Schizophrenia: What It Really Is, What Causes It, and How Modern Treatment Can Help

Learn what schizophrenia really is, its causes, symptoms, and treatment options. Written for families seeking compassionate, expert mental health care

That One Moment Everything Changes

Imagine your loved one: a family member, a child, a spouse, starts behaving differently. They seem suspicious toward individuals that have always cared for them. They speak of hearing voices that no one else hears. They become withdrawn and uninterested in things that used to bring joy.

You're browsing online at 2 am, searching for answers, when the term "schizophrenia" continues to pop up on your screen. Your stomach drops.

If this sounds familiar, know you aren't alone; and you don't need to feel powerless either.

What Is Schizophrenia?

Schizophrenia is a serious, yet treatable mental illness affecting how an individual thinks, interprets their surroundings, and interacts with others. The age range for onset of schizophrenia typically occurs during late adolescent or early adult years (most common within the 16–30-year-old age range), although it can develop at other points in an individual's life.

The name "schizophrenia" derives from two Greek words: schizo ("split") and phrenein ("mind"). However, it does NOT mean a person has a "split personality." A split personality is a very rare condition. Schizophrenia is simply a disorder of the way an individual perceives their environment and processes thoughts. At some point, the brain develops its own means of interpreting reality - for unknown reasons.

 Common Myths vs.  Reality 

It is very important to clarify several common myths which have been detrimental to individuals diagnosed with schizophrenia.

 Myth # 1: "Individuals with schizophrenia are dangerous".

Reality: Numerous studies show that people who live with schizophrenia are at a much higher risk of victimisation as opposed to perpetrating acts of violence. Most individuals with schizophrenia are not violent. The perception of the dangerous stranger came from over-sensationalised reporting of schizophrenia cases and not from the experiences of those clinically diagnosed.

Stigma created through these types of false perceptions has had devastating effects on the lives of individuals with schizophrenia and their families. These false perceptions create barriers for families to seek assistance while creating feelings of shame for the individual experiencing symptoms of an illness they did not choose.

Myth # 2: "Having schizophrenia means hearing voices all of the time and losing contact with reality entirely".

Reality: Schizophrenia is a condition that occurs along a continuum. Individuals may experience episodic periods where their symptoms are exacerbated (i.e., active phase) followed by longer periods where their symptoms may be less severe (relative stabilisations). Regardless of whether symptoms occur during either phase, each individual's symptomatology varies significantly from one another. While some individuals do report hearing voices, other individuals do not report hearing voices. Similarly, while some individuals may report having strong beliefs or delusions, other individuals may experience fewer cognitive symptoms such as motivation to perform activities and withdraw socially. Due to these variations in symptoms, there is no singular representation of the diagnosis of schizophrenia.

Myth # 3: "Once an individual is diagnosed with schizophrenia, they cannot improve; it only continues to worsen".

Reality: While schizophrenia is a chronic disorder, chronic does not necessarily mean hopeless. A number of evidence-supported interventions exist which can enable many individuals diagnosed with schizophrenia to obtain significant improvements. Structured treatments include pharmacological interventions (e.g., antipsychotic medications), psychotherapeutic interventions (e.g., CBT, IPSRT), and structural support services. Early recognition/identification of the first episode(s) of symptoms has been identified as one factor associated with improved prognosis for individuals diagnosed with schizophrenia. Obtaining professional assistance does not indicate surrender; obtaining professional assistance represents the strongest action a family member can take to assist their loved one.

#Signs and Symptoms of Schizophrenia.

When psychiatrists group schizophrenia symptoms, they use three broad categories: positive symptoms, negative symptoms, and cognitive symptoms. Families will have an easier time identifying what they are observing -- and communicating this with their health professionals -- once they understand these three types.

Positive Symptoms. 

The term "positive," in this context, does not denote anything favourable - rather it denotes symptoms which adds some new experience to the individual that had not been present prior to onset of the disorder.

- Hallucinations: Hearing voices that no one else can hear is most common. These voices may be critical, command or conversational. Much less frequent are visual hallucinations (seeing), olfactory hallucinations (smelling) or tactile hallucinations (feeling) things that do not exist.

- Delusions: The individual has strong convictions that are unrelated to fact and could not be altered by evidence. Some examples of delusions include:

• Believing one is being followed;
• That messages on TV are addressed directly to you; 
• Someone is controlling your thoughts;

- Disorganised thinking and/or disorganised speech: The individual may jump rapidly from topic to topic so quickly that the listener finds it difficult to follow the conversation. 

- Disorganised behaviour: Engaging in abnormal or unusual behaviour; at times, individuals may find themselves unable to accomplish basic daily functions.

Negative Symptoms.

The term "negative" refers to a reduction in normal behaviours/emotions:

- A flat affect: Limited expressions of emotion, such as talking in a monotone;
- Lack of motivation, and difficulty initiating or finishing activities (also referred to as avolition); 
- Withdrawal from social interactions -- Avoidance of interaction with friends/family/social events formerly enjoyed;
- Inability to derive pleasure (anhedonia);
- Talking less (alogia); 

Families typically notice negative symptoms first - but they are also commonly misinterpreted as laziness, depression or stubbornness. This is simply not true - they are symptoms of a disease requiring the same level of compassion/patience as any other medical symptom.

