Schizophrenia

What is schizophrenia?

Schizophrenia is a chronic mental illness that affects thinking, feeling, and behavior. It often involves episodes of psychosis with symptoms such as delusions (fixed false beliefs), hallucinations (sensory experiences without external stimuli), and disorganized speech or behavior. People with schizophrenia may also show negative symptoms like reduced emotional expression, lack of motivation, and social withdrawal. This condition does not mean a split personality and is not typically associated with violence.

What causes schizophrenia?

  • Genetic factors

    A family history of schizophrenia increases risk, suggesting heredity plays a role.

  • Brain chemistry and structure

    Imbalances in neurotransmitters such as dopamine and glutamate, and differences in brain volume and connectivity have been observed.

  • Developmental and environmental factors

    Exposure during pregnancy to infections, malnutrition, or toxins, as well as early life stress or trauma, may contribute.

  • Substance use

    Use of mind-altering drugs, especially cannabis in adolescence, has been linked to increased risk of psychotic disorders.

What are the symptoms of schizophrenia?

Positive symptoms

  • Hallucinations (hearing voices, seeing things that aren’t there)
  • Delusions (false beliefs like paranoia or grandiosity)
  • Disorganized thinking and speech (jumping between topics, incoherence)
  • Abnormal motor behavior (agitation, catatonia)

Negative symptoms

  • Flattened affect (reduced facial expression, monotone voice)
  • Alogia (reduced speech output)
  • Avolition (lack of motivation, neglect of daily activities)
  • Asociality (social withdrawal, loss of interest)

Cognitive symptoms

  • Poor executive function (difficulty planning and decision-making)
  • Impaired attention and concentration
  • Problems with working memory (holding and using information)

How is schizophrenia diagnosed?

  • Clinical interview and history

    Assessment of symptoms, onset, duration (at least 6 months with 1 month of active psychosis), and family history.

  • Psychiatric evaluation

    Mental status exam by a psychiatrist to identify psychotic symptoms and rule out mood disorders.

  • Diagnostic criteria

    Use of DSM-5 or ICD criteria requiring characteristic symptoms, social/occupational dysfunction, and duration thresholds.

  • Physical and laboratory tests

    Blood, urine, and imaging studies (CT/MRI) to exclude substance-induced psychosis or medical causes.

How is schizophrenia treated?

Antipsychotic medications

  • First- and second-generation antipsychotics (e.g., risperidone, olanzapine, aripiprazole)
  • Long-acting injectable formulations for better adherence
  • Monitoring for side effects like weight gain, metabolic syndrome, and movement disorders

Psychotherapy and psychosocial interventions

  • Cognitive behavioral therapy to challenge delusional beliefs and improve coping
  • Family therapy to educate relatives and reduce relapse
  • Social skills training and supported employment to enhance functioning

Electroconvulsive therapy (ECT)

Considered for treatment-resistant cases or severe catatonia, under anesthesia.

Hospitalization and crisis care

Inpatient stays may be needed for acute psychosis or safety concerns.

Lifestyle and support

  • Regular exercise, healthy diet, and sleep hygiene
  • Substance use avoidance
  • Peer support groups and community resources

Sources

  • National Alliance on Mental Illness. Schizophrenia Fact Sheet. Accessed May 3, 2024.
  • National Institute of Mental Health. Schizophrenia. Accessed May 3, 2024.
  • American Psychiatric Association. Schizophrenia Spectrum and Other Psychotic Disorders. DSM-5.
  • Merck Manual Professional Version. Schizophrenia. Accessed May 3, 2024.
  • Mind. Schizophrenia: How can friends and family help? Accessed May 3, 2024.