Schizophrenia

Synonyms

Also known as Psychosis, Mental illness, or Mental disorder

Overview

Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. While the exact cause is unknown, schizophrenia is believed to result from a combination of genetic, environmental, and brain chemistry factors. It can cause symptoms such as hallucinations, delusions, disorganized thinking, and impaired daily functioning. The type and severity of these symptoms can vary over time. and there may be periods of intermittent worsening and remission of symptoms. Generally, the symptoms have a gradual onset which mostly occurs between the late teen years to early 30s. Also, it is seen to occur more in men than women. The treatment for Schizophrenia primarily aims to control the psychotic symptoms with antipsychotic drugs and provide supportive care to the individual.

Key Facts

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Symptoms

The symptoms of Schizophrenia can be broadly classified into the following subtypes:

1. Psychotic symptoms

  • Delusions: Individuals fearing harm from nonexistent threats.
  • Hallucinations: Hearing, seeing, or feeling things that do not exist.
  • Abnormal or disorganized behavior: Behavior can range from childlike silliness to unpredictable rage and agitation.
  • Abnormal motor behavior: No eye contact, lack of facial expressions, bizarre postures, and unnecessary or excessive movements.
  • Disordered thinking and speech: Unable to communicate effectively and may use meaningless words or out-of-context replies to questions.

2. Negative symptoms

  • Neglect of personal hygiene.
  • Lose interest in everyday activities.
  • Lack of ability to experience pleasure in everyday life.
  • Show reduced ability to express emotions.
  • Unable to effectively communicate thoughts and struggle to frame words.

3. Cognitive symptoms

  • Difficulties in processing information to make decisions.
  • Difficulty in learning new things.
  • Unable to remember information.

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Cause

There is no single established cause of schizophrenia.

It can be caused by a complex interplay of genetic, environmental, and neurochemical factors.

Imbalances in brain neurotransmitters like dopamine and glutamate, along with structural brain abnormalities, contribute to its development.

Several factors can play a role in the development of this condition, which are discussed in the next segment.

RiskFactors

Certain factors increase a person’s risk of developing schizophrenia:

1. Non-modifiable factors

  • Age
  • Gender (more common in men)
  • Family history of schizophrenia (though no single gene is directly linked)
  • Pregnancy and birth complications

Note: The symptoms of schizophrenia usually start between the ages of 16 and 30 years. Men tend to experience their first episode of schizophrenia in their late teens to early 20s, whereas women typically experience their first episode in their late 20s or early 30s.

2. Environmental factors

  • Stress
  • Exposure to toxins or viruses that affect brain development in early life or before birth
  • Infections like influenza or herpes
  • Autoimmune diseases
  • Consumption of psychoactive drugs during teenage years or early adulthood

3. Social factors

  • Childhood trauma
  • Social isolation
  • Stressful events in life

Diagnosis

Schizophrenia is suspected after a major psychotic episode with other symptoms. Diagnosis requires ruling out other psychiatric, substance-induced, or medication-related disorders. It consists of:

  1. History and Clinical Examination

    A physician conducts a thorough examination, reviews the patient’s history, and checks for schizophrenia symptoms, social and occupational dysfunction, and health-related complications.

    Ruling out other conditions that may mimic schizophrenia is crucial before confirming the diagnosis.

  2. Lab Tests
    • Alcohol Screen (Blood): To rule out alcohol intoxication as a cause of psychotic symptoms through blood tests.
    • Alcohol Screen (Urine): Done to rule out alcohol intoxication as a cause of psychotic symptoms through urine analysis.
    • Drugs of Abuse Panel: Detects the presence or absence of commonly abused drugs that may cause psychotic symptoms.
    • Complete Blood Count (CBC): Evaluates general health status and checks for any infections.
  3. Imaging Studies
    • CT Scan (Brain): To study any structural changes in the brain.
    • MRI (Brain): Provides an in-depth study to identify any pathology in the brain that might be causing symptoms.

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  4. Psychiatric Evaluation

    The American Psychiatric Association has laid down criteria for diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5, which states that a diagnosis of schizophrenia can be made if:

    • Criterion A: At least two of the following indications for at least 1 month: delusions, hallucinations, disorganized speech, grossly disorganized or negative symptoms.
    • Criterion B: The level of functioning has to be lowered significantly and for the long term compared to previously achieved levels.
    • Criterion C: Signs of the disturbance persist for at least 6 months and must include Criterion A symptoms for at least 1 month.
    • Criterion D: Schizoaffective disorder and depressive or bipolar disorder with psychotic symptoms must be ruled out.
    • Criterion E: The disturbance is not caused by substance use or any medical conditions.
    • Criterion F: If the individual has a history of autism or communication disorders from childhood, then schizophrenia is diagnosed based on symptoms like delusions and hallucinations lasting over six months, after ruling out other conditions, as outlined in the DSM-5.

Treatment

Management of schizophrenia consists of:

  1. Conventional antipsychotics or first-generation antipsychotics
    These drugs help control psychotic symptoms of schizophrenia such as delusions and hallucinations. They work by blocking the action of the neurotransmitter dopamine in the brain. Examples include:
    • Chlorpromazine
    • Haloperidol
    • Fluphenazine
  2. Atypical antipsychotics or second-generation antipsychotics
    These are newer antipsychotic medications with fewer movement-related side effects. They work by blocking the receptors for neurotransmitters like serotonin (stronger blocking) and dopamine (moderate blocking). Common examples are:
    • Aripiprazole
    • Ziprasidone
    • Sulpiride
    • Asenapine
    • Clozapine
  3. Long-acting injectable antipsychotics
    Certain formulations are available as long-acting intramuscular injections that need to be administered every 2-4 weeks. This is useful for patients who are resistant to taking daily pills and can help with adherence.
  4. Nutritional supplements
    Studies have shown that taking Vitamin B Complex and Omega-3 fatty acid supplements, like fish oil capsules, helps ease the symptoms of schizophrenia. Vitamin B complex is essential for the normal functioning of the nervous system. Omega-3 fatty acid supplements contain DHA and other fatty acids, which are important for brain health.

