Schizophrenia

Cause

Experts don't know what causes schizophrenia. It may have different causes for different people. Some causes may be related to:

• Genetics. Your chances of getting schizophrenia are greater if your parent or sibling has it. But most people who have a family member with schizophrenia don't get it.
• Changes in brain chemistry. Neurotransmitters send messages between parts of the brain. They may not work the right way in people who have schizophrenia.
• Changes in brain structure. Certain regions of the brain may be larger or smaller than they are in most people.

Schizophrenia isn't caused by anything you did, by personal weakness or bad choices, or by the way your parents raised you.

What Increases Your Risk

Schizophrenia is a severe mental health condition. Experts don't know what causes it or why some people get it and others don't. But some things increase your chances of getting it. These are called risk factors.

You may be at risk for schizophrenia if:

• A parent or sibling has it.
• Before you were born, there were certain problems during the pregnancy. For example, you may have a higher risk if your mother didn't get enough to eat (malnutrition) or had a viral infection.

Life stressors may also play a role in the start of symptoms or cause them to start up again. This may include substance use, especially marijuana use, and major life events like the loss of a job or leaving home for the first time.

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Symptoms

Symptoms of schizophrenia include:

• Negative symptoms. "Negative" doesn't mean "bad." Negative symptoms are things that are "lost" from your personality or how you experience life. You may:
  • Not care about things.
  • Have no interest in or drive to do things.
  • Not take care of yourself, such as not bathing or not eating regularly.
  • Find it hard to say how you feel.
• Positive symptoms. "Positive" doesn't mean "good." Positive symptoms are things "added" or "new" to your personality or how you experience life. They include:
  • Hearing or seeing things that aren't there (hallucinations).
  • Having thoughts or ideas that aren't true (delusions).
  • 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.
  • Having trouble talking clearly to others.

Symptoms usually start as a teen or young adult, but they may start later in life.

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What Happens

There are four stages of schizophrenia: prodromal phase, active or acute phase, remission, and relapse.

Prodromal phase

Schizophrenia usually starts with this phase, when symptoms are vague and easy to miss. In fact, schizophrenia is rarely diagnosed at this time.

These first symptoms often include being withdrawn, having outbursts of anger, or behaving oddly.

This phase can last for days, months, or years.

Active, or acute, phase

In this phase, you start to have symptoms such as hallucinations, delusions, or confusing thoughts and speech.

This is when schizophrenia usually is diagnosed.

Remission and relapse

After an active phase, symptoms get better, especially with treatment. Life may be more "normal." This is called remission. But symptoms may get worse again, which is called a relapse.

Over time, you may develop a unique pattern of illness that often stays the same throughout your life. Or you might have fewer relapses as you get older and may even have no symptoms.

When to Call a Doctor

Call 911 or other emergency services if you (or a loved one with 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 toward others, such as thinking or talking about harming someone or becoming aggressive.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Call a doctor if you (or a loved one with 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 signs of schizophrenia, such as talking to people who aren't there 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.

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Exams and Tests

Your doctor will ask you questions about your health and about any symptoms you may have had, such as hearing voices or having confusing thoughts. You'll 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 an MRI. The CT scan or MRI will check the size, structure, and function of your brain.

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Treatment Overview

When schizophrenia is not treated, the risks are higher for suicide, a hospital stay, and other problems. Medicines can help your symptoms. Counseling and therapy can help you change how you think about things and cope with the condition.

Early treatment called coordinated specialty care (CSC) may help a person who is having their first episode of psychotic thoughts. Ask your doctor about CSC.

The goals of treatment are to:

• Reduce or stop symptoms.
• Reduce the number of relapses.
• Make a personal plan for your recovery by setting and meeting goals for home, work, and relationships.

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 get the support you need.

Medicines and other treatment

Antipsychotic medicines are often used to treat schizophrenia. They include aripiprazole, clozapine, and haloperidol.

Other medicines may include:

• Antianxiety medicines. Examples are clonazepam and diazepam.
• Antidepressants. Examples are amitriptyline, citalopram, desipramine, escitalopram, and fluoxetine.

Medicines help your symptoms. It's important to take your medicines on schedule to keep your moods even. When you feel good, you may think that you don't need them. But it is important to keep taking them. If you struggle to remember to take your medicine, ask your doctor about long-active medicines that are injected (shots).

If medicine and therapy aren't 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 that can help your symptoms.

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

Counseling and therapy

These include:

• Cognitive behavioral therapy. It helps you to change the way you think about things. And it helps you understand why it's important to prevent a relapse and take steps to do so.
• Counseling. This can take place one-on-one or in a group setting. It helps you improve your relationships, deal with your symptoms, and meet your goals.
• Family therapy. This is a type of counseling that helps you and your family work out problems when they occur. It usually includes education about schizophrenia and its treatment.

