What is it?
Schizophrenia is a mental disorder that affects approximately one in 100 people
in Ireland. It affects men and women equally, although
men seem to develop the condition about five to ten
years earlier than women. Schizophrenia is rare in
people aged less than 15 years of age. Schizophrenia
normally presents between the ages of 15 and 35 years
Symptoms of schizophrenia
The symptoms of schizophrenia are often described in two categories: positive
(also called active) symptoms and negative (also called
passive) symptoms. Positive or active symptoms reflect
the experience of new or unusual forms of thought and
behaviour. Negative or passive symptoms reflect a loss
of previous feeling and abilities.
- Disordered/muddled thinking
- Feelings of being controlled
- Difficulty concentrating
- Loss of interest in daily activities
- Reduced motivation
Hallucinations are the perception of a nonexistent object or event. They are unusual or explained
sensations such as hearing voices, or feeling or seeing
something that does not exist. Hearing voices is a
common hallucination associated with schizophrenia.
The voices may comment on your thoughts, actions, feelings
and behaviours or the voices may advise you or issue
demands and orders. The voices themselves sound very
real and believable. For people experiencing hallucinations, it seems like the voices are
from outside of you. The voices may also seem to come
from objects, for example a TV or radio. These voices
can be familiar or friendly but are often abusive and
critical causing the person hearing them to feel like
they must obey them, even when you know you shouldn't. The voices can be very distressing and cause additional problems if you follow
the orders given. These voices are imaginary but they
are created by the mind.
Delusions are experiences or strong beliefs you hold that are not in line with generally-accepted
reality. Examples of delusions include the belief that
you are being followed by secret agents or that someone
is trying to take over the world or hurt someone you
love. Delusions can start suddenly or they may start
after a while of noticing that something strange has
been happening that you can't explain. Delusions can also start as a way of explaining hallucinations. For
example, if you hear voices commenting on your thoughts
and actions, you may be convinced that you are being
monitored or under surveillance. Paranoid delusions
are delusional ideas that make you feel harassed or
persecuted. They may be unusual, for example, the delusion
that you are being influenced by aliens ormore familiar
in that you start believing that your family are trying to control you. Another type of delusion is the idea
that you see special meaning from ordinary day to day
events and feel that they are directly connected with
you. For example the belief that TV programmes are
about you or the sequence of events relay a special
message for you. Delusions can affect someone in a
variety of different ways. Delusions may affect the
way you think, who you interact with and how you behave.
Thought disorder is when it is difficult to follow a logical sequence of thoughts as your thoughts
are muddled. You jump from one idea to the next without
any obvious association between the two ideas. It is
also common with thought disorder not to be able to
seem to remember what you wanted to say. This can affect
you in many ways, for example, problems holding a conversation,
completing studies in college, keeping down a job and
interacting with people.
Feelings of being controlled. This could include the feeling that your body is being taken over by an outside
force like aliens or a robot. You may feel that your
thoughts are not actually yours but that someone else
has put them in your head.
Negative symptoms. These symptoms are less obvious than the positive symptoms. It is sometimes
difficult for others to understand that these symptoms
are a result of schizophrenia. It is important to note
that even though these negative symptoms do not seem
as dramatic as the positive ones, they still can cause
extreme difficulty to the person experiencing them.
Difficulty concentrating, problems with attention and
memory are all commonly associated with schizophrenia.
There may be loss of interest in daily activities this is when you feel completely
disinterested in the activities that you used to really
enjoy. These activities did give you a sense of enjoyment,
satisfaction, enthusiasm and achievement but now you
can not bring yourself to do them.
Loss of motivation - this is when you feel you have no energy, you feel totally drained and find
it hard to be excited or motivated to do anything.
Causes of schizophrenia
It is not known for sure what causes schizophrenia to develop. It is thought
that schizophrenia usually results from a complex interaction
between genetic and environmental factors. As a result,
the causes are different for different people.
Genetic factors have been shown to have an impact on the development of schizophrenia.
Family studies and twin studies have provided valuable
information on the influence of genes and environmental
factors. Identical twin studies show that if one identical
twin has schizophrenia, their twin has approximately
a 50:50 chance of developing it also. If one of your
parents has schizophrenia you have a one in 10 chance of developing schizophrenia yourself. If both parents have schizophrenia the
risk is increased to one in four. The general population
risk of developing schizophrenia is one in 100.
Drugs and alcohol abuse
Studies have revealed that some people may develop symptoms of schizophrenia
as a result of using street drugs such as ecstasy,
LSD, amphetamines and crack. These drugs certainly
make you more vulnerable to developing schizophrenia.
Street drugs and alcohol make matters worse for you
if you already have schizophrenia.
