What is schizophrenia

Schizophrenia is a significant chronic mental illness that causes someone to have an altered experience of reality or interpret reality abnormally. It is one of a group of disorders known as psychosis. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking, disorganized speech and behavior that impairs daily functioning, and can be disabling. Schizophrenia affects people’s thoughts, perceptions and behavior and interferes with their ability to function at work, school or relate to other people.

Schizophrenia has a large variety of symptoms and can seem very different in one person from another.

• Experts believe schizophrenia may be a group of conditions – rather than a single disorder – which causes an altered experience of reality and affects people’s thoughts, perceptions and behavior.
• Schizophrenia is a chronic brain disorder that affects about one percent (about 1 in 100 people) of the population.
• Although schizophrenia can occur at any age, the average age of onset tends to be in the late teens to the early 20s for men, and the late 20s to early 30s for women. It is uncommon for schizophrenia to be diagnosed in a person younger than 12 or older than 40.
• Schizophrenia symptoms usually begin in late adolescence or early adulthood. It is generally a long-term illness and can cause serious disability when left untreated.
• Research has shown that schizophrenia affects men and women about equally but may have an earlier onset in males. Rates are similar in all ethnic groups around the world. Schizophrenia is considered a group of disorders where causes and symptoms vary considerable between individuals.
• In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It’s uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.
• Delusions. These are false beliefs that are not based in reality. For example, you think that you’re being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
• Hallucinations. These usually involve seeing or hearing things that don’t exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.

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

• While there is no cure for schizophrenia, research is leading to new, safer treatments.

Schizophrenia is now more treatable than ever before, however, and getting help as early as possible can improve the outcome. Most people require medication as the major part of their treatment, but it’s important to get support in other areas too. Psychological therapy, rehabilitation and family therapy can help people to cope with their symptoms and rebuild their lives.

Helping someone who may have schizophrenia

Family and friends can help their loved ones with schizophrenia by helping them get treatment and encouraging them to stay in treatment. Supporting a loved one with schizophrenia can be hard. Being respectful, supportive, and kind without tolerating dangerous behavior is the best way to help someone with schizophrenia.

If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can’t force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health professional.

If your loved one poses a danger to self or others or can’t provide his or her own food, clothing or shelter, you may need to call your local emergency number or other emergency responders for help so that your loved one can be evaluated by a mental health professional.

In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.

Are people with schizophrenia violent?

Most people with schizophrenia are not violent; however, the risk of violence is greatest when schizophrenia is untreated. It is important to help a person with schizophrenia symptoms get treatment as quickly as possible. People with schizophrenia are much more likely to harm themselves than others.

If you suspect you or someone you know may be experiencing the symptoms of schizophrenia, see a doctor as soon as possible.

Clinical Course and Prognosis of Schizophrenia

Patients with schizophrenia have a varied clinical course that may include remission, exacerbations, or a more persistent chronic illness. Among patients who remain ill despite therapy, some have a stable clinical course, whereas others experience worsening symptoms and functioning. Factors that predict the clinical course and prognosis of these patients are not understood, and there is no reliable way to predict outcomes. Approximately 20% of patients can be expected to have a positive outcome ¹.

Suicide is a concern when treating patients with schizophrenia. The risk of suicide is 13 times greater in persons diagnosed with schizophrenia compared with the general public, with a lifetime risk of about 5% ². Patients with auditory hallucinations, delusions, substance abuse, or a history of suicide attempts are at higher risk. Adequate treatment of schizophrenia and its comorbidities, along with diligent screening for risk factors, reduces the likelihood of suicide ². The overall mortality rate for patients with schizophrenia is two to three times higher than that of the general public ³. Most deaths are related to an increased rate of cardiovascular and respiratory diseases, stroke, cancer, and thromboembolic events ³.

In the past, schizophrenia was viewed as a disease with a poor prognosis. Currently, the disease course and response to treatment are marked by heterogeneity; differences in treatment response, disease course, and prognosis are to be expected ⁴. Despite adequate treatment, one-third of patients will remain symptomatic. Although most patients need some form of support, most are able to live independently and actively participate in their lives ⁵.

Complications of schizophrenia

Left untreated, schizophrenia can result in severe problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

• Suicide, suicide attempts and thoughts of suicide
• Self-injury
• Anxiety disorders and obsessive-compulsive disorder (OCD)
• Depression
• Abuse of alcohol or other drugs, including tobacco
• Inability to work or attend school
• Legal and financial problems and homelessness
• Social isolation
• Health and medical problems
• Being victimized
• Aggressive behavior, although it’s uncommon

Types of schizophrenia

Childhood schizophrenia

Childhood schizophrenia is an uncommon but severe mental disorder in which children interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. It may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs your child’s ability to function.

Childhood schizophrenia is essentially the same as schizophrenia in adults, but it occurs early in life and has a profound impact on a child’s behavior and development. With childhood schizophrenia, the early age of onset presents special challenges for diagnosis, treatment, education, and emotional and social development.

Schizophrenia is a chronic condition that requires lifelong treatment. Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve your child’s long-term outcome.

Symptoms of childhood schizophrenia

Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.

Schizophrenia symptoms generally start in the mid- to late 20s. It’s uncommon for children to be diagnosed with schizophrenia. Early-onset schizophrenia occurs before age 18. Very early-onset schizophrenia in children younger than age 13 is extremely rare.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.

