What You Need To Know About Schizophrenia

Research shows that people with schizophrenia can get better when treated and often live normal or mostly normal lives, with about 20%¹ recovering in five years and experiencing only the occasional episode. This suggests that although there are many challenges associated with being diagnosed with schizophrenia, there is great potential for people to manage the condition enough to lead fulfilling lives and feel in control of their treatment.

Studies have also shown² that people with schizophrenia have a two to three times higher chance of dying earlier than the general population, due to physical conditions and infections that are often preventable. Many (over 69%) do not receive proper medical care. Poor access to mental health services is a major issue for the 90% of untreated individuals in low and middle-income countries.

How common is schizophrenia?

Schizophrenia is not a common disorder diagnosis in the United States or even worldwide. The National Institute of Mental Health (NIH)³ reports that the prevalence of schizophrenia is somewhere between 0.25% and 0.64% in the U.S., and between 0.33% to 0.75% internationally in non-institutionalized people.

According to Mental Help⁴, schizophrenia is so rare that only about 20 million people have been diagnosed with it worldwide - only about 1% of the global population. For Americans specifically, 3.2 million have been diagnosed, equaling 1.2% of the U.S. population. Additionally, nearly 1.5 million people worldwide will be diagnosed with the disorder each year, approximately 100,000 being Americans.

Who is more likely to have schizophrenia? Men, women, older people, young people?

There is no discernable difference in the rate of schizophrenia diagnosis between men and women. However, men are often diagnosed much earlier (between 18 and 25), while women have two peaks⁴ when they're most vulnerable to the disorder: between 25 and 30, and again around their 40th birthday.

Schizophrenia and the stigma of violence

Not every person with schizophrenia is aggressive or violent. It's only the rare person with schizophrenia who is aggressive. We must combat the stigma and misunderstanding attached to schizophrenia, and the public perception of it as dangerous. Studies have shown that most people with mental illnesses are not violent towards others and are instead a group that is often victimized.

The best way to combat stigma is with knowledge. The National Institute of Mental Health (NIH)⁵ has some great resources for people interested in learning/understanding more about schizophrenia with videos, fact sheets, and publications, national organizations that can assist in treatments, online resources, phone resources, and additional information about RAISE (Recovery After an Initial Schizophrenia Episode).

When active, common symptoms¹ of schizophrenia may include:

• Difficulty sleeping

• Disorganized speech

• Social withdrawal

• Hallucinations

• Delusions

• Difficulty thinking and concentrating 

• Memory loss

• Little to no motivation

• Reduced interest in activities

• Aggression (not common)

• Agitation

• Inappropriate emotional responses

• Disorientation

• Disorganized and compulsive behavior 

• Fear

• Paranoia

What are positive and negative symptoms?

Doctors classify schizophrenia symptoms as positive or negative. Positive symptoms refer to specific changes in behavior or thoughts, like delusions or hallucinations. On the other hand, negative symptoms refer to a person struggling with normal function. That can include withdrawing from the world around them, losing interest in everyday social interactions, and appearing emotionless.

It can be helpful to think of positive symptoms as "extra" or additional symptoms, while negative symptoms are a "reduction" or an absence of normal behavior or function.

Examples of positive symptoms include hallucinations, delusions, trouble concentrating, confusion and disorganization, unexplained behavioral changes, and disorganized movement or speech like becoming mute or even completely still for a long time. On the other hand, examples of negative symptoms of schizophrenia are withdrawing from friends and family, talking little or sometimes not at all, lack of energy and enthusiasm, and abnormal emotional responses.

Negative symptoms can be divided into two categories: primary and secondary. Primary means the symptoms arise from the underlying disease itself. Secondary means that the symptoms are due to an intermediate cause — e.g., medications can cause movement side effects like slowing of movements, muscle rigidity, loss of pleasure or reduced motivation which can look like negative symptoms. Depression or anxiety can cause social withdrawal, poor self-care and loss of enjoyment. Positive symptoms like delusions may lead the person to isolate themselves.

How long must symptoms last or how severe must they be to classify as schizophrenia?

You must experience two or more core symptoms — delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms — for most of the time for one month, and some level of mental disturbance for at least six months to be diagnosed with schizophrenia. At least one symptom must be² disorganized speech, hallucinations, or delusions.

What are the complications of having schizophrenia? How does it affect your life?

Schizophrenia can be challenging for both the diagnosed individual and their family. Symptoms of the disorder, including social withdrawal, paranoia, and aggression (not common) can make it difficult to foster relationships. When left untreated, symptoms can cause more complications³ that can affect the person’s quality of life, including:

• Thoughts of suicide and suicide attempts

• Anxiety disorders

• Drug and alcohol abuse

• Depression

• Isolation

• Inability to go to school or hold a job

• Financial difficulties that can sometimes lead to being homeless

• Medical problems⁴ like metabolic and cardiovascular diseases and infections

What are the causes of schizophrenia?

