Schizophrenia: Symptoms, Causes, Type, and Treatment

Schizophrenia affects how a person thinks, feels, and behaves. It is a severe mental health condition that requires ongoing treatment and support. This mental illness affects how your brain functions, which causes disruptions in your perception of reality. It is a brain disorder because it affects the brain’s structure and function.

Hallucinations, delusions, disorganized thinking and speech, lack of motivation, and difficulty in expressing emotions are some of the main characteristics of schizophrenia. Hallucinations refer to seeing, hearing, or feeling things that are not real, while delusions are false beliefs that a person holds despite evidence.

Manassa Hany from StatPearls Journal  “Schizophrenia” points out that schizophrenia’s cause is a combination of genetic, environmental, and brain chemistry factors. Individuals with a family history of schizophrenia are at a higher risk of developing the disorder.

Treatment for this mental illness involves a combination of medication, therapy, and support from loved ones and mental health professionals. Antipsychotic drugs help to reduce symptoms and improve the quality of life for individuals with schizophrenia. Therapy can also help manage symptoms and teach coping strategies.

What is Schizophrenia?

Schizophrenia is a severe chronic mental illness that affects how a person thinks, feels, and behaves, according to the National Institute of Mental Health article titled “Schizophrenia,”. It is characterized by significant impairments in perceiving reality and changes in behavior, including persistent delusions, hallucinations, disorganized thinking and speech, highly disorganized or abnormal behavior, and “negative symptoms” such as reduced emotional expression and social withdrawal.

Schizophrenia affects approximately 24 million people worldwide, or about 1 in 300 people (0.32%). It affects less than 1% of the adult population in the United States, according to the American Psychiatry Association post on “What is Schizophrenia?” by Felix Torres, M.D. (March 2024).

In Gogtay N, Vyas NS & Testa R’s 2011 review “Age of onset of schizophrenia: perspectives from structural neuroimaging studies” in Schizophr Bull Journal, the onset of schizophrenia typically occurs between the ages of 16 and 30, with symptoms often first appearing in the late teens to early 20s for men and the late 20s to early 30s for women.

The severity of schizophrenia varies from person to person. While some individuals experience only one psychotic episode in their lifetime, others have multiple episodes or struggle with ongoing symptoms. 

In G Harrison and colleagues’ 2001 study, “Recovery from psychotic illness: a 15- and 25-year international follow-up study” from the Journal of Psychiatry, the results showed that approximately one-third of people with schizophrenia experience complete remission of symptoms. From this study, the researchers suggest that schizophrenia is associated with a higher risk of early mortality, with affected individuals being 2 to 3 times more likely to die early compared to the general population. This increased mortality is often due to co-occurring physical health conditions such as cardiovascular disease, metabolic disorders, and infectious diseases.

While there is no cure for schizophrenia, treatments are available that help to manage symptoms and improve quality of life. These include a combination of antipsychotic medications and psychosocial interventions. Early diagnosis and treatment are crucial for improving long-term outcomes and reducing the frequency of relapses and hospitalizations.

What are the Symptoms of Schizophrenia?

The most observed symptoms of schizophrenia are hallucinations, delusions, disorganized speech, and abnormal motor behavior, as seen in Hany M, Rehman B, and Rizvi A’s 2024 review “Schizophrenia” in StatPearls Publishing Journal. 

These symptoms interfere with a person’s perception of reality, thought processes, and social interactions. Schizophrenia often develops gradually, with early signs that may be subtle and easily overlooked.

The most rare symptoms of schizophrenia are given below.

• Hallucinations: Hallucinations are vivid sensory experiences that occur without any external stimuli. They affect any of the senses, but auditory hallucinations, such as hearing voices, are the most common. Hallucinations disrupt a person’s perception of reality, leading to confusion and distress.
• Delusions: Delusions are firmly held false beliefs that persist despite clear evidence to the contrary. Common types include paranoid delusions (believing others are plotting against them) and grandiose delusions (believing they have exceptional abilities or fame). Delusions affect a person’s behavior and relationships, often leading to mistrust and isolation.
• Disorganized Speech: Disorganized speech is characterized by incoherent or illogical communication, making it challenging for others to follow the person’s thoughts. This hinders effective communication, creating barriers in social interactions and complicating treatment.
• Negative Symptoms: Negative symptoms refer to decreased normal emotional responses, motivation, and social engagement. These symptoms lead to significant challenges in daily functioning and quality of life as individuals struggle to connect with others or find joy in activities.
• Cognitive Impairment: Cognitive impairment involves difficulties with attention, memory, and executive functioning, which affects a person’s ability to plan, organize, and execute tasks in daily life. This impairment impacts essential skills needed for independent living and maintaining employment.

