On this Page
Schizophrenia is a chronic, severe, and disabling brain
disease. Approximately 1 percent of the population develops schizophrenia during
their lifetime—more than 2 million Americans suffer from the illness in a given
year. Although schizophrenia affects men and women with equal frequency, the
disorder often appears earlier in men, usually in the late teens or early twenties,
than in women, who are generally affected in the twenties to early thirties.
People with schizophrenia often suffer terrifying symptoms such as hearing
internal voices not heard by others, or believing that other people are reading
their minds, controlling their thoughts, or plotting to harm them. These symptoms
may leave them fearful and withdrawn. Their speech and behavior can be so disorganized
that they may be incomprehensible or frightening to others. Available treatments
can relieve many symptoms, but most people with schizohphrenia continue to
suffer some symptoms throughout their lives; it has been estimated that no
more than one in five individuals recovers completely.
This is a time of hope for people with schizophrenia and their families. Research is
gradually leading to new and safer medications and unraveling the complex causes
of the disease. Scientists are using many approaches from the study of molecular
genetics to the study of populations to learn about schizophrenia. Methods
of imaging the brain’s structure and function hold the promise of new insights
into the disorder.
Schizophrenia is found all over the world. The severity of the symptoms
and long-lasting, chronic pattern of schizophrenia often cause a high degree
of disability. Medications and other treatments for schizophrenia, when used
regularly and as prescribed, can help reduce and control the distressing symptoms
of the illness. However, some people are not greatly helped by available treatments
or may prematurely discontinue treatment because of unpleasant side effects
or other reasons. Even when treatment is effective, persisting consequences
of the illness—lost opportunities, stigma, residual symptoms, and medication
side effects—may be very troubling.
The first signs of schizophrenia often appear as confusing, or even shocking,
changes in behavior. Coping with the symptoms of schizophrenia can be especially
difficult for family members who remember how involved or vivacious a person
was before they became ill. The sudden onset of severe psychotic symptoms is
referred to as an “acute” phase of schizophrenia. “Psychosis,” a common condition
in schizophrenia, is a state of mental impairment marked by hallucinations,
which are disturbances of sensory perception, and/or delusions, which are false
yet strongly held personal beliefs that result from an inability to separate
real from unreal experiences. Less obvious symptoms, such as social isolation
or withdrawal, or unusual speech, thinking, or behavior, may precede, be seen
along with, or follow the psychotic symptoms. Some people have only one such
psychotic episode; others have many episodes during a lifetime, but lead relatively
normal lives during the interim periods. However, the individual with “chronic” schizophrenia, or a continuous
or recurring pattern of illness, often does not fully recover normal functioning
and typically requires long-term treatment, generally including medication,
to control the symptoms.
It is important to rule out other illnesses, as sometimes people suffer
severe mental symptoms or even psychosis due to undetected underlying medical
conditions. For this reason, a medical history should be taken and a physical
examination and laboratory tests should be done to rule out other possible
causes of the symptoms before concluding that a person has schizophrenia. In
addition, since commonly abused drugs may cause symptoms resembling schizophrenia,
blood or urine samples from the person can be tested at hospitals or physicians’
offices for the presence of these drugs.
At times, it is difficult to tell one mental disorder from another. For
instance, some people with symptoms of schizophrenia exhibit prolonged extremes
of elated or depressed mood, and it is important to determine whether such
a patient has schizophrenia or actually has a manic-depressive (or bipolar)
disorder or major depressive disorder. Persons whose symptoms cannot be clearly
categorized are sometimes diagnosed as having a “schizoaffective disorder.”
Children over the age of five can develop schizophrenia, but it is very
rare before adolescence. Although some people who later develop schizophrenia
may have seemed different from other children at an early age, the psychotic
symptoms of schizophrenia—hallucinations and delusions—are extremely uncommon
Return to top
People with schizophrenia may have perceptions of reality that are strikingly
different from the reality seen and shared by others around them. Living in
a world distorted by hallucinations and delusions, individuals with schizophrenia
may feel frightened, anxious, and confused.
In part because of the unusual realities they experience, people with
schizophrenia may behave very differently at various times. Sometimes they
may seem distant, detached, or preoccupied and may even sit as rigidly as a
stone, not moving for hours or uttering a sound. Other times they may move
about constantly—always occupied, appearing wide-awake, vigilant, and alert.