Cognitive Symptoms.

These refer to those aspects of thought/memory that negatively impact daily functioning.

- Difficulty focusing or concentrating on a task;
- Difficulty maintaining focus on an activity;
- Impaired working memory (the ability to hold information in working memory while utilizing it);
- Poor planning skills (planning/organising tasks);

Cognitive symptoms often result in difficulties with employment, school or managing the demands of everyday life - and can remain even if other symptoms are well-managed.

What is the Cause of Schizophrenia? 

Schizophrenia is not caused by a single factor. Most psychiatrists now consider schizophrenia through a biopsychosocial model, which means there are biological, psychological and environmental/social contributions. 

Biology

In terms of genetics, if a close family member has schizophrenia, then the chances of experiencing schizophrenia are much greater than average. Having a family member with schizophrenia does not necessarily mean that a particular individual will experience schizophrenia. Brain chemicals (neurotransmitters), specifically dopamine and glutamate, have shown to be different in people experiencing symptoms of schizophrenia. Research studies have found structural differences in some parts of the brain.

Other biological contributing factors include; complications that may occur in pregnancy or birth, infection to the foetus during pregnancy and older paternal age when conceiving.

Psychology

Childhood trauma (emotional/physical/sexual) appears to increase the likelihood of developing psychotic disorders (including schizophrenia). Stressful situations can trigger a psychotic episode in individuals with biological vulnerabilities.

Environment

Individuals growing up in urban areas, socially isolated individuals, immigrants who experienced social exclusion and those who used marijuana extensively during adolescent years are at an increased risk. They don’t “cause” schizophrenia independently, however they can interact with biological predispositions leading an individual towards becoming ill.

The important message to families: schizophrenia occurs due to a very complex combination of factors - and once we understand this complexity, it becomes easier to seek appropriate treatment.

 How is Schizophrenia Diagnosed?

There isn’t a lab test or MRI that will diagnose schizophrenia. A psychiatrist uses a comprehensive clinical evaluation - discussing the person’s experiences in detail, reviewing their history, gathering information from family members and observing them over a period of time.

In order to meet the criteria for schizophrenia, symptoms must persist for a minimum of six months, with active symptoms (hallucinations/delusional thinking) lasting for at least one month. In addition to evaluating the presence of active symptoms, the psychiatrist will evaluate whether there are alternative explanations for these symptoms (i.e., substance use issues, thyroid disease, etc.) that could potentially explain similar symptomatology.

Early identification truly matters. The longer the first episode of psychosis remains undiagnosed and untreated, the more difficult achieving a complete remission of the disorder may become. If you see notable changes in your loved one's behaviours, thought processes, or functioning, especially as a young adult - do not wait for things to work themselves out.

 Treatment options for schizophrenia

The good news: Schizophrenia is treatable, and most people respond well to a combination of approaches tailored to their individual needs.

Schizophrenia treatment has made huge strides recently. A person diagnosed with schizophrenia today has access to many more effective treatments than did a generation ago.

1. Medication (Antipsychotics) 

Antipsychotic medications are the primary method of treatment. These drugs mainly regulate dopamine levels within the brain and help alleviate hallucinations, delusions, and other disordered thinking patterns. Although they may have some side effects, new generation antipsychotics were developed with fewer side effects than older generation. Many are also available as long-acting injections that allow for longer periods of time before needing to take another dose. This can help ensure consistent dosing for people who may forget or dislike taking medicine each day.

2. Psychotherapy  

Individual therapies such as Cognitive Behaviour Therapy (CBT), and Supportive Therapy helps a person with schizophrenia better manage with their symptoms; challenge their distressing beliefs; and develop coping strategies. Family therapy is just as beneficial. The family members benefit from learning about the disorder and understanding how best to offer support without burnout.

3. Psychosocial Rehabilitation 

 Psychosocial rehabilitation includes vocational training, developing social skills, creating a structured daily routine, all designed to enable a person regain independence and reintegrate into work, education, or community life.

4. Neuromodulation  

When an individual does not experience full improvement on their negative symptoms using medication only (e.g., lack of motivation, social isolation, poor concentration) various forms of neuromodulation are valuable add-on treatments. These include rTMS and MECT. rTMS has been found to be particularly effective with auditory hallucinations, as well as improving the negative symptoms of schizophrenia. 

5. Inpatient Care 

While there are times when outpatient treatment is insufficient to manage the symptoms of schizophrenia - i.e., when symptoms are severe, when an individual is likely to harm themself, when a first episode needs careful supervision and/or initial administration of medication safely, or when a relapse necessitates quick resolution - inpatient psychiatric care offers services that cannot be duplicated at home:

• Round-the-clock clinical monitoring

• A structured/safe environment

• Quickly available medication

• A team of professionals working collaboratively in "real-time"
  

Inpatient psychiatric care is not indicative of failure - it is often the quickest route to regaining stability.

