Understanding Schizophrenia: Diagnosis, Symptoms, & Prognosis

Schizophrenia is a serious mental disorder that affects approximately 24 million people worldwide. When schizophrenia is active, symptoms can include delusions, hallucinations, disorganized speech, trouble with thinking and lack of motivation. While there is no cure for schizophrenia, there are treatments available that can not only improve symptoms but can also diminish the likelihood of symptoms returning. 

Because schizophrenia is such a complex disease, many people have misconceptions about the condition that can lead to stigma and negative perceptions of those suffering. If you or a loved one are living with schizophrenia, learning more about the reality of the condition can help have a positive impact on how you understand the disease, as well as its outcome. 

What is schizophrenia? 

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. Those with the condition act as if they are “disconnected” from reality, which can be distressing for their family and friends. Symptoms of schizophrenia can make it difficult to participate in normal, everyday activities. Schizophrenia is different from both having multiple personalities (also known as dissociative identity disorder) and psychosis. 

What are the signs and symptoms of schizophrenia? 

Schizophrenia usually develops in stages, with different symptoms and behaviors occurring in different stages. 

Onset 

During the early stages of schizophrenia, a person may experience symptoms of social withdrawal, anxiety, lack of motivation and neglect of personal hygiene. This stage does not usually last very long, sometimes taking only weeks before the person progresses to the next stage. 

The most common symptoms at this stage include: 

• Changes in emotional state, feeling afraid, suspicious or paranoid 
• Changes in how they relate to others, often stopping socializing or spending time with friends and family
• Changes in behavior, struggling with thinking and focusing, lack of motivation, and dulled emotions 

Active 

When schizophrenia is active, symptoms are in full effect. When a person shows a complete disconnect from reality, it is usually termed a “psychotic break.” This is when the five main characteristics of schizophrenia are most likely to appear. 

Symptoms can include any combination of the following: 

• Delusions 
• Hallucinations 
• Disorganized or incoherent speaking
• Disorganized or unusual movements
• Negative symptoms, which refer to decreases in certain behaviors like facial expressions, how they speak, and fewer or no gestures with their hands or other parts of their body 

People schizophrenia also often experience a few additional symptoms: 

• Feeling suspicious, paranoid or afraid frequently
• Not caring about their hygiene and appearance
• Depression, anxiety and suicidal thoughts
• Using alcohol, nicotine, prescription medications or recreational drugs, often to “self-medicate” their symptoms 

Residual 

During the residual phase of schizophrenia, people will display some signs and symptoms of the disease, but they are not as severe. Among the most noticeable effects are ​​O\odd beliefs, lack of motivation, decreased feelings of enjoyment or pleasure, limited speaking and reduced emotional expression. While many people improve to the point where these symptoms become less noticable, recovery is usually temporary and requires continual treatment. 

Some people with schizophrenia display another symptom known as anosognosia, or “lack of insight.” This means that a person with anosognosia does not realize that they have a medical problem, disorder or illness. Those with anosognosia do not believe they need medical care or treatment, which can make the condition especially difficult to treat. 

How is schizophrenia diagnosed? 

Diagnosing schizophrenia involves speaking with a psychiatrist or mental health professional, who will conduct a thorough mental and physical exam. Your healthcare professional will rule out other mental health disorders, and ask you about your symptoms and behaviors. They will then compare their findings to the criteria required for a schizophrenia diagnosis. 

A diagnosis of schizophrenia requires the following to be present: 

• At least two of the five main active symptoms. As mentioned above, these include delusions, hallucinations, disorganized or incoherent speaking, disorganized or unusual movements and negative symptoms.
• Duration of symptoms. For a proper diagnosis, you must experience the key symptoms for at least a month and the condition’s effects must last for at least six months. 
• Social or occupational dysfunction. If the condition disrupts either your ability to work or your relationships, this is considered social or occupational dysfunction. 

How is schizophrenia treated? 

Even when symptoms have subsided, schizophrenia requires lifelong treatment. Treatment usually involves medication and psychotherapy, and sometimes hospitalization is also required. In most cases, a qualified psychiatrist will direct treatment, though a patient may also benefit from a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. Those with schizophrenia usually benefit from a full-team approach. 

Medications 

There are two main types of medications used to treat schizophrenia: typical antipsychotics and atypical antipsychotics. Typical antipsychotics, also known as first-generation antipsychotics, block how your brain uses dopamine, a chemical your brain uses for cell-to-cell communication. Atypical psychotics (second-generation antipsychotics), on the other hand, work differently. They instead block two key chemicals in the brain: dopamine and serotonin. While the antipsychotic ​​Clozapine is known to work well for schizophrenic patients, it causes side effects that require regular blood tests, and so isn’t usually used as a first line of treatment for most patients. 

The psychiatrist may also prescribe a number of other medications, whether to deal with side effects of antipsychotic medications or to treat other symptoms that happen alongside schizophrenia. If you have questions about your or a loved one’s medications, your psychiatrist will be the best person to whom you should address those questions and concerns about your specific treatment.  

Psychotherapy 

For those living with schizophrenia, a number of different psychotherapy methods, such as cognitive behavioral therapy (CBT), can help people cope with and manage their condition. Long-term therapy is typically useful in addressing secondary problems, such as anxiety, depression or substance use issues. 

Psychotherapy is especially helpful when it comes to treatment adherence. Due to the lack of insight mentioned above, schizophrenic patients often don’t feel they need or resist treatment. Those who commit to therapy, however, are more likely to follow treatment plans. 

Electroconvulsive therapy

For adults with schizophrenia who do not respond to drug treatment, electroconvulsive therapy (ECT) is an option. Despite the heavy stigma associated with ECT, this treatment method can actually provide quick and dramatic results, especially in life-threatening emergencies. 

How can I manage my schizophrenia? 

To help care for themselves and manage their condition, people with schizophrenia should do the following: 

• Take medication as prescribed. If you have schizophrenia, you should never stop taking your medications without talking to your doctor first, as suddenly stopping these medications often speeds up the return of psychosis symptoms. One of the most important things you can do to help manage your condition is to take your medications as prescribed. If you feel you are experiencing debilitating side effects from one or more of your medications, talk to your doctor—there are many different antipsychotic medications, and you might be able to find a different one that is a better fit. 
• Keep your healthcare appointments. If you are in therapy or have regularly scheduled visits with a psychiatrist, it is important to continue to do so. 
• Don’t ignore or avoid your symptoms. The outcome for those with schizophrenia is better if it is detected and treated early on. 
• Avoid alcohol and recreational drug use. These substances can make schizophrenia worse. If you are having trouble abstaining, talk to your psychiatrist. 

Despite the stigma that can surround mental illness, the reality is that recovery and remission are possible. While it can be scary to suspect that you or someone you care about has symptoms of the condition, it’s important to talk to a healthcare provider as soon as you can. Early diagnosis and treatment can make a big difference in your outlook and prognosis. 

Sources 

• Schizophrenia. (2022, January 11). World Health Organization. 
• Dissociative Identity Disorder: What Is It, Symptoms & Treatment. (n.d.). Cleveland Clinic.
• What is Psychosis? (n.d.). National Institute of Mental Health.