When treatment is stopped

People who have schizophrenia often stop treatment. This may be because they don't understand that they have an illness. Or it might be 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 it might happen months later. A later relapse makes it hard to see that stopping the medicine was the cause. During a relapse, some people who have schizophrenia may need to spend time in a hospital.

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Self-Care

Follow your treatment plan

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. When you feel good, you may think that you do not need your medicines, but it is important to keep taking them as scheduled.
• Go to your counseling sessions. Call and talk with your counselor if you cannot attend or do not think the sessions are helping. Do not just stop going.
• Go to any skill training your doctor recommends. This may include training for social or job skills.
• Go to a support group. A support group gives you the chance to talk with others who are going through the same things you are.
• Work with your family or close friends. They can help you get the right treatment, deal with your symptoms, and manage your daily activities.
• Learn about schizophrenia. This can improve the quality of your life and the lives of those who care about you.
• Learn how to recognize the first signs of relapse. A relapse happens when symptoms return or get worse after you have been doing better. Signs of a relapse include not wanting to do things with others and having problems concentrating. Have a plan to deal with relapse and get help right away.
• Help yourself by focusing on your recovery goals and learning to see schizophrenia as one part of your life, not your entire life.

Live a healthy lifestyle

• Do not drink alcohol or use drugs. Having problems with drugs or alcohol makes treating schizophrenia harder. If you have problems with drugs or alcohol, you need to treat both that problem and schizophrenia to help yourself get better. Talk to your doctor if you have this kind of problem.
• Get plenty of exercise every day. Go for a walk or jog, ride your bike, or play sports. Exercise and activity can keep you fit.
• Relieve stress. Reducing stress may mean fewer relapses.
• Get enough sleep. Sleep can help your mood and make you feel less stressed.
• Eat healthy foods. These include whole grains, dairy products, fruits, vegetables, and protein.
• Do not smoke. Smoking increases the risk for other diseases, such as cancer and heart disease. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Learn more

Watch

Medicines

Many types of medicines can help you. It might be best to use more than one, but it may take time to find which medicines work well for you.

Medicines used most often include:

• First-generation antipsychotics. Examples are chlorpromazine, haloperidol (Haldol), and perphenazine. They are used to reduce anxiety and agitation. They also keep you from hearing or seeing things that aren't there (hallucinations) and from believing things that aren't true (delusions).
• Second-generation antipsychotics. Examples are aripiprazole (Abilify) and risperidone (Risperdal). These medicines keep you from hearing or seeing things that aren't there (hallucinations) and from believing things that aren't true (delusions). They also help the negative symptoms, like not caring about things or finding it hard to say how you feel. These medicines may have fewer side effects than first-generation medicines.

Other medicines may be used with antipsychotics. These include antianxiety and antidepressant medicines.

These medicines sometimes have severe side effects. Always talk to your doctor about how they are working and how you are feeling. If you feel that a medicine isn't right for you, your doctor can help you find a new one. Don't stop taking your medicines unless you talk to your doctor.

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Helping Someone Who Has Schizophrenia

As a family member or close friend, you can help take care of someone who has schizophrenia. You play an important role in the person's life and treatment. Here are some ways you can give support.

• Learn about schizophrenia. Understand what happens in schizophrenia and how you and the person can cope with it. This may make it easier for both of you to work together on treatment.
• Work together as a family. You and your family may benefit from therapy even if the person with schizophrenia doesn't want to participate.
• Encourage the person to take their medicines.
• Be calm and soothing when the person has severe symptoms. Symptoms may include hallucinations and paranoia. Avoid arguing or dismissing what your loved one is experiencing. Try using distraction or change the environment. Call for help if you think the situation could become dangerous.
• Work with the person's health care team. Keep in touch with the person's doctor, therapist, or counselor about how things are going. And work with teachers and other members of your community when needed.
• Learn the warning signs that the person is relapsing. Common signs include staying away from or not being interested in other people, having problems concentrating, and daydreaming.
• Plan for relapse. Make a plan with all family members about how to care for the person during times of relapse.
• Try to accept that schizophrenia is a long-term condition. People who do this usually adjust better to helping someone.
• Learn to manage your emotions. Strong emotions can make recovery harder and more stressful for the person. Try to stay calm, and avoid being overly critical or involved. Don't blame them for their behavior.
• Be aware of attitudes. Be aware of your own and other people's negative attitudes toward the condition and the person you're caring for.
• Encourage daily health. Help the person with good health habits, like getting enough sleep and avoiding alcohol and drugs.

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