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Schizophrenia: Help Is at Hand
Schizophrenia: Help Is at Hand
at hand
Schizophrenia
The
1 Royal College of Psychiatrists
About this leaflet
This leaflet is for you if:
■ you have a diagnosis of schizophrenia
■ you think you might have schizophrenia
■ you know someone with this diagnosis
■ you just want to know more about
schizophrenia.
It covers:
■ what it is like to have schizophrenia
■ what causes it
■ what can help
■ how to help yourself
■ information for relatives.
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What is schizophrenia?
A disorder of the mind which affects how you
think, feel and behave. Its symptoms are often
described as either ‘positive’ or ‘negative’.
‘Positive’ symptoms
These are unusual experiences which are
common in schizophrenia, but can also happen
in other mental disorders.
Hallucinations
A hallucination happens when you hear, smell,
feel or see something – but there isn’t anything
(or anybody) there to cause it. The commonest
one is hearing voices.
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Where do they come from?
Voices are not imaginary – you really do hear
them – but they are created by the mind. Scans
have shown that the part of the brain that is
active when you hear voices is the part that is
active when you talk, or form words in your
mind. The brain seems to mistake your own
thoughts, or ‘inner speech’, for voices coming
from outside you.
Delusions
A delusion happens when you believe something
– and are completely sure of it – while other
people think you have misunderstood what is
happening. It’s as though you see things in a
completely different way from everyone else.
You have no doubts, but other people see your
belief as mistaken, unrealistic or strange. If you
do try to talk about your ideas with someone,
your reasons don’t make sense to them, or you
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can’t explain – you ‘just know’. It’s an idea, or
set of ideas, that can’t be explained as part of
your culture, background or religion.
‘Paranoid’ delusions
These are ideas that make you feel persecuted
or harassed. They may be:
■ unusual – it feels as though MI5 or the
government is spying on you. You may think
that neighbours are influencing you with
special powers or technology.
■ everyday – you start to believe your partner
is unfaithful. You do so because of odd
details that seem to have nothing to do with
sex or not being faithful. Other people can
see nothing to suggest that this is true.
■ upsetting – feeling persecuted is obviously
upsetting for you. It can also be distressing
for the people you see as your persecutors,
especially if they are close to you, like
your family.
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Making strange connections
(‘ideas of reference’)
You start to see special meanings in ordinary,
day-to-day events. It feels as though things are
specially connected to you – that radio or TV
programmes are about you, or that someone is
telling you things in odd ways, for example,
through the colours of cars passing in the street.
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Feelings of being controlled
You feel that:
■ your thoughts suddenly disappear – as though
someone is taking them out of your mind
■ your thoughts feel as though they are not
yours – it’s as though someone else has put
them into your mind
■ your body is being taken over, or that you are
being controlled like a puppet or a robot.
Some people explain these experiences by
thinking it’s the radio, television or laser beams,
or that a device has been implanted in them.
Other people blame witchcraft, angry spirits,
God or the Devil.
‘Negative’ symptoms
■ You start to lose your normal thoughts,
feelings and motivations.
■ You lose interest in life. Your energy, emotions
and ‘get-up-and-go’ just drain away. It’s hard
to feel excited or enthusiastic about anything.
■ You can’t concentrate.
■ You don’t bother to get up or go out of
the house.
■ You stop washing or tidying, or keeping your
clothes clean.
■ You feel uncomfortable with people.
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Does everyone with schizophrenia have
all these symptoms?
No. You can hear voices and have negative
symptoms, but may not have delusional ideas.
Some people with delusional ideas seem to have
very few negative symptoms. If you only have
thought disorder and negative symptoms, they
may not be recognised for years.
Loss of ‘insight’
It feels as though everyone else is wrong, that
they just can’t understand the things that you
can. You feel that the problem is with the rest
of the world, not with you.
Depression
■ Around half the people with schizophrenia for
the first time will feel depressed, often before
they get more obvious symptoms.
■ Around 1 in 7 people with continuing
symptoms will become depressed. This can
be mistaken for negative symptoms.
■ Antipsychotic medication has been blamed –
but research suggests that it actually helps
depression in schizophrenia.
■ If you have schizophrenia and feel depressed,
make sure that you tell someone and that they
take you seriously. Our Help is at Hand
leaflet on Depression has more information.
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How common is schizophrenia?
It affects around 1 in every 100 people over the
course of their life.
Genes
Although only 1 in 100 people get
schizophrenia, about 1 in 10 people with
schizophrenia have a parent with the illness.
