The symptoms of schizophrenia most commonly start between the ages of 15 and 35. Men and women are equally affected. People with schizophrenia can have different symptoms, so what you experience may be different from someone else who also has the condition.
The first symptoms of schizophrenia can be quite vague and are sometimes called ‘negative symptoms’. This is called the prodromal phase of schizophrenia. This period can last a few days or over a year. Symptoms can include:
- difficulty remembering things or concentrating
- spending less time with others (being withdrawn)
- unusual or uncharacteristic behaviour
- difficulty communicating in a way others can understand
- having strange ideas
- having abnormal experiences
- not caring for yourself properly
- reduced interest in day-to-day activities
Your family or friends may feel that you’re not yourself. They may notice that you’re not able to do your job or study or may feel that they can’t relate to you.
If you have schizophrenia, you can become more intensely unwell and experience ‘positive symptoms’. These periods can be called acute psychotic phases. The following are types of positive symptoms.
- 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. You may believe ordinary events, objects or behaviour have an unusual meaning specifically to you. Other people won’t understand this. You might also feel that other people are trying to control your thoughts, feelings or behaviour.
- Difficulty thinking clearly. This is when you find it hard to concentrate and your thoughts feel jumbled or disconnected. You may also find it difficult to hold a conversation.
For some people, the first signs they have schizophrenia are these intense positive symptoms, which can be particularly frightening. Once you’ve started treatment, you should find that your symptoms start to get better. They might disappear altogether.
Ongoing symptoms can include some of the negative symptoms listed above. You may also have a loss of interest in life, less energy, difficulty feeling emotions and trouble managing daily life. You may have periods when more intense symptoms come back. Depression is common for people with schizophrenia. One in seven people with continuing symptoms of schizophrenia become depressed.
It can be hard to recognise that you’re unwell when you have schizophrenia because it affects your thoughts and feelings. You may feel that everyone else is wrong, deluded or hiding something. You may feel you’re the only one who sees things clearly.
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. They may also ask about your medical history. This will help to rule out other mental health conditions.
If your GP thinks you may have schizophrenia, you will be referred to a Primary Mental Health Care team made up of specialist nurses and mental health care workers. This doesn’t necessarily mean having to go to hospital. These health professionals might be based in the community.
Your mental health care worker will ask about your life, how you’re feeling and if you’ve had any recent stressful events. They will assess your general health too. You may have a physical examination, urine test and blood tests. And you may also have your heart function assessed too.
Sometimes, people with schizophrenia can have other conditions too, which you will be checked for. These include depression, anxiety, post-traumatic stress disorder, personality disorder and substance misuse.
Your treatment options will depend on your symptoms and their severity. You’re likely to be offered a combination of different types of treatment. You may have some of your treatment at home or in the local community.
However, you might have some treatment in hospital, especially if you’re very unwell. Your care team will plan your treatment with you.
Your will probably be recommended to take some medicine to control your schizophrenia. Medicines called antipsychotics (also known as neuroleptics) are used to treat the symptoms of schizophrenia. These are usually taken as tablets. However, some people prefer to have them as injections that work for two to four weeks at a time. Medicines can slowly reduce symptoms such as hallucinations and delusions. They can increase your motivation and help you to think and speak more clearly.
There are a number of different antipsychotic medicines. Older types of medicines, such as haloperidol and chlorpromazine, may cause unpleasant side-effects, such as:
- feeling sluggish
- thinking slowly
- muscle stiffness
- sexual problems
- high blood pressure
The newer antipsychotic medicines, such as, risperidone and amisulpride, tend to have fewer side-effects. However, they may still make you feel sleepy or slow and affect your sex life. In addition, they can cause long-term health problems, such as gaining weight, high blood pressure and diabetes.
You might be offered an antipsychotic medicine called clozapine if other types of antipsychotic haven’t worked for you. You might also be offered an additional medicine called a benzodiazepine if you’re suffering from anxiety or a behavioural disturbance.
You may have to try more than one medicine and different doses until you find the one that works best for you. You’ll have a health check at least once a year while you’re on antipsychotic medicine to make sure it’s not making you unwell.
