Understanding Schizophrenia


Schizophrenia Treatment and Recovery

Getting the Help and Support You Need

Schizophrenia treatment

Schizophrenia treatment
Getting a diagnosis of schizophrenia can be devastating. But it doesn't mean you can't live a full and meaningful life. Early diagnosis and treatment can prevent complications and improve the chance of recovery, so if you suspect schizophrenia, see a doctor right away. With proper treatment and support, many people are able to reduce their symptoms, live and work independently, build satisfying relationships, and enjoy a fulfilling life.

Schizophrenia: New hope for treatment and recovery

Despite the widespread misconception that people with schizophrenia have no chance of recovery or improvement, the reality is much more hopeful. Although currently there is no cure for schizophrenia, it can be treated and managed with medication and supportive therapies.
A diagnosis of schizophrenia is not a life-sentence of ever-worsening symptoms and hospitalizations. Recovery is possible. In fact, the majority of people with schizophrenia get better over time, not worse. For every five people who develop schizophrenia:
  • One will get better within five years of their first symptoms.
  • Three will get better, but will still have times when their symptoms get worse.
  • One will continue to have troublesome symptoms.

What does schizophrenia recovery mean?

Recovery from schizophrenia is a lifelong process. It doesn’t mean you won’t experience any more challenges from the illness or that you’ll always be symptom-free. What it does mean is that you are learning to manage your symptoms, developing the support you need, and creating a satisfying, purpose-driven life.
Successful treatment for schizophrenia aims to relieve current symptoms, prevent future psychotic episodes, and restore your ability to function and enjoy a meaningful life. A schizophrenia treatment plan that combines medication with self-help, supportive services, and therapy is the most effective approach.

Encouraging facts about schizophrenia

  • Schizophrenia is treatable. Currently, there is no cure for schizophrenia, but the illness can be successfully treated and managed. The key is to have a strong support system in place and get the right treatment for your needs.
  • You can enjoy a fulfilling, meaningful life. With the right treatment, most people with schizophrenia are able to have satisfying relationships, work or pursue other meaningful activities, be part of the community, and enjoy life.
  • Just because you have schizophrenia doesn’t mean you’ll have to be hospitalized. If you’re getting the right treatment and sticking to it, you are much less likely to experience a crisis situation that requires hospitalization.
  • Most people with schizophrenia get better over time, not worse. People with schizophrenia can regain normal functioning and even become symptom free. No matter what challenges you presently face, there is always hope.

Schizophrenia treatment & recovery tip 1: Get involved in treatment

If you identify schizophrenia symptoms, seek help right away. The earlier you catch schizophrenia and begin treatment with an experienced mental health professional, the better your chances of getting and staying well.
Successful schizophrenia treatment depends on a combination of factors. Medication alone is not enough. It's important to also educate yourself about the illness, communicate with your doctors and therapists, have a strong support system, take self-help steps, and stick to your treatment plan.
While schizophrenia treatment should be individualized to your specific needs, you should always have a voice in the treatment process and your needs and concerns should be respected. Treatment works best when you, your family, and your medical team all work together.

Your attitude towards schizophrenia treatment matters

Accept your diagnosis. As upsetting as a diagnosis of schizophrenia can be, resolving to take prescribed medications and attend medical and therapy appointments is crucial to your recovery.
Don’t buy into the stigma of schizophrenia. Many fears about schizophrenia are not based on reality. Take your illness seriously but don’t buy into the myth that you can’t get better. Associate with people who see beyond your diagnosis, to the person you really are.
Communicate with your doctor. Help your doctor ensure you’re getting the right type and dose of medication. Be honest and upfront about side effects, concerns, and other treatment issues.
Pursue therapies that help you manage symptoms. Don’t rely on medication alone. Supportive therapy can teach you how to challenge delusional beliefs, ignore voices in your head, protect against relapse, and motivate yourself.
Set and work toward life goals. Having schizophrenia doesn’t mean you can’t work, have relationships, or experience a fulfilling life. Set meaningful life goals for yourself beyond your illness.

