The word ‘psychotic’ is often misunderstood – it simply means that someone’s thoughts have become disordered and they have difﬁculty knowing what’s real and what’s not. They may have delusions (false beliefs) or hallucinations (seeing, hearing, smelling or even tasting things that aren’t there).
What is Schizophrenia?
Schizophrenia is an illness that disrupts the functioning of the brain, interfering with the ability to carry out day-to-day activities. It’s one of a number of illnesses that cause what are called ‘psychotic symptoms’ or ‘psychosis’. It is treatable.
What causes Schizophrenia?
The causes are likely to include a combination of factors, including a genetic susceptibility to schizophrenia and a range of environmental factors, such as stress, to which the person is vulnerable.
What we know:
- during late adolescence, the brain is in its final stages of development, and is then especially vulnerable if the person is at higher risk of developing a psychotic illness*research increasingly suggests that cannabis contributes to the onset of Schizophrenia in people who have a genetic vulnerability
- many young people with early signs of Schizophrenia also use cannabis to help them cope with the symptoms, this means it’s hard to know which came ﬁrst – the symptoms or the drug use
- it’s also true that recreational drugs can trigger temporary psychotic symptoms – but this is usually a short term problem that doesn’t last, and isn’t the same as Schizophrenia
- families do not ‘cause’ Schizophrenia – some people worry that family relationships are to blame when a person develops Schizophrenia, but this is deﬁnitely not true and they are now recognised as having an important part to play in supporting the person with the illness.
How many people are affected?
Schizophrenia affects about one in a hundred people at some time in their lives, often beginning in the early teens and twenties.
Do people with Schizophrenia get better?
The outlook for people with Schizophrenia is better than many realise – especially when the person affected receives consistent treatment that starts as early as possible after symptoms are diagnosed.
About 20% of people with Schizophrenia have one or two psychotic episodes and never have symptoms again. Another 60% improve with treatment and time and, with support, can live independently. For a further 20%, treatment is less effective and they need more support.
What do people with Schizophrenia experience?
If someone with Schizophrenia behaves in a way that seems strange, it may be because of a problem with how different parts of the brain communicate with each other. This affects the way the person thinks, jumbling their thoughts and creating hallucinations such as hearing voices that aren’t there.
Myths about Schizophrenia
There are many myths about Schizophrenia. One of them, the idea that it means ‘split personality’, originates in a misunderstanding of the word itself. It is made up of two Greek words: schizos (meaning ‘fractured’ or ’broken’) and phrenos (meaning ‘mind’). This is simply meant to convey that different functions of the brain, such as thinking and feeling, have trouble relating to each other.
Another myth is that people with Schizophrenia are generally violent. In fact, they are more likely to be victims of violence than to commit such acts themselves.
Research does suggest that there is a sub-group of people with Schizophrenia who are slightly more likely to be violent (those not receiving treatment and who have a history of violence or drug and alcohol abuse). Those who are receiving treatment, however, are no more violent than the general population.
What are the symptoms of Schizophrenia?
Psychotic symptoms vary from person to person and even between one episode and another. These symptoms may seem to appear suddenly, but they often follow a time of gradual changes to a person’s thoughts, feelings and behaviour when ‘something is not quite right’. Doctors call this lead-up period a ‘prodrome’. The more obvious psychotic symptoms may only appear after some months or years, and include:
A person may believe that their thoughts are being interfered with. They may believe that others can read their mind, for instance, or that thoughts have been put into their heads somehow by other people. They may believe that others are telling them what to think, or can read their thoughts.
These disturbances make it hard for a person to ‘think straight’, concentrate, remember things, or have a conversation that makes sense to others.
This can make other people so uncomfortable that they start to leave the person alone – so making them feel even more isolated.
Delusions are false beliefs not shared by other people from the same cultural background. Delusional beliefs are unshakeable, and there is no point trying to argue someone out of them. A person with delusions may believe they’re being watched by aliens, stalked by supernatural beings or controlled by other people or forces.
People with Schizophrenia often have paranoid delusions – meaning they believe that they are being watched or followed by people or beings that mean them harm.
Having these delusions can affect the way a person behaves. They can also be very frightening to the person experiencing them – fearing that others want to harm them can make some people suicidal.
One of the most common hallucinations associated with Schizophrenia is hearing voices that no one else can hear.
Although some people hear them only occasionally, others hear them every day and they can be very distressing. Sometimes these voices are abusive, threatening, or tell people what to do. It can be hard to tell whether something is said by a real person or by a hallucinatory voice. People sometimes shout back at their voices, or even have conversations with them.
Some people may also experience hallucinations of taste, touch, smell or sight – tasting, feeling, smelling or seeing things that aren’t there. These symptoms can sometimes reinforce each other – having a taste hallucination, for instance, can convince someone that their food is poisoned, building on their delusion that others want to harm them.
