Schizophrenia

This factsheet aims to explain schizophrenia. You will find a description of schizophrenia, its symptoms and what treatments are available. If you are experiencing schizophrenia you will find suggestions of ways that you may help yourself and what options are open to you. You will also find ideas on how friends and family may help.

What is schizophrenia?

It is what is known as a psychotic illness, meaning that a person with schizophrenia may experience delusions, hallucinations and disordered thoughts. They may have little insight into their illness, and commonly do not recognise that they are ill.

Schizophrenia is a severe illness and though there is as yet no cure, it is treatable with drugs, and most people diagnosed with schizophrenia respond well to treatment. However, around a third of people with schizophrenia do not respond well to treatment and may experience symptoms for a long time.

What are the symptoms of schizophrenia?

Psychiatrists make a diagnosis of schizophrenia on the grounds of two types of symptoms known as positive and negative symptoms.

Acute schizophrenia is characterised primarily by what are termed positive symptoms. Chronic schizophrenia is characterised primarily by what are termed negative symptoms.

Positive symptoms
The positive, also known as florid, symptoms of schizophrenia appear as an excess or distortion of everyday behaviour. Positive symptoms include psychotic features such as delusions or hallucinations, disorganised speech or thinking, and chaotic or confused behaviour.

Delusions are erroneous beliefs that usually involve a misinterpretation of perception or experience. For example, people may believe that they are religious figures or members of the royal family, or they may believe they are being persecuted by the police, or that a group of people are after them.

Hallucinations can be experienced through any of the senses, but auditory hallucinations are by far the most common. Most commonly, people may believe they hear voices in their head telling them to do things, or that the television is speaking to them directly.

Disorganised speech and thinking are characterised by losing track of conversations, changing from one topic to another unrelated topic, or giving loosely or totally unrelated answers to questions. Similarly, thought processes may be jumbled and not follow any discernible sequence.

Chaotic or disorganised behaviour may be expressed in a variety of ways, ranging from childishness to unpredictability and agitation. People may appear dishevelled or dress in an unusual manner, they may display inappropriate sexual behaviour, or extreme agitation such as shouting and swearing for no apparent reason.

Negative symptoms
The negative symptoms of schizophrenia appear as a decrease or loss of everyday functions. Negative symptoms include flattened affect, poverty of speech and loss of motivation.

Flattened affect is characterised by a loss of emotional expressiveness. A person’s face may appear expressionless, they may have poor eye contact and reduced body language.

Poverty of speech,also known as alogia, is manifested by a person’s loss of fluency in spoken communication. They are less likely to initiate conversations and replies to questions may be met with very brief responses.

Loss of motivation, also known as avolition, is characterised by difficulties in initiating or taking part in activities. The person may appear withdrawn and show no interest in participation.

What causes schizophrenia?

Nobody knows for sure what causes schizophrenia. It is likely to be caused by a combination of factors that may be different from person to person. Schizophrenia can run in families, suggesting a genetic link. It has been found that people with schizophrenia have differences in their brain chemistry that might cause the illness. There is some evidence that brain damage before or during birth could be a cause of schizophrenia. Psychological stress seems to trigger schizophrenia and cause relapses in some people.

Overall, it appears that schizophrenia is caused by a combination of factors; someone’s genetic make-up could give them a pre-disposition towards the illness, but stressful life-events or experiences could trigger the onset of symptoms.

How common is schizophrenia?

Schizophrenia is the most common major mental health problem. It affects one person in a hundred. Symptoms can start at any age, but most commonly occur in the late teens or early twenties. More or less equal numbers of young men and women develop schizophrenia, though women are usually four or five years older than men at the onset. Schizophrenia occurs in all cultures and its prevalence is much the same in every country.

It is estimated that around one third of people diagnosed with schizophrenia only experience one episode of illness, another third may have occasional schizophrenic episodes, while the final third may have to live with schizophrenia as a long-term condition.

What treatments are available?

There is, as yet, no cure for schizophrenia. However, most people improve with drug treatment, especially when combined with other forms of help such as support from family and friends, community mental health teams, day centres, social workers, supported accommodation, or hospital admission.

Drug treatment can be very effective at controlling the most disturbing symptoms of schizophrenia. Anti-psychotic drugs, also known as major tranquillisers or neuroleptics, are usually prescribed to control the positive symptoms of the illness, such as delusions, paranoia and hallucinations. However, they are usually less effective at treating the negative symptoms, such as flattened affect and loss of motivation.

Anti-psychotic drugs can have unpleasant side-effects, particularly when taken at high doses. The side effects can include, among other things, stiffening of muscles, tremors, sedation, restlessness and weight gain. It is important to tell your doctor if you are experiencing side-effects as other drugs can be prescribed which can alleviate some of these symptoms.

A broad range of drugs is available, but because different people respond to drugs in different ways, it may take some time to discover what works best for a particular person. There is no quick-fix treatment for schizophrenia, so you should be aware that any prescribed drugs will probably have to be taken for a long period of time.

Although many people diagnosed with schizophrenia can be treated at home or in the community, people with severe symptoms may require hospital admission for a period of assessment and treatment. Hospital admission can provide levels of care and attention that would not be possible at home. It can also give medical staff the opportunity to accurately assess a person’s condition over a period of time, and to provide a broader range of drug treatment than might be possible otherwise. Most people who are admitted to hospital go voluntarily, however, in some extreme situations you can be admitted to hospital compulsorily under the Mental Health Act 1983.

Which treatment may be right for me?

