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Schizophrenia
By Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/schizophrenia/DS00196

Definition
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally.
Schizophrenia may result in some combination of hallucinations, delusions, and disordered
thinking and behavior.
Contrary to some popular belief, schizophrenia isn't split personality or multiple personality. The
word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of
emotions and thinking.
Schizophrenia is a chronic condition, requiring lifelong treatment.

Symptoms
Schizophrenia symptoms also can be attributed to other mental illnesses, and no one symptom
can pinpoint a diagnosis of schizophrenia. In men, schizophrenia symptoms typically start in the
teens or 20s. In women, schizophrenia symptoms typically begin in the 20s or early 30s. It's
uncommon for children to be diagnosed with schizophrenia and rare for those older than 45.
Signs and symptoms of schizophrenia generally are divided into three categories positive,
negative and cognitive.
Positive symptoms
In schizophrenia, positive symptoms reflect an excess or distortion of normal functions. These
active, abnormal symptoms may include:

Delusions. These beliefs are not based in reality and usually involve misinterpretation of
perception or experience. They are the most common of schizophrenic symptoms.
Hallucinations. These usually involve seeing or hearing things that don't exist, although
hallucinations can be in any of the senses. Hearing voices is the most common
hallucination among people with schizophrenia.

Thought disorder. Difficulty speaking and organizing thoughts may result in stopping
speech midsentence or putting together meaningless words, sometimes known as word
salad.

Disorganized behavior. This may show in a number of ways, ranging from childlike
silliness to unpredictable agitation.

Negative symptoms
Negative symptoms refer to a diminishment or absence of characteristics of normal function.
They may appear with or without positive symptoms. They include:

Loss of interest in everyday activities

Appearing to lack emotion

Reduced ability to plan or carry out activities

Neglect of personal hygiene

Social withdrawal

Loss of motivation

Cognitive symptoms
Cognitive symptoms involve problems with thought processes. These symptoms may be the
most disabling in schizophrenia because they interfere with the ability to perform routine daily
tasks. A person with schizophrenia may be born with these symptoms. They include:

Problems with making sense of information

Difficulty paying attention

Memory problems

Symptoms in teenagers
Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be
more difficult to recognize in this age group. This may be in part because some of the early
symptoms in teenagers are common during teen years, such as:

Withdrawal from friends and family

A drop in performance at school

Trouble sleeping

Irritability

Compared with schizophrenia symptoms in adults, teens may be:

Less likely to have delusions

More likely to have visual hallucinations

When to see a doctor

People with schizophrenia often lack awareness that their difficulties stem from a mental illness
that requires medical attention. So it often falls to family or friends to get them help.
Helping someone who may have schizophrenia
If you think someone you know may have symptoms of schizophrenia, talk to him or her about
your concerns. Although you can't force someone to seek professional help, you can offer
encouragement and support and help your loved one find a qualified doctor or mental health
provider.
If your loved one poses a danger to self or others or can't provide his or her own food, clothing or
shelter, you may need to call the police or other emergency responders for help. In some cases,
emergency hospitalization may be needed. Laws on involuntary commitment for mental health
treatment vary by state. You can contact community mental health agencies or police
departments in your area for details.
Suicidal thoughts
Suicidal thoughts and behavior are common among people with schizophrenia. If you suspect or
know that your loved one is considering suicide, seek immediate help. Contact a doctor, mental
health provider or other health care professional.

Causes
It's not known what causes schizophrenia, but researchers believe that a combination of genetics
and environment contributes to development of the disease.
Problems with certain naturally occurring brain chemicals, including the neurotransmitters
dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show
differences in the brain structure and central nervous system of people with schizophrenia. While
researchers aren't certain about the significance of these changes, they support evidence that
schizophrenia is a brain disease.