Living with schizophrenia feels like a constant struggle between reality and an altered perception of the world. Individuals may experience confusion, fear, and isolation as they navigate their symptoms, particularly during first-episode psychosis (FEP). Early intervention and proper treatment improve outcomes and quality of life for those affected by this complex disorder.

What are the Positive Symptoms of schizophrenia?

Positive symptoms of schizophrenia are exaggerated or distorted perceptions, thoughts, and behaviors that individuals do not typically experience without the condition, according to an article on Mental Health UK titled “Symptoms of schizophrenia,.”

These symptoms are called “positive” because they enhance or distort normal functioning rather than diminishing it.

The positive symptoms of schizophrenia are listed below.

• Hallucinations: Sensory experiences that occur in the absence of external stimuli. Hallucinations affect any of the five senses, but auditory hallucinations (hearing voices) are the most common. These voices are either angry, urgent, or demanding and sound like one or many. Visual hallucinations (seeing things that aren’t there) and other sensory hallucinations are also possible.
•  Delusions are false beliefs firmly held despite contrary evidence. They take various forms, such as paranoid delusions (believing one is being persecuted or monitored), grandiose delusions (believing one has special powers or importance), or referential delusions (believing that random events or occurrences have special meaning for the individual). 
• Disorganized thinking and speech: Difficulty organizing and expressing thoughts coherently. This manifests as jumping between unrelated topics, providing unrelated answers to questions, or speaking in a complex way for others to understand. It also involves difficulty concentrating or keeping track of thoughts.
• Disorganized or abnormal motor behavior: Unusual or excessive movement patterns. These can range from childlike silliness to unpredictable agitation. In severe cases, they result in difficulty performing daily tasks or responding to instructions.
• Psychotic episodes: A psychotic episode refers to a period when these positive symptoms are particularly severe or acute. During such episodes, the individual may lose touch with reality and experience intense hallucinations or delusions.

The severity, frequency, and duration of these symptoms can vary significantly among individuals with schizophrenia. Stress, lack of sleep, or medication discontinuation may trigger or exacerbate symptoms.

What are the Negative Symptoms of Schizophrenia?

The negative symptoms of Schizophrenia include blunted affect, alogia, anhedonia, and apathy, according to a study titled “Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment” authored by Christoph U Correll (Feb 2020). These symptoms are categorized as unfavorable because they involve the absence or reduction of expected behaviors and emotions.

The negative symptoms of Schizophrenia are listed below.

• Blunted Affect: This symptom is characterized by a lack of emotional expression, reduced facial expressions and body language, and a decrease in the intensity of emotions. Individuals with this symptom may have difficulty responding appropriately to situations or events.
• Alogia: This refers to the poverty of speech and thought. It manifests as reduced speech output, delayed conversation responses, or difficulty organizing and expressing thoughts coherently.
• Anhedonia: Anhedonia is the inability to experience pleasure or find enjoyment in previously pleasurable activities. This includes hobbies, social interactions, and even basic daily activities.
• Apathy: Apathy refers to a lack of motivation or interest in activities. It can manifest as decreased productivity, neglect of personal hygiene, or lack of goal-oriented behavior.

These adverse symptoms interfere with an individual’s daily functioning and quality of life. They also increase the severity and frequency of positive symptoms such as hallucinations and delusions.

What are the Cognitive symptoms of Schizophrenia?

The cognitive symptoms of schizophrenia include impaired higher or executive functioning, impairment of short-term working memory, attention deficit, dementia, verbal learning and memory deficits, executive functioning deficits, processing speed deficits, and social cognition deficits, according to the Molecular Psychiatry Journal titled, “Cognitive impairment in schizophrenia: etiology, pathophysiology, and treatment”(Jan 2024).

