Table of Contents

Schizophrenia

Schizophrenia is a serious mental health disorder that involves a breakdown in the affected individual’s ability to accurately perceive the world around them. Typically, these skewed perceptions cause the affected individual severe distress and fear. In addition to hallucinations and delusions, affected individuals will often experience blunting of their ability to problem-solve, concentrate, and interact with others.

According to Treatment Advocacy Center, in 2020, an estimated 1.1% of the U.S. population, or about 2.8 million adults aged 18 or older, had schizophrenia. However, a 2023 study by RTI International found that the number may be higher, with 1.8% of adults in the U.S. aged 18 to 65 having a lifetime history of schizophrenia spectrum disorders.

Understanding Schizophrenia

Schizophrenia is a severe mental health disorder that involves a group of symptoms that cause the affected individual to lose touch with reality. “Psychosis” refers to symptoms of hallucinations (often in the form of hearing things), delusions (fixed beliefs that are not based in reality), and disorganized thinking or behavior.

This disorder typically appears in early adulthood. Symptoms of psychosis are often predated with a 6–12-month period of gradual reduction in functioning (diminished performance in school or work, and increased withdrawal from social situations). This period is called the “prodrome.”

Schizophrenia is a chronic condition that requires ongoing treatment throughout the lifespan of the affected individual. By starting and continuing with the right treatment, the affected individual can experience long stretches of remission and reduce the likelihood of a relapse of symptoms.

To be diagnosed with schizophrenia, symptoms of psychosis must have been experienced for at least six months. When these symptoms are more brief, the appropriate diagnosis might be brief psychotic disorder (if symptoms resolve in one month) or schizophreniform disorder (2-6 months duration). It is also possible for psychosis to be caused by either prescription or recreational drugs. In these situations, it remains important to treat the psychosis while also avoiding any drug that may have triggered symptoms.

Misconceptions about Schizophrenia

As with other mental health disorders, misconceptions about schizophrenia can make it difficult for those with the disorder to seek out help. For this reason, it is important to debunk the following myths and misconceptions about schizophrenia:

Myth: Multiple Personalities

A whopping 64 percent of Americans believe that schizophrenics have multiple personalities. However, these two disorders (schizophrenia and dissociative identity disorder) are completely unrelated.

Myth: Schizophrenics are Violent

A very damaging myth about schizophrenia is that affected individuals are violent. While it is always important to consider safety in the context of schizophrenia, having schizophrenia does not necessarily make someone violent. In fact, people who suffer from schizophrenia are more likely to be the victims of crimes and exploitation than the general population, and the highest risk factors for violence among those with schizophrenia is prior history of violence and substance use disorder (rather than the symptoms associated with schizophrenia).

Myth: Schizophrenics need to live in mental institutions

Many also believe that those with schizophrenia are or should be condemned to life in mental institutions. This destructive myth prevents many people from getting the help they need. In reality, inpatient care (time spent in hospitals and mental institutions) is usually brief and only necessary when safety concerns are present. The key factor in limiting the need for inpatient care is consistency with treatment/medication and avoidance of drugs and excessive alcohol consumption.

What Causes Schizophrenia?

The specific cause of schizophrenia is unknown, but experts believe that both genetic and environmental factors play a role in the development of schizophrenia. The following are some known risk factors for developing schizophrenia:

  • Living in poverty
  • Living in stressful or dangerous surroundings
  • Chronic inflammation
  • Complications during pregnancy and birth
  • Viral exposures
  • Drug and alcohol use (particularly if started in childhood or adolescence)
  • Family history of psychosis
  • Traumatic brain injury

Is Schizophrenia Genetic?

People who have a family history of schizophrenia are potentially at higher risk of developing schizophrenia and should avoid additional triggers such as drug and alcohol use (including cannabis).

If you are concerned that you may be suffering from or at risk for schizophrenia, you should consult with a mental health professional.

Schizophrenia Symptoms

Schizophrenia affects many regions of the brain, resulting in a wide array of symptoms. The disease manifests very differently from one individual to the next. Some symptoms of the disorder include:

  • Delusions
  • Disorganized speech
  • Hallucinations
  • Detachment from friends and family
  • Disorganized thinking
  • Insomnia
  • Depressed mood
  • Irritability or paranoid behavior
  • Poor hygiene
  • Fidgeting or jerky movements
  • Monotonous speech patterns
  • Resistance to completing tasks
  • Apathy towards previously enjoyed activities
  • Poor performance in school or work
  • Catatonia
  • Faulty memory

Many of these symptoms are present in other mental disorders. A LifeStance mental health professional can perform a differential diagnosis to help determine whether schizophrenia and/or other disorders might be present.

