Schizophrenia

• What is schizophrenia?
• Who gets schizophrenia?
• Early signs
• Living with schizophrenia
• Physical health problems

What is schizophrenia?

Schizophrenia is a serious mental illness. People who have schizophrenia often have what health professionals describe as ‘positive symptoms’ – delusions, hallucinations, disordered thinking – during episodes of psychosis. People with schizophrenia can also have what health professionals call ‘negative symptoms’. They may have no energy and lose the motivation to do anything; they may lose interest in friends, family members and activities they previously enjoyed. They may also have memory problems and find it very hard to concentrate. They may no longer care about their personal appearance and become isolated and withdrawn. People with schizophrenia may not accept that they are unwell and may not want to ask for help or treatment.

The experiences and symptoms each person has will differ and last for different periods of time. Some people are unwell for only a short period. Others experience the symptoms for months, or even years. A few people have just one episode of psychosis in their lives. Many people have episodes of psychosis that come and go over time. A small number of people have distressing symptoms that continue.

The symptoms of psychosis diminish and often disappear following treatment with medication and talking therapies. However, anti-psychotic drugs don’t work for some people. Their illness is then called ‘treatment-resistant’, or ‘refractory’ schizophrenia.

Sometimes, antipsychotic medication controls the symptoms of psychosis, but people still experience the negative symptoms of schizophrenia, and these may last for some time.

People with schizophrenia often also have depression, anxiety or a personality disorder. Between five and ten per cent will take their own lives.

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Who gets schizophrenia?

About one in every 100 people will have schizophrenia at some time in their lives. People can develop schizophrenia at any age, but the illness usually starts for men when they are in their late teens or early 20s. Women tend to develop schizophrenia when they are slightly older, in their late 20s. A small number of people develop schizophrenia in middle age. There is now some evidence to show that children in their teenage years or younger can also have symptoms.

Anyone can get schizophrenia, though children of a parent who has the illness are slightly more likely to become unwell. Even though genes play a part in the development of schizophrenia, there is no single cause and many contributing factors. Just because one person in the family has schizophrenia doesn’t mean that other family members will inevitably develop the illness.

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Early signs

Sometimes the illness starts suddenly with an acute, and often frightening, episode of psychosis.

However, a first episode of psychosis is often heralded by what health professionals call a ‘prodromal period’ when people’s behaviour begins to change.

People are often depressed or anxious, may find it difficult to concentrate or have problems remembering things, stop seeing their friends, act in a strange and uncharacteristic way, be less interested in study, work or hobbies and care less about how they look. They may become socially withdrawn and spend much more time alone.

They also sometimes have experiences resembling the symptoms of psychosis – hearing voices every now and then, being occasionally suspicious and paranoid for example (see Paranoia page). Research has shown that up to half the people who have these sort of experience go on to have a first episode of psychosis.

After an initial episode, a large proportion of people get better with treatment. Others will improve but may have further episodes.

Research has shown that the quicker treatment is given, the better people recover from the symptoms. People who don’t access mental health services when they first get symptoms get better slower, or are less likely to get completely better, and have an increased risk of relapse in the future (see Early intervention services page).

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Living with schizophrenia

Schizophrenia can severely affect people’s lives and the lives of their families. In addition to the distressing and often frightening symptoms, people with schizophrenia may find it difficult to get jobs, make friends and have relationships. Other people’s fear and misunderstanding of the illness often leads to discriminatory practices that leave people with schizophrenia even more socially isolated (see Discrimination and stigma page).

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Physical health problems

People with schizophrenia are more at risk of physical health problems, including weight gain, high blood pressure, heart disease and diabetes. These problems are caused by changes in lifestyle as a result of the symptoms of the illness, and can also be a side effect of antipsychotic medication. People with schizophrenia are more likely to smoke and less likely to take exercise, for instance.

GPs should check the physical health of people with schizophrenia once a year, including their weight, blood pressure, blood sugar and cholesterol levels. People should be given treatment for any physical health problems and encouraged to raise any such problems with their GP.

People with schizophrenia are more likely to die younger than other people because of these increased rates of physical health problems.