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 studies have shown that the brains of people with the disorder tend to look and work differently from those without mental illness. Scientists suspect that 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 that someone 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. They can seem like 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. This can make it hard 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 Treatment Right Away
Doctors diagnose schizophrenia 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.
"The longer a person goes without treatment, the greater the risk of damage to the brain and a poor outcome,” says Steven Jewell, MD, an associate professor of psychiatry at Northeast Ohio Medical University.
Find a Qualified Therapist
"Medication is always emphasized, but it's only one piece of the puzzle," Jewell says. It’s important to find a therapist who specializes in schizophrenia, especially when someone doesn’t want treatment.
"Patients don't understand that they've been sick or what has to be done about it. This makes it hard to keep them motivated to stay in treatment. Counseling can help."
Effective therapy teaches patients and families about the illness -- "what can make it worse, what can make it better, and how to deal with hallucinations,” Jewell says.
For example, therapy can help patients learn to ignore voices they hear. Counseling should also address substance abuse and social withdrawal, which are common problems for people with schizophrenia.
Train the Brain
Antipsychotic medications are effective at reducing hallucinations and delusions. But they do little to improve concentration and memory.
Researchers are still looking for the right medications to fight these symptoms, Harvey says. In the meantime, cognitive remediation therapy or "brain training” may help.
"These are exercises that are designed to train your brain -- to force you to use skills you might not be using,” Harvey says. They expand working memory and improve processing speed. "These interventions actually do work."
In one study, people with schizophrenia got cognitive therapy, life skills training, or a combination of the two. Those who received both improved the most in functioning at home and at work. They learned money management skills, how to use public transportation, and social skills.
Help Prevent a Relapse
Three keys are:
- Stick with therapy.
- Keep stress levels low. "The tools most of us use on a daily basis to manage stress are just as relevant for someone with schizophrenia," Jewell says.
- Don’t skip medications. Stay on the exact dose prescribed by the doctor, which is usually the lowest needed to control symptoms.
Sometimes, people with schizophrenia feel like they have recovered from the illness or do not want medicine. Stopping medication is a major reason their symptoms start back up.
In cases like these, Harvey suggests using long-acting, injectable medications that the patient gets every 2-4 weeks. "These have a very low relapse rate," he says.
While doctors or family members may not know right away if a loved one stops taking pills, they can respond immediately if they don't show up for an injection.
If someone shows signs of a relapse, Jewell recommends handling the situation carefully. "You can't argue [patients] out of a delusion -- telling them they're wrong will just create tension," he warns. "But you shouldn't tell them they're right, either. You find a way to offer support" and get them back into treatment as quickly as possible.