What is schizophrenia?

Schizophrenia is a psychiatric condition that has severe effects on your physical and mental well-
being. It disrupts how your brain works, interfering with things like your thoughts, memory, senses
and behaviors. As a result, you may struggle in many parts of your day-to-day life. Untreated
schizophrenia often disrupts your relationships (professional, social, romantic and otherwise). It
can also cause you to have trouble organizing your thoughts, and you might behave in ways that
put you at risk for injuries or other illnesses.

What are the types of schizophrenia?

Psychiatrists once referred to different types of schizophrenia, like paranoid
schizophrenia and catatonic schizophrenia. But the types weren’t very useful in
diagnosing or treating schizophrenia. Instead, experts now view schizophrenia as a
spectrum of conditions, including:
 Schizotypal personality disorder (which also falls under the category
of personality disorders).
 Delusional disorder.
 Brief psychotic disorder.
 Schizophreniform disorder.
 Schizoaffective disorder.
 Other schizophrenia spectrum disorders (specified or unspecified). This
diagnosis allows healthcare providers to diagnose unusual variations of
schizophrenia.

Who does it affect?

Schizophrenia starts between ages 15 and 25 for
men and people assigned male at birth (AMAB)
and between 25 and 35 for women and people
assigned female at birth (AFAB). It also tends to
affect men and women in equal numbers. About
20% of new schizophrenia cases occur in people
over age 45. These cases tend to happen more in
men and people AMAB.

Schizophrenia in children is rare but possible.

When schizophrenia does start in childhood, it’s
usually more severe and harder to treat.

Symptoms and Causes

Schizophrenia can include a wide range of possible

symptoms.
What are the five symptoms of schizophrenia?
Many people with schizophrenia can’t recognize
that they have symptoms of schizophrenia. But
those around you might. These are the five main
symptoms of schizophrenia
 1. Delusions: These are false beliefs that you hold even when there’s plenty of
evidence that those beliefs are wrong. For example, you might think that someone
is controlling what you think, say or do.
2. Hallucinations: You still think you can see, hear, smell, touch or taste things that
don’t exist, like hearing voices.
3. Disorganized or incoherent speaking: You may have trouble organizing your
thoughts while speaking. This might look like trouble staying on topic, or your
thoughts might be so jumbled that people can’t understand you.
4. Disorganized or unusual movements: You might move differently than people
around you expect. For example, you may turn around a lot for no clear reason, or
you might not move much at all.
5. Negative symptoms: These refer to a reduction or loss of your ability to do things
as expected. For example, you might stop making facial expressions, or speak with
a flat, emotionless voice. Negative symptoms also include a lack of motivation,
especially when you don’t want to socialize or do things you ordinarily enjoy.

Because of these symptoms, you might:

 Feel suspicious, paranoid or scared.
 Not care about your hygiene and appearance.
 Experience depression, anxiety and suicidal thoughts.
 Use alcohol, nicotine, prescription medications or recreational drugs to try to
ease your symptoms.

What are the risk factors of schizophrenia?

While there aren’t any confirmed causes of schizophrenia, there are risk factors for
developing the condition:

 Environment: Many factors in the world around you can increase your risk of
developing schizophrenia. Being born during the winter increases your risk
slightly. Certain illnesses that affect your brain, including infections
and autoimmune diseases (where your immune system attacks part of your
 body), can also increase your risk. Extreme stress for long periods can also play a
role in developing it.
 Development and birth circumstances: How you developed before you were born
plays a role in schizophrenia. The risk of having schizophrenia goes up if your
birthing parent had gestational diabetes, preeclampsia, malnutrition or a vitamin
D deficiency while pregnant with you. The risk also increases if you were
underweight at birth or if there were complications during your birth (like if you
were born via an emergency cesarean section).
 Recreational drug use: Schizophrenia is linked with the use of certain recreational
drugs, especially in larger amounts and earlier in life. The connection between
heavy marijuana (cannabis) use as a teenager is one of the best-studied of these
links. But experts aren’t sure if marijuana use is a direct cause of schizophrenia or
if it’s just a contributing factor.

Is schizophrenia genetic?
Experts haven’t found one specific cause of schizophrenia, so they can’t say for sure if
genetics cause schizophrenia. But if you have a family history of schizophrenia —
especially a parent or sibling with it — you have a much higher risk of developing this
condition.

How is schizophrenia treated?

