What is Schizophrenia? - Psychiatry.org

Schizophrenia is a chronic brain disorder that affects less than one percent of the U.S. population. When schizophrenia is active, symptoms can include ... AsdescribedinthePrivacyPolicyoftheAmericanPsychiatricAssociation(APA),thiswebsiteutilizescookiesformultiplepurposesincludingtoprovideyouwithpersonalizedcontent,evaluateandanalyzetheuseofoursite,andtoidentifywhichadvertisementsbringuserstoAPA’swebsites.Byclosingthismessage,continuingthenavigation,orotherwisecontinuingtoviewtheAPA’swebsites&applications,youconfirmthatyouunderstandandacceptthetermsoftheAPA’sPrivacyPolicy,includingtheuseofcookies.ReadourfullPrivacyPolicyhere. Accept Skiptocontent Important!APA'sOnlineSystemsUpdated.Passwordresetrequired. Closealert Important!APA'sOnlineSystemsUpdated. Passwordresetwillberequired. Readmorehere> Closealert Youarehere: PatientsandFamilies Schizophrenia WhatisSchizophrenia? Share Print SubNavigation Schizophrenia TogglePageListing WhatisSchizophrenia? ExpertQ&A:Schizophrenia OnThisPage WhatisSchizophrenia? SchizophreniaisachronicbraindisorderthataffectslessthanonepercentoftheU.S.population.Whenschizophreniaisactive,symptomscanincludedelusions,hallucinations,disorganizedspeech,troublewiththinkingandlackofmotivation.However,withtreatment,mostsymptomsofschizophreniawillgreatlyimproveandthelikelihoodofarecurrencecanbediminished. Whilethereisnocureforschizophrenia,researchisleadingtoinnovativeandsafertreatments.Expertsalsoareunravelingthecausesofthediseasebystudyinggenetics,conductingbehavioralresearch,andusingadvancedimagingtolookatthebrain’sstructureandfunction.Theseapproachesholdthepromiseofnew,andmoreeffectivetherapies. Thecomplexityofschizophreniamayhelpexplainwhytherearemisconceptionsaboutthedisease.Schizophreniadoesnotmeansplitpersonalityormultiple-personality.Mostpeoplewithschizophreniaarenotanymoredangerousorviolentthanpeopleinthegeneralpopulation.Whilelimitedmentalhealthresourcesinthecommunitymayleadtohomelessnessandfrequenthospitalizations,itisamisconceptionthatpeoplewithschizophreniaenduphomelessorlivinginhospitals.Mostpeoplewithschizophrenialivewiththeirfamily,ingrouphomesorontheirown. Researchhasshownthatschizophreniaaffectsmenandwomenfairlyequallybutmayhaveanearlieronsetinmales.Ratesaresimilararoundtheworld.Peoplewithschizophreniaaremorelikelytodieyoungerthanthegeneralpopulation,largelybecauseofhighratesofco-occurringmedicalconditions,suchasheartdiseaseanddiabetes. SMIAdviser Findanswerstocommonquestionsaboutseriousmentalillnessandlistentofamiliessharetheirstories. LearnMore Definitions Psychosisreferstoasetofsymptomscharacterizedbyalossoftouchwithrealityduetoadisruptioninthewaythatthebrainprocessesinformation.Whensomeoneexperiencesapsychoticepisode,theperson’sthoughtsandperceptionsaredisturbed,andtheindividualmayhavedifficultyunderstandingwhatisrealandwhatisnot. Delusionsarefixedfalsebeliefshelddespiteclearorreasonableevidencethattheyarenottrue.Persecutory(orparanoid)delusions,whenapersonbelievestheyarebeingharmedorharassedbyanotherpersonorgroup,arethemostcommon. Hallucinationsaretheexperienceofhearing,seeing,smelling,tasting,orfeelingthingsthatarenotthere.Theyarevividandclearwithanimpressionsimilartonormalperceptions.Auditoryhallucinations,“hearingvoices,”arethemostcommoninschizophreniaandrelateddisorders. Disorganizedthinkingandspeechrefertothoughtsandspeechthatarejumbledand/ordonotmakesense.Forexample,thepersonmayswitchfromonetopictoanotherorrespondwithanunrelatedtopicinconversation.Thesymptomsaresevereenoughtocausesubstantialproblemswithnormalcommunication. Disorganizedorabnormalmotorbehavioraremovementsthatcanrangefromchildlikesillinesstounpredictableagitationorcanmanifestasrepeatedmovementswithoutpurpose.Whenthebehaviorissevere,itcancauseproblemsintheperformanceofactivitiesofdailylife.Itincludescatatonia,whenapersonappearsasifinadazewithlittlemovementorresponsetothesurroundingenvironment. Negativesymptomsrefertowhatisabnormallylackingorabsentinthepersonwithapsychoticdisorder.Examplesincludeimpairedemotionalexpression,decreasedspeechoutput,reduceddesiretohavesocialcontactortoengageindailyactivities,anddecreasedexperienceofpleasure. Symptoms