What is Schizophrenia?

Schizophrenia is one specific psychotic disorder that typically emerges in late adolescence through the mid-30s.^{1, 2} It can profoundly alter how someone thinks, feels, and behaves by disrupting the logic that guides their actions, leading to behaviors that may seem unusual to others. ³ As a psychotic disorder, schizophrenia often faces significant stigma, largely due to widespread myths and media misrepresentation. According to the World Health Organization, approximately 1 in 300 people, or 24 million people across the globe have schizophrenia.⁴

What is it like to live with schizophrenia? Psychotic disorders affect an individual’s thoughts, emotions, and behaviors, impacting all aspects of their life, especially their ability to function socially. These disorders blur the lines between reality and illusion, often compromising thoughts, beliefs, and sensory abilities such as vision, hearing, smell, touch, and taste.¹ Imagine the confusion or fear of losing the ability to discern what is real and what isn’t. The certainty that what you see is real and shared by others, and the assurance that the voice in your head is your own, are comforts many take for granted. For those with psychotic disorders, distinguishing reality from delusion can be a daily challenge.

In this article, we'll delve into essential information about schizophrenia, covering symptoms, medications, and treatment options.

Schizophrenia Symptoms^{2, 3}

Everyone with schizophrenia has their own unique experience and combination of symptoms, but the condition includes a few specific types of symptoms.

Hallucinations

One symptom of schizophrenia is hallucinations – when a person’s senses perceive something that isn’t really happening. Hallucinations can happen with any of our senses – like seeing things that aren’t there, known as visual hallucinations, or feeling something is on or happening to your body that really isn’t there, called a tactile hallucination. Hearing something that isn’t there, like hearing voices, is called auditory hallucinations. It’s important to understand that not everyone with hallucinations or delusions necessarily has schizophrenia. These symptoms may also occur in the context of specific medical conditions, reactions to drugs or medications, and other mental health diagnoses.

Delusions

People living with schizophrenia might also have delusions – or strong beliefs in things that are not true or not based in reality. Examples of common delusions include the belief that another person or group is out to harm them or is controlling them or their thoughts. Another example of a delusion for an individual living with schizophrenia is thinking they are a famous person from history or that they are in a relationship with a famous person.

Disorganized Speech

People living with schizophrenia may also have symptoms that impact their ability to think clearly. This is called disorganized thinking and is typically seen in the way a person talks, which may seem to others as rambling, tangential, or even impossible to understand. People living with schizophrenia might also have a hard time focusing or paying attention, causing them to frequently bounce from one topic to other unrelated topics in conversation or provide answers to questions that don’t make sense.

Disorganized Behavior

Disorganized behavior is another symptom of schizophrenia. For some, this might mean acting in unpredictable ways, like getting agitated very quickly or acting in a very childlike manner. For others, this could manifest by repeating a specific motion, such as pacing, or repeating a phrase out loud, over and over again.

Lack of Emotion

People living with schizophrenia might look like they don’t have the usual range of emotions – something called flat affect. Individuals might have difficulty relating to other people and understanding the emotions in others. These are also referred to as “negative symptoms”.. Other negative symptoms of schizophrenia include social withdrawal or decreased interest in social interactions, decreased interest in activities or hobbies, and decreased motivation. The negative symptoms of schizophrenia are frequently the first to occur in individuals, and may at first be mistaken for symptoms of depression.

The diagnosis of schizophrenia is complex and can be challenging, as individuals with this diagnosis frequently lack the insight to reliably describe their own symptoms. Behavioral observations and reports from those who know the individual well are frequently necessary to make an accurate diagnosis. Schizophrenia is diagnosed by a psychiatrist, psychologist, or mental health professional by learning about a person’s symptoms, their impact on their life, mental and medical history, family history, and comparing their information to the criteria for schizophrenia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is published by the American Psychiatric Association and is used by healthcare professionals to determine when a person may have a mental health condition. Healthcare professionals may also perform physical examinations and mental status examinations to help understand symptoms and rule-out other causes for an individual’s symptoms.5

Schizophrenia Treatment Options

The goal of treatment for schizophrenia is to stabilize a person’s symptoms and improve their quality of life throughout their ongoing recovery journey. Most treatment plans for schizophrenia involve the use of antipsychotic medications along with therapeutic and supportive psychosocial treatments.² It’s important for individuals living with schizophrenia to have a support network including both treatment providers as well as social supports (such as family, friends, or peers) to help them navigate symptom management and help them work toward their treatment goals.