Stressful life events
Studies and personal accounts have suggested that periods of stress or life-changing
events can trigger schizophrenia by increasing the
body's production of the hormone cortisol. Such stressful life events could include
sudden events such as bereavement, or an everyday problem
such as difficulty with college or work, or else longer-term
stresses such as difficulties with family members.
Brain chemical imbalances
There is some evidence to suggest that chemical imbalances in certain neurotransmitters
(the substances that allow communications between nerve
cells) play a role in the development of schizophrenia.
Studies suggest that an excess of the neurotransmitter
dopamine in the brain and a low level of glutamate
contributes to the development of schizophrenia.
Twin and adoptive studies suggest that inherited genes make a person vulnerable
to schizophrenia. Environmental factors act on this
vulnerability. A lot of research is pointing to stress
either during pregnancy or at a later stage. Examples
of stress inducing environmental factors that may be
involved in schizophrenia include: prenatal exposure
to a viral infection, low oxygen levels during birth,
exposure to a virus during infancy, early parental
loss or separation, or physical or sexual abuse in
Early warning signs of schizophrenia
For some people schizophrenia appears suddenly and without warning but for others
there are some early warning signs and a slow decline
in functioning before the first severe episode. During
this time people may withdraw from their family and
friends, find it difficult to concentrate and notice
change in their usual patterns of sleep and appetite.
This period is referred to as the prodromal period.
Some of the early warning signs include:
- Social withdrawal
- Hostility or suspiciousness
- Insomnia or oversleeping
- Deterioration of personal hygiene
- Odd or irrational statements
- Flat expressionless gaze
- Forgetfulness and unable to concentrate
- Extreme reaction to criticism
- Unusual use of words or way of speaking
- Inability to cry or express joy
How is schizophrenia diagnosed?
The process of diagnosis can be lengthy. The condition is diagnosed by a psychiatrist
who determines the presence of the symptoms of schizophrenia
via interview. All these symptoms do not need to be
present at once but they do need to be present for
approximately six months. The psychiatrist also needs
to rule out other causes of the symptoms experienced
before a diagnosis of schizophrenia can be reached.
How is schizophrenia treated?
If you feel you have symptoms of schizophrenia you should firstly consult your
GP. He or she will probably refer you to a psychiatrist
for initial assessment and treatment. Treatment for
schizophrenia includes a combination of medication
and psychological therapy, behavioural therapy and
social therapy. Treatments are selected on the basis
of their ability to reduce symptoms and reduce the
chances of recurrence.
What can I do if I am diagnosed with schizophrenia?
It is important to remember that it is estimated that 25% of people diagnosed
with schizophrenia will experience a full recovery,
40% will experience recurrent episodes and 35% will
experience long-term effects. If you have been diagnosed
with schizophrenia the following points are important:
- Keep in contact with your mental health team
- Avoid stressful situations
- Take medication as prescribed by your doctor and have open discussions about
possible side effects
- Ask your doctor questions about your condition and learn more about it. Contact
Schizophrenia Ireland's helpline for information 1890 621 631 (9am-4pm)
- Try to recognise your early warning signs of relapse
- Develop a close relationship with someone who can help you spot early warning
signs of relapse and help you deal with the situation
- Be careful about consuming alcohol
- Join a support group. Contact Schizophrenia Ireland for your nearest local group
(1890 621 631 or www.sirl.ie)
- Look after your general health by eating healthily and getting some exercise.
Exercise and diet can have a positive impact on weight,
sleep, stress and overall outlook on life
What can friends or family do to help?
Families and friends can have a vital role in helping recovery and reducing
the likelihood of relapse. The follow suggestions are
ways that family and friends can help:
- Be available to listen
- Educate yourself: learn about schizophrenia and its treatments. This will allow
you to be more prepared, make informed decisions
and be supportive to your friend or family member
- Seek help straight away: early intervention makes a difference so don't wait to get professional help
- Reduce stress: stress can cause schizophrenic symptoms to flare up so it is important
to provide a structure or supportive environment
for your friend or family member. Avoid putting pressure
on your friend or family member or criticising perceived
- Encourage independence, e.g. encourage your friend or family member to learn
new skills and social outlets. Rather than doing
everything for your friend or family member, encourage
self-care and self-confidence
- Find out about the reality of schizophrenia including different coping strategies.
Find out from the person experiencing schizophrenia
how they would like you to help during a time of
crisis. Some tips could include the following:
- Have a list of emergency contact telephone numbers ready
- Remember that you cannot reason with acute psychosis
- Be aware that your friend or family member may well be terrified. Try to
- Decrease distractions, e.g. turn off radio orTV
- Move to a quiet place with fewer people around
- Devise an emergency plan alongside your friend or family member
- Look after your own general health
- Contact local support groups for family and friends. Schizophrenia Ireland can
supply a list of local contact details. Call 1890