Early signs and symptoms

The earliest indications of childhood schizophrenia may include developmental problems, such as:

• Language delays
• Late or unusual crawling
• Late walking
• Other abnormal motor behaviors — for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with pervasive developmental disorders, such as autism spectrum disorder. So ruling out these developmental disorders is one of the first steps in diagnosis.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

• Withdrawal from friends and family
• A drop in performance at school
• Trouble sleeping
• Irritability or depressed mood
• Lack of motivation
• Strange behavior
• Substance use

Compared with schizophrenia symptoms in adults, teens may be:

• Less likely to have delusions
• More likely to have visual hallucinations

Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

• Delusions. These are false beliefs that are not based in reality. For example, you think that you’re being harmed or harassed; that certain gestures or comments are directed at you; that you have exceptional ability or fame; that another person is in love with you; or that a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
• Hallucinations. These usually involve seeing or hearing things that don’t exist. Yet for the person with schizophrenia, hallucinations have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
• Disorganized thinking. Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.
• Extremely disorganized or abnormal motor behavior. This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
• Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion ― doesn’t make eye contact, doesn’t change facial expressions, speaks in a monotone, or doesn’t add hand or head movements that normally occur when speaking. Also, the person may have reduced ability to engage in activities, such as a loss of interest in everyday activities, social withdrawal or lack ability to experience pleasure.

Symptoms may be difficult to interpret

When childhood schizophrenia begins early in life, symptoms may build up gradually. The early signs and symptoms may be so vague that you can’t recognize what’s wrong, or you may attribute them to a developmental phase.

As time goes on, symptoms may become more severe and more noticeable. Eventually, your child may develop the symptoms of psychosis, including hallucinations, delusions and difficulty organizing thoughts. As thoughts become more disorganized, there’s often a “break from reality” (psychosis) frequently requiring hospitalization and treatment with medication.

When to see a doctor

It can be difficult to know how to handle vague behavioral changes in your child. You may be afraid of rushing to conclusions that label your child with a mental illness. Your child’s teacher or other school staff may alert you to changes in your child’s behavior.

Seek medical advice if your child:

• Has developmental delays compared with other siblings or peers
• Has stopped meeting daily expectations, such as bathing or dressing
• No longer wants to socialize
• Is slipping in academic performance
• Has strange eating rituals
• Shows excessive suspicion of others
• Shows a lack of emotion or shows emotions inappropriate for the situation
• Has strange ideas and fears
• Confuses dreams or television for reality
• Has bizarre ideas, behavior or speech
• Has violent or aggressive behavior or agitation

These general signs and symptoms don’t necessarily mean your child has childhood schizophrenia. These could indicate a phase, another mental health disorder such as depression or an anxiety disorder, or a medical condition. Seek medical care as soon as possible if you have concerns about your child’s behavior or development.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a child or teen who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call your local emergency number immediately. Or if you think you can do so safely, take your child to the nearest hospital emergency room.

Causes of childhood schizophrenia

It’s not known what causes childhood schizophrenia, but it’s thought that it develops in the same way as adult schizophrenia does. Researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder. It’s not clear why schizophrenia starts so early in life for some and not for others.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Risk factors for childhood schizophrenia

Although the precise cause of schizophrenia isn’t known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

• Having a family history of schizophrenia
• Increased immune system activation, such as from inflammation or autoimmune diseases
• Older age of the father
• Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
• Taking mind-altering (psychoactive or psychoactive) drugs during teen years

Complications of childhood schizophrenia

Left untreated, childhood schizophrenia can result in severe emotional, behavioral and health problems. Complications associated with schizophrenia may occur in childhood or later, such as:

• Suicide, suicide attempts and thoughts of suicide
• Self-injury
• Anxiety disorders, panic disorders and obsessive-compulsive disorder (OCD)
• Depression
• Abuse of alcohol or other drugs, including tobacco
• Family conflicts
• Inability to live independently, attend school or work
• Social isolation
• Health and medical problems
• Being victimized
• Legal and financial problems, and homelessness
• Aggressive behavior, although uncommon

Prevention of childhood schizophrenia

Early identification and treatment may help get symptoms of childhood schizophrenia under control before serious complications develop. Early treatment is also crucial in helping limit psychotic episodes, which can be extremely frightening to a child and his or her parents. Ongoing treatment can help improve your child’s long-term outlook.

Diagnosis of childhood schizophrenia

Diagnosis of childhood schizophrenia involves ruling out other mental health disorders and determining that symptoms aren’t due to substance abuse, medication or a medical condition. The process of diagnosis may involve:

• Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
• Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
• Psychological evaluation. This includes observing appearance and demeanor, asking about thoughts, feelings and behavior patterns, including any thoughts of self-harm or harming others, evaluating ability to think and function at an age-appropriate level, and assessing mood, anxiety and possible psychotic symptoms. This also includes a discussion of family and personal history.
• Diagnostic criteria for schizophrenia. Your doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental
• Disorders (DSM-5), published by the American Psychiatric Association ⁶
• Diagnostic criteria for childhood schizophrenia are generally the same as for adult schizophrenia.

Challenging process

The path to diagnosing childhood schizophrenia can sometimes be long and challenging. In part, this is because other conditions, such as depression or bipolar disorder, can have similar symptoms.

A child psychiatrist may want to monitor your child’s behaviors, perceptions and thinking patterns for six months or more. As thinking and behavior patterns and signs and symptoms become clearer over time, a diagnosis of schizophrenia may be made.

