What is schizophrenia?

Schizophrenia is a chronic mental illness that affects approximately 1% of the Irish population. Schizophrenia may be one disorder or many disorders with different causes.

The symptoms can develop at any time, but the illness is more likely to emerge in young adults. It occurs in all races, all cultures, all social classes, and in both sexes.

What causes schizophrenia?

There is no known single cause of schizophrenia. Research has identified a number of factors that appear to increase the risk of developing schizophrenia, although it is not yet clear how these factors interact:

  • Genetic factors: There is some hereditary basis to schizophrenia. However, about 60% of people who develop schizophrenia have no family history of the illness.
  • Chemical defect in the brain: The brain operates by nerve cells communicating with each other through chemical connections — these chemicals are known as neurotransmitters. In schizophrenia it appears that one of these neurotransmitters, dopamine, is produced in a greater quantity or the brain has become extra sensitive to it. No neurochemical cause has yet been firmly established for schizophrenia, but research into brain chemistry and its link to schizophrenia is ongoing.
  • Physical abnormality in the brain: Several imaging techniques are being used to research this area.
  • Viral infection: People born in late spring or early summer are more likely to develop schizophrenia. This suggests that a viral infection may have occurred during the pregnancy and somehow altered the brain’s structure or chemistry. 
  • Drug abuse: Some young people who use psychoactive drugs (e.g. ecstasy, cannabis, heroin) may develop a form of schizophrenia that is difficult to treat.
  • Stress: Stressful events may trigger rather than cause an episode of schizophrenia. These include: a relationship break-up, sudden unemployment or drug abuse.
  • It is not thought that childhood experiences have any impact on the development of schizophrenia.

What are the symptoms of schizophrenia?

Symptoms may include:

  • Hallucination — hearing voices that others cannot hear.
  • Delusions — holding unrealistic beliefs.
  • Moodiness — depression, elation or emotional numbness.
  • Social withdrawal — losing contact with friends or family.
  • Behaviour change — inappropriate laughter or mannerisms.
  • Thought disorder — thought block or insertion.
  • Emotional — inconsistent or unexpected responses.
  • Language — novel use of language, puns and rhymes.
  • Ideas — over-valued or unrealistic plans or schemes.
  • Self-esteem — may be poor or exaggerated.
  • Concentration — vague decision making.
  • Thought disorder — may feel threatened or persecuted.
  • Insight — vague sense of things being different or lost.
  • Sleep — difficulty getting to sleep or excessive sleeping.
  • Personal hygiene — may be neglected. 

How is schizophrenia diagnosed?

The diagnosis is based on the symptoms — what the person says and what the doctor observes. To reach a diagnosis of schizophrenia, other possible causes must be ruled out.

A diagnosis of schizophrenia usually takes a long time because the symptoms either go unrecognised or do not show themselves fully until the illness is advanced.

People who are showing symptoms which may point to schizophrenia should seek medical advice. The first port of call is to a GP who will investigate the symptoms and may refer to a psychiatrist. Diagnosis is not straightforward and sometimes a second opinion may be sought.

How is schizophrenia treated?

Treatments are selected on the basis of their ability to reduce symptoms of schizophrenia and lessen the chances that symptoms will return. A number of treatments and treatment combinations are helpful and more are being developed. The are new classes of drugs which are helpful in controlling symptoms and have fewer side effects. The treatment options include:

  • Medical treatment
  • Psychological therapy
  • Behavioural therapy
  • Social therapy

What can I do if I am diagnosed with schizophrenia?

  • Keep in close contact with your mental health team.
  • Avoid unnecessary stress or pressure.
  • Try to make life changes slowly and one at a time. 
  • Take medication only as prescribed and be aware that some medications can cause weight gain and side-effects, so talk to your doctor about your treatment.
  • Eat plenty of fibre and drink plenty of water as some medications can affect bowel patterns.
  • Ask questions about your treatment and learn more about the disorder.
  • Learn to recognise early signs of relapse — for example, worrying, tension, or sleep disturbance.
  • Develop a close relationship with someone who can help you spot early relapse signs and will intervene on your behalf if necessary.
  • Try to describe clearly any symptoms or side-effects.
  • Join a support group or social club.
  • Be careful with alcohol and talk to your doctor about it.
  • Don’t drive or operate machines if you are feeling sedated.
  • Learn to accept some of the limitations this disorder may impose on you from time to time.
  • Keep looking to the future.

Can other people help?

Family, friends, residential or day-care providers and healthcare professionals are very important as a support to people with schizophrenia. For people who have relatives or friends who have or may have schizophrenia, there are an number of things that can be done to help:

  • Seek professional help.
  • Don’t go along with delusions. Tell your relative or friend that your don’t see things the same way as them, but don’t be overly forceful about it.
  • Keep a record of symptoms and medications. It is important that the person takes all their medication or they could have a serious relapse.
  • Understand the causes of the behaviour: Find out as much as you can about schizophrenia from health professionals, books, support groups etc.
  • Be positive and encouraging.

What is the outlook for people with schizophrenia?

The outlook for people with schizophrenia has improved over the last 25 years. Although no totally effective therapy has yet been developed, it is important to remember that many people with schizophrenia improve enough to lead independent and fulfilling lives. However, there are some people who will require constant care and attention.

A major advance has been the recent development of new drugs to control symptoms.

Schizophrenia is a complex disorder and the major questions are unlikely to be resolved in the near future. However, a better understanding of the condition can help towards improving the lives of those who have schizophrenia and their families and friends.

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