Schizophrenia

Schizophrenia is a long-term condition that belongs to a group called psychotic disorders. Psychosis means losing some contact with reality, for example by perceiving things that others don't or holding beliefs that are not based on evidence.

Schizophrenia often begins in late adolescence or early adulthood, though it can start later. It affects people of all backgrounds.

It is a common myth that schizophrenia means having a "split personality." It does not; that idea is confused with a different condition. Another harmful myth is that people with schizophrenia are typically violent. In fact, people with serious mental illness are more likely to be victims of violence than perpetrators.

The term paranoid schizophrenia was once used for a subtype dominated by suspicious or persecutory beliefs. Current diagnostic systems no longer use subtypes, but paranoia remains a common symptom for some people.

Schizophrenia symptoms are usually grouped into three types:

Positive symptoms (experiences added to normal perception):

• Hallucinations, most often hearing voices that others cannot hear.
• Delusions, such as believing you are being watched, followed or controlled.
• Disorganized thinking and speech that is hard to follow.

Negative symptoms (reductions in usual functioning):

• Reduced motivation and difficulty starting tasks.
• Flat or reduced emotional expression.
• Social withdrawal and speaking less.
• Reduced pleasure in activities.

Cognitive symptoms:

• Difficulty with attention, memory and planning.

Hearing voices does not always mean schizophrenia. It can occur with other conditions, stress, sleep deprivation, substance use or medical problems, and some people hear voices without distress. A psychiatrist can assess what is causing the experience.

Before a first episode of psychosis, many people go through a period called the prodrome, which can last weeks to months. Early signs of schizophrenia may include:

• Withdrawing from friends and family.
• A decline in school or work performance.
• Trouble concentrating or thinking clearly.
• Unusual beliefs, suspiciousness or feeling that things have special meaning.
• Changes in sleep, hygiene or self-care.
• Strong reactions or flat emotions that seem out of character.
• Perceptual changes, such as sounds seeming louder or colors seeming different.

These signs can have many causes, especially in teenagers. However, if several appear together and represent a clear change, it is important to seek a professional assessment. Early intervention services in many health systems specialize in supporting young people with first signs of psychosis, and early treatment is linked to better outcomes.

There is no single cause. Schizophrenia most likely results from a combination of:

• Genetics: having a close relative with schizophrenia increases risk, though most people with a family history do not develop it.
• Brain development: differences in brain structure and chemistry, including dopamine and other neurotransmitter systems.
• Early life factors: complications during pregnancy or birth.
• Environmental stress: trauma, social adversity, isolation or migration-related stress.
• Substance use: heavy cannabis use, particularly high-potency cannabis in adolescence, is associated with a higher risk of psychosis in vulnerable people.

Schizophrenia is not caused by bad parenting or personal weakness. Understanding it as a health condition helps reduce stigma and encourages people to seek care. Researchers continue to study how these factors interact, and risk is never destiny.

Schizophrenia treatment is most effective when it combines several elements:

• Antipsychotic medication, prescribed and monitored by a psychiatrist, which can reduce hallucinations and delusions and help prevent relapse. Finding the right medication may take time, and side effects should be discussed openly.
• Cognitive behavioral therapy for psychosis (CBTp), which helps people cope with distressing voices and beliefs.
• Family interventions that support relatives and improve communication.
• Coordinated specialty care for first-episode psychosis, combining medical, psychological and social support.
• Support with work, education, housing and social connection, often provided by social workers and occupational specialists.

In a first appointment, a psychiatrist will ask about symptoms, history, substance use and daily functioning, and may order tests to rule out medical causes. Involving a trusted family member or friend is often helpful.

Seek urgent help if someone:

• Is talking about harming themselves or others.
• Is acting on voices or beliefs in a way that puts them at risk.
• Is unable to care for themselves or is in severe distress.

Call 911 in the US or your local emergency number. For suicidal thoughts or emotional crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the US, or call Samaritans on 116 123 in the UK and Ireland.

If you are supporting someone with schizophrenia, stay calm, speak simply and avoid arguing about the content of delusions. Acknowledge their feelings, encourage treatment and look after your own wellbeing. Family support programs can help you learn practical skills.