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Schizophrenia

Published by Bupa's health information team, November 2007.

This factsheet is for people who would like information about schizophrenia.

Schizophrenia is a mental illness that affects around one in 100. It usually occurs for the first time during the teens, 20s or 30s. Men and women are equally affected, although young men tend to develop the illness earlier.

• What is schizophrenia?
• Symptoms
• Causes
• Diagnosis
• Treament
• Living with schizophrenia
• Further information
• Questions and answers
• Related topics
• Sources

What is schizophrenia?

Incorrectly, people tend to think that schizophrenia means a "split personality". In fact, schizophrenia is an illness that can affect any aspect of the way a person thinks, feels, speaks and behaves so that he or she loses touch with reality.

Symptoms

The symptoms experienced by people with schizophrenia are usually grouped as positive and negative.

Positive symptoms

These symptoms highlight a change in the usual thinking process and can include the following.

• Delusions, which are false beliefs out of context to their usual cultural or social ideas. For example, a person thinking that their movements are being controlled by someone else.
• Hallucinations, which can occur as voices speaking directly to or about the person without anyone being there, or as visual hallucinations when a person sees things that aren't there.
• Thought disorder, which affects the person's thinking patterns making their speech difficult to follow.

Together these symptoms are called psychosis.

Negative symptoms

These symptoms show there is a reduction or absence of usual mental functions and can include:

• lack of energy
• social withdrawal
• lack of motivation

The person affected may say very little, find social contact difficult and may have difficulty getting out of bed.

Causes

The exact reason why a person may develop schizophrenia isn't fully understood at present.

Schizophrenia may develop due to a combination of factors, the most important of which is having a relative with schizophrenia. Studies have shown that if one parent is affected, the risk of having a child with schizophrenia is around 13 in 100. This rises to around 46 in 100 if both parents are affected.

Schizophrenia may be linked to changes in the brain. The brain sends signals from nerve to nerve using chemicals called neurotransmitters. The neurotransmitters are out of balance in people with schizophrenia.

There are several factors, known as environmental stressors or external triggers, which have been identified in the development of schizophrenia. These may include the following.

• Complications at birth may increase the risk of a child developing schizophrenia.
• People are more likely to develop schizophrenia if they are born in the late winter and early spring.
• Developmental abnormalities in children, such as learning difficulties or problems with speech, have been associated with schizophrenia.
• Illegal drugs, such as amphetamines, can produce almost the same symptoms as schizophrenia. Regular cannabis use can cause a lack of interest in normal activities (apathy) and extreme tiredness (fatigue), and may lead to the development of hallucinations and delusions in some people.
• Stressful events, such as the death of a loved one, break-down of a relationship, a stressful job or fear of unemployment, even moving house, can trigger schizophrenia in vulnerable people.
• People who have migrated to the UK from other countries show an increased rate of schizophrenia compared with both the population that they have left and the general UK population.

Diagnosis

Experiences such as hearing voices always seem very real to the person affected by schizophrenia, who may not realise that they are unwell. Many people with schizophrenia don't recognise that they have an illness. Carers or families may seek medical advice first, usually as a result of behaviour patterns that are strange or out of character.

A GP is usually the first point of contact. The GP will ask about the person's symptoms and will examine them. He or she may also ask about their medical history. The person may be referred to a psychiatrist, a doctor who specialises in mental health, a psychotherapist, a therapist who specialises in mental health, or a counsellor for further help.

Treament

Medication

Antipsychotic medicines help to control schizophrenia, particularly the positive symptoms like delusions or hallucinations. Antipsychotic medicines are the main form of treatment. They have a calming effect, without necessarily causing sleepiness. All medicines have side-effects, so it's important to find the medicine that suits each person best.

Treatments for individuals diagnosed with schizophrenia include the group of medicines called atypical antipsychotics. These include:

• amisulpride (eg Solian)
• olanzapine (Zyprexa)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• clozapine (eg clozaril)

Older antipsychotic medicines include:

• chlorpromazine (eg Largactil)
• flupenthixol (Depixol)
• fluphenazine (eg Moditen)
• haloperidol (eg Haldol)

The older antipsychotics have mainly been replaced by the atypical antipsychotics. This is due to side-effects such as involuntary movements of the face and tremor (shaking) of the body.

There is a high risk that the symptoms of schizophrenia may return, so medicines should be taken for at least one to two years. It's important to follow the doctor's advice and take medicines regularly. Withdrawal of medicines may not be suitable for everyone, so you should always seek advice from your doctor before you stop taking your medicine.

A GP can prescribe antipsychotic medicines which can be given long-term by injection. This is helpful for people who find it difficult to take tablets regularly.

Psychological treatment

Talking therapies can also be useful. These include cognitive behavioural therapy (CBT) and psychotherapy. For more information see Related topics.

Hospital treatment

If psychotic symptoms are severe, people diagnosed with schizophrenia may need to be admitted to a hospital to have appropriate care supervised by a psychiatrist. For a small number of people, a stay in hospital may last several months. However, modern medicines and better community-based services mean far fewer people are having to spend all or most of their time in hospital.

For people who are unwilling to have treatment, the Mental Health Act (1983) gives doctors certain powers to keep them in hospital for treatment. Usually, hospital treatment is only imposed when there is a risk to a person's health or safety, or that of others.

Care programme approach

This aims to provide a support system in the community. Access to a named worker, called a care co-ordinator (eg a community psychiatric nurse), and structured care provides support for the specific problems of the person affected. Their health and progress is monitored, and psychological, medical and practical support is offered. Typical issues may include housing and financial problems, family difficulties, and drug and alcohol misuse.

Living with schizophrenia

Many people get better, but have periods when symptoms of schizophrenia return and may need medicines. Around one in 10 people with schizophrenia find their condition continues to get worse over time.

Many people diagnosed with schizophrenia go on to lead full lives, with steady employment and long-term relationships. About one in three people make a complete recovery after a diagnosis of schizophrenia.

Further information

• Rethink
  0845 456 0455
  www.rethink.org
• The Royal College of Psychiatrists
  www.rcpsych.ac.uk

Related topics

• Cognitive behavioural therapy

Sources

• British National Formulary (BNF) September 2006. BMJ Publishing Group, 2006 52.
• Collier J, Longmore M, Scally P. Oxford Handbook of Clinical Specialities. 6th ed. Oxford: Oxford University Press, 2003
• Effective care co-ordination in mental health services, modernising the care programme approach. Department of Health
  www.dh.gov.uk
  accessed 27 November 2006
• Schizophrenia - Core interventions in the treatment and management of schizophrenia in primary and secondary care. National Institute for Clinical Excellence (NICE). Clinical Guideline 1. December 2002
  www.nice.org.uk
• Schizophrenia - Full national clinical guideline on core interventions in primary and secondary care. National Collaborating Centre for Mental Health commissioned by the National Institute for Clinical Excellence (NICE). 2003
  www.nice.org.uk
  accessed 20 November 2006
• Schizophrenia. NHS Library for Health. Clinical Knowledge Summaries.
  http://cks.library.nhs.uk
  accessed 20 November 2006
• Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002: 466-467

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Adrian Winbow MB, FRCPysch, DPM, Consultant Psychiatrist, Cygnet Hospital; and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: November 2007