Schizophrenia is a mental illness that affects around one in 100 people at some point in their lives. It can affect how someone thinks, feels, speaks and behaves.
 
About schizophrenia
Symptoms of schizophrenia
Causes of schizophrenia
Diagnosis of schizophrenia
Treatment of schizophrenia
Living with schizophrenia
 
 

About schizophrenia

There is a huge amount of misunderstanding and stigma associated with schizophrenia. It’s important to remember that if you have the condition, you probably will recover. You may continue to have problems that can limit your return to work and cause problems in forming relationships, but you’re likely to be able to learn to cope with these difficulties.
 
There is now an emphasis on diagnosing and treating the condition early. If you have schizophrenia, your family, friends and carers can be very important in helping you cope with and treat your illness in the long term.
 
Many people tend to think incorrectly that schizophrenia means a ‘split personality’. In fact, schizophrenia can affect any aspect of how you think, feel, speak and behave so that you lose touch with reality.
 
Schizophrenia usually occurs for the first time in your early teens and twenties. Men and women are equally affected, although young men tend to develop the illness earlier.
 
 

Symptoms of schizophrenia

If you have schizophrenia, you have your own unique combination of symptoms. However, the condition usually involves what are known as positive and negative symptoms. These follow on from an initial period of milder symptoms. This is when you may show changes in your behaviour – these will be similar to negative symptoms but not as severe. These may include:

  • memory and concentration problems
  • social withdrawal
  • unusual and uncharacteristic behaviour
  • having trouble communicating
  • bizarre ideas
  • poor personal hygiene
  • lack of motivation

You may find it difficult to work, do everyday activities and relate to family and friends.

 
Positive symptoms

These symptoms highlight a change in your usual thinking process and can include the following.

  • Delusions are false beliefs that are out of context with your usual cultural or social ideas. For example, you may believe your movements are being controlled by someone else.
  • Hallucinations are when you hear voices that may speak directly to or about you even though there isn’t anyone there. Visual hallucinations are when you see things that aren't there.
  • Thought disorders can affect your thinking patterns and make speech difficult to follow.

Together these symptoms are called psychosis.
 

Negative symptoms

Episodes of positive symptoms are followed by negative symptoms. These include:

  • lack of energy
  • social withdrawal
  • lack of motivation

You may say very little, find social contact difficult and have trouble getting out of bed. It can be frustrating because friends or family may think you’re being lazy.
 
It’s possible that you will also have depression. This can sometimes be mistaken for negative symptoms.
 
How many episodes you have and how long you recover for in between each one can vary. For example, you may go for long periods when you feel well, with occasional relapses or full recovery. Alternatively, you may have occasional periods of illness when you don’t get fully better in between. About one in three people with schizophrenia have a more continuous illness and are never free of symptoms, although the severity may vary over time.

 

Causes of schizophrenia

The exact reasons why you may develop schizophrenia aren’t fully understood at present. It’s thought to be caused by a combination of things.
 
The most important factor is having a relative with schizophrenia. Studies have shown that if one parent is affected, the risk of having a child with schizophrenia is about 13 in 100. This rises to about 46 in 100 if both parents are affected.
 
Schizophrenia may be linked to changes in the brain. Your brain sends signals from nerve to nerve using chemicals called neurotransmitters. If you have schizophrenia, the neurotransmitters are out of balance.
 
Several other things are thought to be involved with the development of schizophrenia. These include the following.
 

  • If you’re from a disadvantaged background, and especially if you’re a young male, you have the greatest risk of developing schizophrenia.
  • If you use a lot of cannabis, you’re six times more likely than non-users to develop schizophrenia.
  • If you use other illegal drugs such as amphetamines, cocaine, ketamine or lysergic acid diethylamide (LSD), these can lead to a short-term, schizophrenia-like illness.
  • Stressful events such as the death of a loved one or a stressful job, can trigger schizophrenia if you’re particularly vulnerable.
  • People who have migrated to the UK from other countries show an increased rate of schizophrenia compared with both the population that they have left, and the general UK population.
  • You’re more likely to develop schizophrenia if you were born in the late winter or early spring.
  • Developmental abnormalities in children, such as learning difficulties or problems with speech, have been associated with schizophrenia.
  • Complications at birth, such as lack of oxygen, or viral infections during pregnancy increase the risk of schizophrenia.