Getting a diagnosis

The first step to schizophrenia treatment is getting a correct diagnosis. This isn't always easy, since the symptoms of schizophrenia can resemble those caused by other mental and physical health problems. Furthermore, people with schizophrenia may believe nothing is wrong and resist going to the doctor.
Because of these issues, it is best to see a psychiatrist with experience identifying and treating schizophrenia, rather than a family doctor. To learn more, see Schizophrenia.

Tip 2: Manage stress

The day-to-day stress of living with a challenging emotional disorder such as schizophrenia can be draining. Stress can also trigger psychosis and make the symptoms of schizophrenia worse, so keeping it under control is extremely important.
Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you feel overwhelmed.
Connect with others. Social interaction with someone who cares about you is the most effective way to calm your nervous system and relieve stress. Find someone you can connect with face to face—someone you can talk to for an uninterrupted period of time, someone who will listen to you without judging, criticizing, or continually being distracted. That person may be a friend, family member, clergy member, or professional therapist.
Use relaxation techniques to relieve stress. Techniques such as mindfulness meditation, deep breathing, or progressive muscle relaxation can put the brakes on stress and bring your mind and body back into a state of balance.
Manage your emotions. Understanding and accepting emotions—especially those unpleasant ones most of us try to ignore—can make a huge difference in your ability to manage stress, balance your moods, and maintain control of your life. See HelpGuide’s Emotional Intelligence Toolkit.

Tip 3: Find support

As well as helping to relieve stress, having the support of others can make a huge difference in the outlook for schizophrenia. When you have people who care about you and are involved in your treatment, you’re more likely to achieve independence and avoid relapse. To find support:
Turn to trusted friends and family members. Your loved ones can help you get the right treatment, keep your symptoms under control, and function well in your community. Ask loved ones if you can call on them in times of need. Most people will be flattered by your request for support.
Stay involved with others. If you’re able to continue work or education, do so. Otherwise, consider volunteering.
Meet new people. Joining a schizophrenia support group can help you meet other people dealing with the same challenges and learn important coping tips. Or get involved with a local church, club, or other organization.
Take advantage of support services in your area. Ask your doctor or therapist about services available in your area, contact hospitals and mental health clinics, or see the Resources section below for links to support services.

The importance of a supportive living environment in schizophrenia treatment

People with schizophrenia often do best when they’re able to remain in the home, surrounded by supportive family members, or can find a stable living environment where they feel safe.
  • Living with family is a particularly good option when your family members understand the illness, have a strong support system of their own, and are able to provide whatever assistance is needed.
  • Any living arrangement is more likely to be successful if you avoid using drugs or alcohol, follow your treatment plan, take care of yourself, and take advantage of outside support services.

Tip 4: Take self-help steps

Medication and other schizophrenia treatment can take time to take full effect but there are still things you can do for yourself to help manage symptoms, improve the way you feel, and increase your self-esteem. The more you do to help yourself, the less hopeless and helpless you’ll feel. Pursuing self-help may also enable your doctor to reduce your medication.
Get regular exercise. As well as all the emotional and physical benefits, exercise may even help reduce symptoms of schizophrenia. It’s also something you can do right now to improve your focus, give you more energy, and make you feel calmer. Aim for 30 minutes of activity on most days or if it’s easier, three 10-minute sessions. Try rhythmic exercise that engages both your arms and legs, such as walking, running, swimming, or dancing. Focus on how your body feels as you move—how your feet hit the ground, for example, the rhythm of your breathing, or the feeling of wind on your skin.
Try to get plenty of sleep. When you’re on medication, you most likely need even more sleep  than the standard 8 hours. Many people with schizophrenia have trouble with sleep, but lifestyle changes (such as getting regular exercise and avoiding caffeine) can help.
Avoid alcohol and drugs. Some evidence indicates a link between drug use and schizophrenia. And it’s indisputable that substance abuse complicates schizophrenia treatment and worsens symptoms. If you have a substance abuse problem, seek help.
Eat a healthy, balanced diet. Eating regular, nutritious meals can help avoid psychosis and other schizophrenia symptoms brought on by substantial changes in blood sugar levels. Omega-3 fatty acids from fatty fish, fish oil, walnuts, and flaxseeds can help improve focus, banish fatigue, and your balance moods.
Do things that make you feel good about yourself. If you can’t get a job, find other activities that give you a sense of purpose and accomplishment. Pursue a passion, cultivate a new hobby, or reach out to help other people, animals, or causes important to you.

