Schizophrenia: symptoms and treatments

Similarly to other mental health conditions, schizophrenia is widely misunderstood. For instance, despite what some may think it doesn’t mean you have a split personality or multiple personalities. It also doesn’t mean that you’re a danger to other people – in fact, people with schizophrenia are more likely to be victims of violence than violent themselves. Keep reading as we clear up the misconceptions and explain why schizophrenia has been given a new name and a new treatment approach. 
 

What is schizophrenia? 

Schizophrenia is a severe mental health problem that often causes long-term recurring symptoms. For instance, people with schizophrenia may hear or see things that other people can’t see or hear making them anxious and overwhelmed. A common myth about schizophrenia is that it can’t be treated, however, the truth is that there are treatments and support for people living with schizophrenia that can help them manage their symptoms and get the most from life. Many find their symptoms get better with treatment, while others may find their symptoms stop completely for a period of time.

However these days the term schizophrenia is controversial. Some feel the word itself is a stigma and unscientific, and would like to see it abolished. This may explain why some people who would have been diagnosed with schizophrenia in the past are now given a diagnosis of psychosis. Indeed, schizophrenia is described by the National Institute of Health and Excellence (NICE) as the most common psychotic disorder (i). 

 

What is psychosis?

According to the NHS, psychosis is when people lose some contact with reality (ii). For instance, you may hear or see things that other people can’t see or hear. This can have a negative impact on your daily life and make you feel anxious and overwhelmed, not to mention confused. 

Besides schizophrenia, other mental illnesses that can cause psychosis include bipolar disorder and severe depression. Psychosis can also be triggered by things such as trauma, stress, drug or alcohol abuse, medicine side effects and even brain tumours and other physical conditions (childbirth, for instance, can occasionally cause a condition called postnatal psychosis). 

However, while some people are now being diagnosed with psychosis, schizophrenia is still a term commonly used by medical professionals  – and the term used for the remainder of this article. 
 

How common is schizophrenia?

According to NICE, the latest figures show around 0.5 percent of people aged 16 or older in England were diagnosed with a psychotic disorder in  2013 (other psychotic disorders include schizoaffective disorder and affective psychosis) (iii). Patient UK, meanwhile, suggests schizophrenia develops in about one in 100 people (men and women) (iv). The Mental Health Foundation also claims that of the one in 100 people who develop schizophrenia, a third will have just one episode while two-thirds will continue to have further episodes (v). 

 

Types of schizophrenia

 

Schizoaffective disorder 

Schizoaffective disorder is often referred to as a subtype of schizophrenia diagnosed in people who have symptoms of schizophrenia, as well as depression or bipolar disorder, occurring at the same time. This disorder combines the symptoms of schizophrenia with those of depression (eg. feeling hopeless, sad, guilty and having no interest in your usual activities) and bipolar disorder (including mania symptoms such as euphoria, high energy levels, overactivity and a racing mind).

Other subtypes of schizophrenia often mentioned in medical texts include :
 

Paranoid schizophrenia

Paranoid schizophrenia (according to the charity Mental Health UK this is the most common type of schizophrenia. (vi) ) The most common symptom is delusional thoughts, whereby you believe someone is trying to harm you or impact you negatively in another way.
 

Catatonic schizophrenia 

This is the most rarely diagnosed type of schizophrenia, and symptoms include unusual and sudden movements, for example suddenly keeping very still after being very active.
 

Residual schizophrenia  

Residual schizophrenia is the mildest form of the condition and symptoms tend to be exclusively negative symptoms.
 

Disorganised schizophrenia 

Disorganised schizophrenia is often also called hebephrenia or hebephrenic schizophrenia, and symptoms typically include confused thoughts with simultaneous delusions and hallucinations (though the latter two symptoms often don’t last very long). According to Mental Health UK, people living with disorganised schizophrenia also often show little or no emotion in their face, voice or mannerisms (vi). 
 

Unspecified schizophrenia 

This diagnosis is often made in those with schizophrenia who don’t fit into any of the above subtypes).
 