Treating schizophrenia usually involves a combination of medication, therapy and self-
management techniques. These include:
 Antipsychotics. These medications block how your brain uses certain chemicals
for cell-to-cell communication.
 Other medications. Your healthcare provider might also prescribe other
medications to symptoms that happen alongside or because of your
schizophrenia symptoms. They might also prescribe medications to help reduce
side effects of antipsychotic medications such as tremors.
 Psychotherapy. Talk therapy methods like cognitive behavioral therapy (CBT) can
help you cope with and manage your condition. Long-term therapy can also help
with secondary problems alongside schizophrenia, such as anxiety, depression or
substance use issues.
 Electroconvulsive therapy (ECT). If other treatments don’t work, your provider
may recommend ECT. This treatment involves using an electrical current applied
to your scalp, which then stimulates certain parts of your brain. The stimulation
causes a brief seizure, which can help improve brain function if you have severe
depression, agitation and other problems. If you have ECT, you receive anesthesia.
You’ll be asleep for this procedure and won’t feel any pain.

1. Genetic Factors:
 Family History: Having a family history of schizophrenia is a significant risk factor.
The heritability of schizophrenia is estimated to be around 80%, indicating a strong
genetic influence.
 Polygenic Nature: Schizophrenia is considered a polygenic disorder, meaning that
multiple genes contribute to its development. No single gene is responsible, but
certain combinations of genetic variations may increase susceptibility.

2. Neurobiological Factors:
 Dopamine Hypothesis: This theory proposes that an overactivity of dopamine
transmission in specific brain pathways contributes to the positive symptoms of
schizophrenia, such as hallucinations and delusions. Antipsychotic medications,
which block dopamine receptors, are effective in alleviating these symptoms.
 Structural Brain Abnormalities: Neuroimaging studies have identified structural
changes in the brains of individuals with schizophrenia. Enlargement of the lateral
and third ventricles, reduced size of the hippocampus and amygdala, and altered
cortical thickness are some examples.

3. Prenatal and Perinatal Factors:

 Complications during Pregnancy or Birth: Factors such as malnutrition, exposure to
infections, and oxygen deprivation during pregnancy or birth may impact fetal brain
development and increase the risk of schizophrenia later in life. The exact
mechanisms are not fully understood.

4. Environmental Factors:
 Stressful Life Events: Chronic stress or significant life events, particularly during
critical developmental periods, may contribute to the onset of schizophrenia. Stress
can interact with genetic vulnerabilities and affect neurobiological processes.

 Urban Upbringing: Some studies suggest an association between urban living and an
increased risk of schizophrenia. The social stressors, pollution, and other
environmental factors in urban areas may contribute, but the precise mechanisms
are still under investigation.

5. Drug Use:
 Substance Abuse: The use of certain psychoactive substances, especially during
adolescence, has been linked to an increased risk of schizophrenia. Cannabis, in
particular, has been associated with a higher likelihood of developing the disorder,
especially in genetically predisposed individuals.

6. Psychological and Psychosocial Factors:

 Early Childhood Adversity: Traumatic experiences during childhood, such as
physical or sexual abuse, neglect, or the loss of a parent, may increase the risk of
developing schizophrenia. The impact of early adversity on brain development and
stress response systems is thought to be involved.
 Family Dynamics: Dysfunctional family dynamics or high levels of expressed emotion
(critical or emotionally overinvolved family environments) may contribute to the
course of schizophrenia. Stressful family relationships can influence the onset and
exacerbation of symptoms.
Other Schizophrenia Spectrum Disorders
The DSM-5 classifies a range of psychological disorders within the schizophrenia spectrum of
disorders. They range from milder forms of disorganized or unusual thinking and difficulties relating
to others associated with schizotypal personal disorder (discussed in Chapter 12) to frankly psychotic
disorders, including brief psychotic disorder, schizophreniform disorder, delusional disorder, and
schizoaffective disorder, as well as schizophrenia itself.

Brief Psychotic Disorder

Some brief psychotic episodes do not progress to schizophrenia. The diagnostic category of brief
psychotic disorder applies to a psychotic disorder that lasts from a day to a month and is characterized
by at least one of the following features: delusions, hallucinations, disorganized speech, or grossly
disorganized or catatonic behavior. Eventually, there is a full return to the individual’s prior level of
functioning. Brief psychotic disorder is often linked to a significant stressor or stressors, such as the
loss of a loved one or exposure to brutal traumas in wartime. Women sometimes experience the
disorder after childbirth.