 

Diagnosis of schizophrenia

If you have schizophrenia, you may not recognise that you’re ill. It’s possible that relatives or friends may seek medical advice first, perhaps because they notice you behaving out of character.
 
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If your doctor thinks you may have schizophrenia, he or she will refer you to a specialist.
 
It’s vital that people with suspected schizophrenia get help early because those who do are more likely to live independently and continue to work. The risk of suicide is also increased if someone is having active symptoms, has become depressed, isn’t receiving treatment or has had his or her level of care reduced.

Treatment of schizophrenia

Medicines

Antipsychotic medicines are the main form of treatment for schizophrenia. These can help to control the condition, particularly positive symptoms. They have a calming effect, without necessarily causing sleepiness.
 
Many traditional antipsychotic medicines cause serious side-effects such as involuntary movements of the face, restlessness and tremor (shaking). Therefore, you will probably be prescribed a newer medicine called an atypical antipsychotic.
 
You need to take your medicine regularly to control the symptoms of schizophrenia. If you stop taking it, your symptoms are likely to return within six months. About half of people with schizophrenia stop taking their medicines. Your family, friends and carers can all play an important role in helping you to take your medicine regularly.
 
Speak to your GP if you’re not happy with the antipsychotic medicine that you have been prescribed. He or she may be able to suggest an alternative. It may also be possible for you to have injections of antipsychotic medicine every few weeks. This may be useful if you have trouble taking tablets every day.
 

Talking treatments

There is good evidence that cognitive behavioural therapy (CBT) can help you if you have schizophrenia. CBT involves identifying negative thought patterns and replacing them with positive ones.
 
If you live with your family or have close contact with them, you may be offered family intervention. Family intervention aims to:

  • help families cope with their relatives’ problems more effectively
  • provide support and education for the family
  • reduce levels of distress
  • improve how the family communicates and negotiates problems
  • prevent any relapses

Hospital treatment

If you have severe psychotic symptoms, you may need to be admitted to a hospital to have care supervised by a psychiatrist (a doctor who specialises in identifying and treating mental health conditions). For a small number of people, a stay in hospital may last several months. However, modern medicines and better community-based services mean that far fewer people have to spend as much time in hospital.
 
If you don’t wish to have treatment but your doctor thinks you need it, it’s possible that he or she will insist you stay in hospital under the Mental Health Act 1983. However, this will usually only be used if there is a risk to your health or safety, or that of others, if you don’t receive hospital treatment.
 

Care programme approach

This aims to provide you with a support system in the community. You will have a care co-ordinator, such as a community psychiatric nurse, and structured care. Your health and progress will be monitored and reviewed, and you will be offered psychological, medical and practical support.
 
The care programme approach can help you to manage issues including housing and financial problems, family difficulties, taking your medicines and alcohol use.
 
This service isn’t always available so if you’re no longer seeing a psychiatrist and your symptoms start to get worse, it’s very important to see your GP as soon as possible. If necessary, he or she will be able to refer you to back to your specialist.
 

Other treatments

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

 

Living with schizophrenia

Many people diagnosed with schizophrenia go on to lead full lives if they are well supported. It’s thought that about one in five people with schizophrenia will recover within five years of first having an episode of the condition. About three in five will improve but still have some symptoms.
 
Getting treatment early and having support from your family, friends and healthcare professionals are very important in improving how you manage your condition day-to-day.

This section contains answers to common question about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 
What should I do if I think my friend has schizophrenia?
Are people with schizophrenia dangerous?
Are people with schizophrenia able to drive a car?

 

What should I do if I think my friend has schizophrenia?

Answer

If you have noticed a change in your friend’s behaviour or thinking patterns and you’re concerned that he or she has schizophrenia, there are several things you can do to help.
 