Risk factors
Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk
of developing or triggering schizophrenia, including:

Having a family history of schizophrenia

Exposure to viruses, toxins or malnutrition while in the womb, particularly in the first and
second trimesters

Stressful life circumstances

Older paternal age

Taking psychoactive drugs during adolescence and young adulthood

Complications
Left untreated, schizophrenia can result in severe emotional, behavioral and health problems, as
well as legal and financial problems that affect every area of life. Complications that
schizophrenia may cause or be associated with include:

Suicide
Self-destructive behavior, such as self-injury

Depression

Abuse of alcohol, drugs or prescription medications

Poverty

Homelessness

Family conflicts

Inability to work or attend school

Health problems from antipsychotic medications

Being a victim or perpetrator of violent crime

Heart disease, often related to heavy smoking

Preparing for your appointment

If you're seeking help for someone with mental illness, you may start by seeing his or her family
doctor or a general practitioner. However, in some cases when you call to set up an appointment,
you may be referred immediately to a psychiatrist.
It's a good idea to prepare for the appointment. Here's some information to help you.
What you can do

Write down any symptoms your loved one is experiencing, including any that may
seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life
changes.

Make a list of medications, vitamins and supplements that he or she is taking.

Go with your loved one to the appointment. Getting the information firsthand will help
you know what you're facing and what you need to do for your loved one.

Write down questions to ask the doctor.

Preparing a list of questions will help you make the most of your time with the doctor. For
schizophrenia, some basic questions to ask include:

What is likely causing the symptoms or condition?

Other than the most likely cause, what are other possible causes for the symptoms or
condition?

What kinds of tests are needed?

Is this condition likely temporary or chronic?

What's the best treatment?

What are the alternatives to the primary approach you're suggesting?

How can I be most helpful and supportive?

Are there any brochures or other printed material that I can take home with me? What
websites do you recommend visiting?

In addition to the questions that you've prepared to ask the doctor, don't hesitate to ask questions
during the appointment.
What to expect from the doctor
The doctor is likely to ask you a number of questions, including:

What are your loved one's symptoms, and when did you first notice them?
Have symptoms been continuous or occasional?

Has your loved one talked about suicide?

How is your loved one functioning in daily life is he or she eating regularly, going to
work or school, bathing regularly?

Has your loved one been diagnosed with any other medical conditions?

What medications is your loved one currently taking?

What you can do in the meantime

If your loved one talks of suicide; isn't attending to basic needs, such as eating, bathing, and so
on; or becomes violent, seek immediate help. If your loved one is violent, don't try to subdue him
or her yourself. Call 911 or your local emergency number for the police.

Tests and diagnosis

When doctors suspect someone has schizophrenia, they typically ask for medical and psychiatric
histories, conduct a physical exam, and run medical and psychological tests and exams. These
tests and exams generally include:

Laboratory tests. These may include a complete blood count (CBC), other blood tests
that may help to rule out other conditions with similar symptoms, screening for alcohol
and drugs, and imaging studies, such as an MRI or CT scan.
Psychological evaluation. A doctor or mental health provider will check mental status by
observing appearance and demeanor and asking about thoughts, moods, delusions,
hallucinations, substance abuse, and potential for violence or suicide.

Diagnostic criteria for schizophrenia

To be diagnosed with schizophrenia, a person must meet the criteria spelled out in the Diagnostic
and Statistical Manual of Mental Disorders (DSM). This manual is published by the American
Psychiatric Association and is used by mental health providers to diagnose mental conditions.
Diagnosis of schizophrenia involves ruling out other mental health disorders and determining
that symptoms aren't due to substance abuse, medication or a medical condition. In addition, a
person must:

Have at least two of the common symptoms of the disorder delusions, hallucinations,
disorganized speech, disorganized or catatonic behavior, or presence of negative
symptoms for a significant amount of time during one month
Experience significant impairment in the ability to work, attend school or perform normal
daily tasks
Have had symptoms for at least six months

There are several subtypes of schizophrenia, but not everyone easily fits into a specific category.
The five most common subtypes are:

Paranoid. Characterized by delusions and hallucinations, this type generally involves

less functional impairment and offers the best hope for improvement.
Catatonic. People with this subtype don't interact with others, get into bizarre positions,
or engage in meaningless gestures or activities.

Disorganized. Characterized by disorganized thoughts and inappropriate expressions of

emotion, this type generally involves the most functional impairment and offers the least
hope for improvement.

Undifferentiated. This is the largest group of people with schizophrenia, whose

dominant symptoms come from more than one subtype.

Residual. This type is characterized by extended periods without prominent positive

symptoms, but other symptoms continue.

