Schizophrenia

Answers to frequently asked questions about schizophrenia. For service users, families, friends or anyone with concerns.

• What is schizophrenia?

• What causes it?

• Where do I go for help?

• What are the treatments for schizophrenia?

• Who are the people involved in treatment?

• What can I do to help myself?

• Want to know more?

What is schizophrenia?

When someone cannot tell the difference between what is real and what is imaginary, they may be described as having a 'psychotic' illness. The most common type of psychosis is schizophrenia. Schizophrenia is different for each person, but usually involves a dramatic disturbance in thoughts and feelings and results in behaviour that may seem odd to other people. Some people hear voices, others see things which are not there, or feel they are being persecuted.

Some people only experience one episode of psychosis and some recover from schizophrenia. For others, schizophrenia is a long-term illness but a combination of medication (drugs) and talking therapies can help to control it and help you get on with your life.

If you have schizophrenia there may be times when you experience some of the following:

• Strange beliefs or thoughts with little no basis in reality (called delusions). For example, you may think that you have special powers. Or you may think someone from the house next door is trying to control your thoughts or feelings (called paranoid delusions).
• Hearing, seeing, feeling or even smelling things that are not there (called hallucinations). For example you may hear voices talking about you.
• Thoughts 'jumping' between completely unrelated topics (called disordered thinking). This can make conversations difficult.
• Inappropriate behaviour, for example taking your clothes off in public.
• Lack of awareness of other people's feelings. Or you may not show your own feelings or emotions, possibly having a blank facial expression.
• Lack of pleasure or interest in activities. This could be social occasions you used to enjoy, like seeing friends, or going to the pub.
• Difficulty in concentrating, making decisions or planning
• Feeling depressed or anxious

What causes it?

Scientists don't know what causes schizophrenia but there are some known risk factors. Recently, studies have indicated that schizophrenia may have a biological basis. For more information about this, see Biology of schizophrenia

Symptoms often start to show after people have a particularly stressful or distressing time.

It's estimated that about 1% of the UK population experiences schizophrenia at some point in their lives. Studies suggest that it runs in families, but the risk of getting the condition if a family member has it is still relatively small.

Chances of developing schizophrenia at any point during lifetime

Having schizophrenia does not mean you have a 'split' personality, nor is it caused by personal weakness. In the past, people have wanted someone to blame for schizophrenia, and 'bad' families or evil spirits were given as 'causes'.

Where do I go for help?

If you have experiences you think could be signs of schizophrenia, the first step is to contact your family doctor (GP) or the doctor involved in your care. If you are worried about a friend or relative, encourage them to see their GP or doctor, and offer to go with them if it helps.

It is important to go for help as early as possible. There are many possible explanations for your thoughts and feelings, and schizophrenia is only one of them. If you get help and treatment early you may be able to avoid your illness developing.

If your doctor thinks you may have a mental illness like schizophrenia, he or she will refer you to a psychiatrist or to a Community Mental Health Team. Most people with schizophrenia live in the community and many only see their doctor when they need a prescription. Some people find they need short stays in hospital when their symptoms are particularly bad.

What are the treatments for schizophrenia?

People diagnosed with schizophrenia are usually treated with medication (drugs), called antipsychotics, and many people continue on this therapy for the rest of their lives. Talking therapies can help to support people living with schizophrenia.

Medication

Typical antipsychotics, such as haloperidol, have been used to treat people with schizophrenia for over forty years. These work for 7 of out 10 people, but they may not treat all the symptoms of schizophrenia. People often find that delusions and hallucinations are reduced, but that cognitive problems - such as difficulty making decisions and remembering things - remain. Typical antipsychotics can cause unpleasant movement problems and other distressing side effects.

Atypical antipsychotics (such as clozapine, risperidone, quetiapine and olanzapine) are newer drugs used for schizophrenia. These act in different ways to the older antipsychotics, and are less likely to cause the same unpleasant side-effects. However they do have different side effects of their own.

Schizophrenia has many different forms and everyone responds to treatment differently. There are many different antipsychotics available - if one doesn't work for you, there may be another one that does You may need to try a few medications before you find the one that suits you.

If you are having problems with your medication, or if you are having unpleasant or worrying side effects, speak to your doctor nurse or key worker. They can advise you on the implications of continuing or stopping your medication, and may be able to find a drug that suits you better.

Antipsychotic drugs can take up to 3 months to work. If you do not feel any better after 3 months, ask your GP or psychiatrist if you can try another medication.

