What is schizophrenia?

Schizophrenia is a mental illness that causes someone to have an altered experience of reality. It causes psychosis, when people experience delusions and hallucinations. Schizophrenia affects people’s thoughts, perceptions and behaviour and interferes with their ability to function at work, school or relate to other people.

People with schizophrenia often experience stigma in the community, which can be one of their biggest problems. Most people find schizophrenia hard to understand and there are many myths about the illness. Contrary to popular belief, people with schizophrenia do not have a ‘split personality’. Only a very small number of people with schizophrenia become violent but they do have a higher rate of suicide than the general population.

Schizophrenia affects about 1 in 100 people, and the symptoms usually begin in late adolescence or early adulthood. It is generally a long-term illness and can cause serious disability when left untreated.

What are the symptoms of schizophrenia?

Schizophrenia has a large variety of symptoms and can seem very different in one person from another. If it’s not treated, schizophrenia may lead to long-term psychosis.

The main symptoms of schizophrenia are:

• hallucinations (hearing or seeing something that isn’t real, such as hearing voices when no one is there)
• delusions (believing something that can be proven to be untrue, such as believing you have a microchip implanted in your head)
• confused thinking: thoughts are jumbled and the person can’t make sense of what other people are saying.

Someone with schizophrenia will have symptoms for more than 6 months. They may have unusual ideas or beliefs about themselves or the world around them, which may be frightening.

What causes schizophrenia?

It is thought that schizophrenia involves complex changes in brain functioning but the causes are not yet fully understood.

Genetics are the most important risk factor for schizophrenia. People with a parent or sibling with schizophrenia have a 1 in 10 chance of developing it, whereas in the general population just 1 in 100 have a chance of developing it. There is no single gene involved; rather, a number of genes may combine to increase the risk.

If people have a genetic predisposition to schizophrenia, things such as stress or drugs (marijuana, LSD or speed) can trigger the first episode.

Malnutrition, serious infections in pregnancy or birth complications can increase the risk of a child developing schizophrenia later in life, and people who have experienced violence or trauma are also at increased risk.

When should I see my doctor?

Some people with schizophrenia do not realise they have a problem or avoid health professionals if they have paranoid thoughts. It’s important to get professional help to manage schizophrenia. If you or someone you know seems to be experiencing signs of schizophrenia, see your doctor as soon as possible.

It can be hard to recognise signs of schizophrenia at first, but over time the changes in someone’s thinking and behaviour may get worse.

See a doctor if you or someone you know:

• gets very preoccupied with something
• starts talking or writing very fast, or is talking much less than normal
• seems muddled, irrational or is hard to understand
• withdraws from normal activities
• is angry, aggressive or suspicious
• has changes in sleep
• is hyperactive or starts behaving recklessly
• laughs or cries inappropriately, or cannot laugh or cry or express happiness
• doesn’t look after their personal hygiene
• develops depression or anxiety

Although the majority of people with schizophrenia are not violent, severe symptoms can cause some people to have thoughts of suicide or harming others. If you think someone may be at risk of suicide or violence, call triple zero (000).

How is schizophrenia diagnosed?

There is no test available for schizophrenia. A doctor or mental health professional can do a mental health assessment in the form of a special interview. This includes questions about the current symptoms, past history of mental health issues, medical history, family history and any substance abuse issues. It is also helpful to speak to a family member for more information about the person’s symptoms.

The doctor will then do a physical examination and may need to do blood tests or a brain scan to rule out any underlying causes. The diagnosis will usually need to be confirmed by a psychiatrist, who can advise on the best treatment options.

For a diagnosis of schizophrenia to be made, the symptoms need to be present for 6 months or more and be severe enough to cause problems in functioning at work, school, home or socially.

Sometimes a diagnosis of psychosis may be used instead of schizophrenia. This is a similar diagnosis but usually means the symptoms are less severe or have been present for a shorter period of time. Some people with psychosis go on to develop schizophrenia later in life but many recover completely.

How is schizophrenia treated?

Schizophrenia is more treatable than ever before. Many people recover completely whereas others might have episodes of schizophrenia that come and go. There are a number of different treatments to help people manage their symptoms and help them to flourish in all areas of life.

Treatment should be under the care of a psychiatrist, but may involve a team of different mental health professionals, including a doctor, mental health nurse, social worker, occupational therapist and clinical psychologist. Treatments are tailored according to the needs of the individual.

Research has shown that early treatment can be more effective, before the illness has time to cause damage. There are early intervention programs in most major cities in Australia.

Medicine

Medicine is the main form of treatment for schizophrenia. Antipsychotic medicines can reduce the main symptoms like hallucinations and delusions, and normally take up to 6 weeks to start working. Recently, a new generation of treatments has been developed, including risperidone, quetiapine, clozapine and many others. Some people develop side effects to medicine, so it is important to have regular appointments with a psychiatrist or doctor. People respond differently to medicine and sometimes it is necessary to try more than one type before finding the ideal medicine.

Psychological treatments

Psychological treatments can help people to understand and manage their symptoms and learn new ways of coping. Cognitive behaviour therapy (CBT), supportive psychotherapy and family therapy may all be used.

Community support

Mental health services can also provide practical support for people with schizophrenia. A stable living environment, supportive relationships and meaningful work or activity are essential ingredients for recovery. Some people with schizophrenia may need rehabilitation and skills training to help them get back to work or education.

Medical care

People with schizophrenia may have higher rates of physical health problems than the wider community. It’s important to see a doctor regularly to stay healthy.

Hospital treatment

Some people with schizophrenia need to be treated in hospital at times. A hospital admission can help when symptoms are out of control or the person is not managing at home.

Resources and support

For further information about schizophrenia, please see the Australian Treatment Guide for Consumers and Carers, from the Royal Australian and New Zealand College of Psychiatrists.

You can also visit Head to Health, an online gateway funded by the Australian Government that can help you find free and low-cost, trusted phone and online mental health resources, including information about schizophrenia and psychotic disorders.