Schizophrenia: Symptoms, Causes, & Treatment

What Is Schizophrenia?

Schizophrenia is a chronic mental health disorder characterized by psychosis and clinically significant difficulties in a person’s daily functioning. This condition typically presents in late adolescence to early adulthood and requires lifelong treatment.

People with schizophrenia may experience:

Hallucinations: Seeing or hearing things other people cannot see or hear, such as a voice making commands.
Delusions: False beliefs that the person holds and will not change even when presented with factual information.
Disorganized thinking and speech: Moving from one thought to the next without a logical connection or speaking in sentences that don’t make sense to others.
Emotional blunting: Also known as “flat affect,” where an individual shows less outward expression of emotions which may not match their internal response.

Schizophrenia vs. Schizoaffective Disorder

Although schizophrenia and schizoaffective disorder have some similar symptoms they are separate diagnoses. Schizoaffective disorder has mood disorder symptoms like depression or mania, as well as symptoms of schizophrenia. Schizophrenia, on the other hand, does not need a mood episode for a diagnosis.

Common Misconceptions

There are several common inaccurate and harmful misconceptions associated with people living with schizophrenia. One of these is the language we use to speak about them and their disorder. Using language like “a schizophrenic” reduces their identity to just their diagnosis.

By talking about someone using person-first language (e.g., “a person living with schizophrenia”), we emphasize their humanity over their illness.

Another prevalent myth is that individuals with schizophrenia have multiple or split personalities. Someone with schizophrenia does not have two separate personalities. Rather, they have lost touch with reality or maintain false ideas. Multiple personality disorder (now known as dissociative identity disorder, or DID) is unrelated.

Another damaging misconception is the belief that people living with schizophrenia are violent or inherently dangerous.

In reality, people with schizophrenia are far more likely to be victims of violence than perpetrators. This stereotype not only stigmatizes those living with the condition but also distracts from the support and resources they truly need.

Recognizing Schizophrenia Symptoms

Symptoms of schizophrenia vary from person to person and may change over time. Some people have one psychotic episode while others experience many throughout their lives. Schizophrenia symptoms usually fall into three categories:

Positive: Hallucinations, delusions and disorganized thinking or speech
Negative: Emotional expression, social withdrawal or lack of motivation
Cognitive: Poor memory, difficulty focusing or executive functioning challenges

What Is Paranoid Schizophrenia?

The term “paranoid schizophrenia” was a subtype of schizophrenia in the diagnostic manual that mental health professionals used to diagnose mental health conditions. However when the DSM-5 came out in 2013 it removed this and other subtypes of schizophrenia.

The paranoid schizophrenia subtype had symptoms related to delusions or auditory hallucinations involving themes of persecution or being targeted. While this subtype has been removed, individuals can still present with paranoia as part of their schizophrenia diagnosis, which is relevant in treatment.

Early Warning Signs

Signs of schizophrenia can come on subtly with varying changes in behavior. Behavioral and general changes to a person can include:

Social withdrawal
Unusual or paranoid thoughts
Changes in sleep or hygiene
Trouble with logic or confusion in communication
Sudden changes in performance at work or school
Mood disruption
Lack of motivation
Reduced facial expressions

Schizophrenia Treatments: What Are the Options?

Treatment for schizophrenia is important, as research shows that untreated schizophrenia has a worse prognosis. The more episodes someone has the further from reality they become. Treatment options include medication, psychotherapy, behavioral therapy and social services, as well as employment and educational interventions.

Medication Management

Antipsychotic medication managed by a psychiatrist is crucial for schizophrenia treatment, as it can help stabilize and lower the risk of future symptoms. These medications work with neurotransmitters in the brain, like dopamine, to help reduce hallucinations and delusional symptoms.

Although medications are effective in schizophrenia treatment, adherence can be difficult due to side effects like weight gain and movement disorders. Additionally, psychotic symptoms from the disorder can interfere with the person’s judgment, and they may feel that they don’t need to take the medications.

Long-acting injectables have been helpful in treatment adherence, as they provide a sustained release of medication that does not require taking a pill every day.

