 100 people will develop schizophrenia in their lifetime. Symptoms often start late in the teen years or in the early 20s.

There is a lot of misunderstanding, fear and stigma about schizophrenia and it can be difficult to deal with other people’s reactions to the condition. Schizophrenia is not a ‘split personality’ as it was once upon a time described - the condition isn’t linked in any way to multiple personalities or any personality disorder. It is a condition that leaves someone with an altered experience of the world that is often disconnected from reality, and characterised by impaired thinking, emotions and behaviours.

The first few years of living with schizophrenia can be very difficult and upsetting, as the condition impacts many areas of your life including your relationships with other people and your work. This can make it difficult for you. However, with time and appropriate management many people can find their symptoms improve. Top of page »

Symptoms of schizophrenia 

The symptoms of schizophrenia are generally categorised into positive and negative symptoms. Positive symptoms are things that happen or are added to a person’s experiences beyond what an otherwise well person would experience, eg hallucinations. Negative symptoms are those things that seem to be missing to some degree in a person with schizophrenia. People with schizophrenia will have different combinations of symptoms, so what you experience may be different from someone else with the condition.

Positive symptoms

Positive symptoms are unusual experiences that most people don’t experience. The main ones are listed below.

  • Hallucinations. This is when you hear, smell, feel, taste or see something that isn't caused by anything or anybody around you. The hallucinations will seem real to you, but the people around you won’t experience them. The most common hallucination is hearing voices.
  • Delusions. This is when you have beliefs or experiences that you are completely sure are real, but that would not be considered to be based in reality by others and that other people often find strange. Delusions may be unusual or extreme and can be very distressing for you and those around you. You may feel like you’re being chased or plotted against, or that you’re being controlled. You can also feel like you have special powers, or are somebody else such as a celebrity or a historical figure.
  • Disorganised or confused thinking. This is when you find it hard to concentrate and your thoughts may feel jumbled or disconnected. You may also find it difficult to hold a conversation.

Negative symptoms

Negative symptoms are less easy to spot because they affect your energy, motivation and emotional responses. They can be difficult for you to live with because they can come across as laziness to other people. Negative symptoms can include:

  • memory problems or difficulty concentrating
  • having less interest in your usual activities
  • wanting to go out less and becoming socially removed and more isolated, even from your own family or people you are living with
  • having problems communicating with others.

Other symptoms

Apart from positive and negative symptoms, people living with schizophrenia may also experience excitement, agitation, anxiety and depression. One in seven people with continuing symptoms of schizophrenia also experience depression.

Having schizophrenia can also change the way you see yourself. You may feel that everyone else is wrong, deluded or hiding something and that you’re the only one who sees things clearly. This lack of insight that your feelings and behaviour might be part of an illness can make schizophrenia hard to diagnose.

Possibly related to their altered experience of the threats (sometimes ‘not real’) posed by the world around them, there is a higher likelihood of people with the condition to be associated with violence. Even so, it's still not common for people with schizophrenia to become violent. Top of page »

Causes of schizophrenia 

The reason why some people develop schizophrenia isn't fully understood.

Your genes could make you more likely to develop schizophrenia. Schizophrenia runs in some families and if you have a close family member with the condition you’re more likely to develop it. For example, one in 10 people who have a parent with schizophrenia develop the condition, whereas only one in 100 people develop it if neither parent has the condition.

But scientists believe that it takes more than genes. This may include how your brain develops in the womb. In addition, when you first experience symptoms or the recurrence of psychotic events (times of losing touch with reality), these may be triggered by a combination of factors, including stressful events, using cannabis (particularly before age 18) or amphetamines, and excessive use of alcohol. Top of page »

Diagnosing schizophrenia 

Because schizophrenia can cause a loss of personal insight, you may not recognise that you’re unwell or that your behaviour has changed. A close family member or friend may be the person that notices the changes and encourages you to see your GP.

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. This will help him or her to rule out other mental health conditions.

If your GP thinks you may have schizophrenia, he or she will refer you to a psychiatrist and possibly to a community mental health team. Other than for severe acute episodes this doesn’t mean having to go to hospital.

