Educational summary
Overview
Schizophrenia is a mental health condition that affects how a person thinks, perceives and experiences the world. It involves periods of psychosis, alongside changes in motivation, emotional expression and thinking that can be present between those periods.
Psychosis means experiencing things others do not, such as hearing voices, or holding beliefs others do not share. These experiences are genuinely experienced, not imagined or pretended.
Two misunderstandings are worth addressing directly, because both are widespread and both cause harm.
Schizophrenia is not a split or multiple personality. That description belongs to dissociative identity disorder, a separate condition. The confusion is common and long-standing.
Most people with schizophrenia are not violent. Violence is rare, and people with the condition are considerably more likely to be victims of violence than to harm others. Media portrayals give a badly distorted impression.
Onset is usually in late adolescence or early adulthood, often somewhat later in women than men. It commonly develops gradually, with changes in functioning, mood or thinking preceding any clear psychotic episode.
Schizophrenia is treatable, and many people manage symptoms well, work, study and maintain relationships. Treatment earlier in the course of the condition is associated with better outcomes.
This page is educational and is not intended to diagnose a mental health condition or replace evaluation by a qualified health professional.
References
- [1]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaWhat is schizophrenia?Supporting reference for the general educational overview.
- [2]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaRisk of violenceSupporting reference for the statement that violence is rare and that people with the condition are more likely to be victims.
- [3]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaSchizophrenia vs. dissociative identity disorderSupporting reference for the distinction from dissociative identity disorder.
Educational summary
Signs and Symptoms
Symptoms are usually described in three groups. What follows describes patterns in general terms; it is not a checklist and is not used here to identify the condition in any individual.
Psychotic symptoms include hallucinations, delusions and disorganised thinking. Hallucinations mean perceiving something others do not, most often hearing voices. Delusions are beliefs held firmly despite evidence against them. Disorganised thinking is usually noticed through speech that moves between loosely connected topics or becomes hard to follow. Movement may also be affected, ranging from agitation to markedly reduced movement.
Negative symptoms describe reductions in ordinary functioning: less emotional expression in face and voice, difficulty starting and sustaining activity, reduced speech, and withdrawal from contact with others. These are frequently misread. Reduced expression is not absence of feeling, and difficulty starting activity is not laziness. Negative symptoms often affect daily life more than psychotic ones and tend to be more persistent.
Cognitive symptoms affect memory, attention and planning. They are easily overlooked because they are less visible, while strongly influencing work, study and independent living.
Symptoms fluctuate. Periods of more intense psychosis may alternate with periods of relative stability, and negative and cognitive symptoms often continue between episodes.
Sleep disturbance is common, and changes in sleep sometimes precede a return of other symptoms.
References
- [1]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaWhat are the signs and symptoms of schizophrenia?Supporting reference for the described symptom groupings.
- [2]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaNegative symptomsSupporting reference for the negative symptoms described.
- [3]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaCognitive symptomsSupporting reference for the cognitive symptoms described.
Educational summary
Causes and Risk Factors
No single cause of schizophrenia has been identified. It is understood to arise from a combination of genetic, environmental and developmental factors, and it is not caused by personal weakness, upbringing or anything the person or their family did.
Genetic factors contribute substantially. Schizophrenia runs in families, and many genes each of small effect appear to be involved rather than any single gene. Most people with a family history do not develop the condition, and many people who develop it have no family history.
Environmental factors associated with increased likelihood include complications during pregnancy or birth, and in some research, being born or raised in an urban environment. Cannabis use, particularly frequent use of high-potency products beginning in adolescence, is associated with increased risk of psychosis. Association is not proof of cause, and most people exposed to any of these do not develop the condition.
Differences in brain structure, chemistry and development are also described, including in systems involving dopamine and glutamate, and in how brain regions connect during adolescence.
Stress does not cause schizophrenia, though stressful circumstances can precipitate an episode in someone already vulnerable.
Contributing factors are described here to aid understanding and are not used to determine whether any individual has the condition.
References
- [1]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaWhat causes schizophrenia?Supporting reference for the contributing factors described.
Educational summary
Related and Co-occurring Conditions
Schizophrenia occurs alongside other conditions, and several conditions produce similar experiences. Distinguishing between them is a clinical task and is described here only to aid understanding.