Hallucinations, like delusions, seem very real to the person who has them – so it’s no surprise that these symptoms can make someone agitated, distressed, and sometimes hostile to others. Some people describe the experience of Psychosis as having a dream or a nightmare while you’re still awake.
The effects of psychotic symptoms can make it very hard for a person to get on with their life and put thoughts and plans into action. Doing everyday things like getting out of bed or washing up can seem like an enormous effort. This is why some people with Schizophrenia become lethargic, lying in bed or watching television all day.
This can be very irritating to family and friends. But while it’s good to encourage the person to be more active, remember that what seems like ‘laziness’ may be the effect Schizophrenia has on the part of the brain that helps with motivation.
Difficulty expressing emotions
One effect of Schizophrenia is to ‘flatten’ a person’s emotions. This doesn’t mean they don’t feel anything. They may feel very emotional, but be unable to express this. It can feel difﬁcult to know how to respond appropriately to emotions.
What does ‘positive’ or ‘negative’ symptoms mean?
Sometimes symptoms of Schizophrenia are referred to as ‘positive’ or ‘negative’. Doctors call disordered thinking, hallucinations and delusions ‘positive’ symptoms because they are something ‘added’ to the person’s normal experience.
Low motivation and changed feelings are called ‘negative’ because they take something away from the person.
People with Schizophrenia can experience long term effects from symptoms
As well as episodes of acute illness, people with Schizophrenia can experience long-term effects from these symptoms, which affect their ability to live an everyday life. These can cause them to have difﬁculty in relating to other people, looking after themselves and working, for example. People are affected by this psychiatric disability to varying degrees.
What are the early signs that someone may be developing Schizophrenia?
There are sometimes early signs that ‘something isn’t quite right’ before a person develops a Psychosis. When these are identified, early assessment and diagnosis mean the person gets treatment and help earlier too, and this can improve the outlook when someone has Schizophrenia.
This illness often appears first when young people are at important stages in their development – getting an education, starting work or exploring relationships. Early treatment helps reduce disruption to these things, so there’s less risk of a young person becoming isolated and out-of-step with their peers.
Early signs may include changes in a person’s behaviour, such as:
- withdrawing completely from family, friends and workmates. (Although it’s normal for teenagers to withdraw from their families sometimes, it’s unusual for them to withdraw from friends.)
- being afraid to leave the house, even in daylight
- not sleeping well, sleeping during the day and staying awake at night, sometimes pacing around
- becoming very preoccupied with a particular theme, for example – death, religion or politics
- neglecting appearance, personal hygiene, or neglecting parenting or housework
- deteriorating performance at school or work
- difﬁculty concentrating, following conversations or remembering things
- talking or writing about things that don’t make sense
- being extremely anxious, panicky or depressed, or suicidal
- believing that they have special powers or that they are important religious or political leaders, or scientists, when they’re not
- difficulty with expressing emotion, appearing emotionally ‘flat’
- fearing – without reason – that others are plotting against them, spying on them or following them
- believing they’re being harmed or influenced to do things against their will – by television, radio, aliens or the devil, for instance
- believing their thoughts are being interfered with, or that they can influence other people’s thoughts.
Who’s at risk of developing Schizophrenia?
When a relative has Schizophrenia, other family members may worry that they or their children are also at risk. In fact the odds are against developing Schizophrenia, even when both parents have the illness. This risk also lessens as people get older – in most cases Schizophrenia develops well before the age of thirty.
How is Schizophrenia diagnosed?
When someone experiences a psychotic episode, a doctor makes a diagnosis by observing their symptoms over a period of time, and ruling out other causes of Psychosis such as drug use or physical disorders. A diagnosis of Schizophrenia may be made if symptoms persist for over six months.
Sometimes the symptoms make it very clear what the problem is – but not always. Although doctors will talk to the person experiencing the symptoms, input from their family or close friends may be helpful too.
It can be useful to keep a record of any worrying changes in behaviour – school reports, work records, comments by teachers, workmates or friends, for instance – and let the health professionals treating the person know about them.
What other conditions cause Psychosis?
Many people experience Psychosis at some time in their lives – it affects around three in one hundred of us, usually in the teens or early twenties. Although Psychosis can be part of long-term mental illnesses such as Schizophrenia or Bipolar disorder, it can also be a temporary problem that soon passes. Besides Schizophrenia, the most common problems that cause it are:
Brief reactive Psychosis
This is usually a short-term reaction to severe stress such as bereavement, or the kind of trauma experienced in situations such as war, for instance, or being lost in the bush for days on end. It lasts for less than a month.