Treatments and drugs

Schizophrenia is a chronic condition that requires lifelong treatment, even when symptoms have
subsided. Treatment with medications and psychosocial therapy can help manage the condition.
During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure
safety, proper nutrition, adequate sleep and basic hygiene.
A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment
team also may include psychologists, social workers and psychiatric nurses and possibly a case
manager to coordinate care. The full-team approach may be available in clinics with expertise in
schizophrenia treatment.
Medications
Medications are the cornerstone of schizophrenia treatment. But because medications for
schizophrenia can cause serious but rare side effects, people with schizophrenia may be reluctant
to take them.
Antipsychotic medications are the most commonly prescribed to treat schizophrenia. They're
thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin. A
person's willingness to cooperate with treatment may affect medication choice. Someone who is
uncooperative may need to be given injections instead of taking a pill. Someone who is agitated
may need to be calmed initially with a benzodiazepine such as lorazepam (Ativan), which may
be combined with an antipsychotic.
Atypical antipsychotics
These newer medications are generally preferred because they pose a lower risk of debilitating
side effects than do conventional medications. They include:

Aripiprazole (Abilify)
Clozapine (Clozaril, Fazaclo ODT)

Olanzapine (Zyprexa)

Paliperidone (Invega)

Quetiapine (Seroquel)

Risperidone (Risperdal)

Ziprasidone (Geodon)

Side effects of atypical antipsychotic medications include weight gain, diabetes and high blood
cholesterol.
Conventional, or typical, antipsychotics
These medications have frequent and potentially significant neurological side effects, including
the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be
reversible. This group of medications includes:

Chlorpromazine
Fluphenazine

Haloperidol (Haldol)

Perphenazine

These typical antipsychotics are often cheaper than newer counterparts, especially the generic
versions, which can be an important consideration when long-term treatment is necessary.
It can take several weeks after first starting a medication to notice an improvement in symptoms.
In general, the goal of treatment with antipsychotic medications is to effectively control signs
and symptoms at the lowest possible dosage. The psychiatrist may try different medications,
different dosages or combinations over time to achieve the desired result. Other medications also
may be helpful, such as antidepressants or anti-anxiety medications.
Psychosocial treatments
Although medications are the cornerstone of schizophrenia treatment, once psychosis recedes,
psychosocial treatments also are important. These may include:

Social skills training. This focuses on improving communication and social interactions.
Family therapy. This provides support and education to families dealing with
schizophrenia.

Vocational rehabilitation and supported employment. This focuses on helping people

with schizophrenia find and keep jobs.

Individual therapy. Learning to cope with stress and identify early warning signs of
relapse can help people with schizophrenia manage their illness.

Many communities have programs to help people with schizophrenia with jobs, housing, selfhelp groups and crisis situations. A case manager or someone on the health care team can help
find one. With appropriate treatment, most people with schizophrenia can manage their
condition.

Coping and support

Coping with an illness as serious as schizophrenia can be challenging, both for the person with
the condition and for friends and family. Here are some ways to cope with schizophrenia:

Learn about schizophrenia. Education about the condition can help motivate the person
with the disease to stick to the treatment plan. Education can help friends and family
understand the condition and be more compassionate with the person who has it.
Join a support group. Support groups for people with schizophrenia can help them
reach out to others facing similar challenges. Support groups may also help family and
friends cope.

Stay focused on goals. Recovery from schizophrenia is an ongoing process. Keeping

recovery goals in mind can help the person with schizophrenia stay motivated. Help your
loved one remember to take responsibility for managing the illness and working toward
goals.

Learn relaxation and stress management. The person with the disease and loved ones
may benefit from stress-reduction techniques such as meditation, yoga or tai chi.

Prevention
There's no sure way to prevent schizophrenia. However, early treatment may help get symptoms
under control before serious complications develop and may help improve the long-term outlook.
Sticking with the treatment plan can help prevent relapses or worsening of schizophrenia
symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia
may lead to earlier diagnosis and earlier treatment.
For people at increased risk of schizophrenia, taking proactive steps such as avoiding illegal drug
use, reducing stress, getting enough sleep and starting antipsychotic medications as soon as
necessary may help minimize symptoms or prevent them from worsening.
References
DS00196 Jan. 27, 2012
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Source: http://www.medicinenet.com/script/main/art.asp?articlekey=470

Schizophrenia
Medical Author:
Roxanne Dryden-Edwards, MD
Medical Editor:
Melissa Conrad Stppler, MD
Schizophrenia facts
What is schizophrenia?

