What Is Schizophrenia? Symptoms, Causes And Treatments

Schizophrenia is a serious and complex mental health condition that affects less than 1% of the U.S. population^[1]Schizophrenia. National Alliance on Mental Illness. Accessed 2/28/2023. . It is often marked by psychosis, or a break from reality, and can include symptoms such as delusions, hallucinations, thought and behavioral disorganization, and “negative symptoms” such as flat affect and loss of interest and motivation.  Schizophrenia is often difficult to diagnose and can lead to significant distress, disability and disruptions to an individual’s family, personal and professional life when not properly treated.

Though schizophrenia may be both difficult to diagnose and treat, there are several options available for effectively managing this condition. With the right treatment, the World Health Organization estimates that one-third of people with schizophrenia experience complete remission^[2]Schizophrenia. World Health Organization. Accessed 2/28/2023. .

Types of Schizophrenia

Previous editions of The Diagnostic and Statistical Manual of Mental Disorders categorized schizophrenia into five subtypes. However, The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) currently defines schizophrenia as a spectrum disorder that includes the former subtypes listed below.

• Paranoid Type: An individual demonstrates preoccupation with one or more delusions or auditory hallucinations but does not display disorganized speech, disorganized or unresponsive behavior or flat or inappropriate affect when speaking.
• Disorganized Type: An individual displays disorganized speech, disorganized behavior, and flat or inappropriate affect when speaking.
• Catatonic Type: An individual displays loss of sensation or consciousness, hyperactivity, lack of response toward stimuli, mutism, exaggerated or repetitive movements or mimics others.
• Undifferentiated Type: An individual experiences symptoms of schizophrenia, such as delusions or hallucinations, but does not fit the paranoid, disorganized or catatonic subtypes.
• Residual Type: An individual does not experience delusions, hallucinations, disorganized speech or disorganized behavior but does present symptoms such as odd beliefs or unusual perceived experiences.

People with schizophrenia often experience episodes that include a break in reality, making it difficult for them to distinguish between what is real and what isn’t. While symptoms and their severity vary from person to person, the hallmarks of schizophrenia include:

• Impaired daily functioning: This may look like struggling with everyday activities, such as making plans, communicating and expressing emotion. These symptoms can often be misdiagnosed as clinical depression.
• Hallucinations: Individuals may have visual, auditory tactile, taste and/or olfactory hallucinations, experiencing sights, sounds, touches and smells that no one else can sense. This may include hearing voices that come from inside their head but are not their internal voice, such as hearing people talking about or commenting on what they’re thinking and doing, or voices that threaten to harm them or their families if they don’t do certain things.
• Delusions: Individuals may hold false beliefs that cannot be swayed by fact or logic. These can include beliefs that others are out to harm them, that they’re being watched or surveilled by powerful agencies, that there are messages meant just for them in tv shows or print media, that they’re the object of someone else’s obsessive affections, or rarely, that they’re dead and living in a version of the afterlife.
• Disorganized thinking: Cognitive issues may present as scattered thoughts, the inability to concentrate, difficulty communicating meaningfully memory issues and trouble completing tasks.
• Grossly disorganized and catatonic behavior: motor behavior, typically involving significant reductions in voluntary movement (sometimes even almost complete immobility or the taking on of statuesque positions) or hyperactivity and agitation. Negative symptoms such as loss of motivation, loss of interest in activities they used to enjoy, and blunted or flat affect.

According to the DSM-5, the standard text mental health providers use to diagnose conditions, to receive a formal diagnosis of schizophrenia, an individual must experience two of the major symptoms listed above, with at least one of the symptoms being hallucinations, delusions or disorganized thinking, for a significant period of time within the same one-month period as a minimum duration.

Schizophrenia is most often diagnosed during an individual’s late teens and 20s, as this typically aligns with the initial onset of psychotic symptoms.

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Schizophrenia Symptoms in Children, Adolescents and Young Adults

Childhood onset schizophrenia, in which children experience psychotic symptoms prior to age 13, is rare. In fact, estimates for all psychotic disorders in children—such as schizophrenia, schizoaffective disorder and schizophreniform disorder—impact just .4% of kids aged 5-18^[3]Grover S, Avasthi A. Clinical Practice Guidelines for the Management of Schizophrenia in Children and Adolescents. Indian J Psychiatry. 2019;61(Suppl 2):277-293. . While research findings suggest that diagnostic criteria are the same for children, adolescents, and adults, the American Academy of Child & Adolescent Psychiatry states that schizophrenia may be expressed differently in younger people. Symptoms for children and adolescents may include:

• Auditory or visual hallucinations
• Atypical behavior and/or speech
• Confused thinking
• Paranoia, fear and severe anxiety
• Social withdrawal and isolation
• Severe mood swings
• Onset of new academic struggles
• Confusing dreams and TV for reality
• Major changes in typical behaviors
• Inattention to personal hygiene

Diagnosing teens with schizophrenia can be particularly difficult, notes Rocco Marotta, M.D., a psychiatrist in New Canaan, Connecticut and the director of Center for the Treatment and Study of Neuropsychiatric Disorders at Silver Hill. Because teens often show symptoms that overlap with several mental health conditions—such as non-hyperactive attention-deficit disorder, substance or alcohol use or severe trauma—pinpointing an exact diagnosis may be complex, he adds.