The exact causes of schizophrenia are not well known.  However, research¹ suggests that complex and multiple factors influence the development of schizophrenia, including:

• Physical

• Genetic

• Psychological

• Environmental

Certain biochemical substances in the brain such as dopamine are believed to be involved in schizophrenia. Alcohol or drug abuse and stressful or emotional life events may trigger the onset of schizophrenia in vulnerable people.

Genetics

No single gene can decide whether or not you develop schizophrenia. However, research shows that a range of genetic differences affects a person’s risk of schizophrenia. According to genetics studies², more than 250 places in the genome can contribute to an individual's risk of schizophrenia.

Additional twin studies (1993³, 1999⁴) found that although the lifetime risk of developing schizophrenia is about 6.5% for individuals with close relatives suffering from the condition, the figure increases significantly for twins: 10-19% for fraternal twins and 40% for identical twins. Nonetheless, the statistics suggest that other factors must also play a role in risk since there is still a chance for one not to be diagnosed.

Environment

According to a 2010 review⁵ of multiple epidemiological studies, there is an association between developing schizophrenia and environmental risks such as psychological, economic, social, and cultural factors. These factors may significantly increase an individual's risk when environmental exposure is in the presence of susceptible genes.

Another study⁶ adds that the season of birth can even play a role in risk, with those born in winter or early spring in the Northern Hemisphere being more prone to developing schizophrenia in later life than those who aren't. Potential mechanisms for this risk factor include viral infections, seasonal genetic effects, variations in light, temperature, nutrition, and obstetric complications.

How schizophrenia is diagnosed

If you are concerned that you or someone you know has schizophrenia, you should consult a doctor as soon as possible. Your doctor will go through a series of steps to rule out other mental health disorders or potential medicinal side effects if applicable.

Determining a diagnosis⁷ may include your physician taking a thorough analysis of your history, performing a physical exam, organizing tests, evaluating your mental status, and comparing your symptoms to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria.

History and screening

Your doctor will likely record a detailed history, including asking about your current symptoms, as well as screening for drug and alcohol use, family history, and personal history. This will help to ascertain the diagnosis and rule out other mental and physical disorders.

Physical exam

Your doctor may perform a physical exam to rule out any health conditions that could be causing your symptoms and check for any possible underlying complications.

Tests

Your physician may order tests to rule out the physical or medical causes of your symptoms. This often includes blood tests, and may sometimes include an MRI or CT brain scan.

Mental State Evaluation

Your doctor may ask questions and observe your behavior, moods, thoughts, and experience with delusions and hallucinations.

DSM-5

The DSM-5⁸ lists criteria that your doctor will compare your symptoms with to determine if you have schizophrenia. It is this manual that requires an individual to have two or more core symptoms present for most of a month, as well as a period of disturbance of at least six months, to be diagnosed.

Of the 20 million people¹ worldwide who have schizophrenia, an estimated 40%² go untreated in any given year. This may be due to people not recognizing their symptoms; sometimes people may not accept that they have the condition and therefore believe they do not need treatment.

However, when treated, symptoms can be substantially reduced in severity, with some symptoms alleviating for the most part as long as treatments continue. Research also shows that treatments for schizophrenia are incredibly successful. Compared to heart patients who have a treatment success rate of 41 to 52%, the National Alliance of Mental Illness (NAMI)³ says that the treatment success rate of schizophrenia is 60%.

Friends and family can help a lot by being understanding and supportive, as well as being active in helping a person with schizophrenia attend appointments to discuss their problems with their doctor and encouraging them to receive appropriate treatment.

How is schizophrenia treated?

Therapies

Treatments such as therapy can be very beneficial alongside medication in helping people manage their symptoms and lead purposeful lives. Therapy treatments for schizophrenia often include:

• Support groups — a place for people with schizophrenia to come together and share their stories, struggles, and triumphs.

• Cognitive behavioral therapy (CBT) — a therapy focused on replacing fictional and negative thoughts with more realistic and positive ones and managing hallucinations if they are present.

• Family therapy — a place for families to work through the challenges of schizophrenia together.

• Group therapy — therapy is provided by a mental health professional in a group setting, which may also improve social skills, provide accountability, and reduce social isolation.

• Psychoeducation — a way to arm patients with the power of knowledge, educating them on their disorder to help them better manage it. 

