Schizophrenia is an illness
that can affect your ability to think clearly, manage your emotions, and interact with others. It affects each person differently.
The way other people react to schizophrenia can make a
difference in how schizophrenia affects you. It can make it easier or harder
for you to cope with the illness.
Most people who have schizophrenia:
With treatment, they may come to understand
that these experiences aren't real but are a problem with how their brains
There are several types of schizophrenia. The most common is paranoid schizophrenia, which causes people to have frightening
thoughts, believe that people or forces are trying to harm them, and hear
voices. Some people think that schizophrenia is the same as a "split
personality" (dissociative identity disorder), but that is a
different mental health problem.
Living with schizophrenia can
cause many challenges. It's a difficult disease. It changes your life and the lives of your
family. But you can live a full and meaningful life if:
Experts don't know
what causes schizophrenia. It may have different causes for different people.
It is not caused by
anything you did, by personal weakness, or by the way your parents raised you.
Symptoms of schizophrenia
Symptoms usually start when you are a
teen or a young adult, but they may start later in life. They may appear
suddenly or may develop slowly. You may not be aware of your symptoms.
Negative symptoms usually appear first. They may be hard to recognize as
schizophrenia, because they are similar to symptoms of other problems, such as
depression. Positive symptoms can start days, months,
or years after the negative symptoms.
Early signs of
schizophrenia may include doing worse in school, thinking that people are
trying to harm you, or having changes in your personality, such as not wanting
to see people.
These signs don't mean you have schizophrenia. But
if you notice these signs, see a doctor.
Your doctor will
ask you questions about your health and about any odd experiences you may have
had, such as hearing voices or having confusing thoughts. You will have a
physical exam. Your doctor also may suggest tests, such as blood tests or
imaging tests, to see if your symptoms may be caused
by another health problem.
help your symptoms, and counseling and therapy help you change how you think
about things and deal with the illness. Treatment may last a long time.
When you have your symptoms under control, you are in recovery. Recovery
usually is a lifelong process. In the recovery process, you learn to cope with
your symptoms and challenges, find and meet your goals, and get the support
you need. Your recovery depends upon a partnership between you, your doctors,
and others who are important in your life.
People who have schizophrenia often stop
treatment. This may be because they don't understand that they have an illness
or because the medicines cause side effects. When treatment stops, symptoms
usually come back (relapse) or get worse. A relapse might happen right after
treatment is stopped or months later. A later relapse makes it hard to see that
stopping the medicine was the cause. During a relapse, some people who have schizophrenia may need to spend time
in a hospital.
schizophrenia can be a scary experience, and knowing that someone you love has
this illness changes your life. Show love, and learn as much as you can about
the illness. Understand that the behavior you may see is caused by the illness
and is not the person you love.
If you think that someone you love has
schizophrenia, help that person get to a doctor. The sooner the illness is
diagnosed and the person begins treatment, the more successful treatment and
recovery may be.
You can help by talking to your loved one and
helping him or her continue treatment. You also can help your loved one deal
with fear and other feelings about the illness and with the negative attitudes
that some people have toward schizophrenia.
Learning about schizophrenia:
Living with schizophrenia:
Experts don't know what causes
schizophrenia. It may have different causes for
Schizophrenia is not caused by anything you did, by
personal weakness or bad choices, or by the way your parents raised you.
The symptoms of schizophrenia can be negative, positive, or
"Negative" doesn't mean
"bad." Negative symptoms are things that are "lost" from your personality or
how you experience life. You may:
"Positive" doesn't mean
"good." Positive symptoms are things "added" or "new" to your personality or
how you experience life because of schizophrenia. You may:
schizophrenia usually start in the late teens to
mid-20s for men and the late 20s to 30s for women.
The symptoms may start suddenly or happen gradually.
Childhood schizophrenia is rare.
There are four stages of schizophrenia: prodromal phase, active or acute phase, remission, and relapse.
Schizophrenia usually starts with this phase, when symptoms are vague and easy to miss. They are often the same as symptoms of other mental health problems, such as depression or other
anxiety disorders. They may not seem unusual for teens or young adults. In fact, schizophrenia is rarely diagnosed at this time.
Symptoms are sometimes triggered by stress or changes, such as going away to school, starting to use drugs or alcohol, or going through a severe illness or a death in the family.
These first symptoms often include being withdrawn, outbursts of anger, or odd behavior. For more information, see Symptoms.
This phase can last for days, months, or years.
At some point you start
symptoms such as
hallucinations, delusions, or confusing thoughts and speech.
These symptoms may appear suddenly or
slowly over time. They can be severe and can cause a
psychotic episode, which means you can't tell the
difference between what is real and what isn't real.
You may need to go to the hospital. You probably won't be able to make
many decisions about your care.
This phase usually lasts 4 to 8 weeks. This is when schizophrenia
usually is diagnosed.