Schizophrenia is frequently confused with dissociative identity disorder, which involves distinct identity states and is a separate condition with different features and treatment. The two are unrelated, and the confusion is one of the most common misunderstandings about schizophrenia.
Psychosis can occur in other conditions. In bipolar I disorder and in severe depression, psychotic experiences may occur during mood episodes; the distinction rests on whether they occur only alongside mood changes or independently of them. Schizoaffective disorder describes a presentation where both feature substantially.
Depressive difficulties commonly co-occur. This matters clinically: the risk of suicide is elevated in schizophrenia, and depression contributes to it.
Substance use is common, and some substances can produce psychotic experiences directly. Distinguishing substance-induced psychosis from schizophrenia usually requires observation over time. Where both are present, treating them together is more effective than addressing either alone.
Physical conditions can also produce psychosis, including some neurological conditions, infections, and effects of certain medicines, which is why assessment includes physical health rather than mental state alone.
References
- [1]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaSchizophrenia vs. dissociative identity disorderSupporting reference for the distinction from dissociative identity disorder.
Educational summary
Treatment
Schizophrenia is treatable, and several approaches have recognized evidence. Which is appropriate depends on the individual, the stage and severity of the condition, other health conditions, personal preference, and what is available locally. These decisions are made with a qualified health professional.
Antipsychotic medicines are the principal pharmacological treatment. Which medicine, at what dose, in what form and for how long are clinical decisions made with the person concerned. Treatment involves monitoring both benefits and side effects, which vary between medicines and can be significant; side effects are a common reason people stop taking medication, and are better addressed with the prescribing clinician than by stopping abruptly.
Psychological and psychosocial treatments are used alongside medication. Cognitive behavioural approaches adapted for psychosis aim to reduce distress associated with symptoms and support daily functioning. Family education and support is recognised as improving outcomes and reducing relapse.
Coordinated specialty care is a team-based approach used particularly after a first episode, combining medication, psychological therapy, family involvement and support with work or education. Treatment earlier in the course of the condition is associated with better outcomes, which is why prompt help matters.
Where difficulties are severe or contact with services has been hard to sustain, intensive community-based support may be offered. Where drug or alcohol difficulties are also present, treating both together is more effective than treating either alone.
Support with housing, income, employment and education is often as important as clinical treatment for living well.
If difficulties are worsening, or distress feels unmanageable, contact a qualified health professional. If there is immediate risk of harm, see our crisis resources page for how to find urgent support. The risk of suicide is elevated in schizophrenia, and thoughts of suicide should be treated as a reason to seek help promptly rather than something to manage alone.
MOMD does not provide individual treatment advice and does not recommend starting, stopping, or changing any medication.
References
- [1]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaHow is schizophrenia treated?Supporting reference for the treatment approaches described.
- [2]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaAntipsychotic medicationSupporting reference for the medication described.
- [3]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaCoordinated specialty careSupporting reference for coordinated specialty care following a first episode.
- [4]SchizophreniaNational Institute of Mental HealthNational Institute of Mental Health - SchizophreniaFamily education and supportSupporting reference for family education and support.
Associated features
Symptoms
- Hallucinationscommon
Perceiving something that others do not, most commonly hearing voices. The experience is real to the person having it, not imagined or pretended.
Hallucinations are among the psychotic symptoms. Hearing voices is the most common form. The perception is genuinely experienced, which is why telling someone it is not real is rarely useful.
- Delusionscommon
Firmly held beliefs that are not shared by others and that persist despite evidence to the contrary.
Delusions are beliefs held firmly despite evidence against them. They are not a failure of reasoning ability and cannot usually be resolved by argument.
Difficulty organising thoughts, so that speech moves between loosely connected topics or becomes hard for others to follow.
Disorganised thinking is usually observed through speech, and can range from occasional tangents to speech that is very difficult to follow.
- Unusual or Disorganised Movementpossible
Movement that is agitated, repetitive without apparent purpose, or markedly reduced, including prolonged stillness.
Changes in movement occur in some people and range from agitation to markedly reduced movement and prolonged stillness, which requires prompt clinical attention.