• Vocational rehabilitation — a service in which an individual with schizophrenia can benefit from prevocational training and supported employment.

Comorbidity (diagnosis of other co-existing mental health conditions) is common in schizophrenia. For example, people with schizophrenia may often experience depression, anxiety, obsessive-compulsive disorder, or trauma-related conditions. Therefore, their doctor may discuss and recommend specific treatments, both medication and psychological, for those disorders.

Medications

Medications are the mainstay of schizophrenia treatment. Most patients will require short to medium-term use; many will require long-term use.

Antipsychotic drugs are effective in treating the positive symptoms of schizophrenia and preventing relapses. The two main groups of antipsychotic medication are Typical Antipsychotics and Atypical Antipsychotics.

Types of Typical Antipsychotics drugs³ include:

• Chlorpromazine (Thorazine)

• Fluphenazine (Prolixin)

• Haloperidol (Haldol)

• Thiothixene (Navane)

• Trifluoperazine (Stelazine)

• Perphenazine (Trilafon)

• Thioridazine (Mellaril)

Common types of Atypical Antipsychotics drugs include: 

• Risperidone (Risperdal)

• Clozapine (Clozaril)

• Olanzapine (Zyprexa)

• Quetiapine (Seroquel)

• Asenapine (Saphris)

• Aripiprazole (Abilify)

• Ziprasidone (Zeldox)

• Brexpiprazole (Rexulti)

• Lurasidone (Latuda)

Anti-tremor medications are another drug prescribed by doctors to help patients manage shaking, tremors, and muscle rigidity which may be a side effect of antipsychotic medication.

People may take one or more of these drugs for treatment over time until they find the right fit for them and their needs. Drug treatment combinations vary from person to person. It often takes a few tries to find a combination that works best. This should be a collaborative process between the person and their doctor, and the person should feel comfortable to discuss any concerns or side effects with their health professional.

Lifestyle changes that can help manage schizophrenia

Sleep disturbance can be a major part of schizophrenia and can amplify symptoms and cause additional health problems. Making certain lifestyle changes can go a long way in managing the disorder.

In particular, it is recommended to make these lifestyle changes⁴:

• Getting a standard eight hours of sleep or more is ideal. Likewise, exercising regularly, limiting your sugar intake, and staying away from caffeine can help. 

• Eating regularly and nutritiously can make a big difference. Vitamins are one way to add more nutrition to your diet, but increasing your fruit, veggie, and protein intake through meals will bring more benefits to your physical and mental health.

• Although it may be tempting to look to alternative substances for relief, you must avoid alcohol and drugs at every opportunity. They will only worsen your symptoms and halt your progress in the long run. 

• Stress reduction is also important. You can reduce stress with meditation, deep breathing, and regular physical exercise. 

Coping strategies

Aside from lifestyle changes and treatment options, there are some other coping strategies you can take advantage of to ensure you continue seeing the best results. The two most important coping strategies to implement include:

1. Provide your doctor with contact information of close friends and loved ones who you are comfortable with them contacting if they need to. Likewise, provide those contacts with your doctor's number. If your disorder takes a turn for the worse without you realizing it, they can help you seek immediate attention when episodes arise. 

2. Work with your health professional to identify your “early warning signs” of illness. Discuss common changes to look out for with close friends and family so that they can help you acknowledge when you may need immediate care. Since it's not always obvious or easy for people with schizophrenia to identify a decline, close friends can help you to get treatment and support sooner rather than later.

Doctors or healthcare professionals involved in diagnosing schizophrenia

The healthcare professionals involved in diagnosing schizophrenia can include:

• Your primary care doctor — when discussing your symptoms and potential for diagnosis, you will first talk to your doctor. Since observation of symptoms is currently the only way to diagnose the disorder, your doctor will then perform a series of assessments to make a decision.

• Psychiatrist — your primary care doctor will often work with a psychiatrist if they suspect that you have schizophrenia. A psychiatrist has more in-depth insight into mental disorders, so they will be better able to rule out other disorders, confirm the diagnosis, and guide treatment. 

Doctors or healthcare professionals involved in treating schizophrenia

The following doctors and health professionals¹ may be involved in your care:

• A case manager, who may have nursing, psychology, or social work background

• Social workers 

• Psychologist and psychiatrists 

• Psychiatric nurses 

• Pharmacists 

• Counselors

• Psychotherapists

When you should get emergency help for schizophrenia

You should get emergency help for schizophrenia if you or someone you know is experiencing:

• Suicidal thoughts or attempted suicide

• Self-harm

• Violent or aggressive thoughts, moods, and actions (not common)

• Suffering from the disorder without treatment or due to your current treatment