Therapeutic Support

Historically, therapy was thought to be unhelpful for symptoms of schizophrenia. However, research has shown that pairing social support and medication with therapy that helps clients reduce stress and anxiety, develop coping skills and improve functioning significantly enhances outcomes.

Collaborative Care

There are many ways to treat schizophrenia, ideally in a team approach. Psychiatrists, primary care doctors, psychologists, social workers and other mental health professionals are crucial in helping people with schizophrenia and their families explore sources of treatment. Treatment plans might also include group therapy, job training and housing support.

FAQs

What is it Like Living With Schizophrenia?

Each person’s experience is different. While schizophrenia is a lifelong illness, especially with early and ongoing treatment, some individuals with schizophrenia live relatively independently. However, others may need more structured support and struggle with daily living.

What are the Five Main Symptoms of Schizophrenia?

The core symptoms include hallucinations, delusions, disorganized speech, disorganized or catatonic behavior and negative symptoms (e.g., lack of emotional expression).

Is Schizophrenia Inherited?

Genetic make-up and brain chemistry play a role, but schizophrenia is not purely hereditary. While it can run in families, just because one family member has it doesn’t mean it will be passed on to other family members. Like most mental health disorders, research suggests it is a combination of genes and environmental factors like trauma or substance use that can contribute.

Can I Live a Normal Life with Schizophrenia?

There is no known cure for schizophrenia, but the outlook for people with this illness is improving. Generally, the earlier treatment is sought, the better the outcome. While “normal” life may look different for each person, many individuals can live fulfilling lives with appropriate treatment.

Therapy for Schizophrenia: How Counseling Can Help

Therapy helps people living with schizophrenia cope with, reduce and manage symptoms associated with the disorder. However, schizophrenia therapy is not just about managing symptoms—it’s about helping people remember who they are outside their diagnosis.

Several types of schizophrenia therapy can be helpful, including:

Cognitive behavioral therapy for psychosis (CBTp): Helps manage delusions by reframing the thoughts and beliefs that fuel the delusions, rather than directly challenging or confronting their reality.
Cognitive behavioral therapy (CBT): Can be used to increase coping skills, manage stress and respond more calmly.
Family therapy: Going to therapy as a family can help increase communication and understanding. It can also teach family members how to respond constructively and avoid unintentionally strengthening delusional beliefs.
Social skills and occupational therapy: Schizophrenia therapy, like these skills-based therapies, helps with communication, conflict resolution and workplace readiness. These skills can increase confidence and reduce social isolation, which is common with schizophrenia.

How to Help Someone with Schizophrenia Who Refuses Treatment

People with schizophrenia may refuse treatment due to distrust, fear of stigma, or a lack of awareness or insight (anosognosia). This can be incredibly difficult for a loved one to watch them suffer and not accept help.

Common reasons for refusal:

Fear of medication side effects
Delusional beliefs about family members, providers or treatment
Denial that something is wrong
Prior traumatic experiences with hospitals or providers

Practical strategies:

Do not challenge their false beliefs or hallucinations, as what they are experiencing is very real to them, and this can make them distrust you.
Encourage them to seek treatment to reduce stress.
Offer choices to help them feel in control. Even small decisions, like choosing a provider or appointment time, can help them feel more in control.
Build trust and empathy by being supportive and kind, without allowing inappropriate or dangerous behaviors.
Find support for yourself, and get educated and connected with others. Programs like NAMI’s Family-to-Family can help you navigate the emotional toll.

Communicating During Delusions

When someone experiences delusions, don’t push back. Instead, listen more. Acknowledge their emotions without agreeing with false beliefs.

Avoid directly challenging their false beliefs. Refrain from intentionally continuing any conversation on the topic. Try to provide a slight acknowledgement and then shift the discussion back to what needs to be the focus. If they are unreasonable or irrational, try to remain neutral.

Attempt to shift the conversation to relevant topics and maintain it there. Be specific, for example, “Right now, we are focusing on XYZ” or “Today, our objective is to accomplish (insert specific thing).”

You can also try stalling, saying, “Let’s save that for later” or “That’s interesting. Let me think about that for a bit.”

Living with schizophrenia can be challenging but also manageable. With early intervention, supportive therapy and the patience of loved ones, individuals can live meaningful, connected lives.