What are the different types of schizophrenia?

How common is schizophrenia in children?

What is the history of schizophrenia?

What are causes of schizophrenia? Is it hereditary?

What are schizophrenia symptoms and signs?

How is schizophrenia diagnosed?

What are treatments for schizophrenia and the side effects of those treatments?

What is the prognosis for schizophrenia?

What research is being done on schizophrenia?

Where can people get more information about schizophrenia?

Schizophrenia FAQs

Patient Comments: Schizophrenia - Treatments

Patient Comments: Schizophrenia - Describe Your Experience

Schizophrenia facts

Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the
population, more than 2 million people in the United States alone.

With the sudden onset of severe psychotic symptoms, the individual is said to be
experiencing acute schizophrenia. Psychotic means out of touch with reality or unable to
separate real from unreal experiences.

There is no known single cause of schizophrenia. As discussed later, it appears that

genetic factors produce a vulnerability to schizophrenia, with environmental factors
contributing to different degrees in different individuals.

There are a number of various treatments for schizophrenia. Given the complexity of
schizophrenia, the major questions about this disorder (its cause or causes, prevention,
and treatment) are unlikely to be resolved in the near future. The public should beware of
those offering "the cure" for (or "the cause" of) schizophrenia.

Schizophrenia is one of the psychotic mental disorders and is characterized by symptoms

of thought, behavior, and social problems.

Symptoms of schizophrenia may include delusions, hallucinations, catatonia, negative

symptoms, and disorganized speech or behavior.

There are five types of schizophrenia based on the kind of symptoms the person has at the
time of assessment: paranoid, disorganized, catatonic, undifferentiated, and residual.

Children as young as 6 years of age can be found to have all the symptoms of
schizophrenia as their adult counterparts and to continue to have those symptoms into
adulthood.

Although the term schizophrenia has only been in used since 1911, its symptoms have
been described throughout written history.

Schizophrenia is considered to be the result of a complex group of genetic, psychological,

and environmental factors.

Health-care practitioners diagnose schizophrenia by gathering comprehensive medical,

family, mental-health, and social/cultural information.

The practitioner will also either perform a physical examination or request that the
individual's primary-care doctor perform one. The medical examination will usually
include lab tests.

In addition to providing treatment that is appropriate to the diagnosis, professionals

attempt to determine the presence of mental illnesses that may co-occur.

People with schizophrenia are at increased risk of having a number of other mental-health
conditions, committing suicide, and otherwise dying earlier than people without this
disorder.

Medications that have been found to be most effective in treating the positive symptoms
of schizophrenia are first- and second-generation antipsychotics.

Psychosocial interventions for schizophrenia include education of family members,

assertive community treatment, substance-abuse treatment, social-skills training,
supported employment, cognitive behavioral therapy, and weight management.

Cognitive remediation, peer-to-peer treatment, and weight-management interventions

remain the focus topics for research.

What is schizophrenia?
Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the
population, corresponding to more than 2 million people in the United States alone. Other
statistics about schizophrenia include that it affects men about one and a half times more
commonly than women. It is one of the psychotic mental disorders and is characterized by
symptoms of thought, behavior, and social problems. The thought problems associated with
schizophrenia are described as psychosis, in that the person's thinking is completely out of touch
with reality at times. For example, the sufferer may hear voices or see people that are in no way
present or feel like bugs are crawling on their skin when there are none. The individual with this
disorder may also have disorganized speech, disorganized behavior, physically rigid or lax
behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which
are ideas about themselves or others that have no basis in reality (for example, the individual
might experience paranoia, in that he or she thinks others are plotting against them when they are
not).

What are the different types of schizophrenia?

There are five types of schizophrenia, each based on the kind of symptoms the person has at the
time of assessment.

Paranoid schizophrenia: The individual is preoccupied with one or more delusions or

many auditory hallucinations but does not have symptoms of disorganized schizophrenia.

Disorganized schizophrenia: Prominent symptoms are disorganized speech and

behavior, as well as flat or inappropriate affect. The person does not have enough
symptoms to be characterized as suffering from catatonic schizophrenia.