In some cases, a psychiatrist may recommend starting medications before an official diagnosis is made. This is especially important for symptoms of aggression or self-injury. Some medications can help limit these types of behavior and restore a sense of normalcy.

Treatment of childhood schizophrenia

Schizophrenia in children requires lifelong treatment, even during periods when symptoms seem to go away. Treatment is a particular challenge for children with schizophrenia.

Treatment team

Childhood schizophrenia treatment is usually guided by a child psychiatrist experienced in treating schizophrenia. The team approach may be available in clinics with expertise in schizophrenia treatment. The team may include, for example, your:

• Psychiatrist, psychologist or other therapist
• Psychiatric nurse
• Social worker
• Family members
• Pharmacist
• Case manager to coordinate care

Main treatment options

The main treatments for childhood schizophrenia are:

• Medications
• Psychotherapy
• Life skills training
• Hospitalization

Schizophrenia medications

Most of the antipsychotics used in children are the same as those used for adults with schizophrenia. Antipsychotic drugs are often effective at managing symptoms such as delusions, hallucinations, loss of motivation and lack of emotion.

In general, the goal of treatment with antipsychotics is to effectively manage symptoms at the lowest possible dose. Over time, your child’s doctor may try combinations, different medications or different doses. Depending on the symptoms, other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks after starting a medication to notice an improvement in symptoms.

Second-generation antipsychotics

Newer, second-generation medications are generally preferred because they have fewer side effects than do first-generation antipsychotics. However, they can cause weight gain, high blood sugar, high cholesterol and heart disease.

Examples of second-generation antipsychotics approved by the Food and Drug Administration (FDA) to treat schizophrenia in teenagers age 13 and older include:

• Aripiprazole (Abilify)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)

Paliperidone (Invega) is FDA-approved for children 12 years of age and older.

First-generation antipsychotics

These first-generation medications are usually as effective as second-generation antipsychotics in controlling delusions and hallucinations. In addition to having side effects similar to those of second-generation antipsychotics, first-generation antipsychotics also may have frequent and potentially significant neurological side effects. These can include the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible.

Because of the increased risk of serious side effects with first-generation antipsychotics, they often aren’t recommended for use in children until other options have been tried without success.

Examples of first-generation antipsychotics approved by the FDA to treat schizophrenia in children and teens include:

• Chlorpromazine for children 13 and older
• Haloperidol for children 3 years and older
• Perphenazine for children 12 years and older

First-generation antipsychotics are often cheaper than second-generation antipsychotics, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

Medication side effects and risks

All antipsychotic medications have side effects and possible health risks, some life-threatening. Side effects in children and teenagers may not be the same as those in adults, and sometimes they may be more serious. Children, especially very young children, may not have the capacity to understand or communicate about medication problems.

Talk to your child’s doctor about possible side effects and how to manage them. Be alert for problems in your child, and report side effects to the doctor as soon as possible. The doctor may be able to adjust the dose or change medications and limit side effects.

Also, antipsychotic medications can have dangerous interactions with other substances. Tell your child’s doctor about all medications and over-the-counter products your child takes, including vitamins, minerals and herbal supplements.

Psychotherapy

In addition to medication, psychotherapy, sometimes called talk therapy, can help manage symptoms and help you and your child cope with the disorder. Psychotherapy may include:

• Individual therapy. Psychotherapy, such as cognitive behavioral therapy, with a skilled mental health professional can help your child learn ways to deal with the stress and daily life challenges brought on by schizophrenia. Therapy can help reduce symptoms and help your child make friends and succeed at school. Learning about schizophrenia can help your child understand the condition, cope with symptoms and stick to a treatment plan.
• Family therapy. Your child and your family may benefit from therapy that provides support and education to families. Involved, caring family members who understand childhood schizophrenia can be extremely helpful to children living with this condition. Family therapy can also help you and your family to improve communication, work out conflicts and cope with stress related to your child’s condition.

Life skills training

Treatment plans that include building life skills can help your child function at age-appropriate levels when possible. Skills training may include:

• Social and academic skills training. Training in social and academic skills is an important part of treatment for childhood schizophrenia. Children with schizophrenia often have troubled relationships and school problems. They may have difficulty carrying out normal daily tasks, such as bathing or dressing.
• Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.

Hospitalization

During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help ensure your child’s safety and make sure that he or she is getting proper nutrition, sleep and hygiene. Sometimes the hospital setting is the safest and best way to get symptoms under control quickly.

Partial hospitalization and residential care may be options, but severe symptoms are usually stabilized in the hospital before moving to these levels of care.

Lifestyle and home remedies

Although childhood schizophrenia requires professional treatment, it’s critical to be an active participant in your child’s care. Here are ways to get the most out of the treatment plan.

• Follow directions for medications. Try to make sure that your child takes medications as prescribed, even if he or she is feeling well and has no current symptoms. If medications are stopped or taken infrequently, the symptoms are likely to come back and your doctor will have a hard time knowing what the best and safest dose is.
• Check first before taking other medications. Contact the doctor who’s treating your child for schizophrenia before your child takes medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals, herbs or other supplements. These can interact with schizophrenia medications.
• Pay attention to warning signs. You and your child may have identified things that may trigger symptoms, cause a relapse or prevent your child from carrying out daily activities. Make a plan so that you know what to do if symptoms return. Contact your child’s doctor or therapist if you notice any changes in symptoms, to prevent the situation from worsening.
• Make physical activity and healthy eating a priority. Some medications for schizophrenia are associated with an increased risk of weight gain and high cholesterol in children. Work with your child’s doctor to make a nutrition and physical activity plan for your child that will help manage weight and benefit heart health.
• Avoid alcohol, street drugs and tobacco. Alcohol, street drugs and tobacco can worsen schizophrenia symptoms or interfere with antipsychotic medications. Talk to your child about avoiding drugs and alcohol and not smoking. If necessary, get appropriate treatment for a substance use problem.