Some people take antipsychotic medicine for a short time and can then stop. But most people will need to keep taking them for a long time. Taking your medicine will help control your symptoms. If you stop taking it, your symptoms are likely to return within three to six months. However, you need to weigh up the side-effects of your medicine too. Speak to your doctor if you're having problems with your medicine. And only stop taking it if your doctor tells you to.
You may need to be admitted to hospital for treatment if you’re very unwell and at risk of hurting yourself or others. This is sometimes called a crisis. You might need to be sedated.
If you don't want to have treatment but your doctor thinks you need it, you may need to be admitted to hospital against your will using the Mental Health Act. This will usually only happen if three mental health experts believe you and others are at risk if you don't have hospital treatment.
Your psychiatrist should offer you talking therapy, such as cognitive behavioural therapy (CBT) or family therapy.
If you have CBT, you should be offered at least 16 sessions. CBT can help you to find different ways of coping with your symptoms. It can allow you to better understand how your thoughts, feelings and behaviour are linked to your symptoms.
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 work together to cope with your condition. This should include at least 10 sessions, over three months to a year.
There are other types of talking treatments, such as counselling and psychotherapy, which are sometimes used for schizophrenia. These aren’t appropriate for everyone though, so a member of your mental health care team will discuss them with you.
Some people want to try using talking therapies alone without medicines. However, talking therapies tend not to work well alone to treat schizophrenia. Your doctor may agree to a trial period though, if you would like this.
You may also be offered art therapy. This can help you to manage negative symptoms and encourage you to express yourself creatively.
You’ll also be offered support staying healthy. This can include help eating a healthy diet, getting regular exercise and stopping smoking.
The reasons why some people develop schizophrenia aren't fully understood. Things that may make you more likely to develop schizophrenia include:
- having a close relative who’s had schizophrenia
- problems during your mother’s pregnancy with you
- difficulties in your early development or childhood
- being born in a city
- using cannabis, particularly during adolescence
Your genes could make you more likely to develop schizophrenia but scientists believe that it takes more than genes. A combination of factors is involved. One in 10 people who have a parent who has had schizophrenia develop the condition. However, only one in 100 people develop schizophrenia if neither parent has had the condition.
Most people who develop schizophrenia get better. 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. See our FAQ about how to manage schizophrenia long-term for more information.
How can I help a family member with schizophrenia?
Your support is vital for someone living with schizophrenia. There are many things you can do to support your relative and to ensure that you’re also getting the support you need.
For someone with schizophrenia, the support of family, partners and friends is very important. You can help your family member in the following ways.
- Focus on how your relative is feeling, rather than the things that they are experiencing. Instead of correcting them, try saying that you accept that they see things a certain way, but that you don’t.
- Learn about schizophrenia and what it’s like to live with. You can do this by talking to other people in a similar situation to you, joining a support group or reading about other people’s experiences.
- Ask your relative about the practical help they need, such as help finding and using local services.
- You may want to think about becoming a ‘Nearest Relative’ for your family member. This means that if they have a crisis, you can request that they have an assessment by a mental health professional. This is especially important if you think they’re at risk of hurting themselves or someone else.
Don’t forget to get support for yourself too. You’re entitled to have a carer’s assessment. If you’re caring for a relative with schizophrenia, you may sometimes feel angry, guilty, fearful or frustrated. These feelings may be hard to deal with. You might find family therapy helpful. Family therapy helps people in a close relationship help each other. You might also find it useful to contact local support groups or voluntary organisations for information and support.
Are people with schizophrenia violent?
It's uncommon for people with schizophrenia to become violent. Occasionally though, schizophrenia can make people feel angry, upset or scared and this can cause violent outbursts. This can mean that they hurt themselves, and sometimes others.
Despite what you may see on the television or read in the newspapers, most people with schizophrenia aren’t violent or dangerous. However, a few people do become violent during a crisis or an acute episode.
If you have schizophrenia, you’re more likely to be violent towards yourself than other people. However, sometimes the people around you might be hurt. You’re more likely to be violent if you’re taking illicit drugs or drinking alcohol.
People with schizophrenia are more likely to attempt suicide. If you’re worried about hurting yourself or others, speak to your GP or mental health care team as soon as possible.
Will I have to stop driving if I have schizophrenia?
