Schizophrenia

Reviewed by Robert P. Bogenberger, Ph.D.

What Is Schizophrenia?

Schizophrenia is a serious mental health disorder that can create a distorted view of reality and can affect how a person thinks, behaves, and feels. Schizophrenia may include hallucinations, incoherent thoughts, delusions, and disordered behavior and speech. According to John Hopkins Medicine, about 1% of Americans are affected by schizophrenia. It affects 20 million people globally.

Although schizophrenia is a long-term, complex mental health disorder, treatment can help individuals experiencing schizophrenia with daily functioning, personal relationships, and achieving independence.

Psychosis vs. Schizophrenia: What’s the Difference?

Although the terms psychosis and schizophrenia have sometimes been used interchangeably, they are different. Psychosis is a symptom of mental illness and refers to a disconnect from shared reality. Schizophrenia is a mental health disorder that includes a range of symptoms, one of which is psychosis.

An individual with schizophrenia may experience psychosis, but not everyone who experiences psychosis has schizophrenia. Other mental health disorders, drug use, brain injuries, some health issues, and neurological disorders can also create episodes of psychosis.

Both psychosis and schizophrenia are treatable. Diagnosis requires both medical and psychological evaluation which can determine if the psychosis is related to schizophrenia or one of its other causes.

Types of Schizophrenia

In the past, scientists used different types of schizophrenia to classify and diagnose cases. However, these types did not prove to be distinctly different disorders. Now, schizophrenia is thought to be a spectrum disorder.  Rather than trying to separate schizophrenia symptoms into types, therapists look at which symptoms an individual has and how severe they are when making a treatment plan.

While therapists no longer use the types of schizophrenia to diagnose individuals, having an understanding of the traditional types can be helpful in seeing how schizophrenia manifests for different people.

5 Primary Types of Schizophrenia

  • Paranoid schizophrenia: Includes hallucinations and delusions, but may not include altered speech or thinking patterns. This is the most common form of acute schizophrenia.  
  • Disorganized schizophrenia: Disorganized thoughts and behaviors and reduced or flat affect; hallucinations and delusions are usually short-lasting
  • Catatonic schizophrenia: Involves limited or sudden movements, with the individual either very still or very active
  • Undifferentiated schizophrenia: May have the symptoms of one of the other types, but doesn’t quite fit into one type
  • Residual schizophrenia: Used when the person has a history of schizophrenia and has not been able to resume social relationships, work or positive self care.  

There are also several conditions related to schizophrenia.

  • Schizophreniform disorder: Symptoms of schizophrenia, but the symptoms have not been present for more than six months.
  • Schizoaffective disorder: A chronic mental health disorder that is characterized by symptoms of schizophrenia and symptoms  of a mood disorder, such as depression or mania.

Schizophrenia Symptoms

Schizophrenia involves a range of symptoms that affect how someone thinks, feels, and behaves. The symptoms may vary from person to person, but they include hallucinations, delusions, and disordered thinking.

Diagnosis of schizophrenia typically occurs in a person’s teens, twenties, or thirties, with men getting diagnosed earlier and women, later. Sometimes, symptoms may begin in childhood. However, the early symptoms of schizophrenia can be difficult to diagnose in teens because the onset may be gradual before the first episode of psychosis. They can involve withdrawing from friends and family members, a drop in grades, or having trouble sleeping, but many other teenage issues can produce these behaviors.

Positive Symptoms

The positive symptoms of schizophrenia are those that are new to the individual, including hallucinations, delusions, and disorganized speech.

Hallucinations 

Hallucinations involve experiencing something with your five senses that isn’t there. They feel real to the person experiencing them and are often characterized by negativity. If a person hears voices, for example, it’s likely that those voices are criticizing or threatening them.

