The symptoms of schizophrenia can appear at any time from your late teenage years, but most commonly start in the early twenties. It’s as likely to affect women as men, although men tend to get more severe symptoms. Symptoms of schizophrenia vary from person to person and over time for the same person.
The first symptoms of schizophrenia can be quite vague. They develop during what’s called the ‘prodromal phase’ (beginning) of schizophrenia. This period varies a lot in how long it lasts. It may be as little as a few days, but is more usually one to two years. You may lose interest in your usual activities and withdraw from other people. You may have trouble concentrating, and feel confused and listless. Your family or friends may feel that you’re not yourself, but not realise that these are symptoms of a medical condition. To some, it may seem that you’re just being lazy, or not making an effort. They may tell you to ‘pull yourself together’. These symptoms can make it a very difficult time for you, and for those you live with.
After the prodromal phase of schizophrenia comes the ‘active phase’, with more marked symptoms. Doctors divide these symptoms of schizophrenia into two main groups which they call ‘positive’ symptoms and ‘negative’ symptoms. Sometimes this active phase appears suddenly, with no preceding prodromal phase.
Some people have symptoms for only a short time while others have them for months or years. Your symptoms may go away for good with treatment, or they may come back again in the future. Everyone is different.
Positive symptoms are unusual mental experiences that you have with schizophrenia – reality is distorted for you. These symptoms are sometimes called psychosis. You can have one or more of these positive symptoms. 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. These are fixed beliefs you have which don’t match with reality, and aren’t explained by your culture or religion. There are different types of delusion. You may believe ordinary events, objects or behaviour have an unusual meaning specifically to you. 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 watch a TV programme to the end, or keep your mind on the task you’re doing.
For some people, the first signs they have schizophrenia are these intense positive symptoms, which can be frightening. Once you’ve started treatment, you should find that your symptoms start to get better. They might disappear altogether.
Negative symptoms are linked to a loss of motivation and ability to enjoy life. Symptoms can include:
- difficulty remembering things or concentrating
- your emotions being ‘flat’, finding it hard to feel excited or enthusiastic about anything
- spending less time with others (being withdrawn); not wanting to go out
- difficulty communicating in a way others can understand
- not caring for yourself properly, for example not washing or keeping your clothes clean
- reduced interest in day-to-day activities
There isn’t a test for schizophrenia. Your doctor makes a diagnosis of schizophrenia based upon your symptoms. Because it’s a serious diagnosis, in some cases your doctor may not give your mental health condition the name schizophrenia if it’s the first episode. They may say you have psychosis or a psychotic disorder.
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, and whether there’s anyone in your family with mental health problems.
If your GP thinks you may have schizophrenia, they’ll refer you to a Mental Health Care team. This is a group of specialist nurses and mental health care workers. You may also see a hospital mental health specialist. You won’t necessarily have 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 experiences. Sometimes, people with schizophrenia can have other conditions too. So your mental health worker will, for instance, check you for symptoms of depression. See our FAQ below about depression in schizophrenia, an important issue. They’ll also ask you about your use of alcohol and whether you take illegal drugs, including cannabis. They’ll assess your general physical health too.
It’s important to begin treatment for schizophrenia as early as possible after the symptoms begin. If you’re treated early you’re less likely to need to go into hospital. You may also need less care at home, and you’re more likely to be able to work and live independently. Because of this you may be referred to a special mental health team called an ‘early intervention’ or ‘first episode’ team.
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. Having support from family and friends will help your treatment to be successful.
The medicines used to treat the symptoms of schizophrenia are called antipsychotics. 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.
There are a number of different antipsychotic medicines. You may have side-effects, but it’s difficult to be sure whether you’ll get these and how they’ll affect you – everyone is different. One group of side-effects is stiffness and shakiness (tremor), sometimes with restlessness and muscle spasms. Some antipsychotic medicines may make you feel sleepy or slow and affect your sex life. Some can cause long-term health problems, such as gaining weight, low blood pressure and diabetes.
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 it 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 given a medicine to make you calmer (sedation).
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. This uses a law called the Mental Health Act. Three mental health experts (including two doctors) must believe that you and others are at risk if you don’t have hospital treatment. You have the right to appeal this decision if you don’t agree with it.
If you do need to be in hospital, it will only be until you’re well enough to manage at home safely.
Your psychiatrist should offer you talking therapy, such as cognitive behavioural therapy (CBT) or family therapy.
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.
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.
Arts therapy may be available for you. This can help you to manage negative symptoms and encourage you to express yourself creatively.
Doctors don’t yet know for sure why people get schizophrenia. Your genes could make you more likely to develop it. For instance, you’re over ten times more likely to get schizophrenia if one of your parents had it. But scientists believe that it takes more than genes. A combination of factors is involved.
