Health A to Z
Schizophrenia is a severe long-term mental health condition. It causes a range of different psychological symptoms.
Doctors often describe schizophrenia as a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality.
Symptoms of schizophrenia include:
Some people think schizophrenia causes a "split personality" or violent behaviour. This is not true.
The cause of any violent behaviour is usually drug or alcohol misuse.
Read about symptoms of schizophrenia.
If you're experiencing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the better.
There's no single test for schizophrenia. It's usually diagnosed after an assessment by a mental health care professional, such as a psychiatrist.
Read about diagnosing schizophrenia.
The exact cause of schizophrenia is unknown. However, most experts believe the condition is caused by a combination of genetic and environmental factors.
It's thought that some people are more vulnerable to developing schizophrenia, and certain situations can trigger the condition.
Read about the causes of schizophrenia.
Schizophrenia is usually treated with a combination of medication and therapy tailored to each individual. In most cases, this will be antipsychotic medicines and cognitive behavioural therapy (CBT).
People with schizophrenia usually receive help from a community mental health team, which offers day-to-day support and treatment.
Many people recover from schizophrenia, although they may have periods when symptoms return (relapses). Support and treatment can help reduce the impact the condition has on daily life.
Read about treating schizophrenia.
If schizophrenia is well managed, it's possible to reduce the chance of severe relapses.
This can include:
There are many charities and support groups offering help and advice on living with schizophrenia. Most people find it comforting talking to others with a similar condition.
Read about living with schizophrenia.
Schizophrenia changes how a person thinks and behaves.
The condition may develop slowly. The first signs can be hard to identify as they often develop during the teenage years.
Symptoms such as becoming socially withdrawn and unresponsive or changes in sleeping patterns can be mistaken for an adolescent "phase".
People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no symptoms. This is known as acute schizophrenia.
The symptoms of schizophrenia are usually classified into:
Hallucinations are where someone sees, hears, smells, tastes or feels things that don't exist outside their mind. The most common hallucination is hearing voices.
Hallucinations are very real to the person experiencing them, even though people around them can't hear the voices or experience the sensations.
Research using brain-scanning equipment shows changes in the speech area in the brains of people with schizophrenia when they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices.
Some people describe the voices they hear as friendly and pleasant, but more often they're rude, critical, abusive or annoying.
The voices might describe activities taking place, discuss the hearer's thoughts and behaviour, give instructions, or talk directly to the person. Voices may come from different places or one place in particular, such as the television.
A delusion is a belief held with complete conviction, even though it's based on a mistaken, strange or unrealistic view. It may affect the way the person behaves. Delusions can begin suddenly, or may develop over weeks or months.
Some people develop a delusional idea to explain a hallucination they're having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions.
Someone experiencing a paranoid delusion may believe they're being harassed or persecuted. They may believe they're being chased, followed, watched, plotted against or poisoned, often by a family member or friend.
Some people who experience delusions find different meanings in everyday events or occurrences.
They may believe people on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing on the street.
People experiencing psychosis often have trouble keeping track of their thoughts and conversations.
Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme.
People sometimes describe their thoughts as "misty" or "hazy" when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand.
A person's behaviour may become more disorganised and unpredictable, and their appearance or dress may seem unusual to others.
People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason.
Some people describe their thoughts as being controlled by someone else, that their thoughts aren't their own, or that thoughts have been planted in their mind by someone else.
Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind.
Some people feel their body is being taken over and someone else is directing their movements and actions.
The negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode.
These initial negative symptoms are often referred to as the prodromal period of schizophrenia.
Symptoms during the prodromal period usually appear gradually and slowly get worse.
They include the person becoming more socially withdrawn and increasingly not caring about his or her appearance and personal hygiene.
It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else.
Negative symptoms experienced by people living with schizophrenia include:
The negative symptoms of schizophrenia can often lead to relationship problems with friends and family as they can sometimes be mistaken for deliberate laziness or rudeness.
Schizophrenia is often described by doctors as a type of psychosis.
A first acute episode of psychosis can be very difficult to cope with, both for the person who is ill and for their family and friends.
