Schizophrenia

	Topic Overview
	FAQs
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When to Call a Doctor
	Exams and Tests
	Treatment Overview
	Medicines
	Recovery
	For Family and Friends
	Other Places To Get Help
	Related Information
	References
	Credits
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What is schizophrenia?

Schizophrenia is an illness that harms how your brain works and how you think. It affects each person in a different way, both on a daily basis and over a lifetime. How society and the people you come in contact with react to schizophrenia also can make a difference in how schizophrenia affects you. They may make it easier or harder for you to cope with the illness.

Schizophrenia can change you in many ways. It may make it harder for you to think clearly, manage how you feel, and deal with other people.

Most people who have schizophrenia hear and sometimes see things that are not there (hallucinations), often believe some things that are not true (delusions), and may think that some people are trying to harm them (paranoia). With treatment, they may come to understand that these experiences are not real but are a problem with how their brains work.

There are several types of schizophrenia. The most common type is paranoid schizophrenia, which causes people to have frightening thoughts, believe that people or forces are trying to harm them, and hear voices. Some people think that schizophrenia is the same as a “split personality” (dissociative identity disorder), but that is a different mental health problem.

Living with schizophrenia can cause many challenges. It is a difficult disease. It changes your life and your family members' lives. But if you are willing to work at helping yourself, you get professional help, and you have the support and understanding of your family, you can live a full and meaningful life.

What causes schizophrenia?

Experts don't know what causes schizophrenia. It may have different causes for different people. In some people, brain chemistry and brain structure are not normal. Family history may play a role. And problems that harm a baby's brain during pregnancy also may help cause it. Schizophrenia is not caused by anything you did, by personal weakness, or by the way your parents raised you.

What are the symptoms?

Symptoms of schizophrenia include:

• Negative symptoms. "Negative" does not mean "bad." Negative symptoms are things that are "lost" from your personality or how you experience life because of schizophrenia. Negative symptoms include not caring about things, having no interest or drive to do things, and not taking care of yourself, such as not bathing or not eating regularly. You may find it hard to say how you feel, or you may become angry with strangers for no reason and react to others in other harmful ways.
• Positive symptoms. "Positive" does not mean "good." Positive symptoms are things "added" or "new" to your personality or how you experience life because of schizophrenia. They include hallucinations, delusions, and thoughts and speech that are confusing.
• Cognitive symptoms. These symptoms have to do with how you think. They can include memory loss, not being able to understand things well enough to make decisions, and having trouble talking clearly to others. Cognitive symptoms often are not obvious to you or others.

Symptoms of schizophrenia usually start when you are a teen or a young adult, but they may start later in life. They may appear suddenly or may develop slowly. You may not be aware of your symptoms.

Negative symptoms usually appear first. They may be hard to recognize as schizophrenia because they are similar to symptoms of other problems, such as depression. Positive symptoms can start days, months, or years after the negative symptoms.

Early signs of schizophrenia may include doing worse in school, thinking that people are trying to harm you, or having changes in your personality, such as not wanting to see people.

These signs don't mean you have schizophrenia. But if you have them, see a doctor.

How is schizophrenia diagnosed?

Your doctor will ask you questions about your health and about any odd experiences you may have had, such as hearing voices or having confusing thoughts. You will have a physical exam. Your doctor also may suggest tests, such as blood tests or imaging tests, to see if your symptoms may be caused by another health problem.

How is it treated?

Getting treatment and other help for schizophrenia can greatly improve your life.

Medicines help your symptoms, and counseling and therapy help you change how you think about things and deal with the illness. Treatment may last a long time.

Once you have your symptoms under control, you are in recovery. Recovery usually is a lifelong process. In the recovery process, you learn to cope with your symptoms and challenges, find and meet your goals, and develop the support you need. Your recovery depends upon a partnership between you, your doctors, and others who are important in your life.

The goals of treatment and recovery are to reduce or stop symptoms, reduce the number of relapses, and develop a personal plan for your recovery by setting and meeting goals for home, work, and relationships. Your treatment and recovery plan may change as your experience of schizophrenia and your life change.

How can family and friends help?

Having schizophrenia can be a scary experience, and knowing that someone you love has this illness changes your life. Show love, and learn as much as you can about the illness. Understand that the behavior you may see is caused by the illness and is not the person you love.

If you think someone you love has schizophrenia, help that person get to a doctor. The sooner the illness is diagnosed and the person begins treatment, the more successful treatment and recovery may be.