Tip 5: Put medication in its place

If you’ve been diagnosed with schizophrenia, you will almost certainly be offered antipsychotic medication. But it’s important to understand that medication is just one component of schizophrenia treatment.
Medication is not a cure for schizophrenia. Rather it works by reducing the psychotic symptoms of schizophrenia such as hallucinations, delusions, paranoia, and disordered thinking.
Medication only treats some of the symptoms of schizophrenia. Antipsychotic medication reduces psychotic symptoms, but is much less helpful for treating symptoms of schizophrenia such as social withdrawal, lack of motivation, and lack of emotional expressiveness.
You should not have to put up with disabling side effects. Schizophrenia medication can have very unpleasant—even disabling—side effects such as drowsiness, lack of energy, uncontrollable movements, weight gain, and sexual dysfunction. Your quality of life is important, so talk to your doctor if you’re bothered by side effects. Lowering the dose or switching medications may help.
Never reduce or stop medication on your own. Sudden or unsupervised dosage changes are dangerous, and can trigger a schizophrenia relapse or other complications. If you’re having trouble with your medication or feel like you don’t need to take it, talk to your doctor or someone else that you trust.

Finding the right medication for schizophrenia treatment

Since many people with schizophrenia require medication for extended periods of time—sometimes for life—the goal is to find a medication regimen that keeps the symptoms of the illness under control with the fewest side effects using the lowest possible dose. Antipsychotics affect people differently. It’s impossible to know ahead of time how helpful a particular antipsychotic will be, what dose will be most effective, or what side effects will occur.
Finding the right drug and dosage is a trial and error process. While medication should not be used at the expense of your quality of life, be patient with the process and discuss any concerns with your doctor.
It takes time for antipsychotic medications to take full effect. Some symptoms may respond to medication within a few days, while others take weeks or months. In general, most people see a significant improvement in their schizophrenia within six weeks—if not, your doctor may alter the dose or try another medication.

Types of medications used for schizophrenia treatment

The two main groups of medications used for the treatment of schizophrenia are the older or “typical” antipsychotic medications and the newer “atypical” antipsychotic medications.
The typical antipsychotics are the older medications and have a successful track record in treating hallucinations, paranoia, and other psychotic symptoms. However, they are prescribed less frequently today because of neurological side effects, known as extrapyramidal symptoms­, which include:
  1. Restlessness and pacing
  2. Extremely slow movements
  3. Tremors
  4. Painful muscle stiffness
  5. Temporary paralysis
  6. Muscle spasms (usually of the neck, eyes, or trunk)
  7. Changes in breathing and heart rate

Tardive dyskinesia in schizophrenia treatment

When typical antipsychotics are taken long-term for schizophrenia treatment, there is a risk of developing tardive dyskinesia. This can cause involuntary facial tics, usually of the tongue or mouth, or random, uncontrolled muscle movements of the hands, feet, limbs, or trunk. According to the National Alliance on Mental Illness, the risk of developing tardive dyskinesia with the typical antipsychotics is 5 percent per year.
While newer drugs known as atypical antipsychotics produce fewer extrapyramidal symptoms, they have side effects that many find even more distressing. These include:
  1. Loss of motivation
  2. Drowsiness
  3. Feeling sedated
  4. Weight gain
  5. Sexual dysfunction
  6. Nervousness
If you’re bothered by the side effects of schizophrenia medication, your doctor may be able to minimize side effects by switching you to another medication or reducing your dose.
Common Schizophrenia Medications
Typical antipsychotics (1st generation)Atypical antipsychotics (2nd generation)

Tip 6: Explore community services

In many countries, government programs and community services can be a helpful part of schizophrenia treatment. To explore your options, make contact with local mental health facilities, social service agencies, support groups, and public housing authorities.

