S chizophrenia is a psychotic disorder that often begins in late adolescence or early adulthood. It is an illness of the brain that affects how a person perceives the world, thinks, and behaves. Many people confuse psychosis with violence but they are not the same thing. In fact, people with psychotic disorders like Schizophrenia are much more likely to be the victim of a crime than to commit one. Psychosis means “to break from reality,” and that’s exactly what Schizophrenia is – a mental disorder that causes the individual to have difficulty distinguishing what is real from what is not. Although Schizophrenia is a psychotic illness, psychosis can also occur in other mental disorders, such as: Bipolar Disorder, Depression, or as a result of drug ingestion or Substance Use Disorder.
Individuals with Schizophrenia experience these two categories of symptoms, plus many others. These categories are symptoms based on problems with cognition (delusions) and problems with perceptions (hallucinations):
Belief in something that is not true, even when confronted with proof. The most common delusions are related to persecution, grandiosity, religion, or jealousy.
- E.g., belief that a group or organization is out to get you; belief that the star of your favourite TV show is speaking directly to you; belief that you are the reincarnation of King Henry VIII; belief that someone you’ve never met is in love with you; belief that someone else is controlling your behaviour.
Realistic sensory perceptions that are not actually happening.
- E.g., hearing a voice when no one is speaking; seeing something when nothing is there
Auditory hallucinations are most common, although hallucinations can happen in any sense (i.e., sight, taste, smell, touch, sound). Common auditory hallucinations include:
- Audible Thoughts: Hearing your thoughts spoken out loud as you think them.
- Voices Arguing or Discussing: Hearing two or more voices discussing or arguing with each other.
- Voices Commenting: Hearing one or more voices commenting on your behaviour, thoughts, speech, appearance, etc. Generally, the voices are experienced as intrusive, abusive and critical.
- Voices Commanding: Hearing one or more voices instructing you to carry out specific demands. The voices may instruct you to do things you usually would not do or to say things you usually would not say.
- Disorganized Thinking/Speech: Disordered thinking is usually inferred from how someone speaks. Their speech is tangential, moving loosely from topic to topic with no clear connection between subjects. Speech itself can be difficult to understand and may even be completely incoherent.
- Abnormal Motor Behaviour: Motor behaviour may take on many different forms, including inappropriate silliness, extreme agitation, stereotyped and repetitive movements, or maintaining a completely rigid posture (i.e., catatonic behaviour). Behaviours can range from mildly socially inappropriate to very disruptive, and may even be threatening in response to hallucinations or part of a delusion. Self-grooming and self-care may also be compromised.
- Negative Symptoms: The absence of something that is typically present. This can include decreased emotional expression (i.e., lack of eye contact, monotone voice, lack of facial/hand movements that imply emotion), diminished involvement in goal-directed activities (e.g., work, school, hobby), and loss of speech, pleasure, and interest in social interaction.
Schizophrenia usually develops gradually over the course of several years. A person with schizophrenia will often have negative symptoms for a few years before other symptoms emerge.
Schizophrenia is equally common in men and women, affecting about one percent of the population, although the age of onset is usually about 10 years later in women than men. Some research suggests that women tend to have more paranoid delusions and hallucinations, where as men often experience more negative and disorganized symptoms.
Schizophrenia is linked to structural and functional abnormalities in the brain. The regions of the brain that control and coordinate thinking, perceptions and behaviours are not functioning properly, making it difficult for people to filter and process information. Frequently, people with Schizophrenia experience the information that comes into their senses as garbled and mixed together. A variety of different neurochemical pathways are involved, including brain pathways that use the chemicals dopamine and serotonin. The limbic system (an area of the brain involved with emotion), the thalamus (which coordinates outgoing messages), the cortex (the part of the brain that is responsible for problem solving and complex thinking) and several other brain regions can all be affected.
Schizophrenia often has a genetic component, although not in all cases. Birth trauma and fetal brain damage in utero increase the risk for Schizophrenia. Recent research also suggests that significant marijuana use may trigger the onset of Schizophrenia in youth who are at risk for the illness. Individuals who have an immediate family member with Schizophrenia should avoid using marijuana or other drugs.
Schizophrenia, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or trained health professional who has spent time with the person and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.
Many young people with Schizophrenia will demonstrate a slow and gradual onset of the illness (often over the period of 6-9 months or more). This is called a prodrome.
The prodrome includes:
- Social withdrawal
- Odd behaviours
- Lack of attention to personal hygiene
- Excessive preoccupation with religious or philosophical constructs
- Focus on bizarre ideas
- Complaints of being persecuted by others
- Abuse of substances – particularly alcohol and marijuana
- Difficulty concentrating
- Flattened mood, decreased speech
It can sometimes be difficult to distinguish the onset of Schizophrenia from other mental disorders, such as Depression, Obsessive-Compulsive Disorder, or Social Anxiety Disorder. To be diagnosed with Schizophrenia, the person must have experienced symptoms for at least 6 months (e.g., delusions, hallucinations, disorganized speech, abnormal motor behaviour, or negative symptoms), including at least one month of delusions, hallucinations, or disorganized speech. These problems cause severe dysfunction in one or more areas of their daily life (social, family, interpersonal, school/work) and are not the result of using a substance (i.e., getting high) or of another medical condition.