Schizophreniform Disorder
Schizophreniform disorder consists of abnormal behaviors identical to those in schizophrenia that
have persisted for at least one month but less than six months. They thus do not yet justify the
diagnosis of schizophrenia. Although some cases have good outcomes, in others, the disorder persists
beyond six months and may be reclassified as schizophrenia or perhaps another form of psychotic
disorder, such as schizoaffective disorder. However, questions remain about the validity of the
diagnosis. It may be more appropriate to diagnose people who show psychotic features of recent
origin with a classification that does not specify a specific type of psychotic disorder until additional
information clearly indicates which specific disorder applies.

Delusional Disorder
Many of us, perhaps even most of us, feel suspicious of other people’s motives at times.
We may feel that others have it in for us or believe that others are talking about us behind our backs.
For most of us, however, paranoid thinking does not take the form of outright delusions. The diagnosis
of delusional disorder applies to people who hold persistent, clearly delusional beliefs, often involving
paranoid themes (Sammons, 2005b).

Delusional
disorder is rare, affecting an estimated 20 people in 10,000 during their lifetimes
(APA, 2013). In delusional disorder, the delusional beliefs may be bizarre (e.g., believing that aliens
have implanted electrodes in the person’s head) or may fall within a range of seeming plausibility,
such as unfounded beliefs concerning the infidelity of a spouse, persecution by others, or attracting
the love of a famous person. The apparent plausibility of some of these beliefs may lead other people
to take them seriously and check them out before concluding that they are unfounded. Apart from the
delusion, the individual’s behavior may not show evidence of obviously bizarre or odd behavior.

Schizoaffective Disorder
Schizoaffective disorder is sometimes referred to as a “mixed bag” of symptoms because it includes
psychotic behaviors associated with schizophrenia (e.g., hallucinations and delusions) occurring at the
same time as a major mood disorder (major depressive episode or manic episode). At some point in
the course of the disorder, however, delusions or hallucinations must have occurred for a period of at
least two weeks without the presence of a major mood disorder (so as to distinguish the disorder from
a mood disorder with psychotic features). The lifetime prevalence of the disorder is estimated to be
0.3% of the general population (APA, 2013). Like schizophrenia, schizoaffective disorder tends to
follow a chronic course that is characterized by persistent difficulties adjusting to the demands of
adult life. Also like schizophrenia, the psychotic features of schizoaffective disorder often respond to
antipsychotic drugs (Glick et al., 2009; Díaz-Marsá et al., 2009). Schizoaffective disorder and
schizophrenia appear to share a genetic link (Bramon & Sham, 2001). We need to discover why this
common genetic substrate or predisposition leads to one disorder and not the other.

1. Psychodynamic Viewpoint:
 Focus: The psychodynamic perspective, rooted in psychoanalytic theory, emphasizes unconscious
processes, early experiences, and internal conflicts as key determinants of behavior.
 Application to Schizophrenia: Psychodynamic theories suggest that disturbances in early
relationships and unresolved conflicts may contribute to the development of schizophrenia. The
symbolic meaning of symptoms, such as delusions, is explored in terms of unconscious conflicts.
2. Behavioral Viewpoint:
 Focus: Behavioral psychology emphasizes observable behaviors and the impact of the environment
on shaping and maintaining those behaviors.
 Application to Schizophrenia: Behavioral models of schizophrenia often focus on the role of
conditioning and reinforcement. Maladaptive behaviors and symptoms may be seen as learned
responses to environmental stressors or as ways of coping with internal and external challenges.
3. Cognitive Viewpoint:
 Focus: Cognitive psychology explores how thoughts, beliefs, and cognitive processes influence
behavior and mental health.
 Application to Schizophrenia: Cognitive theories of schizophrenia highlight cognitive deficits,
distorted thought processes, and dysfunctional beliefs. Cognitive impairments, such as difficulties in
attention, memory, and problem-solving, are considered central to the disorder.
4. Genetic Viewpoint:
 Focus: The genetic viewpoint examines the role of genetic factors in the development of
schizophrenia.
 Application to Schizophrenia: Genetic studies show a strong hereditary component in
schizophrenia. Certain genetic variations are associated with an increased risk, and individuals with
a family history of schizophrenia are more vulnerable. However, genetic factors alone do not account
for the complexity of the disorder.