What Is Schizophrenia?

Schizophrenia is a mental health condition. It is also a syndrome, which means it has a group of symptoms that usually occur together in order for a diagnosis to be made. Some of the most common symptoms are related to the way people view the world around them.^1-3

People with schizophrenia often lose connection with reality. This is called psychosis. Psychosis can take the form of disorganized talking or thinking. People with schizophrenia also may experience things that others do not. These experiences feel real to the person but are due to the brain, not reality.^1,4,5

What are the schizophrenia spectrum disorders?

The word "schizophrenia" can refer to a single mental health condition or describe a group of similar health issues. These are called schizophrenia spectrum disorders. Along with schizophrenia itself, spectrum disorders include:^2,3,6

• Brief psychotic disorder
• Schizophreniform disorder
• Schizotypal personality disorder
• Delusional disorder
• Schizoaffective disorder
• Catatonia
• Other variations of schizophrenia (other schizophrenia spectrum disorders)

Many of these disorders have some of the same symptoms. Some differ in the length of time symptoms are present. For example, brief psychotic disorder and schizophreniform disorder both appear like schizophrenia, but symptoms last for a shorter time.⁶

Other conditions, like delusional disorder, cause people to have false beliefs called delusions. Schizoaffective disorder is a combination of schizophrenia symptoms and another mood disorder, like bipolar disorder or depression.⁶

These issues can be hard to tell apart. If you are having symptoms, you and your healthcare team will work together to figure out what may be going on in your case.

What causes schizophrenia?

Experts do not know the exact cause of schizophrenia. Researchers are looking into different genes and environmental factors to learn more. Other research centers on which treatments work and why.^3-8

For example, antipsychotic drugs help with certain symptoms. These drugs affect specific chemicals in the body, like dopamine. Because of this, some experts think that schizophrenia is related to changes in dopamine levels in the brain.^3-8

There are other chemicals that may be out of balance in people with schizophrenia, too. Some of these are glutamate, gamma-amino-butyric acid (GABA), and acetylcholine. No one is sure what causes the differences in these chemical levels. They may be related to issues with the way the brain develops before birth. These differences also could be genetic or related to the way cells in the brain talk to each other over time. It is believed that schizophrenia develops due to several of these reasons together.^3,4,8,9

Who gets schizophrenia?

Fewer than 1 percent of people across the world have schizophrenia. It affects all genders almost equally. However, men are usually diagnosed at a younger age than women. Most men are diagnosed between ages 15 and 25 years old. Women are often diagnosed between 25 and 35 years old. Being diagnosed in childhood or later in life is rare, but it can happen.^4,6,8

There are a few factors that can increase a person’s risk of developing the condition. Risk factors include having:^3-10

• A family member with schizophrenia (especially a sibling or parent)
• Certain infections or autoimmune issues
• Issues before or during your birth (pregnancy complications, or problems like blood loss or low oxygen when you were born)
• A history of heavy marijuana use or cigarette smoking
• Lower income
• Lived in stressful or dangerous situations
• Differences in the size of certain areas of the brain or how they function
• Childhood trauma
• Social injustices

This is not a complete list of all potential risk factors. More research is needed to understand who gets schizophrenia and why.

What are the symptoms of schizophrenia?

Schizophrenia has 3 phases, and symptoms change during each phase. The phases are:²

• Prodromal
• Active
• Residual

The most severe symptoms occur in the active phase. This is when issues with perceiving reality (psychosis) happen. During this time, people may have:^1-7

• Hallucinations – Hearing, feeling, seeing, or sensing something that is not actually there. This may include hearing voices or feeling bugs crawling on the skin.
• Delusions – Unchanging, false beliefs about the world. A person may feel like they are being watched or like someone is out to get them.
• Speech or thoughts that are hard to understand – Speaking in a way that is hard to follow or understand.
• Little to no movement, emotion, or facial expression – Acting catatonic or “flat,” even in emotional settings, or having very low energy.
• Feeling unmotivated and wanting to isolate – Not wanting to participate in fun hobbies or spend time with loved ones.
• Cognitive barriers – Trouble thinking, planning, paying attention, or remembering things.
• Anosognosia – Not being able to recognize or believe that symptoms are happening.

Some symptoms, like hallucinations and delusions, are called positive symptoms. Other symptoms, like lack of motivation or no emotion, are called negative symptoms. During the prodromal stage, symptoms are slow to come on and are mostly negative symptoms.^1-4

During the residual phase, some symptoms from the active stage are still present but may be less severe. People in the residual stage will often have additional active episodes.^1-4

These are not the only possible symptoms of schizophrenia. Each person’s symptoms are different.

How is schizophrenia diagnosed?

There is no single test that diagnoses schizophrenia. Instead, doctors take a full history of symptoms and do a physical exam. They may also run some blood tests. Your doctor might look at images of your brain or other areas of your body. Also, doctors rule out other possibilities first, as there is no specific test for schizophrenia.^1,3,4,6

This full process is done because schizophrenia-like symptoms can be caused by several different health issues. These symptoms also can be caused by drug side effects. Some symptoms of schizophrenia overlap with those of other mood disorders, like bipolar disorder or depression, too.^1,3,4,6

Schizophrenia is usually diagnosed by a nurse practitioner or psychiatrist, a doctor who specializes in mental health conditions. These doctors look at all your symptoms and test results to make a diagnosis. They use a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM). It lists certain combinations of symptoms that must be present to diagnose schizophrenia.^3,6

How is schizophrenia treated?

There is no cure for schizophrenia at this time. However, there are prescription drugs that can help people manage their symptoms. Drug options include antipsychotic drugs. Antipsychotic drugs are separated into groups called typical and atypical. Both groups have side effects and risks. Drugs that affect mood symptoms, like antidepressants, may help in some cases, too.^3,4,10

Therapy, or counseling, can also help with symptom management. This may include cognitive behavioral therapy (CBT) or family therapy. People usually pursue therapy along with prescription drugs.^4,6

Some people have schizophrenia that does not respond to treatment. This is called treatment-resistant schizophrenia. People with this type may need additional drugs. They may also try alternative options like electroconvulsive therapy (ECT). In ECT, electrical currents are used to directly stimulate the brain.^3,4