What is schizophrenia?
Schizophrenia affects how a person thinks, feels and acts and is a result of altered brain chemicals.
Schizophrenia is one of a group of illnesses that disrupt the brain so much that they cause a condition referred to as psychosis. When someone experiences psychosis they might see or hear things that other people can’t (hallucinations). Maybe they believe things that are very odd or not true (delusions). Also, they might think and behave in a confused or disorganised way.
About one third of people who have a first episode of psychosis recover fully. Two thirds of people have symptoms that don’t go away and will be diagnosed with schizophrenia or schizoaffective disorder.
What does a diagnosis of schizophrenia mean?
The word ‘schizophrenia’ tends to make people feel uneasy because it often triggers inaccurate images of violence and disturbed behaviours.
But that’s not the full story; schizophrenia does not necessarily predict violence. When violence does occur it’s usually when patients are experiencing symptoms such as delusions of persecution. Even then, it is more likely people with schizophrenia will hurt themselves than others (e.g. by drinking or taking illicit drugs and driving, self-harm or by suicide).
Just like anyone else with a long-term or recurring condition, your family member or friend may be able to learn to manage their condition. Their goals will be dependent on how well they are. If they are very unwell their goals may be to accomplish simple living skills like getting dressed and having breakfast every day. If they are well they can work towards living an independent life, holding down a job or maintaining long-term relationships.
Who is likely to develop schizophrenia?
Anyone can experience psychosis. In Australia, about 1 in 100 people experience the symptoms of schizophrenia at some stage in their lives.
Most people start to show symptoms in their late teens and early twenties.
What causes schizophrenia?
No one knows the full story on what causes schizophrenia, and no one understands why some people develop it and others don’t. It’s most likely due to a complicated mix of genetic and environmental factors that vary from person to person.
The end result is an imbalance of brain chemicals that cause altered thoughts, feelings and behaviours.
What are the symptoms?
Schizophrenia is characterised by delusions, hallucinations, disorganised speech and behaviour, and other symptoms that cause social or occupational impairment. People with schizophrenia will not necessarily experience all of the symptoms listed below. See the diagnosis section for more information.
The first two symptoms (delusions and hallucinations) are known as positive symptoms that are ‘extra’ feelings or behaviours that aren’t usually present. They can be intense, troublesome, and distressing.
How is schizophrenia diagnosed?
When diagnosing schizophrenia, doctors may use a combination of screening tools as well as psychological evaluation. Blood tests may be used to rule out conditions with similar symptoms and to screen for drugs and alcohol. Imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may be used to look at the structure of the brain to also rule out other causes of symptoms. A psychological assessment checks a person’s mental status, looking for the symptoms of schizophrenia listed above.
For a diagnosis of schizophrenia:
- symptoms must have been present for at least six months, and
- at least two of the five symptoms must have been present for at least one month
Changes to the latest mental disorders diagnostic manual (DSM-5) include the elimination of schizophrenia subtypes. This means you may no longer hear of schizophrenia defined in terms of a particular symptom such as paranoid, disorganised, catatonic, undifferentiated or residual.
What are the stages of schizophrenia?
When a person you care about starts behaving unusually, it can be alarming – not only for them, but for you as well. If a family member or friend has been diagnosed with the early stages of schizophrenia, or is having their symptoms assessed, you’ll want to know what to expect. By understanding the stages of early schizophrenia, you can prepare for what may lie ahead.
First episode psychosis
Psychosis is a disruption in the brain that affects a person’s thoughts, feelings and behaviour. It’s caused by chemical changes in the brain and it occurs as a symptom of several mental health conditions, including schizophrenia. However, a person can have one episode of pyschosis and never have a repeat episode. This is known as “first-episode psychosis” – it has many of the same symptoms as schizophrenia, but is short-lived.
The three phases of first-onset psychosis
Learn about relapseClose
Relapse describes an increase in unhelpful thinking and behaviours after a period of feeling better (partial recovery). A relapse can involve difficulties coping with day-to-day activities, increased symptoms of schizophrenia or the return of previous symptoms of schizophrenia.
Relapse can have a big impact on a person’s life: relapse can damage personal and social relationships, puts education and employment at risk, and puts the person at risk of harm to themselves or others. Relapse also potentially damages brain tissue.
The first two to five years after the first psychotic episode are critical. If psychosis returns and is not treated quickly, the psychosis becomes harder to treat, and the person you care about will also be less likely to remain employed, in school, or keep in touch with family, friends and others in their social network.
This means that you and your family member or friend should work together with the healthcare team to develop a plan to monitor early signs of relapse (e.g. changes in thinking, feelings or behaviour) and get help as early as possible at this stage of the condition. You can help by ensuring the person you care about takes their medications and attends treatment sessions, and by staying in touch with the healthcare team.
Reducing risk of relapse
Among the factors that can increase a person’s risk of relapse are not taking medication as prescribed, substance abuse, and stress and anxiety.
After the first relapse, the biggest risk of having another relapse is due to missing doses of regular medication or stopping medication without consulting a doctor. That’s why doctors stress the importance of taking medication as they have prescribed.
Staying well through recovery
Here are some simple tips to help you look after the person you care about through their recovery phase.
Be aware of their changing symptoms
Work with their healthcare team to develop a plan to recognise early signs of relapse. Keep a close eye on changes in their demeanour and thoughts.
Look out for the following, as they can be signs they’re becoming unwell:
- Everyday things like going off food, feeling stressed or anxious or not sleeping
- When they stop bothering to shower, change their clothes or clean their home
- When they become a bit suspicious or fearful, or start to worry about people’s motives
- If they start to hear voices quietly or occasionally, or find it difficult to concentrate
It’s really important that the person you’re caring for keeps their body and mind healthy. Here are some tips to share with them:
- Eat healthy food – especially vegetables and fruit. Visit EatforHealth.gov.au for guidelines on healthy eating
- Get regular exercise – it improves mood and feelings of wellbeing. Visit Health.gov.au for Australian guidelines on physical activity. Or if you are in NSW visit GetHealthyNSW.com.au for holistic information about getting healthy, including exercise
- Avoid all illicit drugs – they have a strong negative impact on recovery
- Try not to smoke - not only is it bad for their lungs, it acts on their liver and may mean they will need higher doses of medication. Get help to quit smoking at QuitNow.gov.au
- Minimise alcohol and caffeine (including energy drinks) as much as possible
- Develop good sleeping habits
- Learn and use stress management techniques
- Avoid stressful situations such as having disagreements with people
- Find a support group where they feel comfortable talking about how they feel – in person and/or online
- Don’t be afraid to ask for help – sooner rather than later