Schizophrenia is a severe mental health disorder that significantly impacts the quality of life of those affected. According to the latest statistics, around 24 million people are suffering from schizophrenia globally (1). This makes the disorder one of the leading causes of disability worldwide.

What is Schizophrenia?

Schizophrenia is a life-long complex mental health condition that alters the way a person thinks, perceives reality and the way they feel. It’s common for the condition to cause those affected by it to believe in things that are not there. The exact reason as to what causes this remains unknown. However, there is some research that claims that schizophrenia may be a combination of genetic and environmental factors (2).

One of the most noteworthy signs of schizophrenia is the distorted perception of reality. It’s common for people with schizophrenia to experience delusions and/or hallucinations (3).

This condition can affect anyone no matter their age, sex or race (4). Although symptoms can appear at any age, they typically manifest in the person affected during their late teens or early 20s (5). In some cases, symptoms may show up even later in life.

The exact number of people suffering from schizophrenia is unknown, but it’s believed that this condition affects around 1% of the global population (6).

Early Symptoms of Schizophrenia

Early signs of schizophrenia are challenging to pinpoint. This is mainly due to the fact that they arise in late teens and are commonly mistaken for typical adolescent behavior. Early symptoms of schizophrenia usually vary from person to person (7), but there are some common ones including:

  • Social withdrawal: Those that are later diagnosed with schizophrenia typically start to isolate themselves from others at school, work and at home. A sudden and drastic change in social groups is another factor (8, 9).
  • Changes in Focus and Attention Span: Individuals may also find it harder to focus and concentrate on daily tasks, which end up impacting their performance in the long run (10, 11, 12).
  • Sleep problems: Difficulty falling asleep or waking up frequently might be an early sign of the condition (13, 14, 15).
  • Irritability: Unexplainably shifting into being generally more irritable at school, work, and at home up to the point where it affects daily functioning and relationships with others (16).
  • Poor academic performance: A sudden and noticeable decline in academic performance and other problems at school may be a warning sign of the disorder (17)
  • Unusual thoughts: People that are later diagnosed often express unusual and odd ideas to other people during the early stages of schizophrenia (18).
  • Sense of Alienation: Those in the early stages of schizophrenia start feeling different from other people and feel alienated when surrounded by others (19).

If you or your loved ones are experiencing any of these signs proper medical evaluation is the best option. There are many instances where these early signs just happen to be caused by something completely unrelated such as going through a life crisis or other stress-related issues.

Symptoms of the Active phase of Schizophrenia

As schizophrenia progresses, the symptoms become more noticeable and become divided into three different types of categories. These categories include positive, negative and disorganized symptoms (20). Keep in mind that the terms “positive” and “negative” don’t hold their usual context when describing schizophrenia categories.

Positive Symptoms

Positive symptoms of schizophrenia have to do with the typical thoughts and behaviors of someone affected by the condition. These symptoms are usually related with the distortion of one’s reality. The severity of these symptoms differ in intensity depending on the person.

  • Hallucinations: Hallucinations happen when a person sees, hears or perceives things that other people don’t. These distortions of reality can take the form of seeing or hearing things that aren’t there, smelling unusual odors that aren’t present or feeling sensations throughout the body that aren’t stimulated by anything. A common example is that those affected by schizophrenia may hear a voice inside their head either whispering or shouting at them. Hearing voices differs from person to person. People with schizophrenia have claimed to hear humming, a person whispering a different language, and even repeated disturbing messages (21).
  • Delusions: Delusions are unusual beliefs that don’t entirely fit into reality. People suffering from schizophrenia experience genuine thoughts and emotions that they strongly believe are true. To other people, these beliefs can be odd and difficult to comprehend. There are many ways people with schizophrenia can experience delusions such as being followed, people plotting against you, possessing special powers and even believing that your thoughts are being monitored. Although these beliefs can feel very real to the person experiencing them, they aren’t actually happening in reality (22)

Negative Symptoms

Negative symptoms of schizophrenia have to do with the atypical behaviors or the absence of behaviors. These symptoms include isolation, lack of motivation, and reduced facial expression (18). Here are a list of negative symptoms of schizophrenia:

  • Lack of motivation
  • Reduced interest in life and activities
  • Social withdrawal
  • Changes in sleeping patterns
  • Difficulty concentrating
  • Reluctance to engage in conversations
  • Sense of having nothing to contribute
  • Altered thoughts and feelings
  • Discomfort in social settings
  • Low energy levels
  • Poor grooming or hygiene

Disorganized Symptoms

Disorganized symptoms of schizophrenia are the erratic behaviors that come with the condition. These symptoms are related to disorganized motor behavior and maintaining speech.

Disorganized Thinking or Speech: People suffering from schizophrenia usually find it more difficult to connect their thoughts to their speech. This leads them to have disjointed conversations, talking too slow or too fast or drifting from the conversation (23).