Different people respond to treatments in different ways. What works well for one person may not work well for another. Speaking to your doctor will help you weigh up the pros and cons of the treatments available. Your doctor or psychiatrist should be able to provide you with information on how treatments work, how effective they are, what side-effects you may experience and how these can be minimised.

For more information on drug treatments please see Medical Methods of Treatment

What can I do to help myself?

There are many ways in which you can help yourself cope with schizophrenia. It is important that you come to understand the nature of your illness and its symptoms. If you can recognise the early signs of a relapse or deterioration in your mental health, you can seek help and treatment before your condition worsens.

Talking Treatments
Talking therapies such as psychotherapy, counselling and cognitive behaviour therapy can help people living with schizophrenia. They can provide you with emotional support and enable you to recognise problems, develop coping strategies, and learn how to prevent crisis situations developing.

Self-help groups
Many people find it helpful to meet other people in a similar position. It can be very useful to share experiences with those who may be going through the same thing you are. There are opportunities for mutual support, and you may get ideas of what things other people have found helpful to them. Above all, it is an opportunity that can help you realise that you are not alone in how you are feeling.

Care for yourself
The negative symptoms of schizophrenia can affect how people look after themselves. Many people lose the motivation to look after themselves properly. You may feel better if you are able to eat properly, pay attention to your physical appearance, and don’t abuse alcohol or drugs. Be kind to yourself, allow yourself treats, and try not to cut yourself off from other people

What can friends and family do to help?

It is important for friends and family to try and gain an understanding of what schizophrenia is, how it affects people, and how best to help. Friends and relatives can provide emotional and practical support and can encourage people to seek appropriate support and treatment, especially if the person has little insight into the fact that they are ill. They can become involved in treatment plans and, above all, make the person feel wanted, needed and loved.

A major role of friends and family can be to monitor the person’s mental state, watching out for any signs of relapse, encouraging them to take their medication and to attend medical appointments etc. If carers are concerned about any deterioration in a person’s mental state they should alert the doctor, psychiatrist or mental health team as soon as possible in order to prevent the possibility of a major relapse.

Friends and family can provide invaluable support to someone experiencing mental health problems, however, there is no denying that it can be distressing, stressful or confusing for people trying to cope with a loved one who is in the acute stages of schizophrenia. Friends and family may feel that they need emotional or practical support to help them care for their loved one. There are a number of voluntary organisations that can provide support and information for carers, and carers can have their own needs assessed by social services if the person they are caring for has a community care assessment.

Where can I find help and support?

There is a wide a range of services available that can help provide care, support and information to people experiencing anxiety, their friends, relatives and carers. You may find some of the following useful:

SANEline / SANEmail
1st Floor Cityside House, 40 Adler Street, London, E1 1EE
helpline:0845 767 8000, fax: 020 7375 2162
email: sanemail@sane.org.uk
web:www.sane.org.uk
SANEline and SANEmail offer emotional support and information to those experiencing mental health problems,
their families and carers.

Arbours Association
6 Church Lane, London N8 7BU
tel. 020 8340 7646, fax: 020 8342 5822
crisis centre: 020 8340 8125
email: coordinator@arboursassociation.org
web: www.arboursassociation.org
Offers alternatives to traditional psychiatric hospital treatment in the form of intensive psychotherapy and residential services.

British Association for Behavioural and Cognitive Psychotherapies (BABCP)
Victoria Buildings, 9 – 13 Silver Street, Bury, BL9 0EU
tel.0161 797 4484, fax: 0161 797 2670
email: babcp@babcp.com
web: http://www.babcp.com/
The full directory of psychotherapists is available online.

British Association for Counselling and Psychotherapy (BACP)
BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire, LE17 4HB
tel. 0870 443 5252
email: bacp@bacp.co.uk
web: http://www.bacp.co.uk/
See website or send A5 SAE for details of local practitioners.

British Psychoanalytic Council
West Hill House, 6 Swains Lane, London N6 6QS
tel. 020 7267 3626, fax: 020 7267 4772
email: mailto:mail@bcp.org.uk
web: http://www.bcp.org.uk/
A linking body of psychoanalytical psychotherapist societies.

Carers UK
20–25 Glasshouse Yard, London EC1A 4JT
carers line: 0808 808 7777, tel. 020 7490 8818, fax: 020 7490 8824
email: info@ukcarers.org
web: http://www.carersonline.org.uk/
Information and advice on all aspects of caring.

Hearing Voices Network
79 Lever Street, Manchester, M1 1FL
helpline: 0845 122 8641
email: mailto:hearingvoices@care4free.net
web: www.hearing-voices.org
User-led network. Information about coping strategies and support groups

Rethink
28 Castle Street, Kingston-upon-Thames, Surrey KT1 1SS
tel. 0845 456 0455 advice line: 020 8974 6814
email: advice@rethink.org / info@rethink.org
web: http://www.rethink.org/
Working to help everyone affected by severe mental illness, including schizophrenia, to recover a better quality of life

Samaritans
The Upper Mill, Kingston Road, Ewell, Surrey KT17 2AF
helpline: 08457 90 90 90, fax: 020 8394 8301
email: jo@samaritans.org
web: http://www.samaritans.org/
24-hour telephone helpline offering emotional support for people who are experiencing feelings of distress or despair, including those that may lead to suicide.

United Kingdom Council for Psychotherapy (UKCP)
2nd Floor Edward House, 2 Wakley Street, London, EC1V 7LT
tel. 020 7014 9955, fax: 020 7436 3013
email: ukcp@psychotherapy.org.uk
web: http://www.psychotherapy.org.uk/
Umbrella organisation for psychotherapy in UK. Regional lists of psychotherapists are available free.

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