Schizophrenia

Learn about schizophrenia symptoms, risk factors, treatment, peer support services, and more.

Learn more about schizophrenia:

Definition

Schizophrenia is a mental disorder that affects how a person thinks, feels, and acts. People with the disorder may have changes in:

Thought content—themes or topics of their thinking. For example, hearing or seeing things that do not exist or fixed false beliefs that others are trying to harm them.

Thought processes—how their thinking flows and is connected. For example, their thoughts may jump from topic to topic without reaching a conclusion, or they may repetitively speak the same words or phrases.

Emotions—how they feel and show their feelings. For example, they may not be able to express emotions or may have extreme emotions.

Behavior—how they act or do things. For example, they may have problems at school or work. They may talk with others who are not present, so they seem to be talking to themselves. They may withdraw from people and not complete daily routines.

Not everyone with schizophrenia has all the symptoms. Symptoms often occur in “episodes” that may come and go. The severity of symptoms also varies. The symptoms may impact many parts of life, including school, work, and dealing with family and friends. The symptoms tend to last through life. With treatment, a person with the disorder can achieve recovery and life goals.

Signs and Symptoms

The symptoms of schizophrenia make it hard to function in daily life. A person with the disorder has some of the following symptoms for at least six months. A trained mental health professional should evaluate the person and make the diagnosis.

Delusions

The person has strong beliefs that don’t fit with the person’s culture. These beliefs persist even if not true or logical. The person believes things that are not true. For example, a person may think that they are someone famous, or that music on the radio is a message for them.

Hallucinations

The person may perceive things that others do not. For example, a person may hear a voice that no one else can hear, or see things that others do not.

Disorganized Speech

The person may have trouble organizing their thoughts. Others may find conversations with the person hard to follow. For example, the person may jump from topic to topic, make up words, and be unable to express themselves.

Disorganized Behavior

The person may behave in ways that others view as bizarre or with no purpose. They have trouble holding conversations and keeping relationships. Catatonic behavior means the person does not react to what happens around them. In contrast, catatonic excitement behavior includes excessive, purposeless activity. Rarely, a catatonic person stays in a rigid or awkward posture.

Negative Symptoms

The person has problems expressing emotion or responding to what is happening. The person may not want to start or sustain activities. They may have problems feeling pleasure. For example, a person may show little or no emotion or facial expression when speaking with others.

Risk Factors

Less than 1% of people in the United States have schizophrenia. It occurs in all ethnic and cultural groups. Symptoms usually start in the early to late 20s. The age of diagnosis is usually a few years earlier for men than women. The symptoms may start quickly, but usually emerge slowly. In rare cases, children are diagnosed with schizophrenia.

There is no specific known cause. Risk factors include genetics, brain structure, brain function, environmental factors, and social factors. Having one or more of these factors does not cause schizophrenia.

For statistics on schizophrenia, access Schizophrenia from the National Institute of Mental Health (NIMH).

Genetics

Schizophrenia tends to run in families. But many people with schizophrenia do not have a family member with the disorder. Many people with one or more family members with the disorder do not develop it themselves.

Researchers think several genes combine to increase risk, and no single gene causes the disorder by itself. Genetic information cannot predict who will develop schizophrenia.

Brain Structure and Function

For some people with schizophrenia, images of parts of the brain look different from people without the disorder. As people with schizophrenia age, their brain size seems to decrease more than in other people.

Some research shows that the disorder may be due to an imbalance of neurotransmitters. Brain cells use these substances to communicate. Dopamine and glutamate are neurotransmitters linked to schizophrenia.

Problems with brain development before birth may cause problems with neurotransmitters that can lead to the disorder. The brain undergoes changes during puberty. These may trigger symptoms in people at risk.

Co-occurring Problems

A person with schizophrenia may be at increased risk for other mental disorders such as depression, anxiety, and substance use disorders. Problems with using marijuana and nicotine are common in people with the disorder.

Risk for Suicide

People with schizophrenia have an increased risk of suicide. About 5–6% of people with the disorder die by suicide. About 20% attempt suicide. Suicide is a major health concern and is preventable.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Evidence-based Treatments

The causes of schizophrenia are unknown, so most treatments aim to help the person deal with or stop symptoms, not cure the disorder. Treatment usually aims to reduce symptoms, improve quality of life and ability to function, and support recovery goals. Psychotherapy and medication are often combined.

Co-occurring disorders such as anxiety, insomnia, and depression often require adding psychotherapies and medications to the treatment plan.

Because people with the diagnosis schizophrenia have a high rate of suicide, any suicidal thoughts, self-harming actions, and risk-taking behaviors should be closely monitored. Harm reduction steps should be taken to protect the person.

The treatment plan should consider each person’s needs and choices. A person should consult a healthcare professional when choosing the right treatment and consider his or her own gender, race, ethnicity, language, and culture.

Psychotherapy

Psychotherapy, sometimes called “talk therapy,” involves working with a behavioral health professional one-to-one or in a group. Based on the person’s needs, more than one form of treatment may be needed.

