What is Schizophrenia?

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Schizophrenia is a serious mental health condition that affects how a person thinks, feels, and behaves. It’s a complex brain disorder that usually starts in late adolescence or early adulthood and can significantly impact a person's life, relationships, and ability to function in everyday situations.

Schizophrenia is more than just being confused or having a “split personality” – a common myth. It is a condition that causes disruptions in a person’s perception of reality. This can lead to experiences such as hearing voices, holding unusual beliefs, or becoming withdrawn and emotionally flat.

It is part of a group of conditions known as psychotic disorders. These include related illnesses like schizoaffective disorder and schizophreniform disorder. Schizophrenia is the most well-known and studied among them.

Around 1 in 100 people will experience schizophrenia during their lifetime. It occurs in all cultures and backgrounds, though it is slightly more common in men. Schizophrenia is a leading cause of disability worldwide, largely because it starts young and can persist for many years.

There is no single cause. Schizophrenia develops from a combination of genetic, biological, and environmental factors. This includes:

• Genetics: Having a close family member with schizophrenia increases the risk, though most people with the illness don’t have a family history.
   
• Brain chemistry: Problems with certain brain chemicals, especially dopamine and glutamate, may be involved.
   
• Early development: Complications during pregnancy or birth, or early childhood trauma, may increase risk.
   
• Life stress and drug use: High stress, cannabis use, and other drug use (like methamphetamines) can trigger symptoms in vulnerable individuals.
   

Symptoms of schizophrenia are grouped into three main categories: positive, negative, and cognitive symptoms.

These are experiences that are not usually present in healthy individuals:

• Hallucinations: Most often hearing voices that others cannot hear.
   
• Delusions: Strong beliefs that aren’t based in reality (e.g. thinking you’re being followed or controlled).
   
• Disorganized thinking: Trouble organising thoughts or speech. Speech might be jumbled or make little sense.
   
• Unusual behaviour: This might include unpredictable movements, staring, or appearing very agitated.
   

These involve a reduction in normal functioning and can be mistaken for depression:

• Flat emotions: Speaking in a monotone voice or showing little facial expression.
   
• Social withdrawal: Avoiding friends, family, and usual activities.
   
• Lack of motivation: Difficulty starting or finishing tasks.
   
• Reduced speech: Speaking very little, even when encouraged.

These affect thinking and memory:

• Trouble focusing or paying attention.
   
• Poor memory, especially short-term.
   
• Difficulty making decisions or planning.
   

Cognitive symptoms can be subtle but often have a big impact on a person’s ability to work or study.

There is no blood test or brain scan that can confirm schizophrenia. Instead, diagnosis is based on a clinical assessment by a mental health professional, usually a psychiatrist.

To make a diagnosis, the following need to be present:

• Two or more of the core symptoms (delusions, hallucinations, disorganised speech or behaviour, or negative symptoms) for at least one month.
   
• Signs of the illness must have been present for at least six months overall.
   
• These symptoms must interfere significantly with daily life – for example, affecting work, study, relationships, or self-care.
   

Doctors will also rule out other possible causes, such as:

• Drug use or withdrawal (especially from substances like cannabis, methamphetamine, or LSD).
   
• Brain conditions like epilepsy or head injuries.
   
• Mood disorders like severe depression or bipolar disorder with psychosis.
   

Before full symptoms appear, people often go through a “prodromal phase”, which may last months or years. During this time, they might:

• Become socially withdrawn
   
• Struggle with motivation or concentration
   
• Feel increasingly suspicious or anxious
   
• Appear emotionally flat or disconnected
   

Spotting these early signs can help people get support before a full episode of psychosis develops.

Early treatment leads to better outcomes. People who receive help during the early stages of schizophrenia have a better chance of managing symptoms, recovering function, and staying connected to school, work, and relationships.

Research shows that the longer psychosis goes untreated, the harder it can be to recover. That’s why mental health services often focus on early intervention, especially in young people.

Not all hallucinations or delusions mean a person has schizophrenia. Other conditions that can cause similar symptoms include:

• Drug-induced psychosis: Commonly caused by heavy cannabis or stimulant use.
   
• Severe depression or bipolar disorder with psychosis
   
• Delirium or dementia
   
• Autism spectrum disorder, in some cases
   

Because of this, a thorough assessment is essential.

Schizophrenia is a lifelong condition for many, but not all. With proper treatment and support, many people live fulfilling lives, work, have relationships, and contribute to their communities.

Treatment usually includes:

• Medication (antipsychotics)
   
• Psychological support (such as CBT)
   
• Social supports (like supported employment and housing)
   
• Lifestyle management (sleep, nutrition, exercise)
   

Support from family, friends, and peer networks is also vital.

Although schizophrenia can be severe, recovery is possible. Some people experience only one episode of psychosis and recover fully. Others learn to manage their symptoms and live well with ongoing treatment and support.

It’s important to take a hopeful, person-centred approach – focusing not just on symptoms but on the individual’s goals, strengths, and potential.