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.