The cognitive symptoms of Schizophrenia are listed below.

• Impaired higher or Executive Functioning: This involves difficulties in taking in, retaining, and interpreting information and using it to perform tasks or functions. This impairment can become severe and affect daily activities, such as following instructions or engaging in intellectual activities.
• Impairment of Short-Term Working Memory: This symptom involves difficulties in retaining and processing new information, leading to memory lapses and learning new skills.
• Attention Deficit: Patients with schizophrenia often exhibit attention deficits, which manifest as difficulties in focusing, maintaining attention, or switching between tasks.
• Dementia: Cognitive decline in schizophrenia gets severe enough to warrant a secondary diagnosis of dementia, particularly in older individuals. This decline is linked to the age of onset and early intervention.
• Verbal Learning and Memory Deficits: Schizophrenia is associated with significant impairments in verbal learning and memory, which impacts daily functioning and social interactions.
• Executive Functioning Deficits: Executive functioning deficiencies, including planning, decision-making, and problem-solving, are common in schizophrenia and significantly impact daily life.
• Processing Speed Deficits: Patients with schizophrenia often exhibit slower processing speeds, which affects their ability to perform tasks efficiently.
• Social Cognition Deficits: Social cognition impairments, including difficulties understanding social cues and interpreting emotions, are common in schizophrenia and impact social interactions and relationships.

These cognitive symptoms impact daily functioning, social interactions, and overall quality of life. They are triggered or exacerbated by various factors, including the severity of positive and negative symptoms, medication side effects, and environmental stressors. Alleviating factors include cognitive training, behavioral therapy, and social support.

What are the symptoms of Schizophrenia in Children?

The symptoms of schizophrenia in children are hallucinations (seeing or hearing things that aren’t real), delusions (firmly held beliefs that aren’t based on reality), disorganized thinking and speech, difficulty with social interactions, and difficulty functioning in school or other daily activities., according to the Cleveland Clinic article on “Childhood Schizophrenia,.”

Children with schizophrenia also experience changes in their emotions, such as flat affect (a lack of emotional expression), and may have trouble understanding the feelings of others. Additionally, they display odd behaviors or movements, have difficulty paying attention or focusing on tasks, and struggle with memory and problem-solving skills.

What are the symptoms of Schizophrenia in Women?

The symptoms of schizophrenia in women are delusions, hallucinations, disorganized thinking and speech, reduced emotional expression or lack of emotion, social withdrawal, and difficulty in concentrating, according to the Medical News Today article titled, “What to know about schizophrenia in females” by Mandy French  (February 2024). These are also known as the “positive” symptoms of schizophrenia.

On the other hand, men tend to experience more severe symptoms of schizophrenia, such as a higher rate of delusions and hallucinations.

How common is Schizophrenia?

Schizophrenia affects approximately 24 million people worldwide, according to Preksha Saparia and  Akshat Patel’s report “Schizophrenia: A Systematic Review” in the International Online Medical Council journal.  This report suggests that from 1990 to 2019, the raw global prevalence increased from 14.2 million to 23.6 million, while age-standardized prevalence remained stable. Therefore, it’s a common mental illness that significantly impacts a person’s life and those around them.

What are the Causes of Schizophrenia?

The causes of Schizophrenia are genetic, biological, and environmental factors, according to the Hopkins Medicine article titled “Schizophrenia.”

• Genetics (Heredity): Genetics is the study of how traits are passed down from parents to their offspring. Schizophrenia runs in families, indicating a genetic component. Multiple genes, rather than a single gene, contribute to the development of the disorder. Having a close relative with schizophrenia significantly increases the risk.
• Brain Chemistry and Circuits: Brain Chemistry refers to the complex interactions and chemical processes that occur in the brain, which enable us to think, feel, and behave. An imbalance in certain neurotransmitters, such as dopamine and serotonin, which regulate communication between brain cells, plays a role in the development of schizophrenia. Abnormalities in brain structure and function have also been observed in individuals with schizophrenia.
• Environmental Factors: Environmental factors are the external factors that affect an organism’s survival, growth, and development. Stressful life events, such as trauma, abuse, or social isolation, trigger the onset of schizophrenia in individuals who are genetically predisposed. Exposure to certain viruses, malnutrition, and drug use (particularly cannabis) during critical developmental periods also contributes to the risk of developing schizophrenia.