Being diagnosed early on in your condition allows you to start treatment quickly and keep your life as close to possible as it was before you experienced the symptoms. If you have treatment early, you’re more likely to be able to live independently and continue to work in the future. Top of page »

Treating schizophrenia 

The treatment for schizophrenia is likely to include a combination of different types of treatment, from medicines to psychological treatments such as cognitive behavioural therapy (CBT). The particular medicines and combination with other treatments depends on how severe your symptoms are and whether you’re being treated for an acute episode or need long-term support. Most of your treatment will be provided in your local community but some of your treatment may be in hospital.

Medicines

Medicines called antipsychotics are used to treat the symptoms of schizophrenia. They can slowly reduce symptoms such as hallucinations and delusions, increase your motivation and help you to think and speak more clearly. Most people will need to take these long term.

There are a number of different types of antipsychotic medicines. All can cause unpleasant side effects. The older types of antipsychotic medicines such as haloperidol and chlorpromazine are more likely to cause side effects including shaking, muscle stiffness and restlessness, sexual problems and a fast heartbeat.

The newer antipsychotic medicines, including risperidone, amisulpride, olanzapine, clozapine and quetiapine, tend to have fewer side effects and are the preferred treatments for people newly diagnosed with schizophrenia. These can sometimes cause problems such as gaining weight, high blood pressure, increasing blood sugar and raising blood cholesterol. These side effects also need to be managed, either by changing the medicine or taking steps to control these additional problems.

Your psychiatrist will work with you to find the right medicine and dose for you. You may have to try different medicines and doses until you find the one that works best for you, treats your symptoms and minimises any side effects.

It’s important to keep taking your medicine regularly to control the symptoms of schizophrenia. If you stop taking it, your symptoms are likely to return within six months. Speak to your psychiatrist if you're not happy with the medicine that you have been prescribed.

It may also be possible for you to have injections of medicine every few weeks. This may be useful if you have trouble taking tablets every day.

In addition to your antipsychotic medicines, your doctor may prescribe you medicines to help manage other conditions that are associated with your schizophrenia. These could include antidepressants, anti-anxiety medicines, and medicines that help stabilise your mood such as lithium. You may also need to take medicines that help manage some of the side effects of your antipsychotic medication if these are troubling you or affecting your general health.

Always read the consumer medicines information leaflet for your medicines.

Psychological treatments

As well as prescribing medicines for you, your psychiatrist may also encourage you to have psychological therapy, such as cognitive behavioural therapy (CBT) or family therapy.

CBT can help you to learn new ways of thinking about situations and solving problems and to feel better about yourself. CBT can also help you to control symptoms, such as hallucinations and delusions.

Family therapy may be offered to you if your family or friends live close by and are part of your support network. These meetings can help you and your family to deal with your schizophrenia and learn how to support you emotionally and practically.

There are other types of psychological treatments, such as counselling and psychotherapy, which are used as part of treatment for schizophrenia. These aren’t appropriate for everyone, so your psychiatrist will discuss them with you.

You may also be offered therapy in the form of art, music, drama and dance. These can help you to manage negative symptoms and encourage you to express yourself creatively.

Managing schizophrenia is about more than just controlling your symptoms: it’s also about getting you back on your feet again so you can lead an independent, healthy and fulfilling life. Other therapies that may help you achieve this include vocational and social rehabilitation, which focuses on developing any social and occupational skills that may have suffered because of your schizophrenia. You can also obtain support to find accommodation and employment in the community, as well as join a self-help group where you can meet other people with schizophrenia.

Self help

People with schizophrenia can have concurrent health problems either due to lifestyle habits that can be common with this condition (such as excessive use of alcohol, nicotine or illicit substances) or the medicines they are taking to help manage the condition. Because of this, it’s important to look after your physical health, particularly any cardiovascular (heart and blood vessel) disease risk factors you may have.

Healthy lifestyle habits include daily physical activity, a balanced diet, not smoking, and appropriate alcohol consumption. It’s also a good idea to keep an eye on your blood pressure, cholesterol and blood sugar levels, and to maintain a healthy weight.