Job and social skills training

Vocational and social rehabilitation teaches life and job skills to people with schizophrenia so you can live more independently, find employment, handle finances, better communicate with others, and improve your living arrangements.

Medical coverage for schizophrenia treatment

Medical aid for schizophrenia treatment is a complex issue. Your doctor, social worker, or case manager may be able to offer advice. In the United States, you may qualify for one of two types of social security assistance:
Social Security Disability (SSD) is granted for people who have worked and contributed to the social security system. After one year this is referred to as Medicare funding.
Supplemental Security Income (SSI) is considered Medicaid funding and is available for low-income people ineligible for SSD.

Residential support services for schizophrenia

If an at-home living arrangement isn’t right for you,  residential facilities in your community may include:
Residential treatment facilities or 24-hour care homes – A more structured living environment for those requiring greater assistance or suffering an acute psychotic episode.
Transitional group home – An intensive program that helps individuals transition back into society and avoid relapse after a crisis or hospitalization.
Foster or boarding homes – A group living situation offering a degree of independence, while providing meals and other basic necessities.
Supervised apartments –Residents live alone or share an apartment, with staff members available on-site to provide assistance and support.

More help for schizophrenia

Resources and references

Schizophrenia treatment and recovery

Schizophrenia: An Information Guide – Covers common concerns about schizophrenia and its treatment, including treatment options and relapse prevention. (Centre for Addiction and Mental Health)
Schizophrenia: The Journey to Recovery – Schizophrenia handbook discusses diagnosis and treatment issues including hospitalization, independent living, and emergency planning. (Canadian Psychiatric Association)
Basic Facts About Schizophrenia (PDF) – This 40-page booklet covers the most frequently asked questions about schizophrenia, including treatment options. (British Columbia Schizophrenia Society)
Schizophrenia  – Overview of schizophrenia including self-help, treatment, and hopeful outlooks. (Royal College of Psychiatrists)

Antipsychotic medications and side effects

Antipsychotic Drugs for Schizophrenia and Bipolar Disorder: What You Should Know  – Reviews antipsychotic medications for schizophrenia. (Consumer Reports)
Mental Health Medications  – A thorough guide to the safe use of medications for mental illness, including the antipsychotics prescribed for schizophrenia. (National Institute of Mental Health)
Tardive Dyskinesia  – Learn about tardive dyskinesia, an involuntary movement disorder caused by long-term antipsychotic treatment. (National Alliance on Mental Illness)

Finding support for schizophrenia

Delving deeper into schizophrenia treatment and recovery

Practice Guidelines for the Treatment of Patients with Schizophrenia  – Current expert recommendations for both the acute and maintenance phase of schizophrenia treatment. (American Psychiatric Association)

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How to Recognize the Symptoms, Causes, and Early Warning Signs

Woman leaning on wall
Woman leaning on wall
Schizophrenia is a challenging disorder that makes it difficult to distinguish between what is real and unreal, think clearly, manage emotions, relate to others, and function normally. But that doesn't mean there isn't hope. Schizophrenia can be successfully managed. The first step is to identify the signs and symptoms. The second step is to seek help without delay. With the right treatment and support, a person with schizophrenia can lead a happy, fulfilling life.

What is schizophrenia?

Schizophrenia is a brain disorder that affects the way a person behaves, thinks, and sees the world. People with schizophrenia often have an altered perception of reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. This can make it difficult to negotiate the activities of daily life, and people with schizophrenia may withdraw from the outside world or act out in confusion and fear.
Although schizophrenia is a chronic disorder, there is help available. With support, medication, and therapy, many people with schizophrenia are able to function independently and live fulfilling lives.
Common misconceptions about schizophrenia
Myth: Schizophrenia refers to a "split personality" or multiple personalities.
Fact: Multiple personality disorder is a different and much less common disorder than schizophrenia. People with schizophrenia do not have split personalities. Rather, they are “split off” from reality.
Myth: Schizophrenia is a rare condition.
Fact: Schizophrenia is not rare; the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100.
Myth: People with schizophrenia are dangerous.
Fact: Although the delusional thoughts and hallucinations of schizophrenia sometimes lead to violent behavior, most people with schizophrenia are neither violent nor a danger to others.
Myth: People with schizophrenia can’t be helped.
Fact: While long-term treatment may be required, the outlook for schizophrenia is not hopeless. When treated properly, many people with schizophrenia are able to enjoy life and function within their families and communities.