How Families Can Support Their Loved One

Families are usually the first ones to recognise that something is amiss, and they are also often key figures in supporting their loved one throughout their long-term recovery process.

What Does Make a Difference?

Learning About the Illness

Knowing about schizophrenia (its symptoms, its natural history, its potential triggers) enables families to avoid reacting with anger, frustration, or overwhelm and instead react with patience.

Maintain Calm and Clear Communication 

High-expressed-emotion (criticism, hostility, emotional over-involvement) is one of the most powerful predictors of relapse. This has nothing to do with guilt or blame; this has everything to do with providing your loved one with practical guidance regarding how you can help them through episodes. Communicating calmly, listening without making judgments, and avoiding conflicts or confrontations during episodes can all contribute to this goal.

Support Treatment Participation 

Many individuals experiencing schizophrenia (especially during acute episodes) are resistant to believing they have an illness. This phenomenon is referred to as anosognosia and represents a symptom of the disorder, not stubbornness. Rather than resorting to coercion, encouraging participation in treatment using gentle and persistent approaches, coupled with building trustful relationships with your loved one, is typically more effective.

About Adayu

Families dealing with a loved one’s Schizophrenia - whether a first-time episode, a crisis or needing additional, more intense treatment - can benefit greatly from being able to find, and gain access to, specific, in-patient psychiatric facilities. 
Adayu, an in-patient psychiatric facility is specifically designed to provide compassionate, evidence-based, in-patient psychiatric treatments for individuals living with psychosis in a safe and therapeutic environment. At Adayu, our team is acutely aware that entering in-patient mental health treatment is often a huge leap. Our goal is to aid you in managing your crisis; however, the aim is to create a pathway of stabilisation, assessment, and recovery - together, as a family unit, respectfully acknowledging the individual, and focusing on long term recovery just suppressing symptoms in the short term.

If you are questioning if in-patient psychiatric treatment would be beneficial for someone you know, initiating contact for consultation purposes is always a good starting point.

You don’t have to do it alone

Schizophrenia is an extremely debilitating mental illness. However, it is not a death sentence. Families do not have to go through this alone.

The road to recovery rarely goes smoothly. There will be setbacks. There will be times of doubt. But there will be progress - sometimes slow, sometimes dramatic - when the appropriate level of supportive intervention exists.

If anything within this article has resonated with you, please take the next step. Speak with a psychiatrist. Ask all of your hard questions. Contact a mental health helpline. Look into what type of structured professional interventions may exist. Recovery begins with one decision: to seek help.

You deserve support. Your loved one deserves care. And that care is available.

Frequently Asked Questions (FAQs)

Q1: Can Schizophrenia be cured?

Currently, there is no 'cure' for Schizophrenia – like how we wouldn't call curing an infection as such. In other words, while there isn't a cure in the same sense as say influenza, many people are able to live full and productive lives with long periods of remission from Schizophrenia using consistent treatments - medications, therapies, etc.  and psychosocial supports. Therefore, while there is no cure for Schizophrenia; recovery is possible and very real.

Q2: What is the difference between Schizophrenia and bipolar disorder?

Bipolar disorder and Schizophrenia are both serious mental illnesses; however, they present differently regarding symptomatology. Bipolar disorder is essentially a mood disorder which includes episodes of mania & depression. While Schizophrenia is fundamentally about altering thought processes (and perceptions) - though mood-related issues can develop.

Therefore, a comprehensive diagnostic examination conducted by a licensed psychiatrist is required to identify these differences - since treatments for these disorders differ significantly.

Q3: Are there any early warning signs for Schizophrenia that i should keep an eye out for?

Early warning signs (often referred to as the prodrome) - some examples include social withdrawal; decreased academic/work performance; changes in sleep patterns; unusual/suspicious thinking patterns; difficulty concentrating; and minor changes to speech/behaviour. Often attributed to stress or developmentally related issues, these types of behaviours/changes can easily be overlooked; however, if they continue or increase, a psychiatric evaluation should be initiated immediately.

Q4: Is Schizophrenia treatment available in India? 

Yes. Mental health treatment for Schizophrenia is readily accessible throughout India. Treatments are available at government hospitals, private psychiatric clinics and dedicated in-patient psychiatric facilities. Availability and quality of care vary depending upon region/city/township; however, awareness of availability of services continues to grow and specialised psychiatric facilities continue to expand in urban areas. Early intervention results in better outcomes.

Q5: Under what circumstances is in-patient psychiatric care needed for Schizophrenia? 

Generally speaking; in-patient psychiatric treatment is usually recommended when the person is exhibiting severe psychotic symptoms which cannot be safely managed at home; when there is an imminent risk of harm to self or others; when a first episode has occurred which needed to be safely evaluated/medication started; or when the person has relapsed after a period of stability and needs rapid re-stabilisation. Hospitalisation is not the last resort; it usually provides the most effective means to return to functionality quickly and safely.