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Relatives with Chance of developing
schizophrenia schizophrenia
None 1 in 100
1 parent 1 in 10
1 identical twin 1 in 2
(same genetic make up)
1 non-identical twin
(different genetic make up) 1 in 80
Brain damage
Brain scans show that there are differences in
the brains of some people with schizophrenia –
but not in others. Where this is the case, it may
be that parts of the brain have not grown
normally because of:
■ a problem during birth that stops the baby’s
brain from getting enough oxygen
■ a virus infection during the early months
of pregnancy.
Amphetamines
can give you psychotic symptoms, but they
usually stop when you stop taking the
amphetamines. We don’t yet know whether
these drugs, on their own, can trigger off a
long-term illness, but they may do if you are
vulnerable. Some people start using drugs or
alcohol to cope with their symptoms, but this
can make things worse.
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Cannabis
■ The heavy use of cannabis seems to double
the risk of developing schizophrenia. New
research has shown that the stronger forms
of cannabis, such as skunk, may increase
this risk.
■ It’s more likely if you start using cannabis in
your early teens.
■ If you have smoked it frequently (more than
50 times) during your teens, the effect is
even stronger – you are 6 times more likely
to develop schizophrenia.
Stress
Difficulties often seem to happen shortly before
symptoms get worse. This may be a sudden
event like a car accident, bereavement or
moving home. It can be an everyday problem,
such as difficulty with work or studies. Long-
term stress, such as family tensions, can also
make it worse.
Family problems
At one time people thought that communication
problems in the family could cause
schizophrenia. This doesn’t seem to be the
case. However, if you have schizophrenia,
family tensions can certainly make it worse.
A difficult childhood
As with other mental disorders, schizophrenia
is more likely if you were deprived or
physically or sexually abused as a child.
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What about violence in schizophrenia?
A few people with schizophrenia do become
violent – they usually hurt themselves but
sometimes hurt other people. This can be
caused by feelings of persecution or voices
telling them to do it – often a combination of the
two. It is much more likely if drugs or alcohol
are involved.
Outlook
Many people with schizophrenia now never
have to go into hospital and are able to settle
down, work and have lasting relationships.
For every 5 people with schizophrenia:
■ 1 will get better within five years of their first
obvious symptoms
■ 3 will get better, but will have times when
they get worse again
■ 1 will have troublesome symptoms for long
periods of time.
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The evidence is beginning to suggest that if
schizophrenia is treated early:
■ you are less likely to have to come
into hospital
■ you are less likely to need intensive support
at home
■ if you do come into hospital, you will spend
less time there
■ you are more likely to be able to work and
live independently.
Treatment
If you have the symptoms of schizophrenia for
the first time, you should start medication as
soon as possible.
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Medication
How is it taken?
■ As tablets, capsules, or syrup. It’s hard for
anybody to remember to take tablets several
times a day, so there are now some that you
only need to take once a day.
■ If you find it hard to take tablets every day,
you may find it easier to take antipsychotic
medication as an injection every 2, 3 or 4
weeks. These are called depot injections and
are given by a nurse.
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How well does medication work?
■ About 4 in 5 people get help from them.
They control the symptoms, but do not get rid
of them. You have to go on taking the
medication to stop the symptoms from
coming back.
■ Even if the medication helps, the symptoms
may come back. This is much less likely to
happen if you carry on taking medication,
even when you feel well.
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Getting back to normal
Schizophrenia can make everyday life hard to
deal with. This may or may not be due to the
symptoms. Sometimes you may just get out of
the habit of doing things for yourself. It can be
difficult to get back to doing ordinary things like
washing, answering the door, shopping, making
a phone call or chatting with a friend.
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you to control troublesome hallucinations or
delusional ideas. Most people have between 8
and 20 sessions, each lasting about 1 hour. To
help the symptoms of schizophrenia, you may
need to carry on with ‘booster’ courses from
time to time.
Family meetings
These try to help you and your family cope
better with the situation. They can be used to
discuss information about schizophrenia, how
best to support someone with schizophrenia
and how to solve the practical problems that
can crop up. Around ten meetings happen
over a period of about 6 months.
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■ Work out ways of helping you to do more
for yourself.
■ Help you to improve your social skills
(how to get on with other people).
■ There may be help for families, with
regular meetings for a while. These can
help a family to learn more about the
illness and treatment and can help them to
sort out some of the practical problems of
day to day living.
■ The psychiatrist will usually organise your
medication and take responsibility for
your overall care.
■ The care coordinator is responsible
for making sure that you get the care
you need.
■ Vocational rehabilitation or recovery
workers can help you to get back into
work, education or some sort of activity
that you find rewarding.
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How treatments compare
■ Apart from clozapine, there seem to be few
differences in the effectiveness of any of the
antipsychotics. Treatment should usually start
with one of the newer drugs – an ‘atypical’.
■ It is also not possible to say in advance
whether one antipsychotic will work better for
you than another. You may need to try one
antipsychotic and see how you get on with it.