People who have schizophrenia often stop treatment. This may be because they don't understand that they have an illness or because the medicines cause side effects. When treatment stops, symptoms usually come back (relapse) or get worse. A relapse might happen right after treatment is stopped or months later. A later relapse makes it hard to see that stopping the medicine was the cause. During a relapse, some people with schizophrenia can't deal with treatment on their own and may need to spend time in a hospital.

You can help by talking to your loved one and helping him or her continue treatment. You also can help your loved one deal with fear and other feelings about the illness and with the negative attitudes some people have toward schizophrenia.

Experts don't know what causes schizophrenia. It may have different causes for different people. In some people, brain chemistry and brain structure are not normal. Family history may play a role. And problems that harm a baby's brain during pregnancy also may help cause it.

• Genetics: Your chance of developing schizophrenia is greater if your parent, brother, or sister has the illness.¹ But most people who have a family member with schizophrenia don't develop it.
• Brain chemistry and structure: It's possible that neurotransmitters, which send messages between parts of the brain, don't work the right way in people with schizophrenia.
• Pregnancy: Schizophrenia may be related to pregnancy problems that can harm a baby's developing brain and nervous system.¹ These problems include poor nutrition or a viral infection during pregnancy.

Schizophrenia is not caused by anything you did, by personal weakness or bad choices, or by the way your parents raised you.

More research is needed to understand what causes schizophrenia.

Schizophrenia has many symptoms, and having one or more of the symptoms doesn't mean you have schizophrenia.

Symptoms usually start during your teen years or early adulthood. They may appear suddenly or may develop gradually. When symptoms develop gradually, they may be confused with other conditions that have similar symptoms, such as depression or anxiety disorders. You may not know you have symptoms.

The symptoms of schizophrenia can be negative, positive, or cognitive.

Negative symptoms

"Negative" does not mean "bad." Negative symptoms are things that are "lost" from your personality or how you experience life because of schizophrenia. You may:

• Find little or no pleasure in life. You may not enjoy things you once enjoyed, such as playing sports or video games or visiting with friends. This is a common symptom of schizophrenia.
• Feel like you have no emotions. You may not smile or frown, make eye contact, or use other facial cues that show how you feel.
• Have a hard time focusing or paying attention. You may not understand how to use information well and feel confused. You may not have complete thoughts.
• Not be interested in succeeding or meeting goals. Many people with schizophrenia don't do well at work or in school.
• Not take care of yourself. You may not bother to wash, do laundry, eat on a regular basis, or clean your living space.

Negative symptoms usually appear first. They may be hard to recognize as schizophrenia because they may seem normal in a teen or may be similar to symptoms of other mental health problems, such as depression or substance abuse.

Positive symptoms

"Positive" does not mean "good." Positive symptoms are things "added" or "new" to your personality or how you experience life because of schizophrenia. You may:

• Have hallucinations. Most people with schizophrenia usually hear noises or voices that are not there. Some people with the illness also may see, taste, touch, or smell things that are not there.
• Have delusions, which are ideas that are not true. For example, you may think you are a powerful person or that the police or demons want to harm you or cause problems for you.
• Act oddly. You may become very excited or angry with other people. You may have odd body movements, such as often rocking back and forth or making faces.
• Show emotions that don't fit the situation. For example, you may smile when talking about sad topics or laugh at wrong times.
• Not be able to keep your thoughts straight and not make sense to others when you talk. For example, when someone asks you a question, you may give an answer that does not make sense, not be able to say much, or only give one-word answers.

Positive symptoms can appear days, months, or years after negative symptoms appear. They may appear suddenly or slowly over time. The negative symptoms also may continue.

Positive symptoms can be severe and can cause a psychotic episode. This means you can't tell the difference between what is real and what is not real. A psychotic episode can be very intense and scary, and you may need to go to the hospital.

Cognitive and other symptoms

Other symptoms include:

• Cognitive symptoms. These symptoms affect how you think. They include memory loss and not being able to understand things well enough to make decisions. Cognitive symptoms often are not obvious to you or others.
• Specific behavior changes. Different types of schizophrenia, such as paranoid schizophrenia, catatonic schizophrenia, and disorganized schizophrenia, may result in unique behavior. Symptoms of these different types include being afraid with little reason, standing in awkward positions for a long time, or making up words.

Symptoms of schizophrenia usually start in the late teens to mid-20s for men and the late 20s to 30s for women.¹ The symptoms may start suddenly or happen gradually. Men tend to have more severe symptoms than women do.²

Children and younger teens also may develop symptoms, but this is rare.

How it starts

The first symptoms of schizophrenia may be overlooked. They are often the same as symptoms of other mental health problems, such as depression or other anxiety disorders, and they may not seem unusual in teens or young adults.