Phases of schizophrenia

Medical professionals often also refer to the three phases of schizophrenia, which are the prodromal phase (this is the early stage that often doesn’t get diagnosed or recognised), the active phase (when you’re having symptoms) and the residual phase (when you’re having milder or fewer symptoms). 
 

Schizophrenia and dementia 

There is some evidence that those who develop schizophrenia later on in life – that is, after the age of 60 – may have a higher-than-average risk of developing dementia (vii). This doesn’t mean people who develop schizophrenia in their 60s and older will automatically develop dementia too. In fact, it’s still unclear whether schizophrenia really is a risk factor for dementia, and experts still don’t know exactly how the two may be linked.
 

Schizophrenia symptoms 

Schizophrenia has lots of different symptoms and behaviours that can start gradually or suddenly, and it’s often said that no two people who develop the condition have exactly the same experience. Usually, someone with schizophrenia has episodes when their symptoms are particularly severe – called acute schizophrenia – followed by periods when they have few or no symptoms. 

Schizophrenia  symptoms and behaviours are often classed as positive and negative:

• Positive symptoms, according to Patient UK, cause abnormal mental functions (iv) – or, as the mental health charity Mind puts it, they’re experiences and behaviours the condition adds to your life (viii).

• Negative symptoms, on the other hand, are described as showing the absence of a mental function that should normally be present, which you could also say are experiences or behaviours that the condition takes away from your life. 
   

Positive symptoms of schizophrenia 

 

Delusions 

If you have delusions you’re convinced about things that aren’t true – for instance, you may think someone is out to ‘get’ you, or that people are conspiring against you (to name just two of many examples).
 

Hallucinations   

Hearing voices is a common type of hallucination, but other types include seeing, feeling, smelling or tasting things that aren’t there. 
 

Confused (disordered) thoughts   

This includes having jumbled or blocked thoughts as well as speech patterns – moving from one subject to another completely unrelated subject, for instance, using words or phrases out of context or even using made-up words. If you have this symptom you may also feel your thoughts aren’t your own, that your thoughts are being removed from your mind or that people are reading or hearing what you’re thinking. Sometimes you may also stop what you’re saying before you’re finished saying it, then not be able to remember what you’d been talking about. 
 

Other symptoms of schizophrenia

• Finding things less interesting or enjoyable

• Losing interest in relationships

• Feeling disconnected from your emotions

• Being less active

• Having little interest in taking care of yourself

• Having a lack of concentration and low motivation

• Being less sociable, wanting to avoid other people

• Changes in your sleeping patterns

• Not wanting to leave the house

According to the NHS, negative schizophrenia symptoms can often start years before you have your first acute schizophrenic episode (ix). These symptoms often fail to be picked up because they can be mistaken for laziness or rudeness, and in young people they can even be mistaken for a teenage ‘phase’. The different types of schizophrenia present with varying symptoms.

 

What age does schizophrenia start?

Most people with schizophrenia develop symptoms early on, usually in their teens, 20s and 30s. The most common ages for symptoms to first develop are 15 - 25 in men and 25 - 35 in women (iv). When the symptoms start before the age of 18 the condition is classed as early-onset schizophrenia. Meanwhile, it’s rare for children to develop schizophrenia before the age of 13. 
It’s impossible to generalise whether or not schizophrenia gets worse as you get older, as some people find their condition improves over time while others find their symptoms stay the same or get worse. 
 

How long does psychosis last in schizophrenia? 

Acute schizophrenia – that is, when you’re having an episode – can last days, weeks or, in a few rare cases, months. How long you’ll experience your symptoms can vary depending on what’s causing the episode (see below for what causes schizophrenia). How many episodes you may experience can also vary widely, with some people having just one or two episodes during their lifetime and others having multiple recurring episodes (but with symptom-free periods in between). 
 

What causes schizophrenia?