Cognitive behavioral therapy for psychosis helps the person cope with hallucinations and delusions.

The person learns to identify events or situations that make symptoms worse. They learn how to avoid those events or situations. The therapy also helps people communicate better with others, develop skills for daily life, and learn problems-solving skills.

In family psychoeducation, the person with schizophrenia and their family work with a behavioral health professional. They build a support system and enhance problem-solving, communication, and coping skills. They use a problem-solving approach to deal with the person’s symptoms.

Cognitive remediation therapy helps a person with schizophrenia learn skills to manage daily life. Exercises may involve pencil and paper, a computer, or talking with a clinician. The person works to improve attention, memory, problem-solving, organization, and planning.

Psychosocial Interventions

Assertive community treatment is helpful for people with a serious mental disorder such as schizophrenia. This team-based approach usually includes a psychiatrist, nurse, social worker, occupational therapist, and peer support specialist. Teams may provide employment services, supportive housing, substance use treatment, and other services.

Coordinated specialty care connects people with early symptoms to treatment that may prevent long-term disability. This approach combines medication, psychosocial therapies, case management, family involvement, supported education, and employment services. NIMH tested this model in the Recovery After an Initial Schizophrenia Episode (RAISE) study. Several states have programs in place.

Supported employment, specifically individual placement and support, help people with schizophrenia and other mental disorders get jobs, earn money, and work more. Working and contributing to the community is tied to better long-term outcomes.

Smoking cessation can help people with schizophrenia reduce and or quit smoking cigarettes and using other forms of tobacco. More than 40% of people with a serious mental disorder, including schizophrenia, use tobacco products. Tobacco use poses health risks and can harm treatment, including the effect of medications.

Medication

People with schizophrenia often receive medications to help manage their symptoms. People with schizophrenia should work with a healthcare professional experienced in treating schizophrenia to help identify the treatment options available. Together, they can identify goals and select the best individualized treatment

Antipsychotics are the most common medications prescribed for the symptoms of schizophrenia. These include first-generation antipsychotics and second-generation medications, sometimes called “atypicals.” Many have medical side effects, so the person’s physical health should be closely monitored. Antipsychotics are usually taken daily. Several antipsychotics are available in a long-lasting form and can be administered once or twice a month by a trained clinician.

 

For basic information about medications, visit Medications from NIMH. For up-to-date information on medications, side effects, and warnings, access the Food and Drug Administration.

Behavioral Health Advance Directive

A person with schizophrenia is encouraged to create a behavioral health advance directive, stating:

  • Where they wish to receive care
  • What treatments they want
  • Who make legal healthcare decisions for them, if they cannot do so due to their illness

Advance directive laws vary across states. Learn more about advance directives for behavioral health.

Complementary Therapies and Activities

Complementary therapies and activities can help people improve their overall well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, access the National Center for Complementary and Integrative Health.

Illness management and recovery helps people with schizophrenia understand their illness, learn coping skills to help manage their illness, develop goals, and make informed decisions about treatment. Some people with schizophrenia find meditation and yoga helpful in meeting their recovery goals.

Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, access the Federal Government Mobile App Directory.

Recovery and Social Support Services and Activities

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:

  • Overcoming or managing one’s condition(s) or symptoms
  • Having a stable and safe place to live
  • Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
  • Having relationships and social networks that provide support, friendship, love, and hope

Recovery helps a person develop resilience, increasing the ability to cope with adversity and adapt to challenges or change. To learn more, visit the SAMHSA Recovery and Recovery Support topic.

Self-help and mutual peer support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with behavioral health conditions. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills.

Peer Support Services

Peer support services are delivered by peer specialists who are persons with schizophrenia and other mental illnesses. Peer specialists are trained, and in many states certified to provide these services. Peer specialists may be paid staff or volunteers. They offer support, strength, and hope to a person struggling with mental illness.

They also help the person feel more connected to their community. Peer support services can foster hope, aid recovery, promote resiliency, and reduces health care costs. Family members can also provide family support services.

Here are resources for people with schizophrenia and their families:

Future Directions in Research and Treatment

Current areas of research include looking at the effects of genetics, life events, and brain development on schizophrenia. Also important are racial and ethnic differences in diagnosis and access to treatment and services. Research that focuses on optimizing the treatment of schizophrenia is ongoing.

Early detection of schizophrenia in young people is a growing research focus. Evidence shows that proper treatment when symptoms first start can reduce long-term effects. Promising research suggests ways to identify people at risk or with early signs of the disorder. Early interventions might prevent onset of the disorder.

Studies are exploring new treatment approaches, including new medications, and combining medical care with psychiatric care and psychosocial support.

Finding Treatment

A person should consult a healthcare professional who has training and experience working with schizophrenia. For general information on mental disorders and to locate treatment services in your area, contact the SAMHSA’s National Helpline, at 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the NIMH Help for Mental Illnesses webpage have more information and resources.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Last Updated: 04/06/2018