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When Schizophrenia Appears

Experts offer guidance for newly diagnosed patients and their families
By Sherry Rauh
WebMD Feature
Reviewed by Joseph Goldberg, MD

People with schizophrenia can have a hard time telling what’s real and what’s not. They may see things that aren’t there or hold firm beliefs that fly in the face of fact. Understanding schizophrenia’s nature can help patients and their loved ones regain a sense of control.

Blame Biology, Not Personality

It's crucial to recognize that schizophrenia is a real illness, not a character flaw, says Philip D. Harvey, PhD, a professor of psychiatry and behavioral sciences at the University of Miami. With advances in brain research, he says, "it will become clear that this is a condition that is caused by biological factors."

Recent imaging studies have shown that the brains of people with the disorder tend to look and function differently from those without mental illness. Scientists suspect some of these differences develop before birth -- although symptoms usually don't appear until young adulthood, between ages 16 and 30.

Understand the Symptoms

The symptoms of schizophrenia fall into three broad categories: positive, negative, and cognitive. 

Positive” doesn’t mean something is good. It means the patient has overactive, distorted aspects of thinking. Positive symptoms include:

  • Hallucinations: seeing or hearing things that aren't real. The most common hallucination in schizophrenia is hearing voices.
  • Delusions: unshakable but false beliefs. Some people think they are being followed or persecuted. Others believe they are famous or have superhuman powers.

Negative symptoms are more subtle and may be mistaken for signs of depression. These include speaking in a dull voice and finding no pleasure in daily life.

People with cognitive symptoms might have trouble concentrating, remembering things, or making decisions. These symptoms can make it difficult to keep a job or manage daily activities. "It's very important for people to realize that cognitive problems and a reduction of motivation are symptoms of the illness," Harvey says, "and not signs of laziness."

Begin Medication Right Away

Schizophrenia is diagnosed when someone has psychotic episodes (hallucinations or delusions) that can’t be explained by drug abuse or other medical conditions. Starting an antipsychotic medication immediately offers the best hope of getting symptoms under control.

Untreated psychosis may be associated with a loss of brain tissue, says Steven Jewell, MD. "The longer a person goes without treatment, the greater the risk of damage to the brain and a poor outcome." Jewell is associate professor of psychiatry at Northeast Ohio Medical University.

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