After an active phase, symptoms get better, especially
with treatment, and life may be more "normal." This is called
remission. But symptoms may get worse again, which is
relapse. You may have this cycle of symptoms that get
severe and then improve.
In each cycle,
symptoms such as hallucinations and delusions may become less intense, but other symptoms, such as feeling less interested in caring for yourself, may get worse. You may have few or
many cycles before you are able to stay in remission.
Within 5 to 10 years, you
may develop a unique
pattern of illness that often stays the same
throughout your life. It also is possible that you will have fewer relapses as
you get older and may even not have symptoms.
Watch these areas for
is a complex illness. Experts don't know what causes it or why some people get
it and others don't. But some things increase your chances of getting it. These are called risk factors.
may be at risk for schizophrenia if:
Call 911 or other emergency services if you (or a loved one with schizophrenia):
Call a doctor if you (or a loved one with schizophrenia):
If you are worried that you or a loved one may have schizophrenia but need help
deciding whether to see your doctor, read about
some of the reasons people don't get help and how to overcome them.
who can help diagnose schizophrenia or who may work together with other health
professionals to treat schizophrenia include:
Your doctor will ask you questions about your
medical history and your
mental health and about any odd experiences you may
have had, such as hearing voices or having confusing thoughts. You also will
Your doctor also may
suggest tests to rule out
other conditions with similar symptoms or to diagnose
other schizophrenia disorders. These tests may include
blood tests and a
CT scan or
MRI. The CT scan or MRI will check the size,
structure, and function of your brain.
If your doctor thinks you are
depressed or are thinking about suicide, a
suicide assessment also may be done.
Schizophrenia is diagnosed when:1
Finding out that you have
schizophrenia can be scary and hard to deal with. But
you can treat it.
The goals of treatment and recovery are to:
Medicines help your symptoms. And counseling and therapy help you
change how you think about things and deal with the illness.
If medicine and therapy aren't
helping you, your doctor may suggest
electroconvulsive therapy (ECT). In this procedure,
your doctor uses electricity to create a brief and mild seizure. This may
change your brain chemistry and help your symptoms.
If you struggle with
alcohol, drugs, or tobacco or have other mental health
problems, such as
depression, you need to treat these problems too.
Treatment may last
a long time, and the need to follow a recovery plan usually lasts for your
lifetime. Your treatment and recovery plan may change as your experience of
schizophrenia and your life change.
Most people with
schizophrenia qualify for health care programs such as Medicare or Medicaid. To
find out whether you qualify, check with your local health and welfare agency.
Medicines are the treatment
that works best for schizophrenia, and you may be taking more than one at a time. They may be used for
negative symptoms, but they don't work as well for
negative symptoms as they do for positive symptoms.
It may take time to find
which medicines are best for you. This may be frustrating. Getting support from
your family, your friends, and a community-based rehabilitation program is
helpful, especially while you and your doctor are trying to find the best
medicines. It also may help to speak with and get support from others who have
had trouble finding the right medicines.
If you stop taking your
medicines, you may have a relapse. Don't stop taking your medicines until you
talk with your doctor. If you and your health care team decide you should stop
using medicine, you will need to be checked on a regular basis.
Medicines used most often to
treat schizophrenia include:
These medicines often are used along with
the medicines listed above:
Because of side
effects or the risk of side effects, you may be tempted to stop using your
medicine. But if you stop using medicine, the symptoms of schizophrenia may
come back or get worse.
If you have any concerns about side
effects, talk to your doctor. He or she will work with you. Your doctor may
give you a smaller dose of the antipsychotic medicine, have you try another
antipsychotic medicine, or give you another medicine to treat the side effect.
Some side effects of antipsychotic
medicines can be serious.
You may need regular blood tests to check for side effects. Children, teens, and older adults
may need to have blood tests more often than other people.
Counseling and therapy are
important parts of treatment. You will work with a mental health professional
such as a psychologist, a licensed professional counselor, a clinical social
worker, or a psychiatrist.
Find a therapist you trust and feel
comfortable with. A good therapist not only provides help but gives you support
and encouragement. If you don't feel good about working with one doctor or
therapist, try another one.
Here are some types of therapy that
When you have schizophrenia, you need
more than medicines and counseling to move forward with your life. You need to
partner with your health care team to find and meet your personal goals. This
life-long partnering is known as recovery.
Recovery isn't the
same as being cured, and it doesn't mean that you will be symptom-free. It is being
able to live a full life and enjoy favorite activities with as little trouble
as possible from your symptoms. Recovery may help you manage your symptoms so
that you can be an active member of your community.
support, and training in social and job skills all are important parts of your
treatment and recovery. For example:
10 principles of recovery(What is a PDF document?) that can guide you as you work toward your goals and learn
new things to help yourself. They help you gain self-confidence and respect for
yourself. They make it clear that you make your own decisions with the help of
your doctor, counselor, and family. And they encourage you to be as independent
as possible while living with schizophrenia.