You won’t be able to drive while your condition is unstable and while you’re having treatment. However, once your condition is controlled you may be able to return to driving, as long as you don’t have side-effects from your medicines.
If you have schizophrenia, you must contact the Driver and Vehicle Licensing Agency (DVLA) to tell them. You’ll be asked to complete a form about your condition and treatment. You will also need to give your permission for the DVLA to contact the doctor managing your treatment. If you don’t, you won’t legally be allowed to drive and your insurance may not be valid.
You won’t be allowed to drive at all during an acute psychotic phase or a crisis (if you’re very unwell or at risk of hurting yourself or others). However, after three months of treatment you may be allowed to drive a car or motorcycle if:
- you’re well and your condition is stable
- you’re taking your medicines and following treatment
- you have no side-effects from medicines that might affect your ability to drive safely
If you drive a bus, coach or lorry, you won’t be allowed to drive for three years after your treatment starts. After this time, you may be allowed to drive if your condition is stable and you’re not taking any medicines for schizophrenia.
Speak to your GP or mental health care team if you need more advice.
How can I manage my schizophrenia long-term?
Living with schizophrenia can be a challenge for you, your family and carers. There are many things that you can do to help manage your condition in the long-term.
Some of the main ways to manage schizophrenia are listed below.
- Learn to recognise the early signs that you’re becoming unwell. These might include not taking care of yourself, not sleeping or feeling more anxious than usual. If you notice these signs, speak to your GP or mental health care team.
- Try to stay away from the things that make you worse, for example stressful situations, illicit drugs or alcohol.
- Learn some techniques to help you relax.
- If you hear voices, find ways to control them. This might include things like keeping busy, spending time with other people or listening to music.
- Find out about your condition and your treatment options. This can help you understand what’s happening to you and make choices about your treatment.
- Ask someone you trust to tell you if they think you’re becoming unwell again.
- Eat a healthy balanced diet and be active.
There’s also lots of help available in the community to support you and help you live independently. You may be supported by a mental health care team. These teams are made up of a number of specialists such as a nurse and social worker. They can help you with practical issues, such as employment and housing. They can also organise access to day centres or drop-in centres. Unfortunately, this service isn't always available.
If your symptoms start to get worse and you're no longer seeing a psychiatrist or community mental health team, see your GP as soon as possible. If necessary, they will be able to refer you back to your psychiatrist.
Because of the risk of long-term side-effects from medicines, it’s important you have regular physical check-ups with your GP. They should happen at least once a year. Your GP will check things like your blood pressure and weight. They might also arrange for you to have blood tests.
Mental Health Foundation The Mental Health Foundation is a charity that carries out research and offers information about many areas of mental health. As well as general information about schizophrenia, this article touches on the campaigning work the organisation is doing. There are links to their manifesto to help make mental health research a priority and also to information about self-management programmes. Mind The charity Mind has information to support people with a mental health condition and those who care for them. Their comprehensive content on schizophrenia includes plenty about the wider support services and programmes on offer to people with the condition. Rethink This charity has support groups, runs campaigns and can direct you to local mental health services, as well as providing information. You can download their factsheet that has details of the different types of schizophrenia and dispels some of the myths around the condition.
- Psychosis and schizophrenia in adults: treatment and management. National Institute for Health and Care Excellence (NICE), February 2014. www.nice.org.uk
- Schizophrenia. Royal College of Psychiatrists. www.rcpsych.ac.uk, published June 2014
- Map of Medicine. Schizophrenia. International View. London: Map of Medicine; 2013 (Issue 4).
- Schizophrenia and related psychoses. Oxford Handbook of Psychiatry (online). Oxford Medicine Online. www.oxfordmedicine.com, March 2013 (online version)
- Antipsychotics. Royal College of Psychiatrists. www.rcpsych.ac.uk, published January 2013
- Being sectioned (in England and Wales). Royal College of Psychiatrists. www.rcpsych.ac.uk, published August 2013
- Schizophrenia: what friends and family can do to help. Mind. www.mind.org.uk, accessed 12 September 2014
- Current medical guidelines: DVLA guidance for professionals. Driver and Vehicle Licensing Agency. www.gov.uk, published 14 October 2013
- Driving and mental illness. Rethink Mental Illness. www.rethink.org, published August 2013
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