Early warning signs of schizophrenia

In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.
In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.
The most common early warning signs include:
1. Depression, social withdrawl
2. Hostility or suspiciousness, extreme reaction to criticism
3. Deterioration of personal hygiene
4. Flat, expressionless gaze
5. Inability to cry or express joy or inappropriate laughter or crying
6. Oversleeping or insomnia; forgetful, unable to concentrate
7. Odd or irrational statements; strange use of words or way of speaking
While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.

Signs and symptoms

There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.

Delusions

A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include:
Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).
Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them.
Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napoleon. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).
Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).

Daniel’s story

Daniel is 21 years old. Six months ago, he was doing well in college and holding down a part-time job in the stockroom of a local electronics store. But then he began to change, becoming increasingly paranoid and acting out in bizarre ways. First, he became convinced that his professors were “out to get him” since they didn’t appreciate his confusing, off-topic classroom rants. Then he told his roommate that the other students were “in on the conspiracy.” Soon after, he dropped out of school.
From there, things just got worse. Daniel stopped bathing, shaving, and washing his clothes. At work, he became convinced that his boss was watching him through surveillance bugs planted in the store’s television sets. Then he started hearing voices telling him to find the bugs and deactivate them. Things came to a head when he acted on the voices, smashing several TVs and screaming that he wasn’t going to put up with the “illegal spying” any more. His frightened boss called the police, and Daniel was hospitalized.

Hallucinations

Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.

Disorganized speech

Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include:
Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next.
Neologisms – Made-up words or phrases that only have meaning to the patient.
Perseveration – Repetition of words and statements; saying the same thing over and over.
Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").

Disorganized behavior

Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as:
  • A decline in overall daily functioning
  • Unpredictable or inappropriate emotional responses
  • Behaviors that appear bizarre and have no purpose
  • Lack of inhibition and impulse control

Negative symptoms (absence of normal behaviors)

The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include:
Lack of emotional expression – Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
Lack of interest or enthusiasm – Problems with motivation; lack of self-care.
Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.
Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone.

Causes

The causes of schizophrenia are not fully known. However, it appears that schizophrenia usually results from a complex interaction between genetic and environmental factors.

Genetic causes

Schizophrenia has a strong hereditary component. Individuals with a first-degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the one percent chance of the general population.
But schizophrenia is only influenced by genetics, not determined by it. While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don’t always develop the disease, which shows that biology is not destiny.

Environmental causes

Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder.
As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the body’s production of the hormone cortisol.
Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including:
  • Prenatal exposure to a viral infection
  • Low oxygen levels during birth (from prolonged labor or premature birth)
  • Exposure to a virus during infancy
  • Early parental loss or separation
  • Physical or sexual abuse in childhood

Abnormal brain structure

In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making.
Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia’s positive symptoms. But despite the evidence of brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.

Effects of schizophrenia

When the signs and symptoms of schizophrenia are ignored or improperly treated, the effects can be devastating, both to the individual with the disorder and those around him or her. Some of the possible effects of schizophrenia are:
Relationship problems. Relationships suffer because people with schizophrenia often withdraw and isolate themselves. Paranoia can also cause a person with schizophrenia to be suspicious of friends and family.
Disruption to normal daily activities. Schizophrenia causes significant disruptions to daily functioning, both because of social difficulties and because everyday tasks become hard, if not impossible to do. A schizophrenic person’s delusions, hallucinations, and disorganized thoughts typically prevent him or her from doing normal things like bathing, eating, or running errands.
Alcohol and drug abuse. People with schizophrenia frequently develop problems with alcohol or drugs, which are often used in an attempt to self-medicate, or relieve symptoms. In addition, they may also be heavy smokers, a complicating situation as cigarette smoke can interfere with the effectiveness of medications prescribed for the disorder.
Increased suicide risk. People with schizophrenia have a high risk of attempting suicide. Any suicidal talk, threats, or gestures should be taken very seriously. People with schizophrenia are especially likely to commit suicide during psychotic episodes, during periods of depression, and in the first six months after they’ve started treatment.