It may be hard to understand
and accept that you have an illness, and it's easy to become discouraged. You
can help yourself by focusing on your recovery goals and learning to see
schizophrenia as one part of your life, not your entire life. Make managing
schizophrenia well one of the many successes in your life.
You have schizophrenia, but like other
people, you have wishes and goals for your life. You most likely want healthy
relationships with your partner, family, and friends. You may want a job that
gives you a sense of self-worth.
Your family and community can
support you and help you meet your goals.
If your symptoms come back, it's called a
relapse. Anyone with schizophrenia can have a relapse,
but it may happen much more often when you don't take your medicine.
You can help prevent a
relapse by taking your medicine, going to your counseling sessions, being
active in your own recovery, and not drinking alcohol or using illegal drugs.
If you are having trouble taking your medicine
or feel that you don't need to, talk to your doctor or another trusted person. Your
doctor may be able to change the medicine or how much you take. A partner or
spouse may help you find ways to remember to take the medicine.
The symptoms of schizophrenia
can make it easy to forget some of the basics of good health. But it's
important to try to have a healthy lifestyle.
Here are some
things to do:
Schizophrenia affects everyone around the person who
has the illness. It can be hard to watch a family member or friend develop
symptoms and perhaps act in very different ways.
may feel helpless, but you play an important role in the life and treatment of
a loved one who has schizophrenia.
You can also help the person with good health habits, like getting enough sleep and avoiding alcohol and drugs.
Sometimes people who have schizophrenia are too sick to
seek treatment on their own. If the symptoms are severe, you may have to force
the person to get treatment. Talk with your health care providers and/or local
law enforcement officials about the laws and procedures in your area for
getting treatment in this situation. If you have this information before you
need it, it will reduce your fears and concerns and may make it easier for you.
Some people who have schizophrenia
may become aggressive or violent at times. Call 911 or other emergency help if you
Supporting or caring for someone
who has schizophrenia isn't easy. Finding your own support can help you deal
with the illness and the sense of loss you may feel.
For more information, see the topic Caregiver Tips.
The American Psychiatric Association is a national
society of physicians who specialize in mental and emotional health. This Web
site provides information on how to contact the society's information center
for a local referral to a psychiatrist in your area. You can also request
pamphlets and other resources from this organization at the address above. Be
sure to include a self-addressed, stamped envelope (SASE) for
The National Alliance for Research on Schizophrenia And
Depression (NARSAD) is a national, not-for-profit organization with a primary
objective of raising funds to find the causes of, develop better treatments
for, and find ways to prevent severe mental illnesses. A free newsletter can be
obtained by calling the phone numbers above.
The National Alliance on Mental Illness is a national
self-help and family advocacy organization dedicated solely to improving the
lives of people who have severe mental illnesses such as schizophrenia, bipolar
disorder (manic depression), major depression, obsessive-compulsive disorder,
and panic disorder. NAMI focuses on support, education, advocacy, and research.
The mission of the organization is to "eradicate mental illness and improve the
quality of life of those affected by these diseases."
The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.
The National Suicide Prevention Lifeline is a 24-hour,
toll-free suicide prevention service. Crisis centers are located in 130
locations across the United States. Callers are routed to the closest provider
of mental health and suicide prevention services.
CitationsAmerican Psychiatric Association (2000). Schizophrenia and other psychotic disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th
ed., text rev., pp. 297–343. Washington, DC: American Psychiatric Association.
Other Works ConsultedAmerican Psychiatric Association (2000). Schizophrenia and other psychotic disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th
ed., text rev., pp. 297–343. Washington, DC: American Psychiatric Association.
Lyness JM (2012). Psychiatric disorders in medical practice. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 2236–2245. Philadelphia: Saunders.Sadock BJ, Sadock VA (2010). Schizophrenia. In Kaplan and Sadock's Pocket Handbook of Clinical Psychiatry, 5th ed., pp. 143–158. Philadelphia: Lippincott Williams and Wilkins.Sadock BJ, Sadock VA (2010). Schizophreniform, schizoaffective, delusional, and other psychotic disorders. In Kaplan and Sadock's Pocket Handbook of Clinical Psychiatry, 5th ed., pp. 159–174. Philadelphia: Lippincott Williams and Wilkins.Thaker GK, Carpenter WT (2008). Schizophrenia. In EG Nabel, ed., ACP Medicine, section 13, chap.
7. New York: WebMD.Vannice GK (2012). Medical nutrition therapy for psychiatric conditions. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 956–969. St Louis: Saunders.Walkup J, et al. (2009). Practice parameter on the use of psychotropic medication in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 48(9): 961–973. Also available online: http://www.aacap.org/galleries/PracticeParameters/JAACAP%20Psychotropic%20Meds%202009.pdf.
August 31, 2012
Kathleen Romito, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry
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