If it doesn’t help you, or if the side-effects
are a problem, discuss trying another with
your psychiatrist.
■ Clozapine does seem to work better than
other antipsychotics for some people.
However, its side-effects can be dangerous,
so it can only be prescribed by a specialist
after other treatments have failed. If you have
had both a ‘typical’ antipsychotic and an
‘atypical’ antipsychotic for 8 weeks without
real help from either, clozapine may be
worth trying.
■ CBT seems to be helpful in people who are
taking medication, but we don’t know how
well it works if someone is not taking
medication. It may be particularly helpful in
very early schizophrenia.
■ If you want further information about
treatments, see the NICE guidelines (listed
at end).
■ If you are unhappy with your treatment,
you can ask for a second opinion from
another psychiatrist.
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Social help
Day centres
You may not be working, or may be unable to
go back to work. Even so, it’s good to get out
and do something every day.
Work projects
These can help you develop your skills for work.
They will often have contacts with local
employers and can support you when you go
back to work. If you are unwell for a long time,
you may need a specialist rehabilitation service.
Supported accommodation
This could be a bedsit or flat where there is
someone around to help you with day-to-day
problems.
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CPA – Care Programme Approach
(England & Wales only)
This is a way of making sure that people with
schizophrenia get appropriate care and
support. It involves:
■ a care coordinator who is responsible for
organising all the different parts of your care
and treatment.
■ regular meetings every 3 – 6 months. These
involve you, your care coordinator, your
psychiatrist and any other people who are
giving you care or support. This can include
your family or carers.
■ a care plan that is checked at the regular
CPA meetings. It is re-written each time and
you will have a copy to approve or change.
■ plans are made with you at these meetings
about what to do if you find yourself
becoming unwell again, or run into
difficulties.
■ carers can have an assessment of their
needs every year.
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Self-help
Learn to recognise early signs that you are
getting unwell, such as:
■ everyday things like going off your food,
feeling anxious or not sleeping.
■ other people may notice that you stop
bothering to change your clothes, clean your
flat or cook for yourself.
■ mild symptoms – you feel a bit suspicious or
fearful or start to worry about people’s motives.
You may start to hear voices quietly or
occasionally, or find it difficult to concentrate.
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Join a self-help group for people with similar
experiences to yours.
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For families
It can be hard to understand what is happening
if your son or daughter, husband or wife,
brother or sister develops schizophrenia.
Sometimes, no-one realises what is wrong.
Was it my fault?
You may start to blame yourself and wonder
‘Was it my fault?’ You may wonder if anyone
else in the family is going to be affected,
what the future holds or how they can get
the best help.
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Can I talk to the mental health team?
Families have often been left out of discussions
because of worries about confidentiality. This
should not be the case now. People with
schizophrenia are often living with or being
supported by their family. So, their family should
have the information that will allow them to care
most effectively. Even if the person does not
want their family to be involved, the family can
still tell the mental health team about what is
going on.
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Some myths
Isn’t schizophrenia a split personality?
No. Too many people have the idea that
someone with schizophrenia can appear
perfectly normal at one moment, and change
into a different person the next. This is not true.
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Further help
Rethink: www.rethink.org
National voluntary organisation that helps
people with any severe mental illness, their
families and carers.
Mind: www.mind.org.uk
Mindinfoline: 0845 766 0163. Publishes a
wide range of literature on all aspects of
mental health.
Saneline: www.sane.org.uk
Helpline: 0845 767 8000. A national mental
health helpline offering emotional support and
practical information for people with mental
illness, families, carers and professionals.
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References
Arsenault, L. et al. (2004) Causal association
between cannabis and psychosis: examination
of the evidence. British Journal of Psychiatry,
184: 110-117.
28
Mulholland, C. & Cooper, S. (2000) The
symptom of depression in schizophrenia and
its management. Advances in Psychiatric
Treatment, 6, 169 – 177.
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Further reading
Fast Facts: Schizophrenia.
S Lewis and RW Buchanan
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The Royal College of Psychiatrists produces:
■ a wide range of mental health information for patients,
carers and professionals
■ factsheets on treatment in psychiatry, such as
antidepressants and cognitive behavioural therapy.
These can be downloaded from our website:
www.rcpsych.ac.uk
Illustration by Lo Cole/eastwing.co.uk
© February 2010 Royal College of Psychiatrists, all rights
reserved. This leaflet may not be reproduced in whole or in
part without the permission of the Royal College of Psychiatrists.
This leaflet is due for review in February 2012.
www.rcpsych.ac.uk/info
The Royal College of Psychiatrists is a charity Registered charity number 1104951
registered in England (228636) and in www.stah.org
Scotland (SC038369).