Less expression of emotion through face, voice or gesture. Reduced outward expression does not mean reduced feeling.
One of the negative symptoms. Reduced outward expression is often misread as indifference; it does not indicate absence of feeling.
Difficulty beginning and sustaining purposeful activity, including everyday tasks a person wants to do.
Difficulty initiating and sustaining activity is frequently more disabling day to day than psychotic symptoms, and is commonly mistaken for laziness.
Reduced contact with other people, which may follow from reduced motivation, from distressing experiences, or from the responses of others.
Withdrawal may follow reduced motivation, distressing experiences, or the reactions of other people, and often compounds isolation.
Difficulty holding information in mind, sustaining attention and planning, which often affects daily functioning as much as psychotic experiences do.
Cognitive difficulties affect memory, attention and planning. They are frequently overlooked because they are less visible than psychotic symptoms, while strongly affecting work and study.
- Sleep Disturbanceassociated
A meaningful change in usual sleep, which may include difficulty sleeping, disrupted sleep, waking unusually early, or sleeping substantially more than usual.
Sleep is commonly disrupted, and changes in sleep sometimes precede a return of other symptoms.
- Reduced Interest or Pleasureassociated
A noticeable reduction in interest, enjoyment, motivation, or pleasure in activities that would ordinarily be engaging or rewarding.
Reduced interest and enjoyment commonly occur, and overlap with both negative symptoms and co-occurring depression.
- Thoughts of Death, Self-Harm, or Suicideassociated
Thoughts concerning death, self-injury, or suicide. Such experiences can represent an urgent safety concern and warrant appropriate professional assessment.
Thoughts of suicide occur more often in people with schizophrenia than in the general population, and risk is recognised as elevated. This warrants direct clinical attention rather than being treated as a secondary concern.
Reference systems
Classifications
- System
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
- Classification
- Schizophrenia
- Category
- Schizophrenia Spectrum and Other Psychotic Disorders
- Source
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
- System
- International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
- Classification
- Schizophrenia
- Code
- F20
- Category
- Mental, Behavioral and Neurodevelopmental disorders
- Source
- International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
Treatment reference
Treatments
- Antipsychotic Medicationmedication_class
A group of medicines used in the treatment of manic and some depressive episodes, and sometimes for longer-term stability.
Medication option, prescribed and monitored by a qualified clinician.
Antipsychotic medicines are the principal pharmacological treatment identified in authoritative guidance. Choice, dose, form and duration are clinical decisions, and treatment involves monitoring for effects and side effects.
- Coordinated Specialty Caresupportive
A team-based approach used particularly after a first episode of psychosis, combining medication, psychological therapy, family involvement and support with work or education.
Team-based treatment approach.
Coordinated specialty care is recognised particularly following a first episode of psychosis, and earlier treatment is associated with better outcomes.
- Cognitive Behavioral Therapypsychotherapy
A structured psychological therapy focused on relationships among thoughts, emotions, behaviors, and coping patterns.
Psychological treatment option.
Cognitive behavioural approaches adapted for psychosis are used to reduce distress associated with symptoms and to support daily functioning.
- Family Education and Supportsupportive
Programmes providing families and carers with information about the condition, practical strategies and support, recognised as improving outcomes.
Supportive option involving family and carers.
Family education and support is recognised in authoritative guidance and is associated with reduced relapse and improved outcomes.
- Assertive Community Treatmentsupportive
Intensive support delivered by a team in the community rather than in a clinic, used where difficulties are severe or engagement with services has been hard to sustain.
Intensive community-based support.
Used where difficulties are severe or where maintaining contact with services has been difficult.
Treatment addressing substance use alongside mental health care, rather than as a separate problem, where both are present.
Supportive option where substance use is also present.
Substance use is common alongside schizophrenia, and addressing both together is recognised as more effective than treating them separately.
- Psychoeducation and Relapse Planningsupportive
Structured education about the condition, recognising early warning signs, protecting sleep and routine, and planning ahead for periods of illness.
Supportive option.
Understanding the condition and recognising early signs of relapse commonly accompanies other treatment.
Evidence & references
Sources
- SchizophreniaNational Institute of Mental Health