Schizoaffective disorder

Schizoaffective disorder is a mental condition that causes both a loss of contact with reality (psychosis) and mood problems (depression or mania). A schizoaffective disorder in which the individual suffers from both symptoms that qualify as schizophrenia and symptoms that qualify as a mood disorder (e.g. depression or bipolar disorder) ⁷.

The two types of schizoaffective disorder — both of which include some symptoms of schizophrenia — are:

1. Bipolar type, which includes episodes of mania and sometimes major depression
2. Depressive type, which includes only major depressive episodes

Schizoaffective disorder may run a unique course in each affected person, so it’s not as well-understood or well-defined as other mental health conditions.

Untreated schizoaffective disorder may lead to problems functioning at work, at school and in social situations, causing loneliness and trouble holding down a job or attending school. People with schizoaffective disorder may need assistance and support with daily functioning. Treatment can help manage symptoms and improve quality of life.

Symptoms of schizoaffective disorder

Schizoaffective disorder symptoms may vary from person to person. People with the condition experience psychotic symptoms, such as hallucinations or delusions, as well as symptoms of a mood disorder — either bipolar type (episodes of mania and sometimes depression) or depressive type (episodes of depression).

The course of schizoaffective disorder usually features cycles of severe symptoms followed by periods of improvement with less severe symptoms.

Signs and symptoms of schizoaffective disorder depend on the type — bipolar or depressive type — and may include, among others:

• Delusions — having false, fixed beliefs, despite evidence to the contrary, such as thinking someone is trying to harm you (paranoia) or thinking that special messages are hidden in common places (delusions of reference)
• Hallucinations, such as hearing voices or seeing things that aren’t there
• Symptoms of depression, such as feeling empty, sad or worthless
• Periods of manic mood or a sudden increase in energy with behavior that’s out of character
• Impaired communication, such as only partially answering questions or giving answers that are completely unrelated
• Impaired occupational, academic and social functioning
• Problems with managing personal care, including cleanliness and physical appearance
• Changes in appetite and energy
• Disorganized speech that is not logical
• Lack of concern with hygiene or grooming
• Mood that is either too good, or depressed or irritable
• Problems sleeping
• Problems with concentration
• Sadness or hopelessness
• Seeing or hearing things that are not there (hallucinations)
• Social isolation
• Speaking so quickly that others cannot interrupt you

When to see a doctor

If you think someone you know may have schizoaffective disorder symptoms, talk to that person about your concerns. Although you can’t force someone to seek professional help, you can offer encouragement and support and help find a qualified doctor or mental health professional.

If your loved one can’t provide his or her own food, clothing or shelter, you may need to call your local emergency number for help so that your loved one can be evaluated by a mental health professional.

Causes of schizoaffective disorder

The exact cause of schizoaffective disorder is not known. A combination of factors may contribute to its development, such as genetics and variations in brain chemistry and structure.

Risk factors for schizoaffective disorder

Factors that increase the risk of developing schizoaffective disorder include:

• Having a close blood relative who has schizoaffective disorder, schizophrenia or bipolar disorder
• Stressful events that trigger symptoms
• Taking mind-altering (psychoactive or psychotropic) drugs

Complications of schizoaffective disorder

People with schizoaffective disorder are at an increased risk of:

• Suicide, suicide attempts or suicidal thoughts
• Social isolation
• Family and interpersonal conflicts
• Unemployment
• Anxiety disorders
• Developing alcohol or other substance abuse problems
• Significant health problems
• Poverty and homelessness

Diagnosis of schizoaffective disorder

Diagnosis of schizoaffective disorder involves ruling out other mental health disorders and concluding that symptoms are not due to substance use, medication or a medical condition. A psychiatrist is usually be consulted to confirm the diagnosis. Determining a diagnosis of schizoaffective disorder may include:

• Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
• Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
• Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for suicide. This also includes a discussion of family and personal history.
• Diagnostic criteria for schizoaffective disorder. Your doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ⁶, published by the American Psychiatric Association.

To be diagnosed with schizoaffective disorder, the person has symptoms of both psychotic and a mood disorder. In addition, the person must have psychotic symptoms during a period of normal mood for at least 2 weeks.

The combination of psychotic and mood symptoms in schizoaffective disorder can be seen in other illnesses, such as bipolar disorder. Extreme disturbance in mood is an important part of schizoaffective disorder.

Before diagnosing schizoaffective disorder, the provider will rule out medical and drug-related conditions. Other mental disorders that cause psychotic or mood symptoms must also be ruled out. For example, psychotic or mood disorder symptoms can occur in people who:

• Use cocaine, amphetamines, or phencyclidine (PCP)
• Have seizure disorders
• Take steroid medicines

Treatment for schizoaffective disorder

People with schizoaffective disorder generally respond best to a combination of medications, psychotherapy and life skills training. Treatment varies, depending on the type and severity of symptoms, and whether the disorder is the depressive or bipolar type. In some cases, hospitalization may be needed. Long-term treatment can help to manage the symptoms.