Hallucinations and illusions are disturbances of perception that are common
in people suffering from schizophrenia. Hallucinations are perceptions that
occur without connection to an appropriate source. Although hallucinations
can occur in any sensory form—auditory (sound), visual (sight), tactile (touch),
gustatory (taste), and olfactory (smell)—hearing voices that other people do
not hear is the most common type of hallucination in schizophrenia. Voices
may describe the patient’s activities, carry on a conversation, warn of impending
dangers, or even issue orders to the individual. Illusions, on the other hand,
occur when a sensory stimulus is present but is incorrectly interpreted by
Delusions are false personal beliefs that are not subject to reason or
contradictory evidence and are not explained by a person’s usual cultural concepts.
Delusions may take on different themes. For example, patients suffering from
paranoid-type symptoms—roughly one-third of people with schizophrenia—often
have delusions of persecution, or false and irrational beliefs that they are
being cheated, harassed, poisoned, or conspired against. These patients may
believe that they, or a member of the family or someone close to them, are
the focus of this persecution. In addition, delusions of grandeur, in which
a person may believe he or she is a famous or important figure, may occur in
schizophrenia. Sometimes the delusions experienced by people with schizophrenia
are quite bizarre; for instance, believing that a neighbor is controlling their
behavior with magnetic waves; that people on television are directing special
messages to them; or that their thoughts are being broadcast aloud to others.
Schizophrenia often affects a person’s ability to “think straight.” Thoughts
may come and go rapidly; the person may not be able to concentrate on one thought
for very long and may be easily distracted, unable to focus attention.
People with schizophrenia may not be able to sort out what is relevant
and what is not relevant to a situation. The person may be unable to connect
thoughts into logical sequences, with thoughts becoming disorganized and fragmented.
This lack of logical continuity of thought, termed “thought disorder,” can
make conversation very difficult and may contribute to social isolation. If
people cannot make sense of what an individual is saying, they are likely to
become uncomfortable and tend to leave that person alone.
People with schizophrenia often show “blunted” or “flat” affect. This
refers to a severe reduction in emotional expressiveness. A person with schizophrenia
may not show the signs of normal emotion, perhaps may speak in a monotonous
voice, have diminished facial expressions, and appear extremely apathetic.
The person may withdraw socially, avoiding contact with others; and when forced
to interact, he or she may have nothing to say, reflecting “impoverished thought.”
Motivation can be greatly decreased, as can interest in or enjoyment of life.
In some severe cases, a person can spend entire days doing nothing at all,
even neglecting basic hygiene. These problems with emotional expression and
motivation, which may be extremely troubling to family members and friends,
are symptoms of schizophrenia—not character flaws or personal weaknesses.
At times, normal individuals may feel, think, or act in ways that resemble
schizophrenia. Normal people may sometimes be unable to “think straight.” They
may become extremely anxious, for example, when speaking in front of groups
and may feel confused, be unable to pull their thoughts together, and forget
what they had intended to say. This is not schizophrenia. At the same time,
people with schizophrenia do not always act abnormally. Indeed, some people
with the illness can appear completely normal and be perfectly responsible,
even while they experience hallucinations or delusions. An individual’s behavior
may change over time, becoming bizarre if medication is stopped and returning
closer to normal when receiving appropriate treatment.
News and entertainment media tend to link mental illness and criminal
violence; however, studies indicate that except for those persons with a record
of criminal violence before becoming ill, and those with substance abuse or alcohol problems, people with Schizophrenia
are not especially prone to violence.
Substance abuse is a common concern of the family and friends of people
with schizophrenia. Since some people who abuse drugs may show symptoms similar
to those of schizophrenia, people with schizophrenia may be mistaken for
people “high on drugs.” while most researchers do not believe that substance
abuse causes schizophrenia, people who have schizophrenia often abuse alcohol and/or drugs,
and may have particularly bad reactions to certain drugs. Substance abuse
can reduce the effectiveness of treatment for schizophrenia. Stimulants (such
as amphetamines or cocaine) may cause major problems for patients with schizophrenia,
as may PCP or marijuana. In fact, some people experience a worsening of their
schizophrenic symptoms when they are taking such drugs. Substance abuse also
reduces the likelihood that patients will follow the treatment plans recommended
by their doctors.