While these factors increase the risk of developing schizophrenia, not everyone who experiences them will develop the disorder. It is likely a combination of multiple factors that contribute to an individual’s susceptibility to schizophrenia.

What is the most common cause of Schizophrenia?

The most common cause of Schizophrenia is believed to be family history, according to a published study titled “Gene-Environment Interactions in Schizophrenia: A Literature Review” by Marah H. Wahbeh (Dec 2021).

The study highlights that schizophrenia has a vital genetic component but also emphasizes the significant role of non-genetic factors such as infections, cannabis use, and psychosocial stress. It discusses how interactions between genetic predispositions and environmental exposures can increase the risk of developing psychosis, underscoring the complexity of the disorder’s etiology.

What are the Types of Schizophrenia?

The types of schizophrenia include paranoid, hebephrenic, catatonic, undifferentiated, residual, and simple schizophrenia, according to a 2016 review “Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health” Rockville.

Paranoid Schizophrenia

Paranoid schizophrenia involves delusions and hallucinations, particularly auditory hallucinations like hearing voices. Individuals with paranoid schizophrenia often have a preoccupation with one or more delusions.

Disorganized (Hebephrenic) Schizophrenia

Disorganized schizophrenia is characterized by disorganized speech and behavior, flat or inappropriate affect, and impaired functioning. Individuals may exhibit bizarre behavior and have difficulty with daily activities.

Catatonic Schizophrenia

Catatonic schizophrenia involves disturbances in motor behavior, which can include catatonic stupor (immobility), catatonic rigidity, mutism, and posturing. Individuals may remain in the same position for hours.

Undifferentiated Schizophrenia

Undifferentiated schizophrenia is diagnosed when an individual displays symptoms from multiple subtypes but does not meet the criteria for any single subtype. It is a residual category for cases that do not fit neatly into the other subtypes.

Residual Schizophrenia

Residual schizophrenia is diagnosed when an individual has a history of at least one episode of schizophrenia but currently has no prominent positive symptoms. Negative symptoms like flat affect and social withdrawal may persist.

Simple Schizophrenia

Although not as widely discussed, simple schizophrenia is characterized by a gradual decline in functioning without prominent psychotic features such as hallucinations or delusions. Individuals may show signs of apathy, social withdrawal, and a lack of motivation, but the condition is less severe than others.

These types of schizophrenia vary in severity and the specific symptoms that they present. Individuals must receive an accurate diagnosis to receive the most effective treatment. 

What are the Treatments for Schizophrenia?

The treatments of Schizophrenia include medication and therapies. In medication, specific antipsychotic drugs such as Aripiprazole, Olanzapine, and Quetiapine are used, according to Patel KR, Cherian J, Gohil K, Atkinson D’s 2014 review on “Schizophrenia: overview and treatment options” Pharmacy and Therapeutics Journal.

The best treatment approach combines medication and therapy, as it helps individuals manage their symptoms and improve their quality of life. 

Medications

Medications are the drugs prescribed by medical professionals to help manage the symptoms of schizophrenia. The medication dosage is adjusted during the treatment depending on the individual’s response and side effects. Most drugs work by blocking dopamine receptors in the brain, which is believed to play a vital role in causing psychosis.

Therapies

Therapy involves various approaches that help individuals cope with the challenges of schizophrenia. These include cognitive behavioral therapy, family therapy, and supportive therapy. Cognitive Behavioral Therapy helps individuals recognize and change negative thought patterns, improving their response to symptoms. Family therapy provides support and education for families, helping them understand schizophrenia and improve communication.

Aripiprazole

Aripiprazole is a partial agonist at dopamine D2 receptors and has a high affinity for serotonin receptors, including 5-HT1A and 5-HT2A. This unique mechanism allows it to balance dopamine levels in the brain, which is crucial for managing both positive symptoms (like hallucinations) and negative symptoms (such as lack of motivation) of schizophrenia.

Olanzapine

Olanzapine is primarily an antagonist of dopamine D2 and serotonin 5-HT2A receptors. It is effective in reducing positive symptoms of schizophrenia but is also known for significant metabolic side effects, including weight gain and increased blood glucose levels.