Medications for schizoaffective disorder

In general, doctors prescribe medications for schizoaffective disorder to relieve psychotic symptoms, stabilize mood and treat depression. These medications may include:

• Antipsychotics. The only medication approved by the Food and Drug Administration specifically for the treatment of schizoaffective disorder is the antipsychotic drug paliperidone (Invega). However, doctors may prescribe other antipsychotic drugs to help manage psychotic symptoms such as delusions and hallucinations.
• Mood-stabilizing medications. When the schizoaffective disorder is bipolar type, mood stabilizers can help level out the mania highs and depression lows.
• Antidepressants. When depression is the underlying mood disorder, antidepressants can help manage feelings of sadness, hopelessness, or difficulty with sleep and concentration.

Psychotherapy

In addition to medication, psychotherapy, also called talk therapy, may help. Psychotherapy may include:

• Individual therapy. Psychotherapy may help to normalize thought patterns and reduce symptoms. Building a trusting relationship in therapy can help people with schizoaffective disorder better understand their condition and learn to manage symptoms. Effective sessions focus on real-life plans, problems and relationships.
• Family or group therapy. Treatment can be more effective when people with schizoaffective disorder are able to discuss their real-life problems with others.
• Supportive group settings can also help decrease social isolation and provide a reality check during periods of psychosis.

Life skills training

Learning social and vocational skills can help reduce isolation and improve quality of life.

• Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities. New skills and behaviors specific to settings such as the home or workplace can be practiced.
• Vocational rehabilitation and supported employment. This focuses on helping people with schizoaffective disorder prepare for, find and keep jobs.

Hospitalization

During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep, and basic personal care and cleanliness.

Electroconvulsive therapy

For adults with schizoaffective disorder who do not respond to psychotherapy or medications, electroconvulsive therapy (ECT) may be considered.

Coping and support

Schizoaffective disorder requires ongoing treatment and support. People with schizoaffective disorder can benefit from:

• Learning about the disorder. Education about schizoaffective disorder may help the person stick to the treatment plan. Education also can help friends and family understand the disorder and be more compassionate.
• Paying attention to warning signs. Identify things that may trigger symptoms or interfere with carrying out daily activities. Make a plan for what to do if symptoms return. Contact the doctor or therapist if needed to prevent the situation from worsening.
• Joining a support group. Support groups can help make connections with others facing similar challenges. Support groups may also help family and friends cope.
• Asking about social services assistance. These services may be able to help with affordable housing, transportation and daily activities.

Also, avoid drugs, tobacco and alcohol. Drugs, tobacco and alcohol can worsen schizoaffective symptoms or interfere with medications. If necessary, get appropriate treatment for a substance use problem.

Paranoid schizophrenia

The paranoid type of schizophrenia is dominated by delusions and/or auditory hallucinations. Paranoid schizophrenia is characterized by feelings of persecution, grandiose delusions and auditory hallucinations.

Catatonic schizophrenia

Catatonia, which is characterized by motoric immobility such as catalepsy or stupor, mutism, negativism, is shown in about 10-15% of patients with schizophrenia ⁸. Published works to date demonstrate variable treatment with benzodiazepines, electroconvulsive therapy (ECT), N-Methyl-D-Asparte (NMDA) antagonists, and antipsychotics, even the atypical, which remain discussed, because of worsening in symptomatology and increasing the risk of inducing neuroleptic malignant symdrome ⁹. Aripiprazole, a dopamine D2 receptor partial agonist, is different from other atypical antipsychotics, which are common profile of D2 receptor antagonist.

One of the most dramatic of clinical phenomena is the response of catatonia to treatment with benzodiazepines ¹⁰. Within 3 hours of receiving lorazepam 1–3 mg sublingually or intramuscularly, the vast majority of catatonic patients, who have been immobile, mute, withdrawn, and refusing to eat or drink, enjoy complete release from their “frozen” state. This situation is remarkably akin to the “awakenings,” described by those who first treated parkinsonian patients with levodopa ¹¹.

While benzodiazepines are extremely safe medications when used in the short term, several issues should be kept in mind during benzodiazepine treatment. They include (1) the risk of hypoventilation in obese patients or those with obstructive sleep apnea, (2) falls in elderly patients or those with balance problems after they start to move about following resolution of their catatonia, and (3) the potential, albeit small, for previously immobile patients to switch into a more excited form of catatonia. When the catatonic state is successfully treated and patients become more cooperative, physical and psychiatric examinations as well as additional investigations can be carried out if required. Expeditious treatment will typically obviate the need for interventions such as intravenous hydration and catheterization as patients begin to eat and drink almost immediately.

Psychiatric diagnoses are currently categorized on a syndromic basis. The syndrome of catatonia, however, remains in a diagnostic limbo, acknowledged predominantly as a subtype of schizophrenia. Yet, catatonia is present in about 10% of acutely ill psychiatry patients, only a minority of whom have schizophrenia.

Since the early 20th century, catatonia has been regarded primarily as a subtype of schizophrenia. This view was first put forth by Kraeplin and Bleuler ¹². Recently, the nature and classification of catatonia are being reconsidered. Limited data also indicate that catatonia in the chronic phase of schizophrenia is phenomenologically different from what is usually observed in an acute episode; chronic patients display more stereotypes, mannerisms, automatic movements and bizarre postures, and less immobility, mutism and vegetative symptoms ¹³. Significant associations have been found in schizophrenia between catatonia and sex, younger age, parkinsonian and negative symptoms, and more severe psychopathology ¹⁴. Interestingly, residual but not the acute motor symptoms were correlated with clinical variables ¹⁵.

