What is schizophrenia?

Schizophrenia is a mental illness that causes someone to have an altered experience of reality. It causes psychosis, which is when people experience delusions and hallucinations.

Schizophrenia affects people’s thoughts, perceptions and behaviour. It interferes with their ability to function at work, school or relate to other people.

People with schizophrenia often experience stigma in the community, which can be one of their biggest problems. Many people find this illness hard to understand, and there are many myths about schizophrenia. People with schizophrenia do not have a ‘split personality’. Only a very small number of people with schizophrenia become violent. People with schizophrenia do, however, have a higher rate of suicide than the general population.

Schizophrenia affects about 1 in 500 people in Australia. Its symptoms usually begin in late adolescence or early adulthood. It is generally a long-term illness and can cause serious disability if left untreated.

What are the symptoms of schizophrenia?

Schizophrenia has a large variety of symptoms. Some people may experience some symptoms but not others. If it’s not treated, schizophrenia may lead to long-term psychosis.

The main symptoms of schizophrenia are:

• hallucinations — hearing or seeing something that isn’t real, such as hearing voices when no one is there
• delusions — believing something that can be proven to be untrue, such as believing you have superhuman powers, or can read minds
• confused thinking — jumbled thoughts, or difficulty understanding what others are saying
• ‘negative’ symptoms such as low motivation, difficulties with memory or attention and fewer expressed emotions

Someone with schizophrenia will have symptoms for more than 6 months. They may have unusual ideas or beliefs about themselves or the world around them. This can be very frightening.

What causes schizophrenia?

Schizophrenia involves complex changes in brain functioning, but experts don’t yet know the exact causes.

People are more likely to develop schizophrenia if they have a family member who also has the condition. In the general population, just 1 in 500 people have a chance of developing schizophrenia. People with a parent or sibling with the condition have a 1 in 10 chance of developing schizophrenia.

There is no single gene that causes schizophrenia. Rather, a number of genes may combine to increase the risk. Other factors are also involved, as some people who develop schizophrenia don’t have a family history of it.

If someone has a genetic predisposition to schizophrenia, things such as stress or drugs (marijuana, LSD or speed) can trigger the first episode.

Malnutrition, certain serious infections in pregnancy, and birth complications can increase the risk of a child developing schizophrenia later in life. People who have experienced violence or trauma are also at an increased risk.

When should I see my doctor?

It’s important to get professional help to manage schizophrenia. Some people with schizophrenia do not realise they have a problem. Paranoid thoughts may also lead them to avoid health professionals.

If you or someone you know seems to be experiencing signs of schizophrenia, see your doctor as soon as possible.

See a doctor if you or someone you know:

• becomes very preoccupied (overly focussed) with something specific
• starts talking or writing very fast, or talks much less than normal
• seems muddled, irrational or is hard to understand
• is angry, aggressive or suspicious
• is hyperactive (with very high energy levels) or starts behaving recklessly (dangerously on purpose)
• laughs or cries inappropriately, or finds it hard to laugh, cry or express happiness
• neglects their personal hygiene

Schizophrenia can also cause changes in sleep and difficulties with everyday life including work and social activities.

It can be hard to recognise signs of schizophrenia at first. But over time the changes in someone’s thinking and behaviour may get worse.

Although the most people with schizophrenia are not violent, severe symptoms can cause some people to have thoughts of suicide or harming others.

How is schizophrenia diagnosed?

There is no test available to diagnose schizophrenia.

A doctor or mental health professional may diagnose schizophrenia with a mental health assessment. This is a special interview that includes questions about the person's:

• current symptoms
• past history of mental health issues
• medical history
• family history of health issues
• substance abuse issues

The mental health professional may also find it helpful to speak to a family member for more information about the person’s symptoms.

The doctor will then do a physical examination. This is to rule out any underlying causes of the person’s symptoms. They may refer the person for blood tests or a brain scan as well.

The diagnosis will usually need to be confirmed by a psychiatrist, who can advise on the best treatment options.

To diagnose schizophrenia, the symptoms need to be present for 6 months or more. The symptoms also need to be severe enough to cause problems in functioning at work, school, home or socially.

Sometimes, people have a diagnosis of psychosis, instead of schizophrenia. This is a similar diagnosis, but usually means the symptoms are less severe or have been present for a shorter amount of time. Some people with psychosis go on to develop schizophrenia later in life, but many recover completely.

How is schizophrenia treated?

Schizophrenia is more treatable than ever before. Many people recover completely. Others might have episodes of schizophrenia that come and go. There are many different treatments to help people manage their symptoms and help them succeed in all areas of life.

Treatment should be under the care of a psychiatrist. It may also involve a team of different mental health professionals, including:

• doctors
• mental health nurses
• social workers
• occupational therapists
• clinical psychologists

Treatments are designed and adjusted based on the needs of the individual.

Research has shown that early treatment can be most effective, so it’s good to get help before the illness has time to cause damage. There are early intervention programs in most major cities in Australia.

Medicines

Medicine is the main form of treatment for schizophrenia. Antipsychotic medicines can reduce the main symptoms like hallucinations and delusions. They normally take some time to start working, so it’s important to be patient. You may need to try more than one type before finding the ideal medicine for you.

Some people develop side effects to medicine. This is why you need to have regular appointments with a psychiatrist or doctor.

Psychological treatments

Psychological treatments can help people understand and manage their symptoms and learn new ways of coping. Options may include:

• cognitive behaviour therapy (CBT)
• supportive psychotherapy
• family therapy

Community support

Mental health services can also provide practical support for people with schizophrenia. A stable living environment, supportive relationships and meaningful work or activity are essential for recovery. Some people with schizophrenia may need rehabilitation and skills training to help them get back to work or education.

Medical care

People with schizophrenia may have higher rates of physical health problems than the wider community. It’s important to see a doctor regularly to stay healthy.

Hospital treatment

Some people with schizophrenia need to treatment in hospital at times. A hospital admission can help when symptoms are severe or if the person is not managing at home.

Resources and support

Your GP can refer you to a public mental health service or a private psychiatrist, psychologist or private hospital.

Read more on paying for mental health services.

There is a wide range of services available to help people with schizophrenia, as well as their family and/or carers:

• The Royal Australian and New Zealand College of Psychiatrists provides a Schizophrenia guide with advice for young people and adults.
• Head to Health — for advice and to get connected to local mental health services, you can call 1800 595 212. Check the operating times.
• Headspace offer a variety of tools and resources to help support young people. Chat privately with counsellors over the phone or webchat about your mental health —available seven days a week between 9am – 1am (AEDT).
• For urgent help, call Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467. If you are at risk of harm to yourself or others, call triple zero (000) and ask for an ambulance.