Explanation

You may have noticed changes in your friend’s social behaviour. There are a number of signs that could suggest your friend has schizophrenia. He or she may:

  • become anxious
  • have poor personal hygiene
  • feel depressed or have suicidal thoughts
  • have difficulty concentrating and lack motivation
  • become suspicious
  • change his or her sleep pattern
  • become overly friendly or very distant
  • have unusual new ideas or thoughts that make little sense
  • become paranoid or have hallucinations

It’s important that you talk to your friend and encourage him or her to seek medical help early. You could offer to book the appointment or accompany your friend on any visits.
 
You may find it difficult to talk to your friend at first because he or she may be anxious or frightened. Try to stay calm and think about how you would feel in his or her situation. 
 
It might be useful to get help before you confront your friend. You could speak with your GP or contact a mental health charity for more information so that you’re aware of what your friend is going through.

 

Are people with schizophrenia dangerous?

Answer

No, it’s uncommon for people with schizophrenia to be dangerous. However, occasionally schizophrenia can make people feel angry or upset and this can cause violent outbursts. It may also lead to some people becoming threatening or even lashing out.
 

Explanation

People with schizophrenia are more likely to be harmed by other people than cause harm or become dangerous to someone else. It’s common for people with schizophrenia to hear critical or unfriendly voices. Many people are frightened by those who hear voices as they don’t understand how the person is feeling. Sometimes these voices can suggest that the person with schizophrenia kills him or herself rather than harm someone else.
 
If someone with schizophrenia is admitted to hospital, the staff will make every effort to keep the atmosphere relaxed and calm. The staff are trained to control the situation if things get out of hand and ensure the person with schizophrenia calms down by talking to him or her. The person with schizophrenia may be advised to take medicines to control his or her anger and violence.

 

Are people with schizophrenia able to drive a car?

Answer

This will depend on the severity of the illness and whether or not the person has any side-effects from their medicines.
 

Explanation

People who have schizophrenia should contact the Driver and Vehicle Licensing Agency (DVLA) and stop driving during any episodes of schizophrenia.
 
Once the person has remained stable for at least three months, he or she can drive. If he or she is taking antipsychotic medicines for schizophrenia, it’s important that these don’t cause any side-effects, such as poor concentration or tiredness, as these could affect driving.
Specialist mental health services can carry out a detailed assessment to ensure that the person is fit to drive.
 
If a person continues to have symptoms of schizophrenia, he or she can apply for re-licensing but only if the symptoms don’t affect concentration or cause a short attention span. It can be very dangerous if someone with schizophrenia is distracted while driving.

Further information

Rethink
0845 456 0455
www.rethink.org
 
Royal College of Psychiatrists
www.rcpsych.ac.uk
 
Mind
0845 766 0163
www.mind.org.uk
 

Sources

  • Psychosocial interventions in the management of schizophrenia. Scottish Intercollegiate Guidelines Network (SIGN), October 1998. www.sign.ac.uk
  • Simon C, Everitt H, and Kendrick T, Oxford Handbook of General Practice.  2nd ed, Oxford: Oxford University Press, 2005:
  • Schizophrenia. Clinical Knowledge Summaries. www.cks.library.nhs.uk, published October 2009
  • Collier J, Longmore M, Scally P. Oxford handbook of clinical specialties. 6th ed., Oxford: Oxford University Press, 2003:
  • Schizophrenia. Core interventions in the treatment and management of schizophrenia in primary and secondary care (update). National Institute for Health and Clinical Excellence (NICE), March 2009. www.nice.org.uk
  • Effective care co-ordination in mental health services: modernising the care programme approach. Department of Health. www.dh.gov.uk, published 25 January 1999
  • McIntosh AM, Conlon L, Lawrie SM, et al. Compliance therapy for schizophrenia. Cochrane Database of Systematic Reviews 2006, Issue 3. doi: 10.1002/14651858.CD003442.pub2.
  • Schizophrenia. Royal College of Psychiatrists. www.rcpsych.ac.uk, published January 2010.

Related articles

Schizophrenia is a mental illness that affects around one in 100 people at some point in their lives. It can affect how someone thinks, feels, speaks and behaves.   About...
This factsheet is for people who have stress incontinence, or who would like information about it. Urinary incontinence is the unintentional leaking of urine. Stress incontinence...