The most common form of substance use disorder in people with schizophrenia
is nicotine dependence due to smoking. While the prevalence of smoking in
the U.S. population is about 25 to 30 percent, the prevalence among people
with schizophrenia is approximately three times as high. Research has shown
that the relationship between smoking and schizophrenia is complex. Although
people with schizophrenia may smoke to self medicate their symptoms, smoking
interferes with the response to antipsychotic drugs. Several studies have
found that schizophrenia patients who smoke need higher doses of antipsychotic
medication. Quitting smoking may be especially difficult for people with
schizophrenia, because the symptoms of nicotine withdrawal may cause a temporary
worsening of schizophrenia symptoms. However, smoking cessation strategies
that include nicotine replacement methods may be effective. Doctors should
carefully monitor medication dosage and response when patients with schizophrenia either start or stop smoking.
Most individuals with schizophrenia are not violent; more typically, they
are withdrawn and prefer to be left alone. Most violent crimes are not committed
by persons with schizophrenia, and most persons with schizophrenia do not commit
Substance abuse significantly raises the rate of violence in people with
schizophrenia but also in people who do not have any mental illness. People
with paranoid and psychotic symptoms, which can become worse if medications
are discontinued, may also be at higher risk for violent behavior. When violence
does occur, it is most frequently targeted at family members and friends, and
more often takes place at home.
Suicide is a serious danger in people who have schizophrenia. If an individual
tries to commit suicide or threatens to do so, professional help should be
sought immediately. People with schizophrenia have a higher rate of suicide
than the general population. Approximately 10 percent of people with schizophrenia
(especially younger adult males) commit suicide. Unfortunately, the prediction
of suicide in people with schizophrenia can be especially difficult.
Return to top
There is no known single cause of schizophrenia. Many diseases, such as
heart disease, result from an interplay of genetic, environmental, and behavioral
factors; and this may be the case for schizophrenia as well. Scientists do
not yet understand all of the factors necessary to produce schizophrenia, but
all the tools of modern biomedical research are being used to search for genes,
critical moments in brain development, and environmental factors that may lead
to the illness.
It has long been known that schizophrenia runs in families. People who
have a close relative with schizophrenia are more likely to develop the disorder
than are people who have no relatives with the illness. For example, a monozygotic
(identical) twin of a person with schizophrenia has the highest risk—40 to
50 percent—of developing the illness. A child whose parent has schizophrenia
has about a 10 percent chance. By comparison, the risk of schizophrenia in
the general population is about 1 percent.
Scientists are studying genetic factors in schizophrenia. It appears likely
that multiple genes are involved in creating a predisposition to develop the
disorder. In addition, factors such as prenatal difficulties like intrauterine
starvation or viral infections, perinatal complications, and various nonspecific
stressors, seem to influence the development of schizophrenia. However, it
is not yet understood how the genetic predisposition is transmitted, and it
cannot yet be accurately predicted whether a given person will or will not
develop the disorder.
Several regions of the human genome are being investigated to identify
genes that may confer susceptibility for schizophrenia. The strongest evidence
to date leads to chromosomes 13 and 6 but remains unconfirmed. Identification
of specific genes involved in the development of schizophrenia will provide
important clues into what goes wrong in the brain to produce and sustain the
illness and will guide the development of new and better treatments. To learn
more about the genetic basis for schizophrenia, the NIMH has established a
Schizophrenia Genetics Initiative that is gathering data from a large number
of families of people with the illness.
Basic knowledge about brain chemistry and its link to schizophrenia is
expanding rapidly. Neurotransmitters, substances that allow communication between
nerve cells, have long been thought to be involved in the development of schizophrenia.
It is likely, although not yet certain, that the disorder is associated with
some imbalance of the complex, interrelated chemical systems of the brain,
perhaps involving the neurotransmitters dopamine and glutamate. This area of
research is promising.
There have been dramatic advances in neuroimaging technology that permit
scientists to study brain structure and function in living individuals. Many
studies of people with schizophrenia have found abnormalities in brain structure
(for example, enlargement of the fluid-filled cavities, called the ventricles,
in the interior of the brain, and decreased size of certain brain regions)
or function (for example, decreased metabolic activity in certain brain regions).
It should be emphasized that these abnormalities are quite subtle and are not
characteristic of all people with schizophrenia, nor do they occur only in individuals with this illness. Microscopic studies of brain tissue after
death have also shown small changes in distribution or number of brain cells
in people with schizophrenia. It appears that many (but probably not all) of
these changes are present before an individual becomes ill, and schizophrenia
may be, in part, a disorder in development of the brain.