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HomeCare

Support schizophrenia management at home with nutritious foods, herbal supplements, and mindful eating habits. One such diet is ketogenic. A ketogenic diet is a low-carb, high-fat diet that shifts the body into ketosis, where it burns fat for energy instead of carbs.

How can a ketogenic diet help with schizophrenia?

  • May reduce symptoms: According to studies, a gluten-free or low-carb ketogenic diet may help ease schizophrenia symptoms.
  • Boosts brain health: The diet increases GABA, a neurochemical that supports brain function and may improve schizophrenia symptoms.
  • Prevents weight gain: Helps manage weight, especially for those with a sedentary lifestyle or medication-related weight gain.

Note: Always consider consulting a professional before making any dietary changes.

Complications

If left untreated, Schizophrenia may severely hamper a patient’s quality of life and can potentially cause complications such as:

  • Anxiety disorder
  • Depression
  • Drug and alcohol abuse
  • Aggressive behavior
  • Social isolation
  • Suicide, suicide attempts, and suicidal thoughts

Note: Severe cases may require hospitalization for treatment.

AlternativeTherapies

Alternative therapies for schizophrenia can be supportive but should always be used alongside medical treatment and under a doctor's guidance. Therapies that can help include:

  1. Psychosocial interventions
    • In addition to medication, psychological therapy helps normalize the patient’s thought patterns and cope with stress and anxiety.
    • Social rehabilitation assists the individual in interacting with society and participating in daily activities.
    • These are important interventional programs for managing a patient with schizophrenia.
  2. Cognitive behavior therapy
    • This type of psychological therapy teaches individuals coping skills to manage their challenging conditions.
    • The therapy focuses on the cognitive component, helping the individual change their thinking about particular situations.
  3. Electroconvulsive therapy
    • In rare cases for adults who do not respond well to drug therapy, electroconvulsive therapy, or shock therapy (ECT), may be considered.
    • This involves passing small acceptable amounts of electric currents through the brain to help regulate its electrical activity.
  4. Deep brain stimulation
    • This elective surgical procedure involves making tiny incisions near the brain to implant electrodes.
    • These electrodes generate mild electrical impulses thought to regulate abnormal electrical activity in the brain and improve symptoms.

Living With Disease

Living with the condition or someone who has been diagnosed with schizophrenia may be challenging for the family and caregivers. However, here are a few tips that can help you take care of someone with the condition.

  1. Understand the condition

    Understanding and accepting what your family member or relative is going through is the first step in managing the disease.

    Information about the condition will help caregivers understand the importance of therapy and recognize warning signs if the disease worsens.

  2. Stay focused on the goals of therapy

    The therapy goals are different for each patient and are adjusted to suit individual requirements.

    Help your loved ones adjust to the therapy and encourage them to take responsibility for their goals.

  3. Help the patient abstain from alcohol and substance abuse

    Alcohol and recreational drugs worsen the symptoms of schizophrenia and make the condition difficult to treat.

    Hence, the family or caregivers need to ensure that the patient does not indulge in such activities.

  4. Try relaxation and stress management techniques

    It is not unusual for the family or caregivers to be stressed and anxious along with the patient themselves.

    Learning relaxation techniques and stress management will help cope with the disease.

  5. Join schizophrenia support groups

    Connecting with other people facing similar challenges may help a person come to terms with the disease.

    Mental illnesses are increasingly common today. Sometimes, the best way to help is simply by being there for someone in need.

References

American Psychiatric Association
American Psychiatric Association
N/A
National Institute of Mental Health
National Institute of Mental Health
N/A
Sarah D Holder, Amelia Wayhs
Am Fam Physician
2014 December 01
National Health Service (NHS)
NHS
2024
Substance Abuse and Mental Health Services Administration
Substance Abuse and Mental Health Services Administration (US)
2016 June
World Health Organization
World Health Organization
N/A
Santosh Loganathan, Srinivasa Murthy
Transcult Psychiatry
2011 November
Chou IJ, Kuo CF, Huang YS, Grainge MJ, Valdes AM, See LC, Yu KH, Luo SF, Huang LS, Tseng WY, Zhang W, Doherty M
Schizophr Bull
2017 September 01
Sarnyai Z, Kraeuter AK, Palmer CM
Curr Opin Psychiatry
2019
Brown HE, Roffman JL
CNS Drugs
2014 July
Włodarczyk A, Wiglusz MS, Cubała WJ
Med Hypotheses
2018 September
Patel KR, Cherian J, Gohil K, Atkinson D
P T
2014 September
Grover S, Avasthi A, Chakrabarti S, Kulhara P, Shah R, Rao GP, et al.
Indian J Psychiatry
2019
Schizophrenia Awareness Association
Schizophrenia Awareness Association
c2025

Frequently asked questions

No, schizophrenia cannot be completely cured. It is a chronic and often progressive illness, but most patients can manage their symptoms effectively with recent treatment advances.
Electroconvulsive therapy and deep brain stimulation may offer limited benefits for schizophrenia. A psychiatrist may recommend these treatments based on the individual case.
No, not all patients experiencing psychotic episodes are classified as schizophrenic. Schizophrenia includes additional symptoms beyond psychosis, such as disorganized speech and negative behavior.