Catatonic schizophrenia: The person with this type of schizophrenia primarily has at
least two of the following symptoms: difficulty moving, resistance to moving, excessive
movement, abnormal movements, and/or repeating what others say or do.

Undifferentiated schizophrenia: This is characterized by episodes of two or more of the

following symptoms: delusions, hallucinations, disorganized speech or behavior,

catatonic behavior or negative symptoms, but the individual does not qualify for a
diagnosis of paranoid, disorganized, or catatonic type of schizophrenia.

Residual schizophrenia: While the full-blown characteristic positive symptoms of

schizophrenia (those that involve an excess of normal behavior, such as delusions,
paranoia, or heightened sensitivity) are absent, the sufferer has a less severe form of the
disorder or has only negative symptoms (symptoms characterized by a decrease in
function, such as withdrawal, disinterest, and not speaking).

How common is schizophrenia in children?

Although there have been fewer studies on schizophrenia in children compared to adults,
researchers are finding that in children as young as 6 years old can be found to have all the
symptoms of their adult counterparts and to continue to have those symptoms into adulthood.

What is the history of schizophrenia?

The term schizophrenia has only been in use since 1911. Soon before that, it was deemed a
separate mental illness in 1887 by Emil Kraepelin. Despite that relatively recent history, it has
been described throughout written history. Ancient Egyptian, Hindu, Chinese, Greek, and Roman
writings described symptoms similar to the positive symptoms of schizophrenia. During
medieval times, schizophrenia, like other illnesses, was often viewed as evidence of the sufferer
being possessed by spirits or evil powers.
A number of accomplished individuals suffer from schizophrenia. The film A Beautiful Mind
depicts the life of John Nash, a noted scientist, and his struggles with paranoid schizophrenia.
The film The Soloist explores the challenges faced by Juilliard-trained musician Nathaniel Ayers
as a result of schizophrenia.

What are causes of schizophrenia? Is it hereditary?

One frequently asked question about schizophrenia is if it is hereditary. As with most other
mental disorders, schizophrenia is not directly passed from one generation to another genetically,
and there is no single cause for this illness. Rather, it is the result of a complex group of genetic,
psychological, and environmental factors. Genetically, schizophrenia and bipolar disorder have
much in common, in that the two disorders share a number of the same risk genes. However, the
fact is that both illnesses also have some genetic factors that are unique. There are some genetic
commonalities with schizophrenia and epilepsy as well.
Environmentally, the risks of developing schizophrenia can even occur before birth. For
example, the risk of schizophrenia is increased in individuals whose mother had one of certain
infections during pregnancy. Difficult life circumstances during childhood, like the early loss of
a parent, parental poverty, bullying, witnessing parental violence; being the victim of emotional,
sexual, or physical abuse or of physical or emotional neglect; and insecure attachment have been

associated with the development of this illness. Even factors like how well represented an ethnic
group is in a neighborhood can be a risk or protective factor for developing schizophrenia. For
example, some research indicates that ethnic minorities may be more at risk for developing this
disorder if there are fewer members of the ethnic group to which the individual belongs in their
neighborhood.

What are schizophrenia symptoms and signs?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), symptoms of
schizophrenia include the following:
Positive, more overtly psychotic symptoms

Beliefs that have no basis in reality (delusions)

Hearing, seeing, feeling, smelling, or tasting things that have no basis in reality
(hallucinations)

Disorganized speech

Disorganized behaviors

Catatonic behaviors

Negative, potentially less overtly psychotic symptoms

Inhibition of facial expressions

Lack of speech

Lack of motivation

How is schizophrenia diagnosed?

