Schizophrenia

Schizophrenia is a complex illness. Mental health experts are not sure what causes it. Genes may play a role.

Schizophrenia occurs in just as many men as women. It usually begins in the teen or young adult years, but it may begin later in life. In women, it tends to begin slightly later.

Schizophrenia in children usually begins after age 5. Childhood schizophrenia (younger than 13) is rare and can be hard to tell apart from other developmental problems.

Symptoms usually develop slowly over months or years. The person may have many symptoms, or only a few.

People with schizophrenia may have trouble keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors.

Early symptoms may include:

• Irritable or tense feelings
• Trouble concentrating
• Trouble sleeping

As the illness continues, the person may have problems with thinking, emotions, and behavior, including:

• Hearing or seeing things that are not there (hallucinations)
• Isolation
• Reduced emotions in tone of voice or expression of face
• Problems with understanding and making decisions
• Problems paying attention and following through with activities
• Strongly held beliefs that are not real (delusions)
• Talking in a way that does not make sense

There are no medical tests to diagnose schizophrenia. A psychiatrist should examine the person and make the diagnosis. The diagnosis is made based on an interview of the person and family members.

The psychiatrist will ask about the following:

• How long symptoms have lasted
• How the person's ability to function has changed
• What the person's developmental background was like
• About the person's genetic and family history
• How well medicines have worked
• Whether the person has problems with substance abuse
• Other medical conditions the person has

Brain scans (such as CT or MRI) and blood tests may be used to check for other conditions that have similar symptoms.

During an episode of schizophrenia, the person may need to stay in the hospital for safety reasons.

MEDICINES

Antipsychotic medicines (antipsychotics) are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms.

These medicines can cause side effects, but many side effects can be managed. Side effects should not prevent the person from getting treated for this serious condition.

Common side effects from antipsychotics may include:

• Dizziness
• Feelings of restlessness or jitteriness
• Sleepiness (sedation)
• Slowed movements
• Tremor
• Weight gain
• Diabetes
• High cholesterol

Long-term use of antipsychotics may increase the risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that the person cannot control. Contact your health care provider right away if you think you or your family member may have this condition due to the medicine.

When schizophrenia does not improve with antipsychotic medicines, other medicines may be tried.

Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medicines for life.

SUPPORT PROGRAMS AND THERAPIES

Support therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can help the person function better in social and work situations. Job training and relationship-building classes are also important.

Family members and caregivers are very important during treatment. Therapy can teach important skills, such as:

• Coping with symptoms that continue, even while taking medicines
• Following a healthy lifestyle, including getting enough sleep and staying away from recreational drugs
• Taking medicines correctly and managing side effects
• Watching for the return of symptoms, and knowing what to do when they return
• Getting the right support services

The outlook is hard to predict. Most of the time, symptoms improve with medicines. But many people may have trouble functioning. They are at risk for repeated episodes, especially during the early stages of the illness. People with schizophrenia are also at increased risk for suicide.

People with schizophrenia may need housing, job training, and other community support programs. Those with the most severe forms of this disorder may not be able to live alone. They may need to live in group homes or other long-term, structured residences.

Symptoms are very likely to return when antipsychotic medicine is stopped.

Having schizophrenia increases the risk for:

• Developing a problem with alcohol or drugs. Using these substances increases the chances that symptoms will return.
• Physical illness. This is due to an inactive lifestyle and side effects of medicines.
• Suicide.

Contact your provider if you (or a family member):

• Hear voices telling you to hurt yourself or others
• Have the urge to hurt yourself or others
• Feel scared or overwhelmed
• See or hear things that are not there
• Feel that you cannot leave the house
• Feel that you are not able to care for yourself

If you are thinking about hurting yourself or others, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Schizophrenia cannot be prevented.

Symptoms may be prevented by taking medicine exactly as your provider instructed. Symptoms are likely to return if medicine is stopped.

Changing or stopping medicines should only be done by the provider who prescribed them.

Psychosis - schizophrenia; Psychotic disorders - schizophrenia

American Psychiatric Association. Schizophrenia spectrum and other psychotic disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Arlington, VA: American Psychiatric Publishing; 2022.

Freudenreich O, Brown HE, Holt DJ. Psychosis and schizophrenia. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 28.

Jauhar S, Johnstone M, McKenna PJ. Schizophrenia. Lancet. 2022;399(10323):473-486. PMID: 35093231 pubmed.ncbi.nlm.nih.gov/35093231/.

Lee ES, Kronsberg H, Findling RL. Psychopharmacologic Treatment of schizophrenia in adolescents and children. Child Adolesc Psychiatr Clin N Am. 2020;29(1):183-210. PMID: 31708047 pubmed.ncbi.nlm.nih.gov/31708047/.

McClellan J, Stock S; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013;52(9):976-990. PMID: 23972700 pubmed.ncbi.nlm.nih.gov/23972700/.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Internal review and update on 07/23/2023 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.