What is schizophrenia?

Schizophrenia is a mental illness, however it is not a single disease with a single cause. Specifically, it affects thoughts, behaviour, speech, and perception. A person with schizophrenia may experience an altered perception of reality, meaning they may have trouble distinguishing between what is real and what is not.

Schizophrenia may cause intense delusions and hallucinations as well as long periods of reduced expression, motivation, and general functioning.

Schizophrenia is present in all countries, cultures, and genders. It affects around 24 million people worldwide^[1] and about 1 in every 100 people in Australia^[2]. It usually develops in teenage years or early adulthood, but it can also start later in life. In some rare cases, it can develop in childhood.

Schizophrenia is thought to affect men and women in equal measure, although it may have an earlier onset in males.

Symptoms of schizophrenia

There is no reliable way to predict exactly how schizophrenia will affect someone’s life. The symptoms, severity and effects of the illness can be different between individuals, and the efficacy of any treatment and support can significantly influence their wellbeing.

About 20 to 30 per cent of people with schizophrenia experience it in the form of a few brief episodes.^[3] For others, it’s an ongoing condition.

Schizophrenia tends to initially develop as changes in someone’s thought patterns, emotional responses, and behaviour. These symptoms may be inconsistent or erratic – they ‘come and go’, but if left untreated, they can worsen over time.

People with schizophrenia may experience two or more of the following symptoms:

• Thinking difficulties –Concentration, memory, planning, and organisational ability are affected, making it difficult to make decisions, reason, communicate, or complete simple daily activities.
• Delusions – There is a fixation on beliefs that are implausible or not true, such as false beliefs of being persecuted or targeted or being under external control.
• Hallucinations –Things are experienced that no one else can hear, see, taste, touch, or smell. These most commonly involve hearing voices. These experiences are very real to the person affected but are not actually present.
• Abnormal movement – Catatonia, reduced facial expressions, or agitation are experienced.
• Lack of drive – Difficulty engaging in common daily activities, such as basic domestic tasks. It should be noted that this is not laziness but is an aspect of the mental illness.
• Blunted emotional expression – The capacity to express emotion is reduced, often accompanied by inappropriate reactions to events that may be considered happy or sad.
• Social withdrawal – The capacity to interpret other people’s emotions and motives may be affected, resulting in social withdrawal. This may be motivated by the fear that someone is going to harm them, shame them due to the loss of social skills, or because they do not have the energy to engage.
• Lack of awareness – It is common for people with schizophrenia to be unaware that what they are experiencing is not normal. This can be a reason behind the common reluctance to accept treatment.

Early signs of schizophrenia

A person experiencing the onset of schizophrenia is likely to withdraw from others. They may also feel depressed and anxious or develop unusual ideas or extreme fears. Addressing these early signs is important for early access to treatment.

Subtler signs may present earlier. They may include turbulent relationships, poor performance in studies or work, and reduced motivation.

Some common early signs include^[4]:

• Preoccupation or obsession with a particular subject.
• Speech or writing that is very fast, muddled, irrational or hard to understand.
• Loss of concentration, memory and/or attention.
• Thoughts are hard to follow.
• Increased sensitivity to light, noise and/or other sensory inputs.
• Increased anger, aggression, or suspiciousness.
• Inactivity and/or hyperactivity, including behaviour that is reckless, strange, or out of character.
• An inability to feel or express emotion.

Other complications

People with schizophrenia tend to have a shorter lifespan than the general population. One reason is that they are at greater risk of experiencing health problems such as cardiovascular disease and high blood pressure.^[5] WHO also reports that worldwide, two in three people living with schizophrenia do not receive care for the condition.^[6]

Functional decline

People with schizophrenia can find working, keeping up social contact, and organising daily activities a challenge. The risk of unemployment or not being able to live independently increases with the severity of the illness.

Stigma and social isolation

Schizophrenia is a highly complex condition that has spawned numerous stereotypes and misconceptions. Consequently, people with schizophrenia are among the most highly stigmatised and socially marginalised people in our community.

More information: here are some damaging myths about people living with schizophrenia.

Suicide risk

Sadly, suicide is one of the main causes of death for people with schizophrenia. People with schizophrenia are more likely to die from suicide compared to the rest of the population. This may be attributed to delusions or changes in mood or even as a result of the isolation that often accompanies the illness. Additionally, for some, the fear of recurrence of psychotic symptoms may elevate their suicide risk.

Schizophrenia treatment

There is no cure for schizophrenia currently. However, it can be treated and managed.

A person with schizophrenia is better able to think and act like themselves again when they receive appropriate treatment. In fact, research indicates that the earlier treatment takes place, the better the outcome, including reduced overall impact of the illness.

Treatment can help people live productive and positive lives. However, similar to other illnesses, some people respond better to treatment than others.

A person concerned about schizophrenia can see their GP for an initial assessment. The GP may then refer the person to a specialist (usually a psychiatrist) for an in-depth diagnosis and treatment plans. Psychiatrists make their diagnosis based on a person’s individual symptoms and behaviour, usually over a period of time, to ensure that other causes are not the reason for what is being experienced.

Treatments may include medication, specialist therapies like cognitive behavioural therapy (CBT), mindfulness-based treatments, psycho-education, physical activity, and community support programs to help navigate friendships, health, work, study and living arrangements.

Treatment for schizophrenia can last from two to five years or sometimes longer. Some people need to continue treatment throughout their lives. Treatment may also change over time to improve results or reduce side-effects.

After the symptoms of schizophrenia are controlled, various types of therapy can continue to help people manage the illness and improve their lives, including help with study or work. These therapies can also help people improve social skills, deal with stress, and manage their symptoms.

Helping someone with schizophrenia

If you think you or someone you know might be experiencing schizophrenia, see your GP as soon as possible.

Informed support and understanding from loved ones are an important part of treatment. It helps to encourage the person with schizophrenia to stay connected to social networks and continue hobbies and pursuits they enjoy.

Family and friends of people with schizophrenia can often feel confused and upset, as the illness can affect those connected to the person with the illness. Support and education may be recommended for the support networks of someone with schizophrenia to help them cope with the effects of the illness and provide better support to their loved one.

More help

SuicideLine Victoria counsellors can help if you, or someone you know and care about is experiencing some of the symptoms of schizophrenia. SuicideLine Victoria is available 24/7. Call us on 1300 651 251.

If it is an emergency, call 000.

References

[1] https://www.who.int/mental_health/management/schizophrenia/en/

[2] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/schizophrenia

[3] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/schizophrenia

[4] https://www.sane.org/information-stories/facts-and-guides/schizophrenia

[5] https://www.sydney.edu.au/news-opinion/news/2017/02/06/physical-health-of-people-with-schizophrenia-needs-urgent-nation.html

[6] https://www.who.int/mental_health/management/schizophrenia/en/