Like many other mental health conditions, schizophrenia’s causes aren’t certain – though experts have several ideas as to what may trigger the condition and why some people develop symptoms while others don’t. For instance, as schizophrenia can run in families there’s a good chance that genes are involved – but no single gene has been found to be responsible for causing it (indeed it’s thought that several genes may be implicated). 
 

Is schizophrenia hereditary?

Twin studies, says the NHS, suggest schizophrenia is at least partly inherited (x). Through these studies, experts have found that if one identical twin develops schizophrenia, the other has a one in two chance of developing it too. Non-identical twins have a lower risk – if one develops schizophrenia the other has a one-in-eight chance of developing it, which is far higher than the risk in the general population (about one in 100). 

Other things that could be involved in the development of schizophrenia include:

• Brain chemistry (neurotransmitters – or brain chemicals – are thought to be significant for schizophrenia development, most notably dopamine and serotonin)

• Brain structure (there may be differences in the structure of the brains of people with schizophrenia compared to those of others who don’t have schizophrenia)

• Stress, including stressful situations such as losing a loved one, a job or your home; having financial problems; or experiencing any kind of abuse

• Pregnancy and childbirth complications including having a premature birth, a lack of oxygen during birth and having a low weight at birth

• Drug misuse in people who are susceptible (many recreational drugs have been linked with an increased risk of developing schizophrenia symptoms – cannabis, for instance, is associated with a 40 percent increased risk of developing a psychotic illness – while using some prescribed medicines such as high-dose steroids can trigger psychosis too (xi))

• Migration, particularly from a developing country, as well as being a child of migrants

• Living in an urban area (this is associated with a 2.4 times higher risk of schizophrenia compared with living in a rural area (xi))

 

Schizophrenia life expectancy 

There’s some evidence that schizophrenia may shorten your life expectancy, with one study suggesting the condition reduces your lifespan by an average of 14.5 years (xii).  There are several reasons why this may happen, including that schizophrenia medication has side effects that may increase your risk of developing certain health conditions such as diabetes and high cholesterol. 

People living with schizophrenia may also have an increased risk of leading an unhealthy lifestyle, and may be more likely to smoke, drink alcohol excessively and use recreational drugs. Having a mental illness in general may also increase your risk of experiencing a life-threatening accident or being a victim of violence. 
 

How do you know if you have schizophrenia?

Doctors have their own list of symptoms that help them make a diagnosis of schizophrenia. In general, schizophrenia may usually be diagnosed if:

• You’ve had either delusions, hallucinations, incoherent speech or any negative symptoms (see above) most of the time for a month.

• Your symptoms are affecting your ability to carry out daily activities, including work or studies.

• Other possible causes of your symptoms have been ruled out, such as substance misuse, depression, anxiety,  bipolar disorder, dissociative identity disorder, post-traumatic stress disorder (PTSD) and certain types of personality disorder.

If your GP suspects you have schizophrenia they’ll usually refer you to your local community mental health team, which includes mental health professionals such as psychiatrists who can make a formal diagnosis. If diagnosed, you will usually be treated with a combination of talking therapies (counselling) and medication.

 

Treatment for schizophrenia 

If you think you may be developing any symptoms of schizophrenia it’s important to see your GP as soon as you can, since the earlier the condition is treated the more effective it will usually be. 
 

Talking therapies 

The main type of counselling recommended to treat schizophrenia is cognitive behavioural therapy (CBT), though other types of therapy may also be included in your treatment such as family therapy (also known as family intervention) and art therapy. According to the NHS, CBT helps you identify thinking patterns that are making you have unwanted feelings and behaviour (xiii). CBT can also help you to change your thinking patterns to be more useful and realistic. For instance, it could help you learn how to recognise when you’re having delusional thoughts and how to avoid acting on them. 
 

Medicines   

Doctors can prescribe medication to help when you’re having an episode, such as antipsychotic drugs that aim to reduce symptoms of psychosis. These work by affecting the balance of neurotransmitters in your brain. However, while medication can be useful for some people with schizophrenia, it doesn’t help everyone feel better. Anti-psychotic drugs also have side effects, which your doctor or mental health specialist should make you aware of. 
 