Schizophrenia causes

Schizophrenia is a mental illness that may be a group of conditions, rather than a single disorder. It has a large variety of symptoms, which can seem very different in one person from another. Schizophrenia causes someone to have an altered experience of reality and it affects people’s thoughts, perceptions and behavior.

It’s thought that schizophrenia is caused by complex changes in brain functioning but the causes are not yet fully understood. There is no single cause – the condition usually develops in people who have a combination of genetic, brain chemistry and environmental risk factors contribute to development of the disorder.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Genetics

Genes are the most important risk factor for schizophrenia. People with a parent or sibling with schizophrenia have a 10 per cent chance of developing it, whereas in the general population just 1 per cent have a chance of developing it. There is no single gene involved; rather, a number of genes may combine to increase the risk.

Environmental factors

Even where there is a genetic risk, most people do not develop schizophrenia. It can, however, be triggered by other issues such as:

• Pregnancy and birth factors: malnutrition, serious infections in pregnancy or birth complications can increase the risk of a child developing schizophrenia later in life.
• Drug abuse: in particular, the use of cannabis, amphetamines or hallucinogens.
• Trauma and stress: people who have experienced violence, traumatic events or severe stress have a higher risk of developing schizophrenia.
• Place or season of birth or family income can also influence the risk.

See a doctor if you or someone you know seems to be experiencing any of these symptoms.

Brain chemistry

Problems with certain brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neurotransmitters allow brain cells to communicate with each other. Networks of neurons are likely involved as well.

Substance use

Some studies have suggested that taking mind-altering drugs during teen years and young adulthood can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana increases the risk of psychotic incidents and the risk of ongoing psychotic experiences. The younger and more frequent the use, the greater the risk. Another study has found that smoking marijuana led to earlier onset of schizophrenia and often preceded the manifestation of the illness.

Risk factors

Although the precise cause of schizophrenia isn’t known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

• Having a family history of schizophrenia
• Increased immune system activation, such as from inflammation or autoimmune diseases
• Older age of the father
• Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
• Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood

Prevention of schizophrenia

There’s no sure way to prevent schizophrenia. However, early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook.

Sticking with the treatment plan can help prevent relapses or worsening of schizophrenia symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.

Schizophrenia signs and symptoms

The main symptoms of schizophrenia are hallucinations and delusions. A hallucination refers to hearing or seeing something that isn’t real, such as hearing voices when no one is there. A delusion is believing something that can be proven to be untrue, such as believing you have a microchip implanted in your head. The symptoms can be frightening to experience. Other symptoms include confused thoughts, unusual behavior and lack of motivation for everyday tasks.

Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn’t focused on a goal, so it’s hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

Symptoms usually first appear in early adulthood. Men often experience symptoms in their early 20s and women often first show signs in their late 20s and early 30s. More subtle signs may be present earlier, including troubled relationships, poor school performance and reduced motivation. It is rarely diagnosed in children or adolescents.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.

The symptoms of schizophrenia are divided into 3 main categories, known as positive, negative and disorganized symptoms.

Positive symptoms of schizophrenia

These are symptoms that are ‘added’ to the person’s experience of life. While named ‘positive symptoms’, this does not mean they are ‘good’ symptoms.

• Hallucinations: seeing or hearing something that isn’t there. The most common hallucination in schizophrenia is hearing voices.
• Delusions: odd or unusual beliefs that are generally held to be untrue by others. The person generally holds onto their belief even when there is evidence that it is untrue. Delusions are not consistent with the person’s culture or religion. The most common delusion is paranoia – believing that someone is trying to harm you.

Negative symptoms of schizophrenia

People with schizophrenia often have difficulty functioning at work or school and relating to others. This may be due to negative symptoms, which refers to certain abilities that have been lost. ‘Negative’ symptoms does not mean ‘bad’ symptoms. They include:

• a lack of pleasure in activities that were once enjoyed
• not wanting to talk much
• a lack of emotion or inappropriate emotions
• a lack of interest in socializing or relationships
• self-neglect: not showering, preparing meals or cleaning.

Disorganized symptoms of schizophrenia

These symptoms are due to confusion in the brain (disorganized thinking & speech), and include:

• thoughts or speech that may appear jumbled or disconnected, jumping from one topic to another
• words being used in unusual ways, speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.
• emotions that may seem out of place, such as laughing at sad news
• trouble with planning or making decisions
• finding it hard to understand other people’s feelings or actions.

See a doctor if you or someone you know seems to be experiencing any of these symptoms.

Impaired cognition

Problems with attention, concentration, memory and declining educational performance.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

• Withdrawal from friends and family
• A drop in performance at school
• Trouble sleeping
• Irritability or depressed mood
• Lack of motivation

Compared with schizophrenia symptoms in adults, teens may be:

• Less likely to have delusions
• More likely to have visual hallucinations

Diagnosis of schizophrenia

Schizophrenia is one of a group of disorders known as psychosis. It is a significant mental illness that causes someone to have an altered experience of reality. Schizophrenia affects people’s thoughts, perceptions and behavior and interferes with their ability to function at work, school or relate to other people.

If you or someone you know has unusual thoughts, perceptions or behaviors that sound like schizophrenia, it’s important to seek help. Some people with schizophrenia do not realize they have a problem or avoid health professionals if they have paranoid thoughts. Getting the right diagnosis is the first step towards effective treatment and recovery.