Whenthediseaseisactive,itcanbecharacterizedbyepisodesinwhichthepersonisunabletodistinguishbetweenrealandunrealexperiences.Aswithanyillness,theseverity,durationandfrequencyofsymptomscanvary;however,inpersonswithschizophrenia,theincidenceofseverepsychoticsymptomsoftendecreasesasthepersonbecomesolder.Nottakingmedicationsasprescribed,theuseofalcoholorillicitdrugs,andstressfulsituationstendtoincreasesymptoms.Symptomsfallintothreemajorcategories: Positivesymptoms:(thoseabnormallypresent)Hallucinations,suchashearingvoicesorseeingthingsthatdonotexist,paranoiaandexaggeratedordistortedperceptions,beliefsandbehaviors. Negativesymptoms:(thoseabnormallyabsent)Alossoradecreaseintheabilitytoinitiateplans,speak,expressemotionorfindpleasure. Disorganizedsymptoms:Confusedanddisorderedthinkingandspeech,troublewithlogicalthinkingandsometimesbizarrebehaviororabnormalmovements. Cognitionisanotherareaoffunctioningthatisaffectedinschizophrenialeadingtoproblemswithattention,concentrationandmemory,andtodecliningeducationalperformance. Symptomsofschizophreniausuallyfirstappearinearlyadulthoodandmustpersistforatleastsixmonthsforadiagnosistobemade.Menoftenexperienceinitialsymptomsintheirlateteensorearly20swhilewomentendtoshowfirstsignsoftheillnessintheir20sandearly30s.Moresubtlesignsmaybepresentearlier,includingtroubledrelationships,poorschoolperformanceandreducedmotivation. Beforeadiagnosiscanbemade,however,apsychiatristshouldconductathoroughmedicalexaminationtoruleoutsubstancemisuseorotherneurologicalormedicalillnesseswhosesymptomsmimicschizophrenia. RiskFactors Researchersbelievethatanumberofgeneticandenvironmentalfactorscontributetocausation,andlifestressorsmayplayaroleinthestartofsymptomsandtheircourse.Sincemultiplefactorsmaycontribute,scientistscannotyetbespecificabouttheexactcauseineachindividualcase. Treatment Thoughthereisnocureforschizophrenia,manypatientsdowellwithminimalsymptoms.Avarietyofantipsychoticmedicationsareeffectiveinreducingthepsychoticsymptomspresentintheacutephaseoftheillness,andtheyalsohelpreducethepotentialforfutureacuteepisodesandtheirseverity.Psychologicaltreatmentssuchascognitivebehavioraltherapyorsupportivepsychotherapymayreducesymptomsandenhancefunction,andothertreatmentsareaimedatreducingstress,supportingemploymentorimprovingsocialskills. Diagnosisandtreatmentcanbecomplicatedbysubstancemisuse.Peoplewithschizophreniaareatgreaterriskofmisusingdrugsthanthegeneralpopulation.Ifapersonshowssignsofaddiction,treatmentfortheaddictionshouldoccuralongwithtreatmentforschizophrenia. RehabilitationandLivingWithSchizophrenia Treatmentcanhelpmanypeoplewithschizophrenialeadhighlyproductiveandrewardinglives.Aswithotherchronicillnesses,somepatientsdoextremelywellwhileotherscontinuetobesymptomaticandneedsupportandassistance. Afterthesymptomsofschizophreniaarecontrolled,varioustypesoftherapycancontinuetohelppeoplemanagetheillnessandimprovetheirlives.Therapyandpsychosocialsupportscanhelppeoplelearnsocialskills,copewithstress,identifyearlywarningsignsofrelapseandprolongperiodsofremission.Becauseschizophreniatypicallystrikesinearlyadulthood,individualswiththedisorderoftenbenefitfromrehabilitationtohelpdeveloplife-managementskills,completevocationaloreducationaltraining,andholdajob.Forexample,supported-employmentprogramshavebeenfoundtohelppeoplewithschizophreniaobtainself-sufficiency.Theseprogramsprovidepeoplewithseverementalillnesscompetitivejobsinthecommunity. Formanypeoplelivingwithschizophreniafamilysupportisparticularlyimportanttotheirhealthandwell-being.Itisalsoessentialforfamiliestobeinformedandsupportedthemselves.OrganizationssuchastheSchizophreniaandRelatedDisordersAllianceofAmerica(SARDAA),MentalHealthAmerica(MHA)andtheNationalAllianceonMentalIllness(NAMI)offerresourcesandsupporttoindividualswithschizophreniaandothermentalillnessesandtheirfamilies(seeAdditionalResources). Optimismisimportantandpatients,familymembersandmentalhealthprofessionalsneedtobemindfulthatmanypatientshaveafavorablecourseofillness,thatchallengescanoftenbeaddressed,andthatpatientshavemanypersonalstrengthsthatmustberecognizedandsupported. RelatedConditions DelusionalDisorder