Drastic changes in behaviour may occur, and the person can become upset, anxious, confused, angry or suspicious of those around them.
They may not think they need help, and it can be hard to persuade them to visit a doctor.
Read more about understanding psychotic experiences.
The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition.
Some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it's not known why some people develop symptoms while others don't.
Things that increase the chances of schizophrenia developing include:
Schizophrenia tends to run in families, but no single gene is thought to be responsible.
It's more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes doesn't necessarily mean you'll develop schizophrenia.
Evidence that the disorder is partly inherited comes from studies of twins. Identical twins share the same genes.
In identical twins, if one twin develops schizophrenia, the other twin has a one in two chance of developing it, too. This is true even if they're raised separately.
In non-identical twins, who have different genetic make-ups, when one twin develops schizophrenia, the other only has a one in seven chance of developing the condition.
While this is higher than in the general population, where the chance is about 1 in 100, it suggests genes aren't the only factor influencing the development of schizophrenia.
Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains.
These changes aren't seen in everyone with schizophrenia and can occur in people who don't have a mental illness. But they suggest schizophrenia may partly be a disorder of the brain.
Neurotransmitters are chemicals that carry messages between brain cells.
There's a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia.
Research suggests schizophrenia may be caused by a change in the level of two neurotransmitters: dopamine and serotonin.
Some studies indicate an imbalance between the two may be the basis of the problem. Others have found a change in the body's sensitivity to the neurotransmitters is part of the cause of schizophrenia.
Research has shown people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as:
It may be that these things have a subtle effect on brain development.
Triggers are things that can cause schizophrenia to develop in people who are at risk.
The main psychological triggers of schizophrenia are stressful life events, such as:
These kinds of experiences, although stressful, don't cause schizophrenia. However, they can trigger its development in someone already vulnerable to it.
Drugs don't directly cause schizophrenia, but studies have shown drug misuse increases the risk of developing schizophrenia or a similar illness.
Certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may trigger symptoms of schizophrenia in people who are susceptible.
Using amphetamines or cocaine can lead to psychosis, and can cause a relapse in people recovering from an earlier episode.
Three major studies have shown teenagers under 15 who use cannabis regularly, especially "skunk" and other more potent forms of the drug, are up to four times more likely to develop schizophrenia by the age of 26.
There's no single test for schizophrenia and the condition is usually diagnosed after assessment by a specialist in mental health.
If you're concerned you may be developing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the better.
Your GP will ask about your symptoms and check they're not the result of other causes, such as recreational drug use.
If a diagnosis of schizophrenia is suspected, your GP should refer you promptly to your local community mental health team (CMHT).
CMHTs are made up of different mental health professionals who support people with complex mental health conditions.
A member of the CMHT team, usually a psychiatrist or a specialist nurse, will carry out a more detailed assessment of your symptoms. They'll also want to know your personal history and current circumstances.
To make a diagnosis, most mental healthcare professionals use a diagnostic checklist.
Schizophrenia can usually be diagnosed if:
Sometimes it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, a psychiatrist may have reason to believe you have a related mental illness, such as:
As a result of their delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe there's nothing wrong with them.
It's likely someone who has had acute schizophrenic episodes in the past will have been assigned a care co-ordinator. If this is the case, contact the person's care co-ordinator to express your concerns.
If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative or another loved one to persuade them to visit their GP.
In the case of a rapidly worsening schizophrenic episode, you may need to go to the accident and emergency (A&E) department, where a duty psychiatrist will be available.
If a person who is having an acute schizophrenic episode refuses to seek help, their nearest relative can request that a mental health assessment is carried out. The social services department of your local authority can advise how to do this.
In severe cases, people can be compulsorily detained in hospital for assessment and treatment under the Mental Health Act (2007).
If you or a friend or relative are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn.
It's important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available.
Children and young people with a first episode of schizophrenia should be referred urgently to a specialist mental health service.
This should be either Child and Mental Health Adolescent Services (CAMHS) for those aged up to 17, or an early intervention service for those aged 14 years or over, that includes a consultant psychiatrist with training in child and adolescent mental health.
People with complex mental health conditions are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs.