This disorganized symptom is characterized by rapidly changing the topic of the conversation, using made up words or odd expressions during a conversation. This communication issue often leaves people suffering from schizophrenia unable to be understood by others or effectively communicate their needs and emotions (24).

Schizophrenia may also come with impaired cognitive function:

  • Forgetfulness: People with schizophrenia may have a difficult time with working memory. The severity of this symptom, however, usually varies from person to person (25).
  • Difficulties with Attention and Executive functioning: This symptom is usually characterized with a difficulty concentrating on tasks. This symptom also varies depending on the person. Some might have it difficult to concentrate on work, studying or even more simple tasks such as watching TV (26).

All three symptom categories vary among those who suffer from schizophrenia. That’s why the need for a personalized plan is crucial to aid and support people with this condition. Staying in touch with a health professional is crucial in improving overall quality of life for those experiencing symptoms of schizophrenia.

Schizophrenia Causes

The exact reason for schizophrenia remains a mystery to science. However, there is some research that suggest it might be caused by a combination of factors such as:

  • Biological factors: Researchers believe that biology has a say in the possibility of developing schizophrenia. The exact way it correlates, however, remains unknown (27).
  • Genetic influence: Some studies have found that those with a family member suffering with schizophrenia have a slightly higher chance of developing the condition throughout life (28).
  • Environmental Factors: Scientists believe that those that have a higher chance of developing the condition because of biology and genetics can have an increased risk when exposed to environmental toxins in infant stages (29). Malnutrition and viruses can also play a role in the development of schizophrenia. There is also some research indicating that mind-altering substances can also play a role in developing schizophrenia later in life (30).

While there are many studies that have pinpointed scientists to these causes, they are not definite. Much more research has to be made in order to fully understand what exactly causes schizophrenia.

Schizophrenia Diagnosis

Diagnosing schizophrenia is not straightforward. It typically takes a long evaluation by health specialists, doctors, or a psychiatrist to come to certain conclusions. The examination process takes longer than other conditions as it doesn’t rely on just one simple test, but rather a thorough assessment (31, 32).

It’s common that during your appointment you will start by talking to your doctor about your medical history, the current state of your physical health and mental health, and your family medical history. To gain even further insights, your doctor may ask you to take the following:

  • Physical Exam: A general examination to check on your overall health.
  • Blood tests: These tests are usually taken to rule out any other medical conditions that may be contributing to the symptoms you are experiencing (33).
  • Imaging tests: There are some cases where your doctor may recommend a magnetic resonance imaging (MRI) and computed tomography (CT) scan to check your brain structure (34, 35).

It’s important to keep in mind that some symptoms that resemble schizophrenia might be caused by other factors like:

  • Substance Use: The misuse of drugs and alcohol can impact your mental wellbeing and in some cases interferes with one’s perception of reality (36).
  • Other Mental Illnesses: Schizophrenia symptoms can sometimes be similar to other mental health conditions (37)

To diagnose schizophrenia, your doctor will likely be on the lookout for at least two common symptoms that are strongly linked to the condition (38). Such symptoms include:

  • Disorganized speech
  • Hallucinations
  • Delusions

It’s important to be aware of the fact that diagnosing schizophrenia is a process that requires time, patience and careful consideration as it can also be mistaken for another health related problem.

Schizophrenia Treatments

The exact cure for schizophrenia remains unknown. However, there are many treatment options available that can ease symptoms and improve overall quality of life for people living with this life long condition.
Medication therapies:

Subscription medication are the most common treatment options to soothe symptoms for those who are diagnosed with schizophrenia. Some notable antipsychotic medications for schizophrenia are clozapine, risperidone, or olanzapine. The effectiveness of these medications vary depending on the person. Some have to try different options before finding a treatment method that best works for them (39).

  • Psychotherapy: There are a number of beneficial therapy options for those that suffer with schizophrenia. Psychotherapy, cognitive-behavioral therapy (CBT) and supportive therapy can all be a great way to help people cope with the struggles of schizophrenia (40, 41).
  • Electroconvulsive Therapy (ECT): There are some cases where healthcare professionals recommend Electroconvulsive Therapy (ECT) when the patient is having trouble with other treatment options. ECT induced electric currents throughout the brain in order to impact neurotransmitters in the brain (42).
  • Lifestyle Modifications: People diagnosed with schizophrenia are usually recommended to make healthier lifestyle adjustments in the hopes of easing symptoms. Such lifestyle modifications include staying sober from mind-altering substances, eating a balanced diet, maintaining a healthy weight, exercising and getting enough sleep. These modifications are usually paired with other medications (43).
  • Social Support and Rehabilitation: Social support and rehabilitation programs offer a holistic approach in managing schizophrenia.These support groups often train individuals on social skills, vocalization, and becoming more social (44).

Every person has a different journey upon being diagnosed with schizophrenia. That’s why it’s crucial to understand that treatment plans are often unique and don’t have a one size fits all approach to it.