This is brought on solely by the use of drugs like cannabis, cocaine, amphetamines (including speed and ecstasy), LSD, ‘magic mushrooms’ and even alcohol.
The symptoms, which usually include feeling disoriented, problems with memory and seeing things that aren’t there, generally last for only a few hours, a few days or possibly a few weeks.
Most people who have drug-induced Psychosis recover with treatment and by leaving drugs alone. Obviously not everyone who takes these drugs develops a Psychosis – but it’s difﬁcult to know who’s vulnerable and who isn’t.
For further information, see the Guide to Drugs.
Bipolar disorder (once called manic depression,) affects about two in a hundred people over a lifetime, but is a treatable illness. It causes extreme mood swings, usually with periods of normal moods in between.
For further information, see the Bipolar disorder guide.
This is a less common diagnosis which has symptoms similar to both Bipolar disorder and Schizophrenia, and which is treated in the same way.
These symptoms may change over time – a person may start off with symptoms of Bipolar disorder, for instance, then develop symptoms of Schizophrenia a year or so later. Because of this, it’s sometimes difﬁcult to diagnose Schizoaffective disorder accurately.
A diagnosis of Schizophreniform disorder may be given by a doctor if Psychotic symptoms last more than one month, but less than six months. These symptoms, too, can be treated in a similar way to those of Schizophrenia.
Medication is just the start
The best treatment for Schizophrenia and other psychotic illnesses involves a combination of clinical care and support services in the community.
Most people receive clinical care from community mental health services. These usually include a local clinic with a team of mental health workers, including psychiatrists and other doctors, psychologists, psychiatric nurses and social workers.
In some areas, crisis teams are available around the clock to provide assessment and treatment to people who become seriously affected by their illness.
For further information, please see the ‘Clinical care’ section in the Guide to Medication and other Treatments.
Treatment in hospital
Psychiatrists recommend treatment in hospital only when someone is very ill, or when there’s a risk to their health or safety. A stay in hospital is likely to be in the psychiatric unit of a general hospital, rather than a psychiatric hospital.
Some people may see a private psychiatrist instead (appointments can be claimed under Medicare), or go on to have their mental illness treated by a GP (general practitioner).
Once someone has been assessed as needing treatment, they may be allocated a case manager at the clinic who can ideally provide services including:
- ﬁnding out what the person’s needs are and which services can help
- working with the person and their family or other carers to put together a treatment plan and help it run smoothly
- access to psychological treatments
- support for the family or other carers
- education about the illness and how to deal with symptoms.
While medication is rarely enough on its own, it remains an essential part of clinical care.
Taking medication as prescribed is one of the most positive things a person can do to ﬁght back against Schizophrenia – helping restore the natural chemical balance of the brain, and reducing or even eliminating symptoms.
For further information on the latest antipsychotic medication and getting the best from medication, see the ‘Medication’ section in the Guide to Medication and other Treatments.
Psychological treatments may help some people with illnesses such as Schizophrenia to manage their symptoms better. A psychiatrist, a psychologist or other mental health professional can all provide psychological treatments.
For further information, see ‘Psychological treatments’ in the Guide to Medication and other Treatments.
What do community support services provide
The psychiatric disability experienced by many people with illnesses such as Schizophrenia makes it important that they receive support to live an everyday life in the community.
Disability support services help people by providing:
- accommodation (including supported accommodation)
- social and recreation programs
- respite care
- support for family and other carers.
These services are generally provided by community agencies with funding from State or Federal government. Despite the importance of such programs in the lives of people affected by mental illness, there are still far too few of them, especially in country areas.
A case manager or other mental health professional should be able to explain what is available in the local area. You can also contact the SANE Help Centre on 1800 18 SANE (7263).
Taking control of life again
There are lots of things people with illnesses such as Schizophrenia can do to help themselves.
Taking positive action against an illness helps minimise the risk of another episode and reduce the effect of symptoms. It also helps us feel good about ourselves, because it shows we can start to take control of our lives again.
Find ways to cope with stress
Stress is the name we give to feelings of anxiety and ‘overload’ that threaten to overwhelm us. Everyone has these feelings sometimes, and we all need to ﬁnd ways to cope with them. This is particularly important if you’ve experienced Psychosis because stress may trigger it again. You can help reduce stress if you:
- work out which situations make you feel stressed, and try to avoid them
- work out what helps you deal with stress. It’s different for all of us – it could be meditation, walking, reading, warm baths, listening to music, being with a pet animal or going for a swim, for example. Find what helps and try to do it regularly
- make time to relax and do things you enjoy
- talk over your problems with a family member, friend or health professional
- deal with one thing at a time to avoid being overwhelmed
- ﬁnd ways to solve problems with relationships – conflicts with people, especially those who are close to you, can increase stress. Talking to someone who’s not involved, such as a case manager, can help sort things out.