There are four stages to a CPA:
Not everyone uses the CPA. Some people may be cared for by their GP, while others may be under the care of a specialist.
You'll work together with your healthcare team to develop a care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency.
Your care plan should include a combined healthy eating and physical activity programme and support for giving up smoking, if you smoke.
Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan.
People who have serious psychotic symptoms as the result of an acute schizophrenic episode may require a more intensive level of care than a CMHT can provide.
These episodes are usually dealt with by antipsychotic medication and special care.
One treatment option is to contact a home treatment or crisis resolution team (CRT). CRTs treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis.
Without the involvement of the CRT, these people would require treatment in hospital.
The CRT aims to treat people in the least restrictive environment possible, ideally in or near their home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre.
CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis occurring.
Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis.
More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it's necessary.
People can also be compulsorily detained at a hospital under the Mental Health Act (2007), but this is rare.
It's only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder and if detention is necessary:
People with schizophrenia who are compulsorily detained may need to be kept in locked wards.
All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.
An independent panel will regularly review your case and progress. Once they feel you're no longer a danger to yourself and others, you'll be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.
If it's felt there's a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement.
An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to include contact details for your care co-ordinator.
If you want to make an advance statement, talk to your care co-ordinator, psychiatrist or GP.
Antipsychotics are usually recommended as the initial treatment for the symptoms of an acute schizophrenic episode. They work by blocking the effect of the chemical dopamine on the brain.
Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but may take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts.
It's important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you.
Antipsychotics can be taken orally as a pill, or be given as an injection known as a depot. Several slow-release antipsychotics are available. These require you to have one injection every two to four weeks.
You may only need antipsychotics until your acute schizophrenic episode has passed.
However, most people take medication for one or two years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent.
There are two main types of antipsychotics:
The choice of antipsychotic should be made following a discussion between you and your psychiatrist about the likely benefits and side effects.
Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and the severity will differ from person to person.
The side effects of typical antipsychotics include:
Side effects of both typical and atypical antipsychotics include:
Tell your care co-ordinator, psychiatrist or GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicines that will help you deal with the side effects.
If you don't benefit from one antipsychotic medication after taking it regularly for several weeks, an alternative can be tried. It's important to work with your treatment team to find the right one for you.
Don't stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP. If you stop taking them, you could have a relapse of symptoms.
Your medication should be reviewed at least once a year.
Psychological treatment can help people with schizophrenia cope with the symptoms of hallucinations or delusions better.
They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment.
Psychological treatments for schizophrenia work best when they're combined with antipsychotic medication.
Common psychological treatments include:
Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to replace this thinking with more realistic and useful thoughts.
For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts.
Most people require between 8 and 20 sessions of CBT over the space of 6 to 12 months. CBT sessions usually last for about an hour.
Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist.
Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family.
Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetings over a period of around six months.
Meetings may include:
If you think you and your family could benefit from family therapy, speak to your care co-ordinator or GP.
Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia.
Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others.
Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people.
The National Institute for Health and Care Excellence (NICE) recommends that arts therapies are provided by an arts therapist registered with the Health and Care Professions Council who has experience of working with people with schizophrenia.
As well as monitoring your mental health, your healthcare team and GP should monitor your physical health.
A healthy lifestyle, including having a balanced diet with lots of fruits and vegetables and taking regular exercise, is good for you and can reduce your risk of developing cardiovascular disease or diabetes. You should also try to avoid too much stress and get a proper amount of sleep.
You should have a check-up with your GP at least once a year to monitor your risk of developing cardiovascular disease or diabetes. This will include recording your weight, checking your blood pressure, and having any appropriate blood tests.
Rates of smoking in people with schizophrenia are three times higher than in the general population. If you're a smoker, you're at a higher risk of developing cancer, heart disease and stroke.
Stopping smoking has clear physical health benefits, but it's also been shown to improve the mental health of people with schizophrenia.
Research has shown you're up to four times more likely to quit smoking if you use NHS support as well as stop smoking medicines, such as patches, gum or inhalators.
Ask your GP about this or go to the NHS Smokefree website to find out more.
If you take antipsychotic medicines and want to stop smoking, it's very important to talk to your GP or psychiatrist before you stop.