Developmental neurobiologists funded by the National Institute of Mental
Health (NIMH) have found that schizophrenia may be a developmental disorder
resulting when neurons form inappropriate connections during fetal development.
These errors may lie dormant until puberty, when changes in the brain that
occur normally during this critical stage of maturation interact adversely
with the faulty connections. This research has spurred efforts to identify
prenatal factors that may have some bearing on the apparent developmental abnormality.
In other studies, investigators using brain-imaging techniques have found
evidence of early biochemical changes that may precede the onset of disease
symptoms, prompting examination of the neural circuits that are most likely
to be involved in producing those symptoms. Scientists working at the molecular
level, meanwhile, are exploring the genetic basis for abnormalities in brain
development and in the neurotransmitter systems regulating brain function.
Return to top
Since schizophrenia may not be a single condition and its causes are not
yet known, current treatment methods are based on both clinical research and
experience. These approaches are chosen on the basis of their ability to reduce
the symptoms of schizophrenia and to lessen the chances that symptoms will
Antipsychotic medications have been available since the mid-1950s. They
have greatly improved the outlook for individual patients. These medications
reduce the psychotic symptoms of schizophrenia and usually allow the patient
to function more effectively and appropriately. Antipsychotic drugs are the
best treatment now available, but they do not “cure” schizophrenia or ensure
that there will be no further psychotic episodes. The choice and dosage of
medication can be made only by a qualified physician who is well trained in
the medical treatment of mental disorders. The dosage of medication is individualized
for each patient, since people may vary a great deal in the amount of drug
needed to reduce symptoms without producing troublesome side effects.
The large majority of people with schizophrenia show substantial improvement
when treated with antipsychotic drugs. Some patients, however, are not helped
very much by the medications and a few do not seem to need them. It is difficult
to predict which patients will fall into these two groups and to distinguish
them from the large majority of patients who do benefit from treatment with antipsychotic drugs.
A number of new antipsychotic drugs (the so-called “atypical antipsychotics”)
have been introduced since 1990. The first of these, clozapine (Clozaril®),
has been shown to be more effective than other antipsychotics, although the
possibility of severe side effects—in particular, a condition called agranulocytosis
(loss of the white blood cells that fight infection)—requires that patients
be monitored with blood tests every one or two weeks. Even newer antipsychotic
drugs, such as risperidone (Risperdal®) and olanzapine (Zyprexa®), are safer
than the older drugs or clozapine, and they also may be better tolerated. They
may or may not treat the illness as well as clozapine, however. Several additional
antipsychotics are currently under development.
Antipsychotic drugs are often very effective in treating certain symptoms
of schizophrenia, particularly hallucinations and delusions; unfortunately,
the drugs may not be as helpful with other symptoms, such as reduced motivation
and emotional expressiveness. Indeed, the older antipsychotics (which also
went by the name of “neuroleptics”), medicines like haloperidol (Haldol®) or
chlorpromazine (Thorazine®), may even produce side effects that resemble the
more difficult to treat symptoms. Often, lowering the dose or switching to
a different medicine may reduce these side effects; the newer medicines, including
olanzapine (Zyprexa®), quetiapine (Seroquel®), and risperidone (Risperdal®),
appear less likely to have this problem. Sometimes when people with schizophrenia
become depressed, other symptoms can appear to worsen. The symptoms may improve
with the addition of an antidepressant medication.
Patients and families sometimes become worried about the antipsychotic
medications used to treat schizophrenia. In addition to concern about side
effects, they may worry that such drugs could lead to addiction. However, antipsychotic
medications do not produce a “high” (euphoria) or addictive behavior in people
who take them.
Another misconception about antipsychotic drugs is that they act as a
kind of mind control, or a “chemical straitjacket.” Anti-psychotic drugs used
at the appropriate dosage do not “knock out” people or take away their free
will. While these medications can be sedating, and while this effect can be
useful when treatment is initiated particularly if an individual is quite agitated,
the utility of the drugs is not due to sedation but to their ability to diminish
the hallucinations, agitation, confusion, and delusions of a psychotic episode.
Thus, antipsychotic medications should eventually help an individual with schizophrenia
to deal with the world more rationally.