Avoid recreational drugs
Recreational drugs and mental illness aren’t a good mix. Drugs such as cannabis can make the symptoms of illnesses like Schizophrenia worse, trigger episodes of Psychosis, and can bring on Depression too.
For further information, see the Guide to Drugs.
A smokefree life
For a range of reasons, smoking is common among people with mental illness, and especially among those who have Schizophrenia. Not only does this do a lot of harm to physical health, it’s expensive and can also make the symptoms worse. This sometimes means a smoker needs higher doses of anti-psychotic medication – which in turn may increase the side-effects of the medication.
If you smoke, talk to your doctor about how to prepare to quit – they can keep an eye on your medication and any side-effects, and give good advice on things to help such as nicotine replacement therapy like patches and gum. Some mental health and other services may also run special quit programs – ask your doctor or case manager about these.
For information and advice to help quit smoking, see the Guide to a Smokefree Life or contact the SANE Help Centre on 1800 18 SANE (7263).
Getting up from feeling down
We all feel down sometimes, but if the feeling doesn’t go away, tell your doctor. Try to do things that help counteract Depression, such as:
- talk to a doctor or other health professional
- take regular exercise
- do things you enjoy (that won’t harm your health)
- discuss how you feel with other people (joining a self-help group can help)
- help others, to take your mind off how you are feeling.
Eating healthy food and being physically active can make a big difference to how you feel.
Try to include plenty of fresh, good food in your diet, such as vegetables, fruit, beans, wholegrain breads and cereals, along with some ﬁsh, lean meat and low-fat dairy products. Drinking plenty of water (instead of coffee or cola all the time) is a good idea too.
For further information, see the Guide to Healthy Living for more ideas.
Heading off trouble
Before someone has a relapse, there may be early warning signs such as changes in their behaviour, the way they think about things, or in the things that they do. It’s a good idea for the person with the illness, their family and the case manager to work out what these signs are and write them down. This makes it easier to spot problems and get help sooner.
Planning ahead makes good sense – the less time a person has to spend dealing with the effects of symptoms, the easier it is to get on with their life. Once someone has had one episode of illness, they have a better idea of what can be done to get help sooner if they become ill again.
Another good idea is to talk to family and health professionals and develop a plan that can be used if symptoms occur, including how to go about getting help and what telephone numbers to call, for example.
For further information, please see the Guide for Families, which contains lots of useful information and advice for family and other carers of people with Schizophrenia and other mental illnesses.
Coping with suicidal thoughts
It’s not uncommon for people living with a mental illness to have suicidal thoughts sometimes. If you do have these thoughts, remember that they are only thoughts and you don’t have to act on them, and it’s very important to discuss them with someone who can help.
For further information, see Staying Alive, which is specifically for helping anyone who has suicidal thoughts, their family and other carers, and those bereaved by suicide.
Learn as much about the illness as you can and ﬁnd out what services and support groups are available in your area.
Don’t ignore early warning signs
Encourage the person to see a doctor as soon as possible if they showing early warning signs of becoming ill. If the person doesn’t realise they are ill and refuses to see a doctor, make an appointment yourself and discuss your concerns.
Encourage friends and acquaintances to stay in touch
Remember that having Schizophrenia can affect a person’s self-conﬁdence. Their symptoms may have affected their relationships with other people and they may have lost some of their friends. Try to help friends and acquaintances understand what has happened and encourage them to stay in touch.
Involve the person with the illness in the planning process
Involve the person with the illness in making decisions about their care. Mental illness can make people feel powerless – being part of the planning process helps them regain some sense of control.
Ask the doctor or case manager for support
If the person doesn’t want to take their medication, talk to their doctor or case manager. This attitude is quite common in the ﬁrst years after diagnosis, for a number of reasons. The person may not believe they’re ill, or they may feel so well, they think they can do without it. Or it may be because they’re having problems with side-effects, or because they ﬁnd that taking medication several times a day is too complicated.
This can be frustrating for families and friends, but these concerns need to be taken seriously, and the doctor or case manager has a responsibility to work on this with the person.
Look after yourself
Look after yourself. It’s important to make time for yourself to relax and pursue your own interests. If you don’t, you risk burning out – and then you won’t be much help to anyone. If you care full time for someone with a mental illness, ask your community mental health service if there is a respite care service in your area. This may help you to take a few hours or a few days off.
Contact a peer support group – sharing experiences with other people in a similar situation can really give you strength. The SANE Carers Forum provides an online space where you can discuss issues, exchange information and tips, and provide mutual support in a safe, moderated environment.
For further information:
In a crisis
See In a crisis for advice on how you can help when someone experiences a mental health crisis, such as a psychotic episode or when there is a risk the person may harm themselves or others.