Talk to your GP about any lifestyle habit changes you may need to make to improve your physical health and keep well in the long run. Top of page »

Managing acute schizophrenia and relapse 

You may go through a period of time when you’re first diagnosed when your symptoms are very intense. This is sometimes called acute schizophrenia. Once you have started treatment you should find that your symptoms start to ease and may disappear altogether. However, you may find that you continue to have intermittent acute phases of your condition, which are called relapses.

If you have very severe symptoms (a crisis or relapse) you may need to be admitted to hospital for treatment. This is important if your symptoms have led to you becoming a danger to yourself or to other people. Top of page »

Help and support 

Most people who develop schizophrenia do get better, though some may have symptoms that return every now and again. With treatment and support you’re likely to be able to manage your condition at home and have a full life, including work and lasting relationships.

There are public mental health crisis assessment and treatment (CAT) teams that are available. The teams can help you any time if you feel at risk of becoming ill again with your schizophrenia. Your family can contact them too. You should be given their contact details as part of your treatment plan and your doctor will also have their details. In addition, SANE Australia has a helpline, which is provided in the Further Information section below.

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Further information 

SANE Australia
1800 18 7263 (Helpline)
www.sane.org

Reachout.com
1800 55 1800 (for people 5–25 years old)
13 11 14 (Lifeline)
www.reachout.com 

Mental Illness Fellowship of Australia Inc
1800 985 944 (Helpline)
http://www.mifa.org.au Top of page »

Sources 

Access Economics Pty Ltd for SANE Australia. Schizophrenia: costs. An analysis of the burden of schizophrenia and related suicide in Australia, 2002. [online] [Accessed 7 Sept 2012] Available from: www.sane.org

Better Health Channel. Antipsychotic medication explained. [Online] Melbourne, VIC: State Government of Victoria. c1999-2011 [Last reviewed Apr 2012, accessed 7 Sept 2012] Available from: www.betterhealth.vic.gov.au

Inspire Foundation. All about schizophrenia. [online] Camperdown, NSW: Inspire Foundation [accessed 11 Sept 2012] Available from: au.reachout.com

Mental Illness Fellowship of Australia (MIFA). Understanding schizophrenia. [online] Melbourne, VIC: Mental Health Fellowship Victoria. 2008. [Accessed 7 Sept 2012] Available from: www.mifa.org.au 

National Institute for Health and Clinical Excellence (NICE). Schizophrenia. Core interventions in the treatment and management of schizophrenia in primary and secondary care (update), February 2011. Available from: www.nice.org.uk

Psychotropic Expert Group. Therapeutic guidelines: psychotropic. Version 6. Melbourne: Therapeutic Guidelines Limited. 2008.

Royal Australian and New Zealand College of Psychiatrists (RANZCP). Schizophrenia. Australian treatment guide for consumers and carers. [online] Melbourne, VIC: RANZCP. 2005. [Accessed 7 Sept 2012] Available from: www.ranzcp.org/

Royal Australian and New Zealand College of Psychiatrists (RANZCP). Clinical practice guidelines for the treatment of schizophrenia and related disorders. [online] Melbourne, VIC: RANZCP. 2004. [Accessed 7 Sept 2012] Available from: www.ranzcp.org

Saha S Chant D Welham J McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005 May; 2(5): e141.

SANE Australia. Schizophrenia. [Online] South Melbourne, VIC: SANE Australia. c2010 [Accessed 7 Sept 2012]. Available from: www.sane.org

SANE Australia. Antipsychotic medications. [Online] South Melbourne, VIC: SANE Australia. c2010 [Accessed 7 Sept 2012]. Available from: www.sane.org

Simon C, Everitt H, van Dorp F. Oxford handbook of general practice, 3rd edition. Oxford: Oxford University Press, 2010: 1006.

Virtual Medical Centre. Schizophrenia. [Online] Osborne Park, WA: Virtual Medical Centre [Last modified Oct 2011, accessed 7 Sept 2012]. Available from: www.virtualmedicalcentre.com

Walsh E Buchanan A Fahy T. Violence and schizophrenia: examining the evidence. The British Journal of Psychiatry. 2002; 180: 490-495.

Tags: schizophrenia, psychosis, mental health

Top of page » Last published: 31 January 2013

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This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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