The first symptoms often include:

• Negative symptoms, such as losing interest in school, work, or activities with other people.
• Outbursts of anger.
• Odd behavior or acting in a way that is not normal for you.
• Anxiety or depression.
• Confusion or confused speech.
• Fear of something or someone for no reason.

These symptoms can be triggered by stress or changes in your life, such as going away to school, starting to use drugs or alcohol, or going through a severe illness or a death in the family.¹

Experts call this period—when symptoms are vague and easy to miss—the prodromal phase. Schizophrenia rarely is diagnosed at this time. This phase can last for days, months, or years before positive symptoms appear.

Symptoms get worse

At some point you begin to have positive symptoms, such as hallucinations. These symptoms may appear suddenly or slowly over time. They can be severe and can cause a psychotic episode, which means you can't tell the difference between what is real and what is not real. A psychotic episode can be very intense and scary, and you may need to go to the hospital. You probably will not be able to make many decisions about your care.

This is called the active, or acute, phase. It usually lasts from 4 to 8 weeks. This is when schizophrenia usually is diagnosed. The negative symptoms also may continue during this phase.

A cycle of getting better and relapse

After an active phase, positive symptoms get better, especially with treatment, and life may be more "normal." This is called remission. But symptoms may get worse again, which is called a relapse. You may have this cycle of symptoms that get severe and then improve.³

In each cycle, the positive symptoms may become less intense, but the negative symptoms may get worse. You may have few or many cycles before you are able to stay in recovery. Within 5 to 10 years, you may develop a unique pattern of illness that often stays the same throughout your life. It also is possible that you will have fewer relapses as you get older and may even not have symptoms.

Living with schizophrenia is a challenge. But if you are active in your own treatment and recovery, you understand the illness, and you have the support of your family and others, you can often live a full life.

Medical and social concerns

Schizophrenia can harm your health and change your relationships. Here are some areas to watch for problems:

• Thoughts of suicide or thoughts about harming yourself or others. If you think about these things, call your doctoror 911 right away. Tell your family and friends how to recognize the warning signs of suicide and warning signs of violence toward others.
• Health problems. These include obesity, type 2 diabetes, and heart and lung problems. Talk to your doctor about how you can help prevent these health problems.
• Social concerns, such as other people's attitudes. People who don't understand schizophrenia or other mental health problems may treat you differently. Find family and friends who want to support you and help you with relationships. Help them understand schizophrenia.
• Smoking. Many people who have schizophrenia smoke cigarettes. This may be because smoking helps with some of the symptoms.¹ But smoking makes other illnesses, such as cancer and heart disease, more likely. For information on how to stop smoking, talk to your doctor, and see the topic Quitting Smoking.
• Substance abuse. Many people who have schizophrenia abuse alcohol or drugs. When you have schizophrenia and a substance abuse problem, it's called a dual diagnosis. Substance abuse often starts before the symptoms of schizophrenia are recognized.³ Talk with your doctor or another trusted person about getting help for substance abuse.
• If you have schizophrenia and want to have a baby, talk to your doctor. Medicines that you take for schizophrenia can cause birth defects, and not taking your medicine puts you at risk for a relapse. Your doctor can help you plan your pregnancy so there will be as little risk as possible to you and your baby.

Schizophrenia is a complex illness. Experts don't know what causes it or why some people get it and others don't. But some things make it more likely that a person will develop schizophrenia. These are called risk factors. Having one or more risk factors doesn't mean you will develop the illness, though.

You may be at risk for schizophrenia if:

• Your mother, father, brother, or sister has schizophrenia. But having a relative with schizophrenia doesn't mean you will develop this illness.
• Your mother had certain problems while she was pregnant with you. For example, if your mother did not get enough to eat (malnutrition), had a viral infection, or took medicines (diuretics) for high blood pressure, you may be at increased risk.⁴
• You or a family member have another disorder that is like schizophrenia. An example of this is a delusional disorder, which means you believe things that can't be proven.
• You have a problem with alcohol or drugs.³ Experts don't know whether substance abuse triggers schizophrenia or whether a person with schizophrenia is more likely to have a substance abuse problem.

Risk of relapse

If your symptoms come back, it's called a relapse. Anyone with schizophrenia can have a relapse, but it happens much more often when you don't take your medicine.¹ A relapse is likely if you stop treatment.

People sometimes stop treatment before they should when:

• They have side effects from the medicines.
• They feel better and think they no longer need medicine.
• They abuse alcohol or drugs (substance abuse).
• They don't believe they have the disease.
• They have disorganized or confusing thoughts and forget to take their medicines.
• They are afraid of or think false thoughts about treatment (paranoia or delusions).

