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Frequently Asked Questions About Schizophrenia

  • What is schizophrenia?
  • Answer:

    Schizophrenia is a brain disorder that affects some 2.2 million American adults, most often before the age of 30. It interferes with the way a person acts, thinks, and feels and frequently causes difficulty distinguishing between what is real and what is imaginary. This, in turn makes patients prone to false, fixed (delusional) beliefs about themselves or others. Schizophrenia also can cause disordered thinking, making it difficult to concentrate, maintain attention span, organize one's thoughts, or develop normal motivation. It can also affect the ability to experience normal emotions in social situations, often causing a person to become unusually anxious, unresponsive, or withdrawn.

  • What are the symptoms of schizophrenia?
  • Answer:

    Symptoms of schizophrenia are divided into the following categories:

     

    1. Delusions -- This includes false, fixed ideas about other people or organizations such as the government; commonly thinking that someone is spying on them, cheating them, or out to harm them, even when evidence is to the contrary. A delusion can also be a false belief about oneself -- such as believing you are a famous person.
    2. Hallucinations -- This includes seeing, hearing, or smelling something that is not there, or sometimes even tasting or feeling things that are not real. The most common schizophrenic hallucination is hearing voices that give commands or make comments to the patient about their behavior.
    3. Disorganized thinking/nonsensical speech -- Conversation jumps radically from topic to topic and may contain phrases that are totally irrelevant, or made up words. Sometimes conversation may seem deep and intellectual, when it is really illogical.
    4. Social withdrawal and apathy -- Disinterest in their life or surroundings is frequently coupled with a lack of motivation and emotional unresponsiveness, particularly in a social situation.

  • What is meant by "positive" and "negative" symptoms of schizophrenia?
  • Answer:

    Positive symptoms of schizophrenia are those attributes that are excessive or distorted brain functions, such as delusions or hallucinations, indicating the person has lost touch with reality. In this sense, positive does not mean "good" but instead refers to "extra" or additional brain activity that should not be there.

    Negative symptoms of schizophrenia are those which are indicative of an "under-functioning" brain or a deficit of normal brain functions. Examples include a lack of emotional input or expression, empty thoughts, or an inability to socially interact or take pleasure from interactions with others.

     

  • Do all people with schizophrenia act the same?
  • Answer:

    No. Historically, five subtypes of schizophrenia had been described (paranoid, disorganized, catatonic, residual, and undifferentiated). But in the most recent version of the standard diagnostic coding system used in psychiatry (DSM-5), these subtypes were eliminated. That's because they were found not to help determine treatments or predict treatment outcomes.

    Schizoaffective disorder is a "combined" diagnosis that involves the classic symptoms of schizophrenia along with those of a mood disorder such as bipolar disorder (sometimes called manic depression) or major depression.

     

  • How is schizophrenia diagnosed?
  • Answer:

    Most people with schizophrenia have a cluster of symptoms, some of which can overlap with other mental illnesses, including depression, or more commonly, bipolar disorder. For this reason, diagnosis by a psychiatrist or other mental health professional is based on symptoms that must persist for at least six months. In schizophrenia, some patients have episodes of positive or negative symptoms while others may have symptoms that are long-lasting rather than episodic.

  • What are the risk factors for schizophrenia?
  • Answer:

    The main risk factor for schizophrenia is heredity, with the incidence rising from 1% in the general population to nearly 10% in those whose parents or siblings have the disorder. The risk is also elevated but to a lesser degree if grandparents, aunts, uncles, or cousins have schizophrenia. According to the National Institute of Mental Health, the identical twin of a person with schizophrenia has a 40-65% risk of developing it as well.

    Women and men are at equal risk for developing schizophrenia.  While onset usually occurs during someone's teens and early 20's, women tend to have a later onset than men.  Schizophrenia rarely develops after age 45 or in young children though some as young as 7 occasionally have been diagnosed.

     

  • What causes schizophrenia?
  • Answer:

    No one knows for sure what causes schizophrenia. But researchers believe it is a combination of genetics, which increase the risk, and environmental influences, which interact with the genetic predisposition. There is also evidence that changes in body chemistry during puberty may play a role. 

    More recently, researchers have proposed theories that link schizophrenia to brain developmental problems that occur in a fetus when a woman contracts certain viruses during pregnancy -- most notably influenza, toxoplasmosis, and rubella. Research also implicates genital or reproductive infections present in the mother's body at the time of conception with increasing the baby's future risk of developing schizophrenia. Brain injuries occurring after birth and poor parenting skills are not responsible for a child developing schizophrenia.

  • How is schizophrenia treated?
  • Answer:

    The mainstay treatment for schizophrenia is antipsychotic drugs, medications that work to alter brain chemistry in a particular way. Older antipsychotic drugs, including Thorazine, Haldol, and Prolixin, worked well for "positive" symptoms but less well for "negative" symptoms. They were also fraught with side effects including persistent muscle spasms, tremors, and muscle rigidity. 

    In a newer class of drugs known as "atypical antipsychotics" was developed in the 1990s. The first, Clozaril, remains extremely effective even in those patients who do not respond to other medications. However, it can also cause a problem known as "agranulocytosis," a serious loss of white blood cells, requiring weekly or biweekly blood tests. 

    Drugs developed after Clozaril include Abilify, Fanapt, Geodon, Invega, Latuda, Risperdal, Saphris, Seroquel, and Zyprexa. Some of these drugs can cause weight gain and may increase the risk of diabetes or high blood lipids (for example, cholesterol).

    Generally speaking, many patients respond to antipsychotic drugs quickly, with hallucinations improving within days to weeks and delusions often improved within several weeks (particularly if they are not longstanding). For some patients, symptoms substantially improve after a few weeks of treatment, while for others, positive and negative symptoms may persist despite appropriate medications.

  • Are people with schizophrenia dangerous to themselves or others?
  • Answer:

    If symptoms are under control and medication regimens are adhered to, there is very little chance that a person with schizophrenia will be a threat to self or others. Moreover, most people with schizophrenia are not particularly prone to violence with most preferring to be left alone. Studies also show that if a person has no history of criminal violence prior to developing schizophrenia and is not a substance abuser, he or she is highly unlikely to commit a crime after the illness develops. If someone with paranoid schizophrenia does become violent, it is most often directed at a family member and usually occurs within the home.

    However, people with schizophrenia are at an increased risk for suicide and attempt to take their life more frequently than the general population. About 10% of people with schizophrenia, most particularly young adult men, complete the act of suicide.

     

  • Are there any early warning signs of schizophrenia that parents should look for in their teen or young adult children?
  • Answer:

    Because the teen years are a time of change, with mood swings and behaviors that seem abnormal, it can be difficult to pinpoint very early signs of schizophrenia. Moreover, symptoms of schizophrenia can wax and wane in the beginning, sometimes developing slowly over a period of months or years, making it even more difficult to spot.

    In general, however, parents should look for the following in their teens: 

    • Emotional reactions that are continually out of context, including irrational, angry, or fearful outbursts
    • Inability to sleep or difficulty concentrating in the absence of specific problems
    • Extreme preoccupation with strange ideas or odd beliefs or with religion, a cult, or the occult
    • A change in personal hygiene or a loss of interest in appearance beyond what would be considered a "fad" shared by their peers
    • Deterioration of academic work, usually accompanied by an oblivious attitude
    • Displaying indifference in otherwise emotionally charged social situations
    • Persistent belief they are being watched or spied on (beyond what is normal rebellion in teens), particularly when shown evidence to the contrary
    • Speaking or writing in a way that does not make sense to parents, teachers, or peers

WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on August 21, 2014

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