Antipsychotic medications reduce the risk of future psychotic episodes
in patients who have recovered from an acute episode. Even with continued drug
treatment, some people who have recovered will suffer relapses. Far higher
relapse rates are seen when medication is discontinued. In most cases, it would
not be accurate to say that continued drug treatment “prevents” relapses; rather,
it reduces their intensity and frequency. The treatment of severe psychotic
symptoms generally requires higher dosages than those used for maintenance
treatment. If symptoms reappear on a lower dosage, a temporary increase in
dosage may prevent a full-blown relapse.
Because relapse of illness is more likely when antipsychotic medications
are discontinued or taken irregularly, it is very important that people with
schizophrenia work together with their doctors and family members to adhere
to their treatment plan. Adherence to treatment refers to the degree to which patients follow the treatment plans
decided upon with their doctors. Good adherence involves taking prescribed
medication at the correct dose and proper times each day, attending clinic
appointments, and/or carefully following other treatment procedures. Treatment
adherence is often difficult for people with schizophrenia, but it can be made
easier with the help of several strategies and can lead to improved quality
There are a variety of reasons why people with schizophrenia may not adhere
to treatment. Patients may not believe they are ill and may deny the need for
medication, or they may have such disorganized thinking that they cannot remember
to take their daily doses. Family members or friends may not understand schizophrenia
and may inappropriately advise the person with schizophrenia to stop treatment
when he or she is feeling better. Physicians, who play an important role in
helping their patients adhere to treatment, may neglect to ask patients how
often they are taking their medications, or may be unwilling to accommodate
a patient’s request to change dosages or try a new treatment. Some patients
report that side effects of the medications seem worse than the illness itself.
Further, substance abuse can interfere with the effectiveness of treatment,
leading patients to discontinue medications. When a complicated treatment plan
is added to any of these factors, good adherence may become even more challenging.
Fortunately, there are many strategies that patients, doctors, and families
can use to improve adherence and prevent worsening of the illness. Some antipsychotic
medications, including haloperidol (Haldol®), fluphenazine (Prolixin®), perphenazine
(Trilafon®) and others, are available in long-acting injectable forms that
eliminate the need to take pills every day. A major goal of current research
on treatments for schizophrenia is to develop a wider variety of long-acting
antipsychotics, especially the newer agents with milder side effects, which
can be delivered through injection. Medication calendars or pill boxes labeled
with the days of the week can help patients and caregivers know when medications
have or have not been taken. Using electronic timers that beep when medications
should be taken, or pairing medication taking with routine daily events like
meals, can help patients remember and adhere to their dosing schedule. Engaging
family members in observing oral medication taking by patients can help ensure adherence. In addition, through
a variety of other methods of adherence monitoring, doctors can identify when
pill taking is a problem for their patients and can work with them to make
adherence easier. It is important to help motivate patients to continue taking
their medications properly.
In addition to any of these adherence strategies, patient and family education
about schizophrenia, its symptoms, and the medications being prescribed to
treat the disease is an important part of the treatment process and helps support
the rationale for good adherence.
Antipsychotic drugs, like virtually all medications, have unwanted effects
along with their beneficial effects. During the early phases of drug treatment,
patients may be troubled by side effects such as drowsiness, restlessness,
muscle spasms, tremor, dry mouth, or blurring of vision. Most of these can
be corrected by lowering the dosage or can be controlled by other medications.
Different patients have different treatment responses and side effects to various
antipsychotic drugs. A patient may do better with one drug than another.
The long-term side effects of antipsychotic drugs may pose a considerably
more serious problem. Tardive dyskinesia (TD) is a disorder characterized by
involuntary movements most often affecting the mouth, lips, and tongue, and
sometimes the trunk or other parts of the body such as arms and legs. It occurs
in about 15 to 20 percent of patients who have been receiving the older, “typical”
antipsychotic drugs for many years, but TD can also develop in patients who
have been treated with these drugs for shorter periods of time. In most cases,
the symptoms of TD are mild, and the patient may be unaware of the movements.
Antipsychotic medications developed in recent years all appear to have
a much lower risk of producing TD than the older, traditional antipsychotics.