If you are having trouble with medicine side effects or want to stop using your medicines or any other treatment for any reason, talk to your health care team first.

Call 911 or other emergency services if you (or someone you care about who has schizophrenia):

• Are thinking about suicide or are threatening suicide.
• Hear voices that tell you to hurt yourself or someone else or to do something illegal, such as destroy property or steal.
• Notice warning signs of violence towards others, such as thinking or talking about harming someone or becoming aggressive.

Call a doctor if you (or someone you care about who has schizophrenia):

• Have a sudden change in behavior, such as refusing to eat because you think someone has poisoned your food.
• Have experiences that don't usually occur, such as hearing someone calling your name when no one is there.
• Have a hard time taking care of basic needs, such as grooming, or become confused doing simple chores or tasks.
• Show warning signs of suicide, such as talking about death or spending long periods of time alone.
• Show signs of schizophrenia, such as talking to people who are not present or believing things that you know are false.
• Show the first signs of relapse, such as finding it hard to focus or withdrawing from other people.

Early signs

Early signs of schizophrenia include doing worse in school or at work, thinking that people are out to get you, or having changes in your thoughts or feelings or attitudes, such as not wanting to see other people.

These signs don't mean you have schizophrenia. Many of the symptoms of schizophrenia can be caused by other things, such as other medical problems, stress, grief, medicine side effects, or lack of sleep.

If schizophrenia-like symptoms last longer than 1 week, or if they interfere with your life, talk with a doctor about your concerns. If you have schizophrenia or another problem, early diagnosis and treatment may make treatment more successful.

If you need help deciding whether to see your doctor, read about some of the reasons people don't get help and how to overcome them.

Who can treat schizophrenia?

Health professionals who can help diagnose schizophrenia or who may work together with other health professionals to treat schizophrenia include:

• General practitioners.
• Family medicine physicians.
• Internists.
• Neurologists.
• Psychiatrists.
• Psychologists.
• Physician assistants.
• Nurse practitioners.

Your doctor will ask you questions about your medical history and your mental health and about any odd experiences you may have had, such as hearing voices or having confusing thoughts. You also will have a physical exam.

Your doctor also may suggest tests to rule out other conditions with similar symptoms or to diagnose other schizophrenia disorders. These tests may include blood tests and a CT scan or MRI. The CT scan or MRI will check the size, structure, and function of your brain. The structure of the brain may be different in some people who develop schizophrenia.²

If your doctor thinks you are depressed or are thinking about suicide, a suicide assessment also may be done.

Schizophrenia is diagnosed when:⁵

• You have had at least 2 of the following symptoms and they lasted for at least 1 month:
  • Hallucinations
  • Delusions
  • Disorganized speech, such as not making sense to others when you talk
  • Very disorganized or catatonic behavior, such as sitting or standing in unusual positions for a long time
  • Negative symptoms, such as having no emotion, not being able to feel pleasure, or having a hard time focusing
• You have problems doing your job right or dealing with other people or problems in other areas of your social and work life.
• You have had some of the positive or negative symptoms for at least 6 months.
• Your symptoms are not caused by other mental or physical health problems, a medicine you're taking, or substance abuse problems.

Finding out that you have schizophrenia can be scary and hard to deal with. But you can treat it.

The goals of treatment and recovery are to reduce or stop symptoms, reduce the number of relapses, and develop a personal plan for your recovery by setting and meeting goals for home, work, and relationships.

Medicines help your symptoms, and counseling and therapy help you change how you think about things and deal with the illness. Treatment may last a long time, and the need to follow a recovery plan usually lasts for your lifetime. Your treatment and recovery plan may change as your experience of schizophrenia and your life change.

If you struggle with alcohol, drugs, or tobacco or have other mental health problems, such as depression, you need to treat these problems too.

Medicine

Medicine is the most effective treatment for schizophrenia, and there are many medicines to choose from. Medicines may be used for positive or negative symptoms, but they don't work as well for negative symptoms as they do for positive symptoms.

Medicine doesn't cure most people who have schizophrenia, but it can make life easier for you. Find the medicine that works best for you by working closely with your doctor. Tell your doctor which symptoms the medicine helps you with and how much, and talk about any side effects.

Medicines used most often to treat schizophrenia include:

• First-generation antipsychotics, such as haloperidol (Haldol) and chlorpromazine.
• Second-generation antipsychotics, such as risperidone (Risperdal), paliperidone (Invega), olanzapine (Zyprexa), ziprasidone (Geodon), and quetiapine (Seroquel).
• Clozapine, such as Clozaril.