There is no test available for schizophrenia. A doctor or mental health professional can do a mental health assessment in the form of a special interview. This includes questions about the current symptoms, past history of mental health issues, medical history, family history and any substance abuse issues. It is also helpful to speak to a family member for more information about the person’s symptoms.

The doctor will then do a physical examination and may need to do blood tests or a brain scan to rule out any underlying causes. The diagnosis will usually need to be confirmed by a psychiatrist, who can advise on the best treatment options.

The diagnosis is made according to recognized criteria, such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) ⁶. According to the DSM-5, for a diagnosis of schizophrenia to be made, the symptoms need to be present for 6 months or more and be severe enough to cause problems in functioning at work, school, home or socially.

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

Diagnostic Criteria for Schizophrenia

Criteria for schizophrenia include signs and symptoms of at least six months’ duration, including at least one month of active-phase positive and negative symptoms (Table 1) ¹⁶. Delusions, hallucinations, disorganized speech, and disorganized behavior are examples of positive symptoms. Negative symptoms include a decrease in the range and intensity of expressed emotions (i.e., affective flattening) and a diminished initiation of goal-directed activities (i.e., avolition).

Table 1. Diagnostic Criteria for Schizophrenia

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
	1. Delusions
	2. Hallucinations
	3. Disorganized speech (e.g., frequent derailment or incoherence)
	4. Grossly disorganized or catatonic behavior
	5. Negative symptoms (i.e., diminished emotional expression or avolition)
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)
C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences)
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either: (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated)

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[Source ¹⁶]

Schizophrenia test to determine a diagnosis of schizophrenia may include:

• Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
• Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
• Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. This also includes a discussion of family and personal history.
• Diagnostic criteria for schizophrenia. A doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association ⁶.

Schizophrenia treatment

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed.

Schizophrenia is a significant mental illness which affects people’s thoughts, perceptions and behavior and interferes with their ability to function at work, school or relate to other people. It causes someone to have an altered experience of reality and is one of a group of disorders known as psychosis.

The good news is that schizophrenia is more treatable than ever before. Many people recover completely whereas others might have episodes of schizophrenia that come and go. There are a number of different treatments to help people manage their symptoms and help them to flourish in all areas of life.

Treatment should be under the care of a psychiatrist experienced in treating schizophrenia, but may involve a team of different mental health professionals, including a doctor, mental health nurse, social worker, occupational therapist and clinical psychologist. Treatments are tailored according to the needs of the individual.

Research has shown that early treatment can be more effective, before the illness has time to cause damage. There are early intervention programs in most major cities in the US.

Schizophrenia medication

Medication is the main form of treatment for schizophrenia. Antipsychotic medications can reduce the main symptoms like hallucinations and delusions, and normally take 1-2 weeks to work. They’re thought to control symptoms by affecting the brain neurotransmitter dopamine. Recently, a new generation of treatments has been developed, including risperidone, quetiapine, clozapine and many others. Some people develop side effects to medication, so it is important to have regular appointments with a psychiatrist or doctor. People respond differently to medication and sometimes it is necessary to try more than one type before finding the ideal medication.

The goal of treatment with antipsychotic medications is to effectively manage signs and symptoms at the lowest possible dose. The psychiatrist may try different drugs, different doses or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement in symptoms.

Because medications for schizophrenia can cause serious side effects, people with schizophrenia may be reluctant to take them. Willingness to cooperate with treatment may affect drug choice. For example, someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill.

Ask your doctor about the benefits and side effects of any medication that’s prescribed.

Some people have side effects when they start taking medications, but most side effects go away after a few days. Side effects include:

• Blurry vision
• Body movements a person can’t control, such as shaking
• Dizziness
• Drowsiness
• Fast heartbeat
• Feeling restless
• Menstrual problems
• Sensitivity to the sun
• Skin rashes
• Stiffness in the body

Some types of antipsychotic medications can cause a lot of weight gain and other health concerns, which can lead to diabetes, high cholesterol, or other conditions. Other types of antipsychotic medications can cause side effects related to physical movement where a person cannot control muscle movements, especially around the mouth.

People respond to antipsychotic medications differently, so it is important to report any of these side effects to a doctor. Sometimes a person needs to try several medications before finding the right one. People should not stop taking a medication without first talking to a doctor. Stopping medication suddenly can be dangerous, and it can make schizophrenia symptoms worse.

First-generation antipsychotics

These first-generation antipsychotics have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. First-generation antipsychotics include:

• Chlorpromazine
• Fluphenazine
• Haloperidol
• Perphenazine

These antipsychotics are often cheaper than second-generation antipsychotics, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

Extrapyramidal symptoms such as pseudoparkinsonism, akathisia (a sensation of inner restlessness and inability to be still), and dystonia are associated with first-generation antipsychotics. Patients receiving these medications should be routinely monitored for adverse effects and maintained on the lowest effective dose that controls their symptoms. Medications such as propranolol, lorazepam (Ativan), amantadine, benztropine, and diphenhydramine (Benadryl) are used to treat extrapyramidal symptoms ¹⁷. Tardive dyskinesia involving facial muscles generally occurs after the patient has been taking antipsychotic medications for a prolonged time. Symptoms include puffing of the cheeks, protrusion of the tongue, chewing motions, and pursing of the lips. The condition is typically irreversible, but symptoms may lessen after the medication is discontinued. Laboratory monitoring is not necessary for patients receiving first-generation antipsychotics. Patients receiving the second-generation antipsychotic clozapine (Clozaril) are at high risk of agranulocytosis, and the package insert recommends a complete blood count weekly for six months, then every two weeks for an additional six months, then monthly. Clozapine is reserved for patients with severe refractory symptoms because of its increased risk of adverse effects; it should be prescribed only by a psychiatrist ¹⁸.