Things that may make you more likely to develop schizophrenia include:
- having a close relative, such as a parent or sibling, who’s had schizophrenia
- problems during your mother’s pregnancy with you
- difficulties in your early development or childhood
- using cannabis, particularly during your teenage years
Altogether, around one in 100 people will develop schizophrenia in their lifetime.
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.
Some of the main ways you can help yourself 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, illegal drugs (including cannabis) 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.
- Look after your physical health. Eat a healthy balanced diet and be active. If you smoke, consider cutting down or stopping altogether.
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 get worse and you’re no longer seeing a psychiatrist or community mental health team, contact your GP as soon as possible. If necessary, they’ll be able to refer you back to the mental health team.
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 to monitor your health.
The support of family, partners and friends is very important for someone with schizophrenia. You can make a real difference.
Here are some ways to help.
- Focus on how your relative is feeling, rather than the things that they’re experiencing. If they’re worried or scared, remember that this is very real for them. 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.
- Try to notice positive things: focus on what your relative can do, and set small goals which they can achieve.
- Ask your relative about the practical help they need, such as help finding and using local services. You may be able to help by making sure they are paying their bills and responding to important letters and emails.
- Try to encourage and support them in keeping a healthy lifestyle. This includes eating a healthy balanced diet, stopping smoking and avoiding illegal drugs.
Don’t forget to get support for yourself too. 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’re entitled to have a carer’s assessment, where your own needs are discussed. You can ask the mental health team or your GP about this.
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. See our section below on other helpful websites for details of organisations which can help.
Despite what you may think, see on the television or read in the newspapers, most people with schizophrenia aren’t violent or dangerous. They are more likely to be harmed by others, than to do harm. 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.
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 less likely to be violent while you’re having treatment. And you’re more likely to be violent if you’re taking illegal 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.
Many people become depressed after they’ve recovered from an episode of active schizophrenia (see our symptoms section above for ‘positive’ symptoms, or psychosis).
Symptoms of depression include:
- feeling unhappy most of the time
- losing interest in life, not being able to enjoy anything
- feeling tired
- losing your appetite
- difficulty getting to sleep and waking early
- feeling worthless or useless
The symptoms of depression are similar to the ‘negative’ symptoms of schizophrenia. However differences do exist. For instance, a person suffering from depression may be inactive because they are feeling extremely sad and despondent. But a person with the negative symptoms of schizophrenia may be inactive because they don’t feel emotion of any kind, neither happy nor sad.
If you’re feeling depressed it’s important that you tell your doctor or mental health team member. They can then assess you. Depression can, and should be treated in someone with schizophrenia, just as it would be in someone who doesn’t 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, it’s the law that 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’ll also need to give your permission for the DVLA to contact the doctor managing your treatment.
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 at least 12 months after your treatment starts. After this time, you may be allowed to drive if the conditions mentioned above apply to you.
It’s important to let your motor insurer know of any medical condition which might affect your driving, including schizophrenia. If you don’t, and if you don’t inform the DVLA if that’s necessary, you won’t be insured. Speak to your mental health care team or GP if you need more advice.
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.
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- Psychosis and schizophrenia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2015
- Psychosis and schizophrenia in adults: treatment and management. National Institute for Health and Care Excellence (NICE), February 2014. www.nice.org.uk
- Antipsychotic drugs. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 4 April 2017
- Schizophrenia and related psychoses. Oxford handbook of psychiatry (online). Oxford Medicine Online. www.oxfordmedicine.com, March 2013
- Map of Medicine. Schizophrenia and Psychosis. International View. London: Map of Medicine; 2015 (Issue 3)
- Management of schizophrenia (SIGN 131). Scottish Intercollegiate Guidelines Network. www.sign.ac.uk, 2013
- Schizophrenia. Royal College of Psychiatrists. www.rcpsych.ac.uk, published August 2015
- Antipsychotics. Royal College of Psychiatrists. www.rcpsych.ac.uk, published January 2014
- What is schizophrenia. Camh Centre for Addiction and Mental Health. www.camh.ca, accessed 4 May 2017
- Schizophrenia: what can friends and family do to help? MIND. www.mind.org.uk, published February 2017
- Sectioning. Mind. www.mind.org.uk, published January 2015
- Rethink Mental Illness. www.rethink.org, last updated April 2017
- Nearest relative. Rethink Mental Illness. www.rethink.org, last reviewed February 2016
- Depression. Royal College of Psychiatrists. www.rcpsych.ac.uk, published June 2015
- Driving and mental illness. Rethink Mental Illness. www.rethink.org, last updated October 2015
- Schizophrenia. National Institute of Mental Health. www.nimh.nih.gov, accessed 5 April 2017
- Psychiatric disorders: assessing fitness to drive. GOV.UK. www.gov.uk, first published 11 March 2016
- Schizophrenia and driving. GOV.UK. www.gov.uk, last updated March 2017
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Reviewed by Dr Kristina Routh, Freelance Health Editor, April 2017
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