Other medicines also may be used. For more information, see the Medicines section.

Counseling and therapy

Counseling and therapy are important parts of treatment. You will work with a mental health professional such as a psychologist, licensed professional counselor, clinical social worker, or psychiatrist.

Find a therapist you trust and feel comfortable with. A good therapist not only provides help but gives you support and encouragement. If you don't feel good about working with one doctor or therapist, try another one.

Here are some types of therapy that may help you.

Cognitive-behavioral therapy (CBT) helps you change the way you think about things. It can help you understand why it's important to prevent a relapse and take steps to do so.⁶ CBT may help reduce delusions and hallucinations.^{1, 6}

Counseling helps you improve your relationships, deal with your symptoms, and meet your goals. It often focuses on the problems and plans of everyday life.

Counseling can take place one-on-one or in a group setting. Group counseling also helps you make friends and learn social skills. Group counseling may be best if it has a clear leader and structure.²

Family therapy is a type of counseling that focuses on everyday life and helps you and your family work out problems when they occur. It usually includes education about schizophrenia and its treatment. Family therapy is important because your family can play a large role in supporting you if you have schizophrenia. For more information, see the Recovery and the Family and Community sections.

Recovery

When you have schizophrenia, you need more than medicines and counseling to move forward with your life. You need to partner with your health care team to find and meet your personal goals. This life-long partnering is known as recovery.

Recovery is not the same as being cured and does not mean you will be symptom-free. It is being able to live a full life and enjoy favorite activities with as little trouble as possible from your symptoms. Recovery may help you manage your symptoms so that you can be an active member of your community.

Education, support, and training in social and job skills are all important parts of your treatment and recovery. For example:

• Learning about schizophrenia can improve the quality of your life and the lives of those who care about you.
• Job training may help you find a job that interests you and that you can be successful in. This can help with finances and self-esteem.
• Social skills training can help you develop life skills such as learning to communicate, managing frustration, and coping. It may include cognitive enhancement therapy, which may help you improve how well you understand and deal with other people.
• Case management and assertive community treatment can help you organize the many different parts of treatment and recovery. You receive this kind of help at your home. You don't have to go anywhere special to get it.
• Support groups give you the chance to talk with people who are going through the same things you are.

For more information, see the Recovery section.

Other treatment

If medicine and therapy are not helping you, your doctor may suggest electroconvulsive therapy (ECT). In this procedure, your doctor uses electricity to create a brief and mild seizure. This may change your brain chemistry and help your symptoms.⁷

Relapse

If your symptoms come back, it's called a relapse. Treatment can help prevent or reduce relapses and make it possible for you to go to school, to work, and to have successful relationships. Here are some ways to help yourself:

• Learn how to recognize the first signs of relapse, such as not wanting to do things with others, and have a plan to deal with it and get help right away.
• If you need help deciding whether to see your doctor, read about some of the reasons people don't get help and how to overcome them.
• Take your medicine. This makes a relapse less likely.¹
• If side effects are making your life hard, talk with your doctor to see whether you can try a different medicine.
• Treat health problems that may occur along with or because of schizophrenia. These include obesity, substance abuse, type 2 diabetes, and heart and lung problems.
• Stay in counseling or therapy, and continue with your recovery plan.

What to think about

It may be hard to understand and accept that you have an illness and it's easy to become discouraged. You can help yourself by focusing on your recovery goals and learning to see schizophrenia as one part of you life, not your entire life. Make managing schizophrenia well one of the many successes in your life.

Medicine is the most effective treatment for schizophrenia, and there are many medicines that can help. Medicines may be used for positive or negative symptoms, but they don't work as well for negative symptoms as they do for positive symptoms.

• During a first psychotic episode or a relapse, you probably will need constant care and may have to go to a hospital. If you already are using medicine, you may need higher doses or other adjustments.
• When your symptoms are better, you may need to continue to take medicines, sometimes in lower doses. Talk to your doctor before making any changes in your medicines.

Using more than one medicine may be the best treatment for schizophrenia, and there are many to choose from. But it may take time to find which medicines are best for you. This may be frustrating. Getting support from your family, your friends, and a community-based rehabilitation program is helpful, especially while you and your doctor are trying to find the best medicines. It also may help to speak with and get support from others who have had trouble finding the right medicines.

Medicines sometimes have severe side effects, so you and your doctor need to keep in touch about how they are working and how you are feeling. If you feel a medicine isn't right for you, your doctor can help you find a new one. Don't stop taking your medicines without talking to your doctor.