Schizophrenia vs. Psychosis

Schizophrenia is a mental health disorder and psychosis is used more as a term to describe a state of mind. Psychosis is a term which can be more broadly used in the medical field to express an individual’s lost sense of reality (45).

Some psychotic behaviors include hallucinations, delusions, disorganized thoughts, and impaired insight. But this doesn’t necessarily mean that these symptoms are specifically related to schizophrenia. Similar psychosis symptoms can be found in other mental health conditions.

People with psychosis can be linked to schizophrenia, bipolar disorder, substance use and major depression.

Schizophrenia vs. Bipolar Disorder

Schizophrenia and bipolar disorder are both complex mental health conditions. Both conditions do share some traits, but they also have their differences (46). Bipolar disorder is a condition where the individual suffers from mood instability and experiences episodes of mania and depression. Similar to schizophrenia, people with bipolar disorder experience psychosis symptoms such as delusions and hallucinations especially during a manic episode. This makes it difficult for those that suffer with bipolar disorder to complete everyday tasks while experiencing a manic episode.

On the other hand, people with schizophrenia experience hallucinations or delusions with an addition to experiencing disorganized thinking and speech. Schizophrenia is also not accompanied by manic and depressive episodes.

The proper diagnosis for the exact condition an individual suffers from is not a straightforward process (47). There is no specific medical evaluation to distinguish the two apart. That’s why the diagnosing process usually takes time and a team of health specialists to come to a definite conclusion.

Childhood Schizophrenia

Childhood schizophrenia is when the symptoms of schizophrenia start showing before the age of 13 years old (48). Although this is a less common phenomenon, it’s still possible. Diagnosing childhood schizophrenia is also a more challenging task due to the individual being in the developmental stage of life.

The symptoms listed can be indicators of childhood schizophrenia, but can also be present in other mental health conditions such as depression, bipolar disorder and attention disorders. Some symptoms of childhood schizophrenia may include:

  • Unusual fears or anxieties (paranoia)
  • Decreased attention to self-care
  • Sleep problems
  • Sudden changes in behavior
  • Hearing voices or seeing things (hallucinations)
  • Emotional swings
  • Deterioration in academic performance
  • Odd beliefs or thinking

Childhood schizophrenia diagnosis should be approached with caution as is it more challenging to distinguish from other potential problems or conditions the child might be experiencing. Talking to a specialist is the first step to find out if a child has schizophrenia (49).

Myths about Schizophrenia

There are many myths of schizophrenia out there. This has led many to use the word out of context or confuse people on how to treat others suffering from the condition.

Myth #1. Schizophrenia means someone has a split personality: This is highly inaccurate. This myth primarily arises from the word itself. The word schizophrenia comes from Greek which means “split” “mind”. This word doesn’t describe that the individual has a split personality, but rather the mind being split from reality (50).

Myth #2. If you live with schizophrenia, you can’t work: A lot of people suffering from schizophrenia can be able to work a normal job. This is more true when the person is seeking proper treatment for managing their symptoms (51).

Myth #3. People who live with schizophrenia are dangerous: This is a common misconception. Although there is a slight risk of a person with schizophrenia being more violent, it’s usually associated with the misuse of drugs and alcohol and not with the condition itself (52, 53).

Understanding these myths is important to break the stigma associated with the condition. With proper awareness we can help those suffering with schizophrenia live a more meaningful life and feel included.

Schizophrenia Prevention

Even though schizophrenia is not preventable, there are ways to manage its symptoms. It’s a common misconception that schizophrenia can be prevented at an early age, but science has yet found no evidence to back up these claims (54).

The good news is that people with schizophrenia can live a long and normal life just like everyone else by sticking to the proper treatment plan that works for them (55).

To improve symptoms of schizophrenia, you can:

  • Educating Yourself: Learning about schizophrenia is an important step to better understand the symptoms and how to cope with them. Knowledge eventually leads to seeking a more effective treatment journey (56).
  • Identifying Risk Factors: Although the prevention of this condition isn’t guaranteed, being aware of what it is can help diagnose it in its early stages and take the proper treatment to ease symptoms early (57).
  • Sticking to Treatment Plans: Working closely with your doctor for a proper treatment plan is a must. Lifestyle modifications, prescription medications and therapy can all make a tremendous difference (58).

For those that are interested to learn more about the symptoms and treatment options of schizophrenia, you can find more information through the Substance Abuse and Mental Health Services Administration’s Early Serious Mental Illness Treatment Locator. Additionally, the Early Psychosis Intervention Network (EPINET) clinic locator might also help you find centers that offer specialized services.

Conclusion

Being aware of the symptoms and treatment options for schizophrenia is important for those suffering from the condition and for those surrounding them. Even though there is no cure, people with schizophrenia can live a normal and purposeful life by managing their symptoms. If you or a loved one are noticing signs that could point to schizophrenia, don’t hesitate to reach out to a mental health professional.

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