The risk is not zero, however, and they can produce side effects of their own
such as weight gain. In addition, if given at too high of a dose, the newer
medications may lead to problems such as social withdrawal and symptoms resembling
Parkinson’s disease, a disorder that affects movement. Nevertheless, the newer
antipsychotics are a significant advance in treatment, and their optimal use
in people with schizophrenia is a subject of much current research.
Antipsychotic drugs have proven to be crucial in relieving the psychotic
symptoms of schizophrenia—hallucinations, delusions, and incoherence—but are
not consistent in relieving the behavioral symptoms of the disorder. Even when
patients with schizophrenia are relatively free of psychotic symptoms, many
still have extraordinary difficulty with communication, motivation, self-care,
and establishing and maintaining relationships with others. Moreover, because
patients with schizophrenia frequently become ill during the critical career-forming
years of life (e.g., ages 18 to 35), they are less likely to complete the training
required for skilled work. As a result, many with schizophrenia not only suffer
thinking and emotional difficulties, but lack social and work skills and experience
It is with these psychological, social, and occupational problems that
psychosocial treatments may help most. While psychosocial approaches have limited
value for acutely psychotic patients (those who are out of touch with reality
or have prominent hallucinations or delusions), they may be useful for patients
with less severe symptoms or for patients whose psychotic symptoms are under
control. Numerous forms of psychosocial therapy are available for people with
schizophrenia, and most focus on improving the patient’s social functioning—whether
in the hospital or community, at home, or on the job. Some of these approaches
are described here. Unfortunately, the availability of different forms of treatment
varies greatly from place to place.
There is a common notion that schizophrenia is the same as "split
personality”—a Dr. Jekyll-Mr. Hyde switch in character.
This is not correct.
Broadly defined, rehabilitation includes a wide array of non-medical interventions
for those with schizophrenia. Rehabilitation programs emphasize social and
vocational training to help patients and former patients overcome difficulties
in these areas. Programs may include vocational counseling, job training, problem-solving
and money management skills, use of public transportation, and social skills
training. These approaches are important for the success of the community-centered
treatment of schizophrenia, because they provide discharged patients with the
skills necessary to lead productive lives outside the sheltered confines of
a mental hospital.
Individual psychotherapy involves regularly scheduled talks between the
patient and a mental health professional such as a psychiatrist, psychologist,
psychiatric social worker, or nurse. The sessions may focus on current or past
problems, experiences, thoughts, feelings, or relationships. By sharing experiences
with a trained empathic person—talking about their world with someone outside
it—individuals with schizophrenia may gradually come to understand more about
themselves and their problems. They can also learn to sort out the real from
the unreal and distorted. Recent studies indicate that supportive, reality-oriented,
individual psychotherapy, and cognitive-behavioral approaches that teach coping
and problem-solving skills, can be beneficial for outpatients with schizophrenia.
However, psychotherapy is not a substitute for antipsychotic medication; it
is most helpful once drug treatment first has relieved a patient’s psychotic
Very often, patients with schizophrenia are discharged from the hospital
into the care of their family; so it is important that family members learn
all they can about schizophrenia and understand the difficulties and problems
associated with the illness. It is also helpful for family members to learn
ways to minimize the patient’s chance of relapse—for example, by using different
treatment adherence strategies—and to be aware of the various kinds of outpatient
and family services available in the period after hospitalization. Family “psychoeducation,”
which includes teaching various coping strategies and problem-solving skills,
may help families deal more effectively with their ill relative and may contribute
to an improved outcome for the patient.
Self-help groups for people and families dealing with schizophrenia are
becoming increasingly common. Although not led by a professional therapist,
these groups may be therapeutic because members provide continuing mutual support
as well as comfort in knowing that they are not alone in the problems they
face. Self-help groups may also serve other important functions. Families working
together can more effectively serve as advocates for needed research and hospital
and community treatment programs. Patients acting as a group rather than individually
may be better able to dispel stigma and draw public attention to such abuses
as discrimination against the mentally ill.
Family and peer support and advocacy groups are very active and provide
useful information and assistance for patients and families of patients with
schizophrenia and other mental disorders. A list of some of these organizations
is included at the back of this booklet.
Return to top
A patient's support system may come from several sources, including the
family, a professional residential or day program provider, shelter operators,
friends or roommates, professional case managers, churches and synagogues,
and others. Because many patients live with their families, the following discussion
frequently uses the term "family." However, this should not be taken to imply that families ought to be the primary
There are numerous situations in which patients with schizophrenia may
need help from people in their family or community. Often, a person with schizophrenia
will resist treatment, believing that delusions or hallucinations are real
and that psychiatric help is not required. At times, family or friends may
need to take an active role in having them seen and evaluated by a professional.