Second-generation antipsychotics

These newer, second-generation medications are generally preferred because they pose a lower risk of serious side effects than do first-generation antipsychotics. Second-generation antipsychotics include:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Brexpiprazole (Rexulti)
• Cariprazine (Vraylar)
• Clozapine (Clozaril)
• Iloperidone (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)

The most worrisome adverse effects associated with second-generation antipsychotics are metabolic changes, such as weight gain, insulin resistance, hyperglycemia, and lipid abnormalities ¹⁹. All second-generation antipsychotics confer varying degrees of risk for metabolic changes ²⁰ and these effects are not dose-dependent ²¹. Weight gain is usually rapid in the first few weeks of treatment, then plateaus; however, this can take a year or more to occur. Therefore, patients should be examined frequently after initiating treatment with second-generation antipsychotics, and at least annually if they have normal baseline values. Patients with cardiovascular risk factors require more frequent monitoring ²⁰. Table 2 outlines the recommended frequency of monitoring for patients receiving second-generation antipsychotics ²². Primary care physicians should regularly assess body mass index, fasting glucose levels, and lipid profiles, and work toward minimizing these and other cardiovascular risk factors ²³.

Table 2. Recommended Screening Frequency for Patients Receiving Second-generation Atypical Antipsychotics

Screening component	Baseline	Every six weeks	Every 12 weeks	Quarterly	Annually
Blood pressure	X	X	X	X	X
Body mass index	X	X	X	X	X
Fasting glucose level	X	X	X		X
Fasting lipid levels	X	X	X		X
Lifestyle counseling	X	X	X	X	X
Medical history	X				X
Waist circumference	X				X

[Source ²⁴]

Psychological treatments

Once psychosis recedes, in addition to continuing on medication, psychological and social (psychosocial) interventions are important.

Psychological treatments can help people to understand and manage their symptoms and learn new ways of coping. Cognitive behaviour therapy (CBT), supportive psychotherapy and family therapy may all be used.

These may include:

• Individual therapy. Psychotherapy may help to normalize thought patterns. Also, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.
• Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities.
• Family therapy. This provides support and education to families dealing with schizophrenia.
• Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.

Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their illness.

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 ingredients 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 be treated in hospital at times. A hospital admission can help when symptoms are out of control (crisis periods or times of severe symptoms) or the person is not managing at home. Although the majority of people with schizophrenia are not violent, severe symptoms can cause some people to have thoughts of suicide or harming others. If you think someone may be at risk of suicide or violence, call your local emergency number immediately.

It’s important to get professional help to manage schizophrenia. If you or someone you know seems to be experiencing symptoms of schizophrenia, see your doctor as soon as possible.

Electroconvulsive therapy

For adults with schizophrenia who do not respond to drug therapy, electroconvulsive therapy (ECT) may be considered. ECT may be helpful for someone who also has depression.

Lifestyle and home remedies

Although schizophrenia requires professional treatment, it’s critical to be an active participant in your loved one’s care. Here are ways to get the most out of the treatment plan.

• Follow directions for medications. Try to make sure that your loved one takes medications as prescribed, even if he or she is feeling well and has no current symptoms. If medications are stopped or taken infrequently, the symptoms are likely to come back and your doctor will have a hard time knowing what the best and safest dose is.
• Check first before taking other medications. Contact the doctor who’s treating your loved one for schizophrenia before your loved one takes medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals, herbs or other supplements. These can interact with schizophrenia medications.
• Pay attention to warning signs. You and your loved one may have identified things that may trigger symptoms, cause a relapse or prevent your loved one from carrying out daily activities. Make a plan so that you know what to do if symptoms return. Contact your loved one’s doctor or therapist if you notice any changes in symptoms, to prevent the situation from worsening.
• Make physical activity and healthy eating a priority. Some medications for schizophrenia are associated with an increased risk of weight gain and high cholesterol. Work with your loved one’s doctor to make a nutrition and physical activity plan for your loved one that will help manage weight and benefit heart health.
• Avoid alcohol, street drugs and tobacco. Alcohol, street drugs and tobacco can worsen schizophrenia symptoms or interfere with antipsychotic medications. Talk to your loved one about avoiding drugs and alcohol and not smoking. If necessary, get appropriate treatment for a substance use problem.

Coping and support

Coping with a mental disorder as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. Here are some ways to cope:

• Learn about schizophrenia. Education about the disorder can help motivate the person with the disease to stick to the treatment plan. Education can help friends and family understand the disorder and be more compassionate with the person who has it.
• Join a support group. Support groups for people with schizophrenia can help them reach out to others facing similar challenges. Support groups may also help family and friends cope.
• Stay focused on goals. Managing schizophrenia is an ongoing process. Keeping treatment goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the illness and working toward goals.
• Ask about social services assistance. These services may be able to assist with affordable housing, transportation and other daily activities.
• Learn relaxation and stress management. The person with schizophrenia and loved ones may benefit from stress-reduction techniques such as meditation, yoga or tai chi.

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