Schizophrenia is a chronic, or lifelong, brain disorder that interferes with a person’s thoughts, feelings, and behaviors. People with schizophrenia may have hallucinations, delusional or distorted thoughts, or feelings of paranoia. Hearing voices is the most common type of hallucination among people with schizophrenia. They may hear these voices talking directly to them about their behavior, ordering them to do things, or warning them of danger. They may also hear these voices talking to each other. People with schizophrenia may hear voices for a long time before their family and friends notice a change in their behavior. They also may have have firmly held beliefs that others find irrational. These delusions may include paranoid beliefs that others intend to harm them, or are spying on them, or are reading their mind. These delusions can involve a wide range of beliefs that others in the same cultural community find to be strange and contrary to their experience. Symptoms of SchizophreniaSchizophrenia is a common form of psychosis, a medical condition that skews the way a person perceives reality. A sudden change in personality and behavior, which occurs when a person with schizophrenia mentally “disconnects” from reality—when they can’t tell what is real from what is imagined—is called a psychotic episode. Hallucinations and delusions are part of psychosis, and people with schizophrenia often experience psychotic episodes. Psychosis can have many causes, and the process of diagnosis often involves ruling out other conditions that can produce similar symptoms, such as substance use, depression, or bipolar disorder. Symptoms of schizophrenia can vary and even change over time. People with schizophrenia may have poor interpersonal skills. They are sometimes unable to show emotion and may have difficulty initiating a conversation or participating in other activities. Personal hygiene may deteriorate, and some people experience a decline in cognitive functioning, including difficulty with attention, memory, the speed of mental processing, and problem solving. The condition affects men and women equally. It most often appears in men in their late teens or early 20s and in women in their late 20s or early 30s. Schizophrenia occurs in about 1 percent of the general population and in 10 percent of people who have a first-degree relative with the disorder, such as a parent or sibling. People who have second-degree relatives with schizophrenia, such as aunts, uncles, or grandparents, also develop the condition more often than the general population. Causes of SchizophreniaThe exact cause of schizophrenia is not known, but scientists believe a combination of genetics and environmental factors—such as exposure to viruses while in the womb, or complications during birth, such as a baby deprived of an adequate supply of oxygen—may play a role. Imbalances in certain chemical messengers in the brain, called neurotransmitters, may also contribute to schizophrenia. Neurotransmitters transmit messages between nerve cells and the body’s muscles and organs. They play a role in mood, attentiveness, anger, learning, and memory. Diagnostic ProcessThe illness often follows a progression, starting with a prodromal stage, in which the person exhibits a decline in functioning and may display very mild forms of psychosis, such as odd beliefs or unusual perceptional experiences. A diagnosis is not made until more clear-cut symptoms of psychosis emerge and only after a very careful review of all other possible causes. Our specialists are experts in this process. To make a diagnosis, a doctor performs a physical exam and conducts a thorough review of a person’s medical, psychiatric, and family history. The doctor may ask the person to describe any distressing experiences and perceptions. In addition, he or she asks about any concerns the person may have about achieving life goals as a result of new difficulties with motivation or cognition. Safety is also carefully assessed. To receive a diagnosis of schizophrenia, a person must have experienced at least two of the following symptoms most of the time during a one-month period, with some level of disturbance being present for six months:
At least one of the symptoms must be delusions, hallucinations, or disorganized speech. In determining a diagnosis, the doctor may order additional tests, including an MRI scan or blood test. MRI ScanAn MRI scan—in which magnetic fields and sound waves are used to create two- or three-dimensional images—may provide a good view of the structure of the brain and rule out schizophrenia by detecting abnormalities that may be causing schizophrenia-like symptoms. Blood TestA routine blood test can help a doctor rule out conditions with similar symptoms, such as alcohol and drug abuse. Interactions between certain medications, such as corticosteroids and cardiovascular medications, can also cause schizophrenia-like symptoms. At the end of an evaluation for schizophrenia, the doctor shares the diagnostic results with the person and his or her family. They then decide if they’d like to schedule a consultation appointment with an NYU Langone specialist to discuss treatment, which often includes a combination of medication and psychosocial therapy.
There's no single test for schizophrenia and the condition is usually diagnosed after assessment by a specialist in mental health. If you're concerned you may be developing symptoms of schizophrenia, see a GP as soon as possible. The earlier schizophrenia is treated, the better. The GP will ask about your symptoms and check they're not the result of other causes, such as recreational drug use. If a diagnosis of schizophrenia is suspected, the GP should refer you to your local community mental health team (CMHT). CMHTs are made up of different mental health professionals who support people with complex mental health conditions. A member of the CMHT team, usually a psychiatrist or a specialist nurse, will carry out a more detailed assessment of your symptoms. They'll also want to know your personal history and current circumstances. To make a diagnosis, most mental healthcare professionals use a diagnostic checklist. Schizophrenia can usually be diagnosed if: Sometimes it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, a psychiatrist may have reason to believe you have a related mental illness, such as:
You may also be assessed for post-traumatic stress disorder, depression, anxiety and substance misuse. As a result of their delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe there's nothing wrong with them. It's likely someone who has had acute schizophrenic episodes in the past will have been assigned a care co-ordinator. If this is the case, contact the person's care co-ordinator to express your concerns. If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative or another loved one to persuade them to visit their GP. In the case of a rapidly worsening schizophrenic episode, you may need to go to the accident and emergency (A&E) department, where a duty psychiatrist will be available. If a person who is having an acute schizophrenic episode refuses to get help, their nearest relative can request that a mental health assessment is carried out. The social services department of your local authority can advise how to do this. Find your local authority. In severe cases, people can be compulsorily detained in hospital for assessment and treatment under the Mental Health Act (2007). If you or a friend or relative are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn. It's important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available. Children and young people with a first episode of schizophrenia should be referred urgently to a specialist mental health service. This should be either children and young people's mental health services (CYPMHHS) for those aged up to 17, or an early intervention service for those aged 14 years or over, that includes a consultant psychiatrist with training in children and young people's mental health. For more information, see the National Institute for Health and Care Excellence (NICE) guidelines on psychosis and schizophrenia in children and young people.
Page last reviewed: 11 November 2019 |
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