The dosage of your prescription drugs may need to be monitored and the amount you have to take could be reduced.
While alcohol and drugs may provide short-term relief from your symptoms, they're likely to make your symptoms worse in the long run.
Alcohol can cause depression and psychosis, while illegal drugs may make your schizophrenia worse. Drugs and alcohol can also react badly with antipsychotic medicines.
If you're currently using drugs or alcohol and finding it hard to stop, ask your care co-ordinator or GP for help.
In the course of your treatment for schizophrenia, you'll be involved with many different services. Some are accessed through referral from your GP, others through your local authority.
These services may include:
Avoid too much stress, including work-related stress. If you're employed, you may be able to work shorter hours or in a more flexible way.
Under the Equality Act 2010, all employers must make reasonable adjustments for people with disabilities, including people diagnosed with schizophrenia or other mental illnesses.
Several organisations provide support, training and advice for people with schizophrenia who wish to continue working.
Your community mental health team is a good first point of contact to find out what services and support are available for you.
Mental health charities such as Mind or Rethink Mental Illness are also an excellent source of information on training and employment.
If you're unable to work as a result of your mental illness, you're entitled to financial support, such as Incapacity Benefit.
Many people find it helpful to meet other people with the same experiences for mutual support and to share ideas. It's also an important reminder that you're not alone.
Charities and support groups allow individuals and families to share experiences and coping strategies, campaign for better services, and provide support.
Useful charities, support groups and associations include:
There are also other places that offer support to people with schizophrenia and other mental illnesses.
Even if you don't have a job or are unable to work, it's still important to go out and do everyday things and give a structure to your week.
Many people regularly go to a day hospital, day centre or community mental health centre. These offer a range of activities that allow you to get active again and spend some time in the company of other people.
These provide training to help you develop your work skills and support you back into work. They often have contacts with local employers.
This could be a bedsit or flat where there's someone around who is trained to support you and help you deal with day-to-day problems.
You may be offered the chance to meet regularly with a trained peer support worker who has recovered from psychosis or schizophrenia themselves.
Friends, relatives and partners have a vital role in helping people with schizophrenia recover, and make a relapse less likely.
It's very important not to blame the person with schizophrenia or tell them to "pull themselves together", or blame other people. It's important to stay positive and supportive when dealing with a friend or loved one's mental illness.
As well as supporting the person with schizophrenia, you may want to get support to cope with your own feelings. Several voluntary organisations provide help and support for carers.
Friends and family should try to understand what schizophrenia is, how it affects people, and how they can help. You can provide emotional and practical support, and encourage people to seek appropriate support and treatment.
As part of someone's treatment, you may be offered family therapy. This can provide information and support for the person with schizophrenia and their family.
Friends and family can play a major role by monitoring the person's mental state, watching out for any signs of relapse, and encouraging them to take their medication and attend medical appointments.
If you're the nearest relative of a person who has schizophrenia, you have certain rights that can be used to protect the patient's interests.
These include requesting that the local social services authority ask an approved mental health professional to consider whether the person with schizophrenia should be detained in hospital.
Many people with schizophrenia experience periods of depression. Don't ignore these symptoms. If depression isn't treated, it can worsen and lead to suicidal thoughts.
Studies have shown people with schizophrenia have a higher chance of committing suicide.
If you've been feeling particularly down over the last month and no longer take pleasure in the things you used to enjoy, you may be depressed. See your GP for advice and treatment.
Immediately report any suicidal thoughts to your GP or care co-ordinator.
The warning signs that people with depression and schizophrenia may be considering suicide include:
If you see any of these warning signs:
If you feel there's an immediate danger of the person committing suicide, stay with them or have someone else stay with them. Remove all available means of suicide, such as sharp objects and medication.
Stuart was diagnosed with paranoid schizophrenia when he was 31. After a difficult period coping with depression, anxiety and paranoia, Stuart feels his illness is under control thanks to a very effective antipsychotic drug. His goal is to climb Mount Everest, having already conquered base camp.
"In August 1991, I was on holiday in Moscow taking part in a march against communism. It was a very stressful time as hardline communists were attempting a coup against Mikhail Gorbachev, then president of the Soviet Union.