Medicine choices

Medicines used most often to treat schizophrenia include:

• First-generation antipsychotics, such as haloperidol (Haldol), perphenazine, and chlorpromazine. They are used to reduce anxiety and agitation and to stop delusions and hallucinations. These medicines can work very well but often have severe side effects, such as tardive dyskinesia, which causes uncontrolled body movements.
• Second-generation antipsychotics, such as risperidone (Risperdal), paliperidone (Invega), olanzapine (Zyprexa), ziprasidone (Geodon), and quetiapine (Seroquel). These medicines effectively treat symptoms of schizophrenia and may help reduce the risk of relapse.
• Clozapine, such as Clozaril. This medicine is approved in the United States for treating severe schizophrenia that has not improved with other treatment and for suicidal behavior caused by schizophrenia. In the U.S., your doctor needs special permission to prescribe clozapine for treating schizophrenia. You may need checkups as often as once a week if you take clozapine.

The first-generation and second-generation antipsychotic medicines both can help the symptoms of schizophrenia. Which medicine is best for you usually depends on how well a medicine has worked in the past for you and its side effects. Your doctor will help you find the best medicine for you.

The following medicines often are used along with antipsychotic medicines and clozapine:⁸

• Lithium carbonate, such as Lithobid and Eskalith. This medicine regulates moods. You will need your blood tested every week when you first start taking it and every 6 or 12 months after you know the correct dose. These tests check the levels of lithium carbonate in your blood, because too much can be dangerous.
• Antianxiety medicines, such as clonazepam (Klonopin) and diazepam (for example, Valium). These medicines reduce anxiety and nervousness.
• Anticonvulsant medicines, such as carbamazepine (for example, Tegretol) and valproate (for example, Depakote). These medicines can keep your mood stable and reduce symptoms during a relapse.
• Antidepressant medicines, such as selective serotonin reuptake inhibitors (SSRIs) (for example, Zoloft or Celexa) or tricyclic antidepressants (for example, Pamelor). These medicines reduce symptoms of depression that often occur along with schizophrenia.

Side effects

Some side effects of antipsychotic medicines can be serious.

• Neuroleptic malignant syndrome is a rare but life-threatening side effect of antipsychotics. The first signs usually include a fever between 102°F (38.9°C) and 103°F (39.4°C), a fast or irregular heartbeat, rapid breathing, and severe sweating.
• Tardive dyskinesia is body movement that you can't control. Signs may include lip-smacking or continuous chewing, tongue-twitching or thrusting the tongue out of the mouth, or quick and jerky movements (tics) of the head.

Because of side effects or the risk of side effects, you may be tempted to stop using your medicine. But if you stop using medicine, the symptoms of schizophrenia may come back or get worse.

If you have any concerns about side effects, talk to your doctor. He or she will work with you. Your doctor may give you a smaller dose of the antipsychotic medicine, have you try another antipsychotic medicine, or give you another medicine to treat the side effect.

You may need regular blood tests to check for side effects when you are taking medicines for schizophrenia. Children, teens, and older adults may need to have blood tests more often than other people.

What to think about

If you stop taking your medicines, you may have a relapse. Don't stop taking your medicines until you talk with your doctor. If you and your health care team decide you should stop using medicine, you will need to be checked on a regular basis.

Read about some ways to help you remember to take your medicine.

Taking medicines for schizophrenia during pregnancy may make birth defects more likely. If you are pregnant or thinking of becoming pregnant, talk to your doctor. Your doctor can help you plan your pregnancy so that there will be as little risk as possible to you and your baby.

Most people with schizophrenia qualify for health care programs such as Medicare or Medicaid. To find out whether you qualify, check with your local health and welfare agency.

Recovery from schizophrenia is a journey of healing and change. It will help you live a fulfilling and meaningful life.

Recovery doesn't always mean you are symptom-free. It begins with treatment and usually is a lifelong process. In the recovery process, you learn to cope with your symptoms and challenges, find and meet your goals, and develop the support you need.

There are 10 principles of recovery(What is a PDF document?) that can guide you as you work toward your goals and learn new things to help yourself. They help you gain self-confidence and respect for yourself. They make it clear that you make your own decisions with the help of your doctor, counselor, and family. And they encourage you to be as independent as possible while living with schizophrenia.

Many people with schizophrenia are finding that the sooner they start recovery with their health care team, family, and friends, the sooner they are able to return to satisfying life activities. These people can all help you with the support, education, and learning that take place in recovery.