Is there a cure for schizophrenia?

There’s no actual cure for schizophrenia, but the treatments available – if taken as your doctor recommends – can often be successful and may help you have a happy and meaningful life. Most people, says the NHS, will make a recovery from schizophrenia, though many will have one or more recurring episodes (relapses). 
 

Living with schizophrenia

As well as medical treatments, there are several things you can do yourself that could help you manage your symptoms and reduce the impact they have on your life. One of the most important things you can do is to learn to spot the early signs that suggest you’re about to have an episode – for instance, just before you start having symptoms you may feel anxious, lose your appetite, find it hard to concentrate or have problems sleeping. When you can recognise the early signs, you can get help and support from your doctor or a member of your mental health team quickly, which could even help you avoid relapsing. Taking any medicine your GP or mental health specialist has prescribed as they’ve instructed is also important, even if you feel you’re better and don’t need any medication. 

Other things you can do include:

Eat as healthily as you can   Give your overall well-being a boost by having a healthy, balanced diet with plenty of fruit and vegetables. Also, try to eat regularly and not skip meals, as some people find changes in their blood sugar levels can trigger the symptoms of psychosis.
 
Get plenty of sleep   Try to sleep as well as you can, as when you’re tired you’re more likely to feel stressed and anxious than after you’ve had a good night’s sleep. If you haven’t had much sleep you may also find it more difficult to keep your symptoms in check. It’s not always easy to get the right amount of sleep, however. So if you’re experiencing problems in that department, take a look at our guide to sleep and insomnia for tips on sleeping more soundly.
 
Quit smoking   According to the NHS, people with schizophrenia are three times more likely to smoke than the general population, and giving up smoking has been shown to improve the mental health of people with the condition (xiv). For more advice on quitting, take a look at our stop smoking guide.
 
Stay physically active   Taking regular exercise is an important part of healthy living, and may be particularly helpful if you are experiencing depression – which is a common complication of schizophrenia. Aim to exercise moderately for 150 minutes each week, so that your heart is beating faster and you feel warmer (but you’re not out of breath.) If you haven’t been very active lately, start gradually and work up to those 150 weekly minutes bit by bit (also check with your GP before starting any new exercise regime).
 
Avoid alcohol and drugs   A third of people with schizophrenia are thought to misuse alcohol and/or illegal recreational drugs (iv). However, while drinking or taking drugs may help in the short term, they can make your symptoms worse over time. According to the NHS alcohol can cause depression and psychosis, and illegal drugs may also make your symptoms worse – plus both can react badly with antipsychotic medicines (xiv).
 
For help with stopping using alcohol or drugs, speak to your mental health team or your GP. You can also find advice about cutting back on alcohol in our guide to alcohol misuse. 
 
Reduce stress   If you’re under a lot of stress it can make schizophrenia symptoms worse as well as increase your chances of having another episode. If you’re feeling overwhelmed, try cutting back on your responsibilities at home or at work if that’s possible. Meanwhile, have a look at our guides to stress symptoms and signs and using mindfulness to manage stress.
 

Nutritional supplement for schizophrenia 

If you’ve been diagnosed with schizophrenia, always check with your doctor before taking any natural supplements, especially if you’re taking antipsychotic medication. If your doctor confirms that you can take supplements safely, there are a few that may be beneficial, including

High-strength fish oils   The omega-3 fatty acids found in oily fish such as salmon, sardines, mackerel, herring and pilchards are thought to support your general physical health as well as your mental and cognitive health. One review of studies has also found some people with schizophrenia have low levels of omega-3s, and that giving them omega-3 supplements may help reduce the severity of their symptoms (xv). Numerous studies also point out that omega-3s may be helpful in treating depression. 

If you have a vegetarian or vegan diet you can also enjoy the benefits of omega-3 fatty acids, as supplements containing omega-3s sourced from marine algae are now more widely available.

