Schizophrenia is a severe mental illness that affects around one in a hundred people at some point in their lives, usually for the first time in their late adolescence or twenties. Both men and women are equally affected, although young men tend to develop the illness earlier.
Incorrectly, people tend to think that schizophrenia means a 'split personality'. Instead, it is an illness that affects any aspect of the way a person thinks, feels, speaks and behaves, so that he or she may lose touch with reality. The most common signs of schizophrenia are the development of delusions (false beliefs) and hallucinations (usually the experience of hearing voices when nobody is there). These experiences always seem very real to the person affected, who may not recognise that they are unwell.
Doctors classify the types of symptoms experienced by people with schizophrenia, into positive and negative symptoms.
Positive symptoms include delusions, hallucinations and thought disorder, which together may be called 'psychosis'.
- Delusions are false beliefs which are held despite evidence to the contrary. Some examples of delusions include 'I am the re-incarnation of Mary Queen of Scots' or 'A microchip is controlling my fingers'.
- Hallucinations are typically of voices, which may speak directly to or about the person, without the experience of anyone being there. Visual hallucinations (seeing things that aren't there) can also occur.
- Thought disorder is a phenomenon where the person's thinking patterns become disorganised, which often makes their speech difficult to follow.
Negative symptoms include a lack of energy, social withdrawal and lack of motivation. The person affected may say very little, find social contacts difficult and may find it difficult to out of bed. Often, carers find negative symptoms frustrating, perceiving a person with schizophrenia as lazy. In fact, these symptoms are part of illness.
About one in four people who experience schizophrenia will get better within five years. Two out of three will get better but have periods when symptoms return and may have to continue taking medication. Many people who suffer from the illness are able to settle down, work and have families.
Around 10 per cent of people with schizophrenia have a significant long term disability as a result of their condition. The rate of self-harm and suicide in people diagnosed with schizophrenia is much higher than in the general population.
The media tends to focus on violent acts committed by people with mental illness. This has contributed to a negative public perception (or stigma) of schizophrenia. In reality, most violent crime is committed by people who are not mentally ill and the vast majority of people with schizophrenia do not pose a danger to the public.
There is no specific test for schizophrenia. The diagnosis is made by mental health professionals interviewing and observing a person, usually over a period of time. Most people with schizophrenia do not think they have an illness and will be brought to the attention of medical professionals by their carers or families.
The illness can be difficult to diagnose, as some people have difficulty talking about their experiences. However, behaviour patterns may appear out of character or strange. A period of observation in a hospital ward can help doctors to make the diagnosis. Another difficulty in diagnosis, is distinguishing true schizophrenia from drug misuse. Amphetamines and some other illicit drugs can produce almost the same symptoms as schizophrenia, although usually the symptoms go away once the drug is stopped. Regular cannabis use can produce symptoms of apathy and fatigue and may lead to the development of hallucinations and delusions in some people.
Nobody understands the true cause of schizophrenia, although it certainly has a genetic element. Studies have shown that if one parent is affected, the risk of having a child with schizophrenia is estimated at 14%. This rises to 46% if both parents are affected. Studies have also linked schizophrenia to difficulties in childbirth and winter births, or viral infection in pregnancy. None of these studies have given us the whole picture.
It is likely that the brain functions differently in people with schizophrenia. Studies suggest that the positive symptoms are caused by an over-activity of brain chemicals (neurotransmitters) in certain areas of the brain. There may be under-activity in other areas, which lead to negative symptoms. Neurotransmitters thought to be particularly significant in the development of schizophrenia include dopamine, serotonin and noradrenaline.
TreatmentAntipsychotic medicines help to control schizophrenia, particularly the positive symptoms such as delusions or hallucinations. They have a tranquillising (calming) effect, without necessarily causing sleepiness. Over two-thirds of people treated with drugs receive substantial benefit. There are two main classes of medicines, the older medicines, which were until recently standard treatment, and the newer 'atypical' antipsychotics.
The older medicines include chlorpromazine (Largactil), flupenthixol (Depixol), fluphenazine (Moditen) and pimozide (Orap). Side-effects commonly caused by this type of medication include muscle stiffness, tremor and restlessness. Certain side effects from some antipsychotic drugs may be irreversible, even when medication is stopped. Some people with schizophrenia have weekly or two-weekly injections of their medication (depot injection), so that they did not need to remember to take a daily tablet.
Newer types of medication have been developed which do not have the same side-effects as conventional treatment, making them more acceptable to people taking them long term. These are known as 'atypical antipsychotics' and include clozapine (Clozaril), olanzapine (Zyprexa) , risperidone (Risperdal), quetiapine (Seroquel) and amisulpride (Solian). Current evidence is that they are as effective as the older treatments and may cause troublesome weight-gain. Several aspects of antipsychotics medication are controversial. For example, the relatively high cost of the newer drugs, and the fact that, occasionally, treatment is given against a patients wishes, making the issue of side-effects particularly important. To clarify the position, the National Institute of Clinical Effectiveness has provided guidance, which suggests both older and the newer antipsychotic medications should be considered. People suffering unacceptable side-effects from the older drugs, should be considered for switching to the newer ones
Most medication takes a few weeks to start working and needs to be taken for at least two years. Withdrawal of medication should always be discussed with a psychiatrist and may not be suitable for everybody, as symptoms can return.
When the symptoms are severe, people diagnosed with schizophrenia may spend some time in hospital, with care supervised by a psychiatrist. For a small number, hospital stays may last several months. However, modern medicines and better services in the community mean far fewer people have to spend all or most of their time in hospital than in the past.
A mental health team comprised of psychiatrists, social workers and psychologists. The health and progress of the patient is monitored and psychological, medical and practical support is offered. Attention is focused on having regular contact with the patient, who may still not believe they are mentally ill. Typical issues may include housing and financial problems, family difficulties, drugs and alcohol use and finding a constructive use of time. It is only with this continued monitoring and help that successful community treatment is possible.
For people who are unwilling to have treatment the Mental Health Act gives doctors certain powers to keep them in hospital for treatment. In general, hospital treatment is only imposed when there is a risk to a sufferer’s health or safety, or that of others.
Schizophrenia – an alternative view
While most psychiatrists have no doubt that schizophrenia is a mental illness, some people are critical of the orthodox approach to diagnosis and treatment. One alternative view is that the symptoms of schizophrenia are, at least in part, a natural psychological reaction to extreme emotional or environmental distress.
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Rethink (formerly National Schizophrenia Fellowship)
Helpline 020 8974 6814
The Royal College of Psychiatrists http://www.rcpsych.ac.uk/infor/help/schiz/index.htm
Helpline 08457 660 163
National Institute of Mental Health (NIMH)