Delusionaldisorderinvolvesapersonhavingfalsebeliefs(delusions)thatpersistforatleastonemonth.Thedelusionscanbebizarre(aboutthingsthatcannotpossiblyoccur)ornon-bizarre(thingsthatarepossiblebutnotlikely,suchasabeliefaboutbeingfollowedorpoisoned). Apartfromthedelusion(s),itdoesnotinvolveothersymptoms.Thepersonmaynotappeartohaveanyproblemswithfunctioningandbehaviorexceptwhentheytalkaboutoractonthedelusion. Delusionalbeliefscanleadtoproblemswithrelationshipsoratwork,andtolegaltroubles.Delusionaldisorderisrare:around0.2%ofpeoplewillhaveitintheirlifetime.Delusionaldisorderistreatedwithindividualpsychotherapy,althoughpeoplerarelyseektreatmentastheyoftendonotfeeltheyneedtreatment. BriefPsychoticDisorder Briefpsychoticdisorderoccurswhenapersonexperiencesasuddenshortperiodofpsychoticbehavior.Thisepisodelastsbetweenonedayandonemonthandthenthesymptomscompletelydisappear,andthepersonreturnstonormal. Briefpsychoticdisorderinvolvesone(ormore)ofthefollowingsymptoms: Delusions, Hallucinations, Disorganizedspeech Grosslydisorganizedorcatatonicbehavior. Althoughthedisturbanceisshort,individualswithbriefpsychoticdisordertypicallyexperienceemotionalturmoiloroverwhelmingconfusion.Briefpsychoticdisordercanoccuratanyage,thoughtheaverageageatonsetisthemid-30s.Itistwiceascommoninfemalesthaninmales. Itisimportanttodistinguishsymptomsofbriefpsychoticdisorderfromculturallyappropriateresponses.Forexample,insomereligiousceremonies,anindividualmayreporthearingvoices,butthesedonotgenerallypersistandarenotperceivedasabnormalbymostmembersoftheindividual’scommunity. SchizophreniformDisorder Thesymptomsofschizophreniformdisorderaresimilartothoseofschizophrenia,butthesymptomsonlylastashorttime—atleastonemonthbutlessthansixmonths.Ifthesymptomslastlongerthansixmonths,thenthediagnosischangestoschizophrenia. Schizophreniformdisorderinvolvestwoormoreofthefollowingsymptoms,eachpresentforasignificantportionoftimeduringaone-monthperiod(orlessifsuccessfullytreated):: Delusions, Hallucinations Disorganizedspeech, Grosslydisorganizedbehaviororcatatonicbehavior,and/or Negativesymptoms. Adiagnosisofschizophreniformdisorderdoesnotrequireproblemsinfunctioning(asschizophreniadoes).IntheU.S.,schizophreniformdisorderissignificantlylesscommonthanschizophrenia.Aboutone-thirdofindividualswithaninitialdiagnosisofschizophreniformdisorderrecoverwithinthe6-monthperiodandschizophreniformdisorderistheirfinaldiagnosis.Mostoftheremainingtwo-thirdsofindividualswilleventuallyreceiveadiagnosisofschizophreniaorschizoaffectivedisorder. SchizoaffectiveDisorder Peoplewithschizoaffectivedisorderexperiencesymptomsamajormoodepisodeofdepressionorbipolardisorder(majordepressionormania)atthesametimeassymptomsofschizophrenia(delusions,hallucinations,disorganizedspeech,grosslydisorganizedbehavior,ornegativesymptoms).Symptomsofamajormoodepisodemustbepresentforthemajorityofthedurationoftheactiveillnessandtheremustbeaperiodofatleasttwoweekswhendelusionsorhallucinationsarepresentintheabsenceofamoodepisode. Schizoaffectivedisorderisaboutone-thirdascommonasschizophrenia,affectingabout0.3%ofpeopleatsometimeintheirlives.Thetypicalageatonsetofschizoaffectivedisorderisearlyadulthood,althoughitcanbeginanywherefromadolescencetolateinlife.Asignificantnumberofindividualsinitiallydiagnosedwithanotherpsychoticillnesslaterreceivethediagnosisschizoaffectivedisorderwhenthepatternofmoodepisodesbecomesapparent. PhysicianReview FelixTorres,M.D.,MBA,DFAPA August2020 Resources Schizophrenia&PsychosisActionAlliance Helpline Findalocalsupportgroup MentalHealthAmerica Schizophrenia LiveYourLifeWell 800-969-6642 NationalAllianceonMentalIllness Discussiongroups 800-950-NAMI(6264) NationalInstituteonMentalHealth Whatisschizophrenia? Clinicaltrials Medicalleadershipformind,brainandbody. JoinToday Mobilemenu Closemenu Home Psychiatrists Residents&MedicalStudents PatientsandFamilies Membership AboutAPA Newsroom Advocacy&APAPAC APASites RENEW JOIN SignIn Back Psychiatrists Education Practice Diversity&HealthEquity Research&Registry Advocacy&APAPAC Meetings&Events SearchDirectories&Databases International Back Residents&MedicalStudents Residents MedicalStudents Back PatientsandFamilies ViewAllTopics WhatisPsychiatry? 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