Support

You have schizophrenia, but like other people, you have wishes and goals for your life. You most likely want healthy relationships with your partner, family, and friends. You may want a job that gives you a sense of self-worth.

Your family and community can support you and help you meet your goals.

• Your family can help you get the right treatment, deal with your symptoms, and get along in your community. Family therapy is an important part of this.
• Social support and support groups give you the chance to talk with people who are going through the same things you are.
• Case management and assertive community treatment can help you deal with the many different parts of treatment and recovery. If you feel overwhelmed, ask your doctor or therapist about these programs.
• Your local or state health department may have programs to help you. The National Alliance on Mental Illness (NAMI) provides contact information for support organizations nationwide. For more information, go to www.nami.org.

Education and training

Education and training can help you deal with others and be part of your community.

• Learn about schizophrenia. This can improve the quality of your life and the lives of those who care about you.
• Get job training to help you find a job that interests you and that you can be successful in. This can help with finances and self-esteem. Work can be an important part of your recovery.
• Get social skills training. This helps you develop life skills such as learning to communicate, managing frustration, and coping with others. Training may include cognitive enhancement therapy, which may help you improve how well you understand and deal with other people.
• Be aware of people's negative attitudes (stigma) toward schizophrenia. Do what you can to educate people about schizophrenia and recovery. Your health care team, family, and friends may be able to help you.

Relapse

If your symptoms come back, it's called a relapse. Anyone with schizophrenia can have a relapse, but it happens much more often when you don't take your medicine.¹

If you are having trouble taking your medicine or feel you don't need to, talk to your doctor or another trusted person. Your doctor may be able to change the medicine or how much you take. A partner or spouse may help you find ways to remember to take the medicine. Read about help remembering to take your medicine.

You can help prevent a relapse by taking your medicine, going to your counseling sessions, being active in your own recovery, and not drinking alcohol or using illegal drugs.

Read more about relapse, including the signs of relapse, how avoid a relapse, and how to make an action plan in case of relapse.

A healthy lifestyle

The symptoms of schizophrenia can make it easy to forget some of the basics of good health. But it's important to try to have a healthy lifestyle.

Here are some things to do:

• Don't abuse drugs or alcohol. Having a substance abuse problem makes treating schizophrenia harder. If you have a substance abuse problem, you need to treat both problems to help your recovery.
• Exercise and be active. Exercise and activity can keep you fit, and people who are fit usually have less anxiety, depression, and stress than people who aren't fit.⁹ Exercise and activity also make other diseases, such as heart disease or diabetes, less likely.⁹
• Relieve stress. Reducing stress may mean fewer relapses. For more information, see the topic Stress Management.
• Get enough sleep. This is very important. Sleep can help your mood and make you feel less stressed.
• Eat a balanced diet. This helps your body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.
• Stop smoking, if you smoke. Smoking increases the risk for other diseases, such as cancer and heart disease. For information on how to stop smoking, see the topic Quitting Smoking.

Schizophrenia affects everyone around the person who has the illness. It can be hard to watch a family member or friend develop symptoms and perhaps act in very different ways.

Family and friends may feel helpless, but they play an important role in the life and treatment of people who have schizophrenia.

As a family member or close friend, you may help support or take care of your loved one. After severe symptoms (called a psychotic episode), your loved one may come to you for help. You can encourage this person to stay in treatment, to take his or her medicines, and to take an active role in his or her recovery. This may help prevent a relapse. You also can help your loved one deal with symptoms and learn skills to help him or her get along better in the community.

What family and friends can do

Show your love, and learn as much as you can about the illness. Understand that the behavior you may see is part of the illness, not the person you love. Understand that symptoms that make no sense to you are real to your loved one. Don't argue with, give up on, or make fun of him or her. Help your loved one feel safe and in control.

• Learn about schizophrenia. Understand what happens in schizophrenia and how you and your loved one can cope with the it.⁷ This may make it easier for you and your loved to work together on treatment.²
• Work together as a family. Get family therapy, and know what may or may not be helpful. Don't press your loved one to make changes too quickly.¹ You and your family may benefit from therapy even if your loved one does not want to participate.
• Help during hallucinations and paranoia. Call the person quietly by name, or ask the person to tell you what he or she is going through. Be calm and soothing, and don't argue with the person or tell him or her that the voices are not real. Call for help if you think the situation could become dangerous.
• Deal with negative symptoms. Be clear in any suggestions you make, and praise positive actions.
• Encourage the person to take medicines. Talk about how the medicines help symptoms. You also can help by watching for side effects.
• Be aware of your own and other people's negative attitudes (stigma) toward the illness and your loved one. Do what you can to fight stigma and teach people about schizophrenia.

