Schizophrenia

Schizophrenia is a long-term mental health condition that changes how you think, feel and experience the world around you. Doctors often describe it as a type of psychosis, meaning there are times when it's hard to tell your own thoughts and ideas apart from what's really happening.

What are the symptoms of schizophrenia?

Symptoms vary a lot from person to person, and they often come in episodes. You may go through a period where symptoms are severe, followed by a stretch where you have few or none at all.

Symptoms can include:

• hallucinations, where you hear, see, smell, taste or feel things that don't exist outside your mind. Hearing voices is the most common
• delusions, which are strong beliefs that aren't based on reality and that other people find hard to understand
• muddled thoughts and speech, often connected to the hallucinations or delusions
• losing interest in things you used to care about
• not wanting to look after yourself, including your personal hygiene
• wanting to avoid people, including friends
• feeling cut off from your own emotions
• difficulty concentrating, or difficulty with everyday tasks
• feeling frightened or worried, including worrying that others want to harm you

Hallucinations feel entirely real to the person having them. Brain scans show changes in the speech areas of the brain when someone with schizophrenia hears voices, as though the brain is mistaking thoughts for real voices.

Two beliefs about schizophrenia are worth correcting. It does not mean having a split personality, and it does not usually make someone violent.

What causes schizophrenia and who is at risk?

The exact cause isn't known. Most experts think it comes from a combination of genetic and environmental factors working together.

The general picture is that some people are more vulnerable to developing schizophrenia than others and that certain situations can then trigger it. That helps explain why two people with a similar family background can have very different experiences.

There is also research suggesting a possible link with the menopause, which may relate to the hormonal changes at that stage of life.

Because the causes are complicated and differ between individuals, there's rarely a single explanation for why one person develops the condition.

Are there different types of schizophrenia?

Rather than splitting the condition into named types, the sources describe it by the kind of symptoms involved.

• Positive symptoms are changes to your thoughts or behaviour that weren't there before, such as hallucinations and delusions.
• Negative symptoms are things that fall away, such as withdrawing from people around you, losing interest in day-to-day life, and appearing flat or emotionless.

Negative symptoms often come first. They can appear months or even years before a first acute episode with hallucinations or delusions, and they usually build up slowly. This early stage is called the prodromal period, and at the time it can be hard to tell whether it's schizophrenia or something else entirely.

Psychosis is a symptom rather than a diagnosis in itself, and you can have an episode of psychosis without having schizophrenia. Several other conditions cause similar symptoms, which is why some people end up with more than one diagnosis, or find that their diagnosis changes over time.

How is schizophrenia diagnosed?

There's no single test for schizophrenia. It's usually diagnosed after an assessment by a mental health professional, such as a psychiatrist.

The usual route starts with your GP. They'll ask about what you've been experiencing and check that the symptoms aren't being caused by something else, then refer you on for a fuller assessment if needed.

Because the diagnosis rests on what you describe and what professionals observe, rather than on a scan or blood test, it can take time to reach. Conditions with overlapping symptoms make this harder still.

If your doctor thinks you may be having a first episode of psychosis, you should be referred to an NHS early intervention team. You can usually refer yourself to your local team, and a carer or someone close to you may be able to refer you too.

How is schizophrenia treated?

The National Institute for Health and Care Excellence (NICE), which recommends treatments to the NHS, says you should be offered a combination of medication and talking therapies. People respond to treatment differently, so finding what works for you is part of the process.

Medication

Antipsychotic medication is the most common treatment after a diagnosis. If you have questions or worries about your medication, raise them with your doctor, nurse or pharmacist rather than stopping on your own.

Talking and psychosocial therapies

These involve talking, listening and doing. Professionals are trained to listen without judging you.

• some therapies help you understand your illness and recognise your own pattern, including the early signs that you may be becoming unwell again
• others work on reducing the impact of the symptoms you find most distressing
• occupational therapy takes a practical, activity-based approach to managing the condition day to day

Some newer digital therapies for psychosis have also been developed.

Specialist teams

Early intervention teams support people going through a first episode of psychosis or schizophrenia. They usually include psychiatrists, psychologists, mental health nurses, social workers and support workers. NICE suggests treatment should start within two weeks of referral.

When should I see a doctor?

Speak to your GP as soon as you can if you're experiencing symptoms of schizophrenia. The earlier it's treated, the better the outcome tends to be.

It's worth making an appointment if:

• changes in your thoughts or behavior have lasted a while, or are affecting your everyday life
• you've already been diagnosed and your treatment doesn't seem to be helping.

If you're worried about someone else, encourage them to speak to their GP. You can also call NHS 111 yourself for advice.

If you or someone else is in a mental health crisis, urgent help is available. Don't wait for a routine appointment.