Schizophrenia

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have schizophrenia, or who would like information about it.

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

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 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 is very important in improving how you manage your condition day-to-day.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.