Quetiapine

Quetiapine functions as an antagonist at multiple receptor sites, including serotonin and dopamine receptors. It is effective in alleviating both positive and negative symptoms of schizophrenia but is less effective than aripiprazole in some studies.

The best treatment for Schizophrenia depends on the individual’s condition and response to treatment. Working closely with a mental health professional to determine each person’s most effective treatment plan is essential.  

How can you treat Schizophrenia without medication?

Schizophrenia can be treated without medication through psychotherapy, particularly cognitive behavioral therapy (CBT) and cognitive enhancement therapy (CET), according to Bighelli I, Çıray O & Salahuddin NH’s 2024 review “Cognitive behavioral therapy without medication for schizophrenia.” in Cochrane Library Journal. 

CBT helps patients change their thought patterns and develop coping mechanisms, while CET teaches them to recognize triggers and organize their thinking. Other complementary treatments that benefit when used alongside traditional therapies include vitamin B supplements, deep brain stimulation cannabidiol (CBD), antioxidants like vitamin E, and Amino acids, such as taurine.

While these alternative treatments are beneficial, they are not intended to replace conventional strategies like medication and psychotherapy. A combination of treatments, including psychosocial therapy, social skills training, and support groups, is often the most effective approach for managing schizophrenia symptoms and improving quality of life.

What are the Risk Factors for Schizophrenia?

The common risk factors of Schizophrenia include a family history of the condition, life experiences such as living in poverty, stress or danger, and confident pregnancy and birth complications, according to a published study titled “Gene-Environment Interactions in Schizophrenia: A Literature Review” by Marah H. Wahbeh (Dec 2021).

Schizophrenia is considered a neurodevelopmental disorder, meaning it involves disruptions in the normal development and maturation of the brain. This can lead to differences in brain structure and function, which may contribute to the development of the condition.

Genetic factors play a significant role in the risk of developing schizophrenia. Multiple genes may be involved, and having a family history of the condition increases the risk. For example, if a parent or sibling has schizophrenia, the risk is higher.

How long does Schizophrenia last?

Schizophrenia is a chronic mental health condition that lasts for approximately 22 years, according to Huber G, Gross G, Schüttler R. A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatr Scand. 1975 This study suggests that following a 22.4-year mean duration of the illness, 22.1% of the patients exhibited total psychopathological remission, 43.2% displayed non-typical forms of remission, and 34.7% experienced characteristic schizophrenic deficiency syndromes. 

The symptoms of schizophrenia come and go, with periods of remission and relapse. While the condition is not curable, it can be managed with proper treatment and support.

How does Schizophrenia Affect Daily Life?

Schizophrenia can have a profound impact on a person’s daily life, affecting their ability to function generally in various areas like work, school, relationships, and even self-care. People with schizophrenia often struggle with basic tasks like personal hygiene, maintaining a job or attending school, and managing their finances. 

The disorder disrupts their thought processes, making it difficult to concentrate, remember things, or make decisions. Social interactions and relationships become challenging due to disorganized speech, inappropriate emotional responses, or social withdrawal. 

Hallucinations and delusions can interfere with a person’s perception of reality, causing distress and confusion in everyday situations. The negative symptoms of schizophrenia, such as lack of motivation and reduced emotional expression, make it hard to engage in and enjoy daily activities. 

Is Schizophrenia Curable?

No, schizophrenia is not curable, according to Dr Felix Torres’s 2024 article in the American Psychiatry Association’s article, “What is Schizophrenia?”.  However, schizophrenia is a manageable condition. With appropriate treatment, which often includes a combination of medication, therapy, and support, many individuals with schizophrenia can lead fulfilling lives.

Can Schizophrenia be Prevented?

Yes. You can prevent schizophrenia. According to Klosterkotter, J., Schultze-Lutter, F., Bechdolf, A., & Ruhrmann, S. (2011). World Psychiatry, to prevent schizophrenia, a multifaceted approach is recommended, focusing on early detection and intervention. Cognitive behavioral therapy (CBT) is effective in addressing initial prodromal symptoms, while low-dose atypical antipsychotics are beneficial in later stages of the prodrome.