Diagnosing schizophrenia

A diagnosis of schizophrenia is made based on a full psychiatric evaluation, medical history, physical exam, and lab tests.
Psychiatric evaluation – The doctor or psychiatrist will ask a series of questions about you or your loved one's symptoms, psychiatric history, and family history of mental health problems.
Medical history and exam – Your doctor will ask about your personal and family health history. He or she will also perform a complete physical examination to check for medical issues that could be causing or contributing to the problem.
Laboratory tests – While there are no laboratory tests that can diagnose schizophrenia, simple blood and urine tests can rule out other medical causes of symptoms. The doctor may also order brain-imaging studies, such as an MRI or a CT scan, in order to look for brain abnormalities associated with schizophrenia.
Criteria to diagnose schizophrenia
The presence of two or more of the following symptoms for at least 30 days:
1.   Hallucinations
2.   Delusions
3.   Disorganized speech
4.   Disorganized or catatonic behavior
5.   Negative symptoms (emotional flatness, apathy, lack of speech) 
Significant problems functioning at work or school, relating to other people, and taking care of oneself.
Continuous signs of schizophrenia for at least six months, with active symptoms (hallucinations, delusions, etc.) for at least one month.
No other mental health disorder, medical issue, or substance abuse problem is causing the symptoms.

Conditions that can look like schizophrenia

The medical and psychological conditions the doctor must rule out before diagnosing schizophrenia include:
Other psychotic disorders – Schizophrenia is a type of psychotic disorder, meaning it involves a significant loss of contact with reality. But there are other psychotic disorders that cause similar symptoms of psychosis, including schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder. Because of the difficulty in differentiating between the psychotic disorders, it may take six months or longer to arrive at a correct diagnosis.
Substance abuse – Psychotic symptoms can be triggered by many drugs, including alcohol, PCP, heroin, amphetamines, and cocaine. Some over-the-counter and prescription drugs can also trigger psychotic reactions. A toxicology screen can rule out drug-induced psychosis. If substance abuse is involved, the physician will determine whether the drug is the source of the symptoms or merely an aggravating factor.
Medical conditions – Schizophrenia-like symptoms can also result from certain neurological disorders (such as epilepsy, brain tumors, and encephalitis), endocrine and metabolic disturbances, and autoimmune conditions involving the central nervous system.
Mood disorders – Schizophrenia often involves changes in mood, including mania and depression. While these mood changes are typically less severe than those seen in bipolar disorder and major depressive disorder, they can make diagnosis tricky. Schizophrenia is particularly difficult to distinguish from bipolar disorder. The positive symptoms of schizophrenia (delusions, hallucinations, and disorganized speech) can look like a manic episode of bipolar disorder, while the negative symptoms of schizophrenia (apathy, social withdrawal, and low energy) can look like a depressive episode.
Post-traumatic stress disorder (PTSD) – PTSD is an anxiety disorder that can develop after exposure to a traumatic event, such as military combat, an accident, or a violent assault. People with PTSD experience symptoms that are similar to schizophrenia. The images, sounds, and smells of PTSD flashbacks can look like psychotic hallucinations. The PTSD symptoms of emotional numbness and avoidance can look like the negative symptoms of schizophrenia.

Hope for schizophrenia

Treatment options for schizophrenia are good, and the outlook for the disorder continues to improve. With medication, therapy, and a strong support network, many people with schizophrenia are able to control their symptoms, gain greater independence, and lead fulfilling lives.
If you think that someone close to you has schizophrenia, you can make a difference by showing your love and support and helping that person get properly evaluated and treated. To learn more, see the related articles below.

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