You can also help the person with good health habits. Encourage the person to:

• Limit alcohol and not use drugs. Having a substance abuse problem makes treating schizophrenia harder. Both problems need to be treated.
• Quit smoking, if the person smokes. Many people with schizophrenia smoke cigarettes. This may be because it may help with some of the symptoms.¹ For information on how to stop smoking, see the topic Quitting Smoking.
• Be active. People who are fit usually have less anxiety, depression, and stress than people who aren't fit.⁹
• Deal with stress. Reducing stress may mean fewer relapses. For more information, see the topic Stress Management.
• Get enough sleep. This is very important. Sleep can help mood and stress levels.
• Eat healthy foods. This helps the body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.

Sometimes people who have schizophrenia are too sick to seek treatment on their own. If the symptoms are severe, you may have to force the person to get treatment. Talk with your health care providers and/or local law enforcement officials about the laws and procedures in your area for getting treatment in this situation. If you have this information before you need it, it will reduce your fears and concerns and make it easier for you.

Emergency help

Some people who have schizophrenia may become aggressive or violent at times.⁷Call 911 or other emergency help if you notice:

• Warning signs of suicide, such as talking about death or heavy use of drugs or alcohol.
• Warning signs of violence towards others, such as talking about harming someone or becoming aggressive.

Helping yourself

Supporting or caring for someone who has schizophrenia is not easy. Finding your own support can help you deal with the illness and the sense of loss you may feel.

• Take care of yourself. Do things you enjoy, such as seeing family or going to movies.
• Don't feel you need to do everything possible to help a loved one who has schizophrenia. Remember that you need to respect the wishes and choices of your loved one, unless those wishes and choices are dangerous. Everyone learns from a wrong choice or mistake. Recovery may be faster if your loved believes that family members trust him or her with decision making.
• Don't do it alone. Ask others to help you, or join a support group. The more support you have, the more help you can give.
• Get help from a local organization. Your city or state may have programs to help you. Ask at your local or state health department. The National Alliance on Mental Illness (NAMI) provides contact information for support organizations nationwide. For more information, go to www.nami.org.

These caregiver tips also can help you.

Organizations

Related Information

• Reducing Medication Costs
• Support Groups and Social Support

Citations

1. Sadock BJ, Sadock VA (2007). Schizophrenia. In Kaplan and Sadock's Synopsis of Psychiatry, 10th ed., pp. 467–497. Philadelphia: Lippincott Williams and Wilkins.

2. Ho BC, et al. (2003). Schizophrenia and other psychotic disorders. In RE Hales, SC Yudofsky, eds., Textbook of Clinical Psychiatry, 4th ed., pp. 379–438. Washington, DC: American Psychiatric Publishing.

3. Buchanan RW, Carpenter WT Jr (2005). Schizophrenia. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Textbook of General Psychiatry, 8th ed., vol. 1, pp. 1329–1558. Philadelphia: Lippincott Williams and Wilkins.

4. Sørensen HJ, et al. (2003). Do hypertension and diuretic treatment in pregnancy increase the risk of schizophrenia in offspring? American Journal of Psychiatry, 160(3): 464–468.

5. American Psychiatric Association (2000). Schizophrenia section of Schizophrenia and other psychotic disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 287–313. Washington, DC: American Psychiatric Association.

6. Bustillo JR, et al. (2001). The psychosocial treatment of schizophrenia: An update. American Journal of Psychiatry, 158(2): 163–175.

7. Lehman AF, et al. (2004). Practice guideline for the treatment of patients with schizophrenia, second edition. American Journal of Psychiatry, 161(2, Suppl): 1–56.

8. Drake RE, et al. (2000). Evidence-based treatment of schizophrenia. Current Psychiatry Reports, 2(5): 393–397.

9. Buchner DM (2008). Physical activity. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., pp. 64-67. Philadelphia: Saunders.

Other Works Consulted

• Carpenter WT, Thaker GK (2004). Schizophrenia. In DC Dale, DD Federman, eds., ACP Medicine, section 13, chap. 7. New York: WebMD.

• Ghaziuddin N, et al. (2004). Practice parameter for use of electroconvulsive therapy with adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(12): 1521–1539.

• Murphy KC (2002). Schizophrenia and velo-cardio-facial syndrome. Lancet, 359(9304): 426–430.

• Veterans Administration, U.S. Department of Defense (2004). Management of Persons With Psychoses. Available online: http://www.oqp.med.va.gov/cpg/PSY/PSY_cpg/content/toc.htm.