"That night, in my hotel room, I got a phone call at about 2am. A very angry Russian man was shouting and swearing down the line at me, asking why I was involving myself in their business. I put the phone down and my heart started to pound. I began to get quite scared and paranoid.
"About eight days later, I arrived back in London. I felt I was being followed by the KGB. From there, fears of persecution and depression gradually built up. I got so stressed. About a month after returning from Moscow, I was unable to work and my doctor signed me off.
"I remember having my first psychotic attack, which was absolutely terrifying. I think it was brought on by sheer stress and anxiety. I was lying on my bed and I suddenly felt pressure on the top of my head, and found myself in total darkness.
"It was like I'd been sucked into my own mind and had lost all sense of reality. I screamed out loud, then suddenly found myself back in my bedroom again with this really strange sensation round my head.
"I didn't have a clue what was going on. I decided to move away from London to Devon to try to escape persecution from the KGB. I thought nobody would find me there.
"In 1996, I moved to Dorchester. I saw my local GP and was referred immediately to the psychiatric team, where I was diagnosed with schizophrenia. The diagnosis was a relief. Yet all I knew about schizophrenia was what I'd read in the papers; that it was related to violence.
"I did some research and got in touch with the mental health charity Rethink. I met one of Rethink's volunteers, Paul. He is the kindest man I've ever met in my life. I could tell Paul my deepest thoughts and fears and completely trust him. He never judged me at all.
"After doctors gave me various medicines, some with unpleasant side effects, I was prescribed a drug that worked for me. It was one of the newer atypical antipsychotics.
"I'm now on an extremely low dose of this drug and don't really have any symptoms of schizophrenia anymore. I feel it's completely under control.
"In 2003, I won a Winston Churchill Memorial Trust travel fellowship. I went to Everest for the first time and trekked to base camp. It was symbolic of my own journey with schizophrenia and conquering my own mountains.
"I want to climb Everest in the future. I think I can do it. I want to do something to inspire people and to show people that recovery is possible."
Delusions and voices have been a daily feature of Richard's life for more than 10 years. Despite this, he recently completed a master's degree in broadcast journalism and successfully runs his own business.
"When I was about 21, I had a bad experience with hallucinogenic mushrooms, after which I started having delusions and hallucinations. Voices in my head would say unkind things, and I had suspicious thoughts that felt like they came from outside me.
"I was diagnosed with paranoid schizophrenia shortly afterwards, and the thoughts and voices have been with me ever since.
"A lot of the time the thoughts and voices are like another layer of interaction with people and the world. It's as if there are two co-existing realities.
"If I'm listening to the radio, for instance, the rational part of me knows that the programme is being transmitted to lots of listeners and that it is a one-way form of communication.
"My delusional thinking, however, makes me believe that the radio can project what I say out loud to the people making the show and all the listeners.
"My delusions will also make me think that a lot of the discussion in the programme has a special meaning or relevance to me. For example, the host of a show might mention that they are going to the dentist soon.
"If I happen to have a dental appointment in the near future, then it can seem like the presenter has just dropped that into the conversation as a hidden message. They aren't going to the dentist, but they want me to understand that they know I will be.
"In truth, when something like that happens it is, of course, just a coincidence, but there's a part of my thinking for which it becomes another reality.
"I've come to accept that they are an ongoing part of my life, but there are times when it is hard to deal with.
"Out shopping, it sometimes seems people are looking at me in a sinister way because they don't like something about me. The truth is they're probably noticing my clothes or are just looking in my direction.
"Nonetheless, it can get me down, to the point where I won't go out of the house. In the past it has made me feel depressed, even suicidal.
"At times like that, it helps to have friends around who can either tell me to stop thinking rubbish or, if needs be, help me work through my delusions and do some reality checking.
"I had some cognitive behavioural therapy when I first got these symptoms. It was helpful because it gave me another way to work through negative emotions and keep on top of things that could be disabling. I also take medication and have decided that I always will.
"The media consultancy company I've just set up keeps me busy. That's important, too, because when I have lots of work on it helps me keep focused, rather than drift off with my delusions."