As is true with virtually any mental-health diagnosis, there is no one test that definitively
indicates that someone has schizophrenia. Therefore, health-care practitioners diagnose this
disorder by gathering comprehensive medical, family, and mental-health information. Patients
tend to benefit when the professional takes into account their client's entire life and background.
This includes but is not limited to the person's gender, sexual orientation, cultural, religious and
ethnic background, and socioeconomic status. The symptom sufferer might be asked to fill out a
self-test that the professional will review if the person being evaluated is able to complete it. The
practitioner will also either perform a physical examination or request that the individual's
primary-care doctor perform one. The medical examination will usually include lab tests to
evaluate the person's general health and to explore whether or not the individual has a medical
condition that might produce psychological symptoms.
In asking questions about mental-health symptoms, mental-health professionals are often
exploring if the individual suffers from hallucinations or delusions, depression and/or manic
symptoms, anxiety, substance abuse, as well as some personality disorders (for example,
schizotypal personality disorder) and developmental disorders (for example, autism spectrum
disorders). Since some of the symptoms of schizophrenia can also occur in other mental
illnesses, the mental-health screening is to determine if the individual suffers from
schizoaffective disorder or other psychotic disorder, depressive disorder, bipolar disorder, anxiety
disorder, or a substance-abuse or personality disorder. Any disorder that is associated with
bizarre behavior, mood, or thinking, like borderline personality disorder or another psychotic
disorder, as well as dissociative identity disorder (DID), also known as multiple personality
disorder (MPD) may be particularly challenging to distinguish from schizophrenia. In order to
assess the person's current emotional state, health-care providers perform a mental-status
examination as well.
In addition to providing treatment that is appropriate to the diagnosis, determining the presence
of mental illnesses that may co-occur (be comorbid) with schizophrenia is important in
improving the life of individuals with schizophrenia. For example, people with schizophrenia are
at increased risk of having a substance-abuse, depressive, or anxiety disorder and of committing
suicide.

What are treatments for schizophrenia and the side effects of those treatments?
Medications
While there are a number of helpful treatments available, medication remains the cornerstone of
treatment for people with schizophrenia. These medications are often referred to as
antipsychotics since they help decrease the intensity of psychotic symptoms. Many health-care
professionals prescribe one of these medications, sometimes in combination of one or more other
psychiatric medications, in order to maximize the benefit for the person with schizophrenia.
Medications that are thought to be particularly effective in treating positive symptoms of
schizophrenia include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel),
ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphis),
lurasidone (Latuda), and lloperidone (Fanapt). These medications are the newer group of

antipsychotic medications, also called second-generation antipsychotics. They are known for
having the ability to work quickly compared to many other psychiatric medications. As a group
of medications, side effects that occur most often include sleepiness, dizziness, and increased
appetite. Weight gain, which may be associated with higher blood sugar levels, elevated blood
lipid levels, and sometimes increased levels of a hormone called prolactin, may also occur.
Although older antipsychotic medications in this class like haloperidol (Haldol), perphenazine
(Trilafon), and molindone (Moban) are more likely to cause muscle stiffness, shakiness, and very
rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health-care
practitioners appropriately monitor the people they treat for these potential side effects as well.
Also, more recent research regarding all antipsychotic medication seems to demonstrate that the
older (first-generation) antipsychotics are just as effective as the newer ones and have no higher
rate of people stopping treatment because of any side effect the medications cause. Not all
medications that treat schizophrenia in adults have been approved for use in treating childhood
schizophrenia.
Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine
(Tegretol), and lamotrigine (Lamictal) can be useful in treating mood swings that sometimes
occur in individuals who have a diagnosable mood disorder in addition to psychotic symptoms
(for example, schizoaffective disorder, depression in addition to schizophrenia). These
medications may take a bit longer to work compared to the antipsychotic medications. Some (for
example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels,
and some can be associated with birth defects when taken by pregnant women.
Antidepressant medications are the primary medical treatment for the depression that can often
accompany schizophrenia. Examples of antidepressants that are commonly prescribed for that
purpose include serotonergic (SSRI) medications that affect serotonin levels like fluoxetine
(Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram
(Lexapro); combination serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor)
and duloxetine (Cymbalta), as well as bupropion (Wellbutrin), which is a dopaminergic
(affecting dopamine levels) antidepressant medication.
Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for
people whose schizophrenia has inadequately responded to a number of medication trials and
psychosocial interventions.
When treating pregnant individuals with schizophrenia, health-care practitioners take great care
to balance the need to maintain the person's more stable thoughts and behavior while minimizing
the risks that medications used to treat this disorder may present. While some medications that
treat schizophrenia may carry risks to the fetus in pregnancy and during breastfeeding, careful
monitoring of how much medication is administered and the health of the fetus and of the mother
can go a long way toward protecting the fetus from any such risks, while maximizing the chance
that the fetus will grow in the healthier environment afforded by an emotionally healthy mother.
Psychosocial interventions