The issue of civil rights enters into any attempts to provide treatment. Laws
protecting patients from involuntary commitment have become very strict, and
families and community organizations may be frustrated in their efforts to
see that a severely mentally ill individual gets needed help. These laws vary
from state to state; but generally, when people are dangerous to themselves
or others due to a mental disorder, the police can assist in getting them an
emergency psychiatric evaluation and, if necessary, hospitalization. In some
places, staff from a local community mental health center can evaluate an individual's illness at home if he or she will not voluntarily
go in for treatment.
Sometimes only the family or others close to the person with schizophrenia
will be aware of strange behavior or ideas that the person has expressed. Since
patients may not volunteer such information during an examination, family members
or friends should ask to speak with the person evaluating the patient so that
all relevant information can be taken into account.
Ensuring that a person with schizophrenia continues to get treatment after
hospitalization is also important. A patient may discontinue medications or
stop going for follow-up treatment, often leading to a return of psychotic
symptoms. Encouraging the patient to continue treatment and assisting him or
her in the treatment process can positively influence recovery. Without treatment,
some people with schizophrenia become so psychotic and disorganized that they
cannot care for their basic needs, such as food, clothing, and shelter. All
too often, people with severe mental illnesses such as schizophrenia end up
on the streets or in jails, where they rarely receive the kinds of treatment
Those close to people with schizophrenia are often unsure of how to respond
when patients make statements that seem strange or are clearly false. For the
individual with schizophrenia, the bizarre beliefs or hallucinations seem quite
real—they are not just "imaginary fantasies." Instead of “going along with ” a person's delusions, family members or friends
can tell the person that they do not see things the same way or do not agree
with his or her conclusions, while acknowledging that things may appear otherwise
to the patient.
It may also be useful for those who know the person with schizophrenia
well to keep a record of what types of symptoms have appeared, what medications
(including dosage) have been taken, and what effects various treatments have
had. By knowing what symptoms have been present before, family members may
know better what to look for in the future. Families may even be able to identify
some "early warning signs" of potential relapses, such as increased withdrawal or changes in sleep patterns,
even better and earlier than the patients themselves. Thus, return of psychosis
may be detected early and treatment may prevent a full-blown relapse. Also,
by knowing which medications have helped and which have caused troublesome
side effects in the past, the family can help those treating the patient to
find the best treatment more quickly.
In addition to involvement in seeking help, family, friends, and peer
groups can provide support and encourage the person with schizophrenia to regain
his or her abilities. It is important that goals be attainable, since a patient
who feels pressured and/or repeatedly criticized by others will probably experience
stress that may lead to a worsening of symptoms. Like anyone else, people with
schizophrenia need to know when they are doing things right. A positive approach
may be helpful and perhaps more effective in the long run than criticism. This
advice applies to everyone who interacts with the person.
Return to top
The outlook for people with schizophrenia has improved over the last 25
years. Although no totally effective therapy has yet been devised, it is important
to remember that many people with the illness improve enough to lead independent,
satisfying lives. As we learn more about the causes and treatments of schizophrenia,
we should be able to help more patients achieve successful outcomes.
Studies that have followed people with schizophrenia for long periods,
from the first episode to old age, reveal that a wide range of outcomes is
possible. When large groups of patients are studied, certain factors tend to
be associated with a better outcome—for example, a pre-illness history of normal
social, school, and work adjustment. However, the current state of knowledge
does not allow for a sufficiently accurate prediction of long-term outcome.
Given the complexity of schizophrenia, the major questions about this
disorder—its cause or causes, prevention, and treatment—must be addressed with
research. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia. Such claims can provoke unrealistic expectations that, when
unfulfilled, lead to further disappointment. Although progress has been made
toward better understanding and treatment of schizophrenia, continued investigation
is urgently needed. As the lead Federal agency for research on mental disorders,
NIMH conducts and supports a broad spectrum of mental illness research from
molecular genetics to large-scale epidemiologic studies of populations. It
is thought that this wide-ranging research effort, including basic studies
on the brain, will continue to illuminate processes and principles important
for understanding the causes of schizophrenia and for developing more effective
Return to top