Schizophrenia changes how a person thinks and behaves.
Schizophrenia may develop slowly. The first signs can be hard to identify as they often develop during the teenage years. With young people, some symptoms can be mistaken for normal adolescent behaviour. For example, becoming socially withdrawn and unresponsive. Or changes in sleeping patterns People often have episodes of schizophrenia when their symptoms are severe. This is acute schizophrenia. They can then go through periods with few or no symptoms. Thoughts can still be confused or muddled. Even when there are no obvious external symptoms. Positive and negative symptoms
The symptoms of schizophrenia are usually grouped into the following types of symptoms. Positive symptoms
Any change in behaviour or thoughts, such as hallucinations or delusions. Negative symptoms
A withdrawal or lack of function that you would not usually expect to see in a healthy person. For example, appearing emotionless and flat, with confused or muddled thoughts. Hallucinations
Hallucinations are when you see, hear, smell, taste or feel things that don't exist. The most common hallucination is hearing voices.
Hallucinations are very real to the person experiencing them. Even though people around them can't hear the voices or experience the sensations.
Brain-scanning shows changes in the speech area, in the brains of people with schizophrenia, when they hear voices. These show the experience of hearing voices as a real one - as if the brain mistakes thoughts for real voices.
Some people describe the voices they hear as friendly and pleasant. More often they're rude, critical, abusive or annoying.
The voices might:
- describe activities taking place
- discuss the hearer's thoughts and behaviour
- give instructions or talk directly to the person
Voices may come from different places or one place in particular, such as the television.
Delusions
A delusion is a belief held with very strong conviction. Even though it's based on a mistaken, strange or unrealistic view. It may affect the way the person behaves. Delusions can begin suddenly, or may develop over weeks or months.
You may develop a delusional idea to explain a hallucination you're having. For example, if you hear a voice describing your actions, you may think someone is monitoring you.
You may experience a paranoid delusion. This is when you believe you're being persecuted or harassed. You may believe you're being chased, followed, watched, plotted against or poisoned. Often by a family member or friend.
You may believe people on TV or in newspaper articles are communicating messages to you. Or you may believe there are hidden messages in everyday events or coincidences.
Confused thoughts (thought disorder)
People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Psychosis is a symptom of Schizophrenia. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme. People sometimes describe their thoughts as "misty" or "hazy" when this is happening . Thoughts and speech may become jumbled or confused. This makes conversation difficult and hard for other people to understand. Changes in behaviour and thoughts
A person's behaviour may become more disorganised and unpredictable. Their appearance or dress may seem unusual to others. People with schizophrenia may behave inappropriately. They may become very agitated and shout or swear for no reason. They may believe that their thoughts : - are being controlled by someone else - are not their own - have been planted in their mind by someone else - are disappearing, as though someone is removing them from their mind. - some people feel their body is being taken over. They may feel someone else is directing their movements and actions. Negative symptoms of schizophrenia
Negative symptoms of schizophrenia often appear several years before the first acute episode. These initial negative symptoms are the 'prodromal period' of schizophrenia. Symptoms during the prodromal period usually appear gradually and slowly get worse. They include the person becoming more socially withdrawn. They may also lose interest in their appearance or personal hygiene. It can be difficult to tell if the symptoms are part of the development of schizophrenia. They could be caused by something else. Negative symptoms experienced by people living with schizophrenia include: - losing interest and motivation in life and activities, including relationships and sex - lack of concentration, not wanting to leave the house - changes in sleeping patterns - feeling uncomfortable with people - being less likely to start conversations or feel there's nothing to say - the negative symptoms of schizophrenia often lead to problems with friends and family. - symptoms can sometimes be mistaken for deliberate laziness or rudeness. Psychosis
1st episode psychosis - A first acute episode of psychosis can be very difficult to cope with. It can be difficult for the person who is ill and for their family and friends. Drastic changes in behaviour can occur. They might become upset, anxious, confused, angry or suspicious of those around them. They may not think they need help. It can be hard to persuade them to visit a doctor.
Causes
The exact causes of schizophrenia are unknown.
A mix of factors can make a person more likely to develop the condition. Factors such as:
- physical
- genetic
- psychological
- environmental
You may be prone to schizophrenia. A stressful or emotional life event might trigger a psychotic episode. But it's not known why some people develop symptoms and others don't. Increased risk
There are a number of things that increase the chances of schizophrenia developing, Genetics
Schizophrenia tends to run in families. Research suggests that no single gene is responsible. It's more likely that combinations of genes make people more vulnerable. But having these genes doesn't mean you will develop schizophrenia. Evidence that the disorder is partly inherited comes from studies of twins. Identical twins share the same genes. If one identical twin develops schizophrenia, the other has a 1 in 2 chance. Even if they're not raised together. In non-identical twins with different genetic make-ups, the other twin only has a 1 in 7 chance. This is higher than in the general population, where the chance is about 1 in 100. It suggests genes aren't the only factor influencing the development of schizophrenia. Brain development
There are some differences in the structure of the brain for people with schizophrenia. These changes aren't seen in everyone with schizophrenia. They can occur in people who don't have a mental illness. But they suggest schizophrenia may partly be a disorder of the brain. Neurotransmitters
Neurotransmitters are chemicals that carry messages between brain cells. There's a connection between neurotransmitters and schizophrenia. Drugs that change the levels of neurotransmitters can relieve some of the symptoms. A change in the level of two neurotransmitters may cause schizophrenia. These are dopamine and serotonin. An imbalance between the two may be the basis of the problem. It is also thought that a change in the body's sensitivity to the neurotransmitters may be part of the cause. Pregnancy and birth complications
If you have schizophrenia, you are more likely to have experienced complications before and during birth. For example: - a low birth weight - premature labour - a lack of oxygen (asphyxia) during birth - it may be that these things have a subtle effect on brain development. History of traumatic events
Early traumas in life increase the risk of psychosis. These include:
- child sexual abuse
- physical abuse
- bullying
But not everyone who has had early trauma will develop psychosis. Also, not everyone who has psychotic experiences has experienced childhood abuse.