Lifestance Health specializes in Schizophrenia treatment with multiple locations in 33 states. Services and available treatments vary by location.

Find a provider near you:

Diagnosing Schizophrenia

There is currently no imaging study or lab test that can diagnose schizophrenia. However, it remains important to “rule out” other health conditions that can cause psychosis. The following are some examples of conditions that can mimic schizophrenia:

  • Severe thyroid disease
  • Intoxication with drugs
  • Seizure
  • Certain infections
  • Lesion in the brain (rare)
  • Heavy metal exposure (rare)
  • Disordered copper metabolism (rare)

The most important available diagnostic tool to diagnose schizophrenia is the history gathered by the affected individual and their loved ones about the nature and timeline of symptoms. Observations regarding changes in affect (how mood appears to others), body movements, and interactions with others are also valuable.

It can be very helpful for people who might be dealing with schizophrenia to bring a support person with them to their appointments, especially when they are first establishing care.

Treating Schizophrenia

Schizophrenia requires lifelong treatment, and affected individuals must continue taking prescribed medications even when symptoms are not present. Medications used to treat this disorder include neuroleptics (which have also been referred to as “antipsychotics,” antidepressants, mood stabilizing medications, and anti-anxiety medications).

Medications come in the form of capsules, tablets, or injections, and some long-acting injectable medications (LAIs) may be available.  The advantage of LAIs is that they only need to be administered once per month (or for some LAIs, up to once per six months), which is much more convenient than medications that need to be taken daily. When prescribed and administered by appropriately licensed and trained professionals, LAIs are safe and can be effective and reduce rates of hospitalization.

If symptoms are so severe that there are safety concerns (risk of harm to self, risk of harm to others, or inability to care for one’s basic needs), hospitalization is required. This is most often a brief stay and may be followed by a “step-down” option of partial hospitalization or intensive outpatient treatment.

Talk therapy is another powerful tool that can contribute to remission from symptoms of schizophrenia. Therapists can help affected individuals develop healthy coping strategies, improve their insight and ability to self-reflect accurately, and improve communication within families.

Telepsychiatry for Schizophrenia

LifeStance offers both in-office and telehealth visits for treatment of schizophrenia. Telehealth allows patients to access their healthcare provider via their own secure and reliable internet connection from the privacy of their home. At times, an in-office appointment may be required. Among other things, an in-office appointment allows the psychiatric clinician to observe movement-related side effects and check vital signs.

Citations:

de Vries B, van Busschbach JT, van der Stouwe ECD, Aleman A, van Dijk JJM, Lysaker PH, Arends J, Nijman SA, Pijnenborg GHM. Prevalence Rate and Risk Factors of Victimization in Adult Patients With a Psychotic Disorder: A Systematic Review and Meta-analysis. Schizophr Bull. 2019 Jan 1;45(1):114-126. doi: 10.1093/schbul/sby020. PMID: 29547958; PMCID: PMC6293237.

Inyang B, Gondal FJ, Abah GA, Minnal Dhandapani M, Manne M, Khanna M, Challa S, Kabeil AS, Mohammed L. The Role of Childhood Trauma in Psychosis and Schizophrenia: A Systematic Review. Cureus. 2022 Jan 21;14(1):e21466. doi: 10.7759/cureus.21466. PMID: 35223250; PMCID: PMC8858420.

New study finds at least twice as many US adults experience schizophrenia spectrum disorders than previously thought (June 16, 2023). RTI International. Retrieved from https://www.rti.org/news/new-study-finds-least-twice-many-us-adults-experience-schizophrenia-spectrum-disorders

Uçok A, Polat A, Cakir S, Genç A. One year outcome in first episode schizophrenia. Predictors of relapse. Eur Arch Psychiatry Clin Neurosci. 2006;256:37–43.
https://childmind.org/article/first-episode-psychosis-early-treatment-critical/

Schizophrenia Fact Sheet. Treatment Advocacy Center and Anosognosia, SMI Research. Retrieved from https://www.treatmentadvocacycenter.org/reports_publications/schizophrenia-fact-sheet/#:~:text=Schizophrenia%20is%20a%20chronic%20and,untreated%20in%20any%20given%20year.

Volavka J, Swanson J. Violent behavior in mental illness: the role of substance abuse. JAMA. 2010 Aug 4;304(5):563-4. doi: 10.1001/jama.2010.1097. PMID: 20682936; PMCID: PMC3640530.