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What is schizophrenia?

Schizophrenia is a severe long-term mental health condition affecting roughly 1% of people in the UK. Symptoms usually first appear in early adulthood. More subtle signs may be present earlier, including troubled relationships, self-medicating with drugs and alcohol, poor school performance, and reduced motivation.

Schizophrenia essentially involves the fragmentation of someone’s thoughts, emotions, and behaviour, which in turn leads to faulty perception, inappropriate actions and feelings, withdrawal from reality, and a sense of mental disorganisation.

Contrary to popular belief, schizophrenia does not cause someone to become violent. In fact, people living with the condition are more likely to hurt themselves before hurting someone else. When someone with schizophrenia does become violent, this is usually as a result of trying to protect themselves against an actual or perceived threat from another person, or voices telling them to do it – often a combination of the two. However, despite what the media might portray, people with schizophrenia are statistically less likely to become violent than someone without the condition who is under the influence of drugs or alcohol.

Another common myth about schizophrenia centres on the idea that someone with the condition has a ‘split personality’ or has a ‘Jekyll and Hyde’ character. Although the word schizophrenia comes from the Latin for ‘splitting of the mind’, the term refers to the way thoughts are processed when someone is unwell as opposed to a personality trait.

Schizophrenia is a heavily stigmatised mental health condition and is devastating for those directly affected and for the person’s friends and family. Treatments are available but lifelong monitoring is required to offer the best chance of returning to a life of quality.

What causes some people to develop schizophrenia?

Although the causes of schizophrenia aren’t entirely clear, it’s likely that a combination of several different factors play a role in who develops the illness.

  • Genetic factors

Genes appear to play a role although the extent to which this is the case is still unknown. We do know that one in 100 people live with schizophrenia of which 10% have a parent with the illness. In other words, if someone has a parent with schizophrenia, they themselves have a one in ten likelihood of developing the condition.

  • Neurological factors

Brain imaging amongst people with schizophrenia suggests that there are some differences in the brains of some people with the illness but not in others. Some hypotheses include:

    • Changes to the brain caused by a lack of oxygen during birth
    • A viral infection during the early months of pregnancy.
  • Street drugs

Some street drugs appear to bring on schizophrenia in some people. Whether this is because the individual has a genetic predisposition towards the illness is unclear, but it is agreed that some drugs such as amphetamines can cause psychotic symptoms. However, for most people, this type of psychosis clears when the drug is stopped.

The heavy use of cannabis also seems to double the risk of developing schizophrenia. New research has shown that the stronger forms of cannabis may increase this risk. Those at risk appear to be people who start using cannabis in their early teens or who have smoked it more than 50 times during their teenage years. Young people who use cannabis on a daily basis are six times more likely to develop schizophrenia than those who do not.

  • Stressful life events

Some research suggests that a major life event can instigate the emergence of schizophrenia in some people. In other words, if an individual already has a genetic or environmental predisposition to the illness and experiences a traumatic event such as a bereavement, or a traumatic injury to the brain such as heavy drug use, they may be at higher risk of becoming unwell. This is not to say that everyone who lives with schizophrenia experienced a trauma around the time of becoming unwell, but simply that such an event may work in tandem with other factors and bring about the onset of the illness.

What are the symptoms of schizophrenia?

People with schizophrenia can feel very stable in between active episodes, especially when they are taking their prescribed medication as directed. Some people will have a few episodes and then ‘outgrow’ the condition for reasons that aren’t yet clear, while others will experience relapses throughout their lives. As with any illness, the severity, duration and frequency of symptoms can vary between people although the incidence of severe psychotic symptoms often decreases as the person ages.

Not taking medications as prescribed, the use of alcohol or recreational drugs, and stressful situations can increase the severity and longevity of symptoms. It is for this reason that self-care is extremely important in the condition’s ongoing management.

Symptoms of schizophrenia fall into four main categories:

  • Positive psychotic symptoms

These include hallucinations, such as hearing voices, paranoid delusions and exaggerated or distorted perceptions, beliefs and behaviours.

  • Negative symptoms

These include a decrease in the ability to make plans, speak, express emotions, or find pleasure in day-to-day life.

  • Disorganisation symptoms

Someone with these symptoms may appear to be confused, and are likely to exhibit disordered thinking and speech. They may encounter problems with logical thinking and may also behave in an unusual manner or move abnormally.

  • Impaired cognition

These symptoms can lead someone to have problems concentrating, and they may also find that their memory and ability to retain information is impaired.

When and where to get support

If you are concerned that you might have schizophrenia or any other kind of mental health problem, it’s important to speak with your GP as soon as possible. While he or she can’t diagnose schizophrenia themselves, if they suspect that you are affected by it, they will refer you to a psychiatrist who will conduct a thorough medical examination to rule out substance misuse or other neurological or medical illnesses whose symptoms mimic schizophrenia.

You can visit Rethink, the leading charity for information on all aspects of schizophrenia diagnosis and treatment. They offer support for friends and family members who are concerned about a loved one’s mental health.

Mental health charity Mind have also put together some tips to help yourself as well as guidance for friends and family members.

Treatment for schizophrenia

There are a range of treatments available to prevent episodes of illness and to help people stay well over the long-term. It’s important that people living with schizophrenia are regularly monitored by a healthcare practitioner such as a GP or psychiatrist so self-care is only part of the picture.

It’s thought using a combination of different treatment methods is the best way to control the condition which may include some or all of the following.

  • Medication

The majority of people living with schizophrenia take daily medication to prevent episodes of illness (known as relapses). The medication might include anti-psychotics. Because the side effects of such medication can present challenges for some people, it’s critical that they are under the care of a psychiatrist or a Community Mental Health Team (CMHT) so that they can be supported and medication changed when needed.

  • Psychological treatments or talking therapies

Depending on the severity of the symptoms, some people attend talking therapy including cognitive behavioural therapy (CBT). Talking therapies can help people to stay well, manage their symptoms, and learn how to recognise the signs that they are becoming unwell. There are also national groups which can offer guided support, lifestyle advice and social interaction. The Hearing Voices Network offers help in locating such a group.

  • Lifestyle monitoring

Many people living with schizophrenia find that regular exercise, healthy eating, avoiding stimulants such as alcohol and caffeine, and getting enough sleep can not only help them to stay well but can lessen the symptoms when they do arise.

People with schizophrenia are three times more likely to be cigarette smokers than those in the general population. Apart from the obvious health risks that smoking cigarettes presents, people who take anti-psychotic medication must be closely monitored if they stop smoking as the amount of medication they take may need to be reduced as a result. NHS Smokefree is a helpful resource for people wanting to stop smoking but don’t quit until you’ve let your GP or psychiatrist know so that plans can be made to monitor your medication.