Schizophrenia

A–Z / S / Schizophrenia

When a person has schizophrenia they go through patches where it is hard to think clearly, manage their emotions, distinguish what is real and what is not, and relate to others.

They may have times when they lose contact with reality. This can all be very frightening.

Schizophrenia most often begins between the ages of 15 and 30 years, occurring for the first time slightly earlier in men than in women. Schizophrenia happens in approximately the same numbers across all ethnic groups.

The onset of schizophrenia can be quite quick. Someone who has previously been healthy and coped well with their usual activities and relationships can develop psychosis (loss of contact with reality) over a number of weeks. That said, symptoms may also develop slowly, with the ability to function in everyday life declining over a number of years.

The course of schizophrenia is very variable

Everyone experiences it differently and most will make a reasonable recovery, going on to lead a fulfilling life. About one third of people experiencing schizophrenia will have ongoing problems, perhaps with continuing symptoms such as hearing voices.

The effects of the illness do reduce with time. With early, effective, recovery-oriented treatment and care (including knowing how to look after yourself well), schizophrenia can be successfully managed. There is also some suggestion that as people progress into their later years, that the signs and symptoms of schizophenia may lessen.

It's very important to get a diagnosis and treatment as early as possible. Schizophrenia can be effectively treated and you can recover. It is now an accepted fact that the earlier effective treatment is started, the better your chances of recovery.

Recovery is not defined as the complete absence of symptoms, but living well with or without symptoms – and will have a different meaning for each person.

If you think you have schizophrenia, or you are worried about a loved one, it's important to talk to your doctor or counsellor, or someone else you can trust as a first step to getting the important help you or they need.

Myths about schizophrenia

Schizophrenia means the person has a split personality.

NOT TRUE Split or multiple personality is an extremely rare condition that does not cause psychosis. So this statement is untrue. On the other hand, the behaviour of people with acute psychosis does change, but this is due to the illness not to any personality change. When the illness resolves the behaviour returns to normal.

People with schizophrenia are aggressive violent people.

NOT TRUE It is clear that outside times of acute illness, people with schizophrenia are no more violent than any other member of the community. With good care and treatment, risk during times of acute illness can be minimised. However, people with schizophrenia, especially if it’s not treated well, can be violent or victims of violence.

What causes schizophrenia?

The exact cause of schizophrenia is unknown. Different causes may operate in different people. This may be why there is wide variation in the way the condition develops, in its symptoms and in the way it develops.

It is known that there is genetic (inherited) component to schizophrenia. If someone in your family/whānau has schizophrenia, you and your relatives have an increased chance of developing it – about a one in 10 chance. Childhood stresses and trauma, such as abuse, are also being shown to be linked to increased chance of developing mental illnesses in adults.

Signs to look for (symptoms)

The symptoms of schizophrenia can vary between individuals and, over time, within an individual. They are often divided into two categories – psychotic symptoms and mood symptoms.

Psychotic symptoms

These symptoms are not there all the time and occur when you are having a severe, or acute episode. They include the following:

  • Delusions – an unusual belief that seems quite real to you, but not to those around you. A delusional person is convinced their belief is true. An example might be they strongly believe the FBI are trying to hunt them down.
  • Thought disturbances – how you process thoughts or your ability to concentrate and maintain a train of thought may be affected. For example, you may feel like your thoughts are racing and friends may notice you constantly changing the topic of conversation or that you are easily distracted, or may laugh at irrational times. Your speech may become quite disorganised, and you may use made up words that only you understand.
  • Hallucinations – this is when someone hears, sees, feels or smells something that is not there. Hearing voices that others cannot hear or when there is no-one else in the room is very typical of psychosis. Sometimes these voices will talk about or to you. They will sometimes command you to do things. For some, these voices can be inside their head; occasionally they may seem to come from within their body.

Mood symptoms

These could include:

  • Loss of motivation, interest or pleasure in things. Everyday tasks such as washing up become difficult.
  • Mood changes –You'll tell friends you're feeling great or never better. However, your ‘happy’ behaviour will be recognised as excessive by friends or family. You may also be quite unresponsive and be unable to express joy or sadness.
  • Social withdrawal –people may notice that you become very careless in your dress and self-care, or have periods of seeming to do little and periods of being extremely active.

Other symptoms include subtle difficulties with tasks like problem solving or you may show signs of depression – commonly experienced by people with schizophrenia.

The strongest feature of schizophrenia is loss of insight – the loss of awareness that the experiences and difficulties you have are the result of your illness. It is a particular feature of psychotic illnesses, and is the reason why the Mental Health Act (1992) has been developed to ensure people with these conditions can get the assessment and treatment they need.

How the doctor tests for schizophrenia (diagnosis)

Once you have spent some time talking to your doctor, they will refer you to a psychiatrist qualified to diagnose and treat people with this condition. Psychiatrists diagnose schizophrenia when a person has some or all of the typical symptoms described above. For this reason it is important the psychiatrist gets a full picture of the difficulties you have had, both from you and your family/whānau or others who know you well.

Before schizophrenia can be diagnosed, the symptoms or signs must have been present for at least six months, with symptoms of psychosis for at least one month.

Treatment options

The best treatment for schizophrenia involves a number of important components, each of which can be tailored to your needs and the stage of the condition. The main components are psychosocial (talking) therapies, medication, with complementary therapies potentially valuable as well.

Talking therapies and counselling (psychosocial treatments)

Talking therapies are effective in the treatment of schizophrenia, especially for the treatment of depressive symptoms. Sessions may be held on a one to one basis, sometimes include partners or family, or be held in a group.

 The focus of psychological therapy or counselling is on education and support for you to understand what is happening to you, to learn coping strategies and to pursue a path of recovery. Sessions help you regain the confidence and belief in yourself that is critical to recovery.

All types of therapy/counselling should be provided in a manner which is respectful to you and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Medication

In treating schizophrenia, medicines are most often used for making your mood more stable and for helping with depression (anti-depressants). If you are prescribed medication, you are entitled to:

  • know the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for
  • and understand the side effects.

Finding the right medication can be a matter of trial and error. There is no way to predict exactly how medicines will affect you but it is worth persevering to find what medication works best for you.

If you're pregnant or breastfeeding no medication is entirely safe. Before making any decisions about taking medication in pregnancy you should talk with your doctor.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking.

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

Thanks to Janet Peters, Registered Psychologist, for reviewing this content. Date last reviewed: September, 2014.