Common types of hallucinations include:

  • Visual (seen): Seeing something that isn’t there, such as seeing a person or animal in the corner of the room
  • Auditory (heard): Hearing something that isn’t there, such as hearing the voice of a god speaking directly to you
  • Olfactory (smelled): Smelling something that cannot be reasonably coming from a nearby source, such as smelling the scent or perfume of your childhood bully
  • Tactile (felt): Feeling like something is touching you when nothing reasonably can be or feeling other distinct sensations that are not actually occurring, such as feeling as if your skin is burning
  • Gustatory (tasted): Tasting something that cannot be reasonably coming from something you recently ate or put in your mouth, such as tasting something incredibly foul or bitter

Delusions

Delusions are strong beliefs not based in reality. They persist even when presented with contradictory facts and evidence. Common delusions among people with schizophrenia include beliefs in being harassed, surveilled, or chosen by a higher power. 

Disorganized speech

Disorganized speech disrupts a person’s ability to communicate coherently. It affects both a person’s ability to speak as well as their ability to think clearly.

Negative Symptoms

The negative symptoms of schizophrenia are those that remove skills or behaviors from the affected individual, such as: 

  • Flat affect: Individuals with a flat affect appear to have a lack of emotions. Speaking in a monotone is one of the most common signs of flat affect.
  • Reduced cognitive ability: This includes trouble concentrating, paying attention, or remembering things. Individuals may experience difficulty in processing information to make decisions and may not be able to follow along with conversations.
  • Diminished interest in life: A person struggling with schizophrenia may lose interest in both their hobbies and their responsibilities. Necessary self-care activities, such as bathing or eating, are often severely affected.

Schizophrenia Risk Factors

The causes of schizophrenia are unknown. However, research has identified risk factors that may put someone at a greater risk of developing schizophrenia, including:

  • Genetics: Genetics play a big role in mental health. If you have a family member who has been diagnosed with schizophrenia, you may be at an increased risk.
  • Brain chemistry: Studies indicate that differences in brain structure and the function of neurotransmitters (chemicals that carry messages in the brain) may be related to schizophrenia. These differences may begin developing before birth. While the differences seem to be connected to schizophrenia, scientists are still trying to understand how and why they lead to developing schizophrenia.
  • Environmental factors: A number of environmental factors may influence the development of schizophrenia. Poverty, stress, and pregnancy and birth complications increase the risk of schizophrenia when combined with other risks. 
  • Substance abuse: While drug use does not cause schizophrenia, it can trigger development in those with other risk factors. Some studies have shown that cannabis (marijuana) use increases the risk of schizophrenia when used by teens and young adults. Both younger ages and frequency of use appear to influence the amount of risk.

While a stressful or emotional event may trigger the onset of schizophrenia, it is unclear why some people at risk for schizophrenia will develop those symptoms and others will not.

Schizophrenia Treatment

The treatment of schizophrenia  includes both medication and therapy. The goal of treatment is to manage symptoms and the day-to-day issues that they may cause. 

Is Schizophrenia Curable?

Schizophrenia is not a curable mental disorder. Typically, individuals with schizophrenia will need treatment throughout their life, even if their symptoms subside. 

However, effective treatment and an active support system helps many individuals to manage symptoms and, for some, to work and live on their own.

Effective Treatments

Effective treatment for schizophrenia will vary from person to person, but there are some common treatments that individuals with schizophrenia may use.

  • Antipsychotic medication: The most common medication prescribed for schizophrenia, antipsychotics are thought to help by blocking the effect of dopamine in the brain.
  • Cognitive behavioral therapy (CBT): CBT helps people identify unhelpful or harmful thinking patterns and change them to more helpful or realistic interpretations.
  • Job coaching: Supportive work settings with supervision, accommodation for disrupted periods, and ongoing structure is one of the most effective methods of restoring functionality and social engagement.
  • Social skills training: This helps individuals with schizophrenia develop skills for social situations and independent living.
  • Family therapy: Family therapy can help individuals with schizophrenia and their families find ways of coping with the disorder together.
  • Electroconvulsive therapy (ECT): ECT uses electrical impulses to change the brain’s activity. It is used most often for those with severe schizophrenia symptoms.

Get Help for Schizophrenia

If you or someone you love has schizophrenia or is experiencing symptoms of schizophrenia, help is available. Contact a therapist today for treatment options.