It’s important to note that believing or sensing something that other people do not is not always a sign of Schizophrenia. We can all believe things that other people do not – whether it’s that a higher power exists, that an old house is haunted, that the government is monitoring our internet use, or something else entirely. Age-appropriate or culturally-appropriate beliefs are not considered delusions. The same is true for hallucinations. If you can hear your neighbour’s conversation on the other side of the wall but someone standing on the other side of the room cannot – you are not “hearing voices” (e.g., a hallucination). A child’s imaginary friend is also not a hallucination. Age-appropriate displays of imagination are not hallucinations. A hallucination is when something is experienced through your senses (sound, sight, smell) that is not there. Delusions and hallucinations are diagnosed when people believe or sense something despite many other people giving evidence that the belief or sensory perception does not exist.
*In accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
Remember, you cannot diagnose someone with Schizophrenia without a proper mental health assessment conducted by a properly trained health provider.
No. People with Schizophrenia do not have multiple personalities. This error is perpetuated by errors in mainstream media and likely comes from the fact that Schizophrenia means “split brain”. “Split brain” refers to how the brain splits from reality for people with Schizophrenia, not to split personalities. Dissociative Identity Disorder is the proper diagnosis for someone with apparent multiple personalities. It is a separate and unrelated diagnosis.
Start a conversation with the person, asking them some questions about how they are feeling. These questions might include:
- Can you tell me what you are concerned about?
- Do you feel comfortable in school? In your class?
- Are you having any problems thinking?
- Are you hearing or seeing things that others may not be hearing or seeing?
If you’re concerned that someone you know might have Schizophrenia, encourage them to see a doctor as soon as possible (or take them yourself, if appropriate). Early identification and provision of treatment are essential to successfully treating the disorder.
If someone in your life has been diagnosed with Schizophrenia, here’s what you can do:
- Be well-informed. Learn about Schizophrenia and the treatment options available. Read books, trusted websites (like this one!), and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.
- A person with Schizophrenia will require immediate effective treatment – usually in a specialty mental health program. Early identification and effective intervention is the key to successfully treating the disorder and preventing future disability. You can help by arranging a meeting with a qualified health practitioner and making sure that the person receives a professional diagnosis and appropriate treatment plan. In many cities across Canada and elsewhere, specialized “first onset psychosis” programs are available. These generally can provide the complex treatments that are needed to fully treat the many symptoms of Schizophrenia.
- Encourage the person to get lots of rest and eat a well-balanced diet. Having at least eight full hours of sleep each night and steering clear of junk foods makes a big difference in how someone feels. For information on healthy sleep habits, check out: Healthy Sleeping
- Encourage the person to avoid drugs and alcohol, which can trigger the onset of Schizophrenia and make symptoms much worse.
A variety of treatment options exist for Schizophrenia. Determining which course of action is appropriate for each individual should be done with the guidance of a mental health professional. Early diagnosis coupled with appropriate treatment is critical for reducing the impact of Schizophrenia on the individual.
During severe episodes of psychosis, individuals with Schizophrenia may need to be hospitalized in order for them to stabilize and for a more appropriate treatment plan to be developed. Some individuals, however, are able to be helped using intense outpatient treatment and will not require hospitalization. A person with schizophrenia should leave the hospital or outpatient facility with a treatment plan that will minimize symptoms and maximize quality of life. A comprehensive treatment program should include:
- Medication: Medication helps the brain correct the functioning of its cognitive and emotional control circuits. The most common medications prescribed for Schizophrenia are antipsychotic medications. For more information on how to properly use medications, check out MedEd.
- Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. For someone with Schizophrenia, there are several different types of psychological treatments that might be helpful, including:
- Cognitive Behavior Therapy (CBT): CBT can help reduce the severity of the person’s symptoms. In CBT, they will learn to identify problems and symptoms, and develop cognitive and behavioural coping strategies that can help.
- Family-Based Services: Family interventions educate the person’s family about Schizophrenia and how to cope, and provide crisis intervention and emotional support.
- Assertive Community Treatment: This type of treatment involves a high level of contact between a variety of mental health professionals and the person with Schizophrenia and helps to decrease hospitalizations and homelessness.
- Supported Employment: Supported Employment helps people to look for a job and be effective in that job, once found.
- Skills Training: Skills training helps people with Schizophrenia work on their social skills, ability to live independently, and any other skills necessary for living in the community.
- School Supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing their symptoms.
- Community Supports: Community supports can include peer support groups, support groups for families, and other helpful resources.
- Regular Routine: Maintaining a healthy, regular daily routine is very important for a person with Schizophrenia. For help maintaining the kind of healthy lifestyle that should accompany professional treatment for Schizophrenia, check out Taking Charge of Your Health.
Once the person’s symptoms are under control, they will likely still need to continue taking medication in order to reduce the risk of relapsing.
Remember, all treatments have the same goals: decrease symptoms and improve functionality; decrease risk of relapse; and promote recover. Think about it this way: Get well; Stay well; Be well.
It’s not uncommon for people to have more than one mental illness. Other common co-occurring disorders (also called comorbid disorders) include:
- Schizophrenia Society of Canada
- Psychosis Sucks
- Cannabis and Psychosis
- Nova Scotia Early Psychosis Program
- Dealing with Psychosis Toolkit
- Intervoice: The International Hearing Voices Network
- Mood Disorders Society of Canada
- National Institute of Mental Health
- American Academy of Child & Adolescent Psychiatry