Vitamin D   Vitamin D is widely acknowledged as important for your bones, muscles and teeth, as well as your immune system. But in more recent years researchers have discovered it could be important for your mental health too. A large review of studies has even found that people who aren’t getting enough vitamin D may have twice the risk of developing schizophrenia as those who have normal vitamin D levels, with the authors saying they found a strong association between vitamin D deficiency and the condition (xvi).
 
Many people in this and other northern hemisphere countries are at risk of vitamin D deficiency, which is why the UK government advises that everyone considers taking a daily vitamin D supplement during the autumn and winter (xvii). Meanwhile, people who are also at high risk of not getting enough vitamin D during the spring and summer are advised to take vitamin D all year round.
 
If you’re considering taking a vitamin D supplement the recommended form is vitamin D3 (cholecalciferol), as this is the natural form of vitamin D our bodies make when we’re exposed to sunlight. You can get D3 in tablet form as well as in veggie-friendly drops. Most vitamin D3 supplements aren’t suitable for vegans, however, since they’re made from the fat of lamb’s wool. But the good news is you can get vegan vitamin D3 supplements available these days that are sourced from lichen.

Vitamin B complex   As well as being essential for your overall health, B vitamins may be useful if you have schizophrenia. For instance, one review that included more than 800 people with schizophrenia found those who took high-dose B vitamins – including B6, B8 and B12 – had significantly reduced symptoms compared with those who didn’t take any B vitamins (xviii). You can take individual B vitamin supplements, but a good-quality B complex formulation should provide all the Bs you need (plus it’s much more convenient).

Vitamin E   Taking vitamin E may help prevent the development of one of the possible side effects of antipsychotic medicines called tardive dyskinesia (TD), suggest experts writing in a Cochrane Library review (xix). TD is a neurological disorder that can cause involuntary stiff, jerky movements of your face and body. The researchers, however, found no evidence that vitamin E may help those who have already developed TD. 

Live bacteria   Researchers are becoming increasingly interested in the relationship between the gut microbiota – the community of micro-organisms such as bacteria that live in the human gastrointestinal system – and many mental health conditions, including schizophrenia. Results of schizophrenia studies are currently mixed, however, though future research may be more positive in recommending live bacteria supplements for those who have the condition. In general, however, taking probiotics may help your digestive system absorb nutrients from food and supplements more effectively, which could help support your overall health. 

 

For more information about mental health conditions

 
Charities, associations and groups that offer support and advice for people living with schizophrenia include Hearing Voices Network, Mind, Rethink Mental Illness, Living With Schizophrenia and SANE. You can also find lots more information on a range of mental health conditions in the mental health section of our pharmacy health library.

 

References

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15. Mei-Chi Hsu, Yung-Sheng Huang, Wen-Chein Ouyang. Beneficial effects of omega-3 fatty acid supplementation in schizophrenia: possible mechanisms. Lipids Health Dis 2020;19:159. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333328/

16. Valipour G, Saneei P, Ezmaillzadeh A.. Serum vitamin D levels in relation to schizophrenia: a systematic review and meta-analysis of observational studies. J Clin Endocrinol Metab 2014 Oct;99(10):3863-72. Available online: https://academic.oup.com/jcem/article/99/10/3863/2836573

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18. Firth J et al.. The effects of vitamin and mineral supplementation on symptoms of schizophrenia: a systematic review and meta-analysis. Psychol Med 2017 Jul;47(9):1515-1527. Available online: https://www.cambridge.org/core/journals/psychological-medicine/article/abs/effects-of-vitamin-and-mineral-supplementation-on-symptoms-of-schizophrenia-a-systematic-review-and-metaanalysis/3CFE6C3B0FED2ED04B9968AD2660EA08

19. Soares-Weiser K, Maayan N, Bergman H. Vitamin E for antipsychotic-induced tardive dyskinesia. Cochrane Database Syst Rev 2018 Jan 17;1(1):CD000209. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491331/

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 
 

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