Want to know more?

see Treatment of schizophrenia

What about compulsory treatment?

Compulsory treatment is not a routine part of the lives of most people with schizophrenia, although this may change with the current review of the Mental Health Act. In the UK, people with schizophrenia are usually treated according to the Care Plan Approach. Your care plan will include details of your treatment, your key worker and others involved in your care. In the unlikely situation that you do not comply with your care plan and you are considered by several mental health professionals to be a danger to yourself or to others, you may be admitted to hospital for assessment and/or treatment without your consent. It is called sectioning, because these legal powers are given in a 'section' of the Mental Health Act.

For more information about this, see Information on the 1983 Mental Health Act

Talking therapies

Talking therapies, such as counselling, can help people with schizophrenia live with their condition and deal with difficulties arising from their illness, such as family or relationship problems.

Some mental health services offer help for the whole family, such as family therapy. This can help families adjust to changes in their loved one and in their own lives, by helping them to understand the condition and its treatment.

Talking therapies may be available on the NHS in your area, but they are in short supply, and what is available varies across the country. If you are interested in these therapies, ask your GP, psychiatrist or nurse.

Who are the people involved in treatment?

If you have a diagnosis of schizophrenia in the UK, you may receive care from your community mental health team. This team may include some or all of the following, depending on your needs:

• Consultant psychiatrist
• Psychologist
• Community psychiatric nurse (CPN)
• Occupational therapist (OT) and /or physiotherapist (if you are elderly)
• Junior doctor (senior house officers, specialist registrars, registrars)
• Nutritionist
• Nurse from the ward (if you've been recently discharged)
• Social worker
• GP (they are invited to meetings to review your treatment)
• Member of the family

You will be given a key worker who is the member of this team (often a social worker or CPN, but could be another professional). They will have most contact with you. If you're worried about your treatment, how you feel or you have any questions, your key worker is the best person to contact. The mental health team will meet with you about every three to six months to discuss how you are, and to decide on any changes in your treatment and care.

The key worker is also a useful person for the family. They can help the family to recognize early on if their relative may be getting ill again, and can help them to prepare for some of the changes that may occur as a result of caring for someone with schizophrenia.

What can I do to help myself?

There are things you can do to look after your mental health and improve your quality of life:

1. Identify which situations or events make you feel unwell or particularly stressed (such as overworking or arguments with your partner) and try to avoid these 'triggers'.
2. Try to reduce stress or worry in your life, generally.
3. Try to recognize early signs that you are becoming unwell - if you get help you may be able to avoid a severe bout of illness. Be aware that your friends or family may notice the signs first, even if you feel better than ever.
4. Find a member of the mental health team you can talk to. They should be able to help if you have any worries about your health or treatment. They may also notice any signs of illness before it develops.
5. Avoid illegal drugs and heavy drinking. You may feel better in the short term, but they can make symptoms worse and can affect your medication and cause a relapse of your illness.
6. Take care of your physical health - eat well, exercise regularly, and try to get enough sleep.
7. Take up new activities. Art, drama, creative writing or music can have a positive effect on mental health
If you cannot work, find out which benefits you and your carer, if you have one, are entitled to. In the UK, visit your benefits office for information or visit the DSS website www.dss.gov.uk.
8. Take your medication according to the instructions from your doctor.

Want to know more?

Support/Groups

National Schizophrenia Fellowship - the largest severe mental illness charity in the UK.

Open The Doors - an international site from the World Psychiatric Association

World Fellowship for Schizophrenia and Allied Disorders - helps promote public education about schizophrenia and related topics through conferences and newsletters.

Other pieces on emental-health.com

History - insight into history of approaches to schizophrenia.

Biology - referenced guide to diagnosis, biological techniques and findings

Treatment - referenced guide to approaches to treatment and the way they work.

Fastfacts - a quick guide to who gets it, how it's treated, and hot topics.

Links - to other resources

Personal accounts

Read others' experiences of schizophrenia

Christine's story - Christine is active, intelligent and caring. She was diagnosed with schizoaffective disorder in her 40s.

Fighting to become me again - Claire's story - Claire is young, bright and creative, and has finally found a medication that suits her.

Pauline's story - A patient's mum describes her experience as a carer

Please email us with other questions you would like to see featured.

Jessica Sheringham - February 2001, with medical input from Dr Sukhi Shergill, Wellcome Clinical Fellow / Lecturer, Institute of Psychiatry