What Is Schizophrenia?

Schizophrenia is a chronic and severe brain disorder that affects how a person thinks, behaves, and feels. People with schizophrenia often have a hard time distinguishing between reality and fantasy, expressing and managing their emotions, and making decisions. Symptoms usually start to appear in late adolescence or early adulthood.

There is currently no cure for schizophrenia. However, medications and other treatments can help people manage their symptoms and improve their quality of life.

Read on to learn more about the causes and symptoms of schizophrenia and some of the treatment options available.

Schizophrenia Symptoms

Schizophrenia can cause a variety of dysfunctions. One of the common features of the condition is a lack of insight. It can be difficult for someone to recognize that they have the condition or that it’s acting up. Often, family members, close friends, or coworkers are the first to identify the symptoms. 

Schizophrenia usually begins when a person is in their 20’s, but it can start sooner during the teen years or later in adulthood. Symptoms can flare up, gradually becoming more severe over time. 

Symptoms of schizophrenia can include: 

• Unusual, disorganized speech that can be panicked at times
• Agitation 
• Neglect of personal hygiene 
• Unusual appearance in the way a person dresses or grooms 
• Delusions
• Hallucinations (seeing or hearing things that are not there) 
• Paranoia 
• Withdrawal from others
• Excessive sleeping or a lack of sleep

Often, the delusions are characterized by a fear that others are conspiring or communicating in a secret way. 

Complications 

Schizophrenia can cause a serious impact on the functioning and safety of the person who has the condition.

Causes

There is a strong genetic component to schizophrenia. The condition runs in families. For example, one study showed an increase in certain cognitive impairments in first-degree relatives of people who have schizophrenia. But many people who are diagnosed with schizophrenia don’t have any affected family members.

Experts have also looked at the role of drug use and its contribution to schizophrenia, but it is often challenging to tease out to what degree drug use is a way to cope with the early effects of the condition before it is diagnosed or whether drug use contributes directly to schizophrenia.

Brain Alterations 

Schizophrenia is associated with a disruption in dopamine, as well as other neurotransmitter activity, in the brain. Medications that increase dopamine activity in the brain can sometimes induce symptoms similar to those of schizophrenia.

Research suggests that brain inflammation and atrophy (shrinking) of certain parts of the brain are associated with schizophrenia, but these results are not consistent or reliable enough to be used as diagnostic tools.

Diagnosis

The diagnosis of schizophrenia is based on criteria defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), a guide that is used by psychiatrists and other mental health professionals in the diagnosis and management of psychiatric conditions. 

For a diagnosis of schizophrenia, symptoms must be present for at least six consecutive months, with an associated decline in work, self-care, and/or relationships compared to the time before the symptoms started. 

Diagnostic Testing 

Your healthcare provider will rule out other conditions that are similar to schizophrenia before making a definitive diagnosis of the condition. 

You may need to have blood tests or urine tests to identify potential medical or substance contributions to your symptoms. Schizophrenia is diagnosed only if the symptoms are not caused by drugs. You might also have a brain imaging test, such as computerized tomography (CT) or magnetic resonance imaging (MRI) test to rule out lesions in the brain. 

Other conditions that are often considered during the diagnosis of schizophrenia include:

• Schizoaffective disorder: This condition includes features of schizophrenia, as well as major mood disorders. 
• Bipolar disorder: This condition causes episodes of mania and depression. Sometimes there is an overlap between depression and the negative symptoms of schizophrenia. Episodes of mania and depression in bipolar disorder can involve features of psychosis.
• Drugs or medications: Drugs and drug withdrawal can induce hallucinations or delusions and other cognitive and behavioral symptoms that can appear similar to aspects of schizophrenia. Sometimes certain prescription medications such as some used for the treatment of Parkinson’s disease can cause hallucinations. 
• Brain tumor: A brain tumor or a lesion in the temporal lobe of the brain may cause hallucinations similar to the hallucinations of schizophrenia. Brain imaging studies can usually identify a lesion in the brain. 
• Epilepsy: Temporal lobe epilepsy can cause behavior that can be mistaken for schizophrenia. Often an electroencephalogram (EEG) can help distinguish the conditions. 
• Post-traumatic stress disorder (PTSD): Rarely, the effects of PTSD can manifest with symptoms such as hypervigilance and flashbacks that can have a hallucinatory quality. However, a careful psychiatric history can often differentiate between the conditions. 

Treatment

The treatment of schizophrenia requires a comprehensive plan that includes prescription antipsychotics, counseling, support from loved ones, and possibly hospitalization for flare-ups. There is no cure for the condition, but symptoms can be managed with treatment. 

Family members and loved ones can provide emotional support and can recognize issues such as early signs of flare-ups. Counseling can be a beneficial way for a person who has schizophrenia to express themselves and learn how to manage the emotional burden of the condition.

Prescription Medications 

If you or a loved one is living with schizophrenia, it’s important to know that sometimes people who have the condition are willing to take medication, but sometimes they are very reluctant.

The effects of the condition can make a person suspicious of medical treatment, and the illness itself can lead to changes in the brain that impact awareness of the illness (anosognosia). Sometimes people who have schizophrenia may say they took their medication even when they didn’t take it. 

Medications used in the treatment of schizophrenia include:

First-generation "typical' antipsychotics such as:

• Thorazine (chlorpromazine)
• Haldol (haloperidol)

Second-generation "atypical" antipsychotics such as:

• Risperdal (risperidone)
• Clozaril (clozapine)

Hospitalization 

Worsening of schizophrenia can include agitation, attempts at self-harm, inability to care for oneself, overwhelming fear or paranoia, and rarely, aggressive behavior. In these cases, hospitalization may be necessary. These episodes can be triggered by a variety of emotional or physical triggers, and often by non-adherence to medication. 

During a hospital stay for an acute worsening of schizophrenia, a person will be in a safe place and receive appropriate medications, nutrition, and counseling. It may take days or weeks before an acute episode of schizophrenia begins to improve.

A Word From Verywell

Schizophrenia can be very distressing for the person who is experiencing it, in ways that are sometimes difficult to communicate. With a multidisciplinary approach to treatment and a strong support system, it is possible to lead a healthy, happy, and productive life with schizophrenia.