Triggers
Triggers are things that can cause schizophrenia to develop in people who are at risk. Stress
The main psychological triggers of schizophrenia are stressful life events, such as:
- bereavement
- losing your job or home
- divorce
- the end of a relationship
- physical, sexual or emotional abuse
These kinds of experiences, although stressful, don't cause schizophrenia. But they can trigger its development in someone who is already vulnerable to it. Drug abuse
Drugs don't directly cause schizophrenia. But drug misuse increases the risk of developing schizophrenia, or a similar illness.
Certain drugs may trigger symptoms of schizophrenia in people who are susceptible, particularly
- cannabis
- cocaine
- LSD
- amphetamines
Using amphetamines or cocaine can lead to psychosis. This can cause a relapse in people recovering from an earlier episode. People under 15 who use cannabis regularly are up to 4 times more likely to develop schizophrenia by the age of 26. This is especially true for "skunk" and other more potent forms of the drug.
Diagnosis
There's no single test for schizophrenia. The condition is usually diagnosed after assessment by a mental health specialist. If you're concerned you may be developing schizophrenia, talk to your GP as soon as possible. Your GP will ask about your symptoms and check they're not the result of other causes. For example, recreational drug use. Community mental health team
If your GP thinks you may have schizophrenia, they will refer you to a community mental health team. They support people with complex mental health conditions.
A psychiatrist or a specialist nurse will carry out an assessment of your symptoms. They'll also want to know your personal history and current circumstances.
To make a diagnosis, most mental healthcare professionals use a diagnostic checklist.
A diagnosis is usually made if you have experienced one or more of these regularly for a month:
- delusions
- hallucinations
- hearing voices
- incoherent speech
- negative symptoms, such as a flattening of emotions
You may be diagnosed if your symptoms have an impact on your ability to work, study or perform daily tasks. The psychiatrist, or a specialist nurse, will rule out other possible causes first. For example, recreational drug use or bipolar disorder. Related illnesses
Sometimes it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, you have a related mental illness. This could be bipolar disorder or schizoaffective disorder.
Bipolar disorder
If you have bipolar disorder you may have periods of elevated mood, followed by periods of deep depression. You can go from very active, excited behaviour (mania) to being very low and depressed. You may also hear voices, experience other kinds of hallucinations or have delusions. Schizoaffective disorder
This is often described as a form of schizophrenia. The symptoms are like schizophrenia and bipolar disorder. But schizoaffective disorder is a mental illness in its own right.
It may occur once in a lifetime, or come and go. It can also be triggered by stress.
You should also be assessed for:
- post-traumatic stress disorder
- depression
- anxiety
- substance misuse
Getting help for someone else
People with schizophrenia may be reluctant to visit their GP. They may believe there's nothing wrong with them. This can be caused by their delusional thought patterns. It's likely someone who has had acute episodes in the past will already have a care coordinator. If this is the case, contact their care coordinator to express your concerns. If someone is having an episode for the first time, you might need to persuade them to visit their GP. For a worsening episode, you may need to go to the emergency department (ED). A duty psychiatrist will be available. A person having an acute schizophrenic episode may refuse to seek help. In this case, their nearest relative can request a mental health assessment. Social services will tell you how to do this. In certain circumstances, you may have to be admitted to hospital against your will. This is called an ‘involuntary admission.’
After diagnosis
If you are diagnosed, you may feel anxious about what will happen. You may worry about the stigma or feel frightened and withdrawn.
It's important to remember that a diagnosis can be a positive step. It can help to get information about the illness and the kinds of treatment and services available.
Information by HSE.ie
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Other services you where you can reach someone to talk to:
Samaritans offers a 24 hour listening service over text message, text 'Hello' to 087 260 9090 to get started (standard text messaging rates apply) or call 116 123 to talk to someone over the phone.
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Visit Your GP:
We always recommend that you visit your GP with whatever health issues you are facing. Don’t feel embarrassed or ashamed. Your doctor is a professional health care provider and will be familiar with how you are feeling. You mental health is just that - your health. You would visit your GP if you had been feeling physically unwell right ? Your emotional health is just as important as your physical well-being - in fact the two go hand in hand. If you don’t have a current GP you can find a list of services in your area here. You can also contact the CareDoc service on 1850 334 999
Contact the Emergency Services:
If you are an immediate danger to yourself and are going through a suicidal crisis please contact the emergency services by dialling 999 or visit your nearest Emergency Department.