Medication for Schizophrenia

Medication is an important part of treatment for schizophrenia. Studies show that when individuals living with schizophrenia consistently and properly take their prescribed medication, the likelihood of symptoms returning or getting worse is lower.⁵ There are many factors involved when making decisions about medication. Finding a psychiatrist or other qualified prescriber that you can talk with about your options is an important step in finding the right treatment.

Antipsychotics

Medications typically prescribed as part of a treatment plan for schizophrenia are classified as antipsychotic medications. Antipsychotics are used to help reduce symptoms of psychosis like hallucinations, delusion, and disordered thinking.⁶

There are options for how, and how often, to take antipsychotic medication. Medication options range from daily pills or liquids to long-acting injectables. Some examples include:²

• Pills
• Dissolvable tablets
• Liquids
• Injections that are taken at monthly or longer intervals
• Patches applied to the skin

It’s important to collaborate with healthcare providers and work collaboratively to find an appropriate treatment and medication regimen for each individual with schizophrenia. Considerations in the selection of medications to treat schizophrenia include how each medicine may help, the potential side effects and even the costs can be weighed carefully.²

Outpatient or Psychosocial Treatment

Outpatient treatment refers to schizophrenia care and support provided through services in the community. Using these resources in a collaborative manner can help individuals create a support network to help them manage their treatment goals and help them on their journey by holding them accountable for progress and providing extra support when needed.²

Examples of outpatient treatment might include:⁵

• Regular appointments with a doctor to manage medication
• Attending support group therapy sessions
• Individual psychotherapy sessions with a mental health therapist
• Family therapy and education for family and loved ones
• Social skills training
• Working with a case manager to obtain education and employment support

Inpatient Treatment

Outpatient treatment options enable many people with schizophrenia to effectively manage their symptoms. But sometimes, a person’s symptoms can significantly worsen, and 24-hour medical care is needed to ensure that they are safe. A temporary stay in the hospital, also known as inpatient treatment, can help to stabilize schizophrenia symptoms when they have become severe.

• A person might require inpatient treatment if they:
• Attempt to hurt themselves
• Display aggressive or threatening behavior toward others
• Hear voices that tell them to hurt themselves or others.

Sometimes, people choose to go to the hospital when they are in crisis. Other times, if a person is a danger to themselves or others and is refusing treatment, they might be admitted involuntarily. The laws about who can initiate and approve involuntary hospitalization vary from state to state. But the important thing to know is that inpatient treatment for schizophrenia is a decision that is taken seriously, with consideration towards an individual’s autonomy as well as their safety.

Usually, people participate in inpatient treatment for the shortest amount of time needed to stabilize symptoms following an episode, also known as a return of schizophrenia symptoms. When a person is stable, the treatment team will help with discharge planning. This is the plan that is put in place with the person’s input so that when they leave the hospital, they have the treatment and community support necessary to maintain recovery in the community. This might include a medication treatment plan, referrals to outpatient care like a psychiatrist they can visit regularly, community mental health support like a case manager, and even housing options.

Living with Schizophrenia

Schizophrenia is a lifelong condition. Recovery from schizophrenia is an ongoing process, which means symptoms may be present, but to a lesser degree. While the recovery journey is different for everyone, with proper treatment and support, many individuals with schizophrenia can effectively manage their symptoms and live fulfilling, productive lives. There is a misconception that individuals with schizophrenia cannot participate in some common life experiences such as going to college, having a job, or living independently. As treatments have evolved and attitudes towards mental illness have changed, this is no longer true. There is strong evidence to suggest that early intervention for individuals with schizophrenia can lead to a significant decrease in symptoms and improvement in functioning and quality of life.

Learning to manage symptoms is essential to maintain ongoing recovery, however ongoing recovery from schizophrenia means more than not having symptoms anymore. An individual’s recovery journey is about reaching goals that are important to them, like finding a job, finishing school, and living life beyond mental illness.²

Summary

Schizophrenia is a complex mental health disorder characterized by a range of symptoms, including hallucinations, delusions, disorganized thinking and behavior, and an apparent lack of emotion. Each individual's experience with schizophrenia is unique, but these common symptoms can significantly impact their daily lives. With medication, therapy, and help from friends, family, and community support, many people with schizophrenia can manage their symptoms and work toward their treatment and life goals.