Family psycho-education: In addition to educating family members about the symptoms, course,
and treatment of schizophrenia, this form of treatment consists of providing family support,
problem-solving skills, and access to care providers during times of crises. When this
intervention is consistently provided for at least several months, it has been found to decrease the
relapse rate for the individual with schizophrenia and improve the person's social and emotional
outcomes. Also, the burden that family members experience as a result of having a loved one
with schizophrenia is lessened, family members tend to be more knowledgeable about the
disorder and feel more supported by the professionals involved, and family relationships are
improved.
Assertive community treatment (ACT): This intervention consists of members of the person's
treatment team meeting with that individual on a daily basis, in community settings (for example,
home, work, or other places the person with schizophrenia frequents) rather than in an office or
hospital setting. The treatment team is made up of a variety of professionals. For example, a
psychiatrist, nurse, case manager, employment counselor, and substance-abuse counselor often
make up an ACT team. ACT tends to be successful in reducing how often people with
schizophrenia are hospitalized or become homeless.
Substance abuse treatment: Providing medical and psychosocial interventions that address
substance abuse should be an integral part of treatment as about 50% of individuals with
schizophrenia suffer from some kind of substance abuse or dependence.
Social skills training: Also called illness management and recovery programming, social-skills
training involves teaching clients ways to handle social situations appropriately. It often involves
the person scripting (thinking through or role-playing) situations that occur in social settings in
order to prepare for those situations when they actually occur. This treatment type has been
found to help people with schizophrenia resist using drugs of abuse, as well as improve their
relationships with health-care professionals and with people at work.
Supported employment: This intervention provides supports like a work coach (someone who
periodically or consistently counsels the client in the workplace), as well as instruction on
constructing a rsum, interviewing for jobs, and education and support for employers to hire
individuals with chronic mental illness. Supported employment has been found to help
schizophrenia sufferers secure employment, earn more money, and increase the number of hours
they are able to work.
Cognitive behavioral therapy (CBT): CBT is a reality-based intervention that focuses on helping
a client understand and change patterns that tend to interfere with his or her ability to interact
with others and otherwise function. Except for people who are actively psychotic, CBT has been
found to help individuals with schizophrenia decrease symptoms and improve their ability to
function socially. This intervention can be done either individually or in group sessions.
Weight management: Educating people with schizophrenia about weight gain and related health
problems that can be a side effect of some antipsychotic and other psychiatric medications has
been found to be helpful in resulting in a modest weight loss. That is also true when
schizophrenia sufferers are provided with behavioral interventions to assist with weight loss.

What is the prognosis for schizophrenia?

Individuals with schizophrenia have more than twice the rate of death than those without the
disorder. Almost half of people with schizophrenia will suffer from a substance-use disorder (for
example, alcohol, marijuana, or other substance) during their lifetime. Research shows that
people with schizophrenia or schizoaffective disorder have a better quality of life if their family
members tend to be more supportive and less critical of them.

What research is being done on schizophrenia?

Cognitive remediation continues to be an experimental treatment that addresses the cognitive
problems that are associated with schizophrenia (for example, memory problems, learning
problems). Studies using this intervention in combination with vocational rehabilitation to
improve work functioning have shown some promise, but more research is needed, particularly
that which focuses on improving how well the person with schizophrenia functions in real-world
situations as a result of this treatment.
Peer-to-peer treatment is a promising possible intervention since it promotes active constructive
involvement from people who have schizophrenia, provides role models for individuals whose
functioning is less stable, and may be accessible in individual and group settings, in person as
well as by telephone or through the Internet. However, further research is necessary to
demonstrate its effectiveness in decreasing symptoms or otherwise clearly improving functioning
for people with schizophrenia.
In terms of weight management, more research is needed to explore how to best help people with
schizophrenia retain the weight loss they achieve and even to prevent weight gain in the first
place.

Where can people get more information about schizophrenia?

NARSAD
800-829-8289
National Institute of Mental Health
9000 Rockville Pike
Bethesda, Maryland 20892
NIHinfo@od.nih.gov
301-496-4000
NAMI (National Alliance on Mental Illness)
http://www.nami.org/
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