“Failure to address the actual cause of the behavioral abnormality can have long-term consequences,” Dr. Marotta says. “For example, prescribing stimulants or antidepressants for a disorder that is really schizophrenia can worsen symptomatology over time and lead to unfortunate delays in treatment.”

In young adults, Dr. Marotta says receiving a diagnosis may be complicated by a co-occuring substance use disorder, which he notes is very common in young people with schizophrenia. “Young adults who are developing a psychotic disorder tend to try to hide their symptoms and to adjust as best they can until the symptoms become overwhelming,” he adds.

There is no known singular cause of schizophrenia. Instead, there may be several contributing factors, such as:

• Family history: The risk for developing schizophrenia is higher for those with a family history of the condition. Having an immediate family member with schizophrenia renders an individual six times more likely to also develop symptoms.
• Environment: Certain environmental factors—such as exposure to viruses and malnutrition in utero—may increase the risk of developing schizophrenia later on. Additionally, research suggests that the use of cannabis and other mind-altering substances during adolescence and early adulthood may increase the likelihood of psychosis.
• Brain chemistry: Changes to serotonin and dopamine levels, two chemicals within the brain, may contribute to disease onset.
• Brain anatomy: Brain structure and development may also play a role in schizophrenia. While the research is limited, studies suggest lower brain volume, smaller skull size and atypical maturation may signal an increased risk for schizophrenia.

There is no single test that can diagnose schizophrenia. Diagnosis typically consists of a health care provider evaluating symptoms of an individual’s condition over several months.

To receive a diagnosis for schizophrenia, an individual must demonstrate two or more of the following symptoms (to the detriment of their daily lives):

• Hallucinations
• Delusions
• Disorganized speech or behavior
• Catatonic behavior
• Impaired ability to function

Schizophrenia can be a difficult condition to diagnose, as the symptoms associated with schizophrenia often mimic symptoms of conditions like substance misuse, brain tumors and other psychiatric conditions or neurological disorders. It is generally recommended that a thorough medical exam is performed to rule out other conditions that may be mistaken for schizophrenia.

Misconceptions about schizophrenia abound. According to the American Psychological Association, people in treatment for schizophrenia are often falsely stereotyped as dangerous or chronically hospitalized.

“On the contrary, research shows that individuals with schizophrenia who are in treatment are no more dangerous than the general population,” says Sampath.

Underscoring the critical need for proper diagnosis and treatment, Sampath notes that only when left untreated, schizophrenia has potential to increase the risk of harm to self or others. This stigma can come at a cost to individuals with the condition, as it may exacerbate depressive symptoms and further impair self-reliance and self-esteem, and may also deter the individual from seeking and sticking with treatment.

Treatment for schizophrenia is multifaceted and may combine a number of medications as well as therapeutic support. “In addition to what are often complex, individually tailored medication regimes, there is a need for continued support from a highly trained treatment team, psychological therapeutic interventions and sustained support from family and the wider community,” explains Dr. Marotta.

Recovering from an acute and severe episode of psychosis may require a months-long stay in a residential treatment facility, he adds, followed by step-down programs and continued care by a team highly qualified in long-term treatment of the condition.

Treatments for schizophrenia may include:

• A combination of medications, including antipsychotics
• Cognitive behavioral therapy (CBT) or other types of evidence-based psychotherapy
• Lifestyle changes, such as a healthy diet and regular exercise
• Housing that fosters socializing and community living
• Ongoing care from a clinical team
• Community and/or family support

“Research shows that treatment within the first two years of symptom onset shows significantly improved treatment outcomes, even full recovery being possible,” says Melissa Sampath, a licensed professional counselor and the vice president of community mental health services at Care Plus in Paramus, New Jersey.

Medication for Schizophrenia

Medications used to treat schizophrenia include first generation or second generation antipsychotics. Antipsychotics may improve symptoms such as delusions and hallucinations and reduce the likelihood of these symptoms reoccurring in the future.

First generation (typical) antipsychotics block dopamine receptors in the brain. Common first generation antipsychotics used to treat schizophrenia include:

• Chlorpromazine (Thorazine)
• Fluphenazine (Proxlixin)
• Haloperidol (Haldol)
• Loxapine (Loxitane)
• Perphenazine (Trilafon)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)

Second generation (atypical) antipsychotics block dopamine and serotonin receptors in the brain. Common second generation antipsychotics used to treat schizophrenia include:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Clozapine (Clozaril)
• Iloperidone (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)

Can Online Therapy Help Someone With Schizophrenia?

Research indicates that online therapy may be an effective tool for treating individuals who experience the symptoms associated with schizophrenia. However, treatment for schizophrenia often involves a combination of talk therapy and medication, meaning individuals who seek online therapy for schizophrenia may want to opt for a platform that also offers psychiatric services or medication management.

Schizophrenia requires lifelong treatment. If left untreated, individuals may experience more severe symptoms, including hallucinations, delusions, disorganized speech or behavior and an inability to complete daily tasks. Untreated schizophrenia may also lead to increased feelings of depression or suicidal ideation. Additionally, individuals who experience the symptoms of schizophrenia are at an increased risk of substance misuse, which may interfere with medication, worsen symptoms or reduce the likelihood of adhering to treatment plans.

If you or a loved one is experiencing symptoms of psychosis, it’s important to seek professional help as soon as possible, says Dr. Marotta. He notes that most often it’s people close to the individual, like a family member or teacher, who first notice something amiss.