Schizophrenia

People with schizophrenia go through phases or episodes in which their perception of reality is often very distorted. During these phases, people may have delusions, hear voices or think they are being watched or influenced by other people.

At a glance

  • The term “schizophrenia” means “split mind”.
  • People with schizophrenia experience phases of acute psychosis, in which they perceive reality differently.
  • They may have delusions, hear voices or think they are being followed or influenced by other people.
  • Acute psychosis is usually temporary and these phases are experienced only once or a small number of times in total.
  • The exact causes of schizophrenia are unknown.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Schizophrenia: figure showing profile of young woman. Her face is hidden by a transparent vase. The woman’s face is reflected upside down in the glass.

What is schizophrenia?

People with schizophrenia experience phases or episodes of acute psychosis, in which their perception of the world is frequently distorted. For example, they may hear voices or think they are being followed or influenced by other people. Their behavior also changes, and many stop speaking coherently. Some of those affected become almost completely detached from reality.

Acute psychosis is usually temporary and these phases are experienced only once or a small number of times in total. Others have the symptoms permanently, in which case they need a lot of support.

Important: The word “schizophrenia” means “split mind”. However, this often leads to the misconception that someone with schizophrenia has a “split personality”.

This mistaken view increases prejudices against people with schizophrenia. Although their perception of reality can be severely impaired and their behavior may change during phases of psychosis, their personality does not change or “split”. Schizophrenia also has a wide range of symptoms, causes and progression.

What are the symptoms of schizophrenia?

A distinction is made between various types of schizophrenia, based on typical symptoms. The most common types are:

Paranoid schizophrenia

People with paranoid schizophrenia have delusions and hallucinations. For example, they hear voices or think they are being watched and influenced by other people. This is the most common type of schizophrenia. It usually begins between the ages of 25 and 35.

Residual schizophrenia

People with this form of schizophrenia have chronic symptoms that mostly occur after an acute psychotic phase. They are very passive, lethargic and appear depressed. They may also have difficulty concentrating or experience memory problems.

Disorganized (hebephrenic) schizophrenia

This type is characterized by an abnormal emotional life with a mood that barely changes and is often inappropriate to the situation, as well as erratic thinking and inappropriate behavior. Disorganized (hebephrenic) schizophrenia usually begins between the ages of 15 and 25.

Catatonic schizophrenia

This is a very rare form of the illness that affects the way people move. For example, they may become hyperactive for no reason, remain completely immobile or pull faces. It also usually begins between the ages of 15 and 25.

In many cases, indications of an acute psychotic phase or episode occur well in advance. People with schizophrenia themselves and, in most cases, those close to them notice a change in the weeks or months leading up to the episode. People are often tense, restless and have problems sleeping before an acute psychotic episode. They also have difficulty concentrating or memory problems. They may also experience mild hallucinations. They may think they are being watched and influenced by other people.

For more detailed information, for example, about the symptoms of schizophrenia, visit gesundheitsinformation.de.

What causes schizophrenia?

While the exact causes of schizophrenia are unknown, it is likely that a complex interaction of various factors is at play. It is known that some people have a congenital predisposition to schizophrenia, particularly if a parent or sibling already has it. Around 12% of children who have a parent with schizophrenia go on to develop it too.

There may also be other factors involved that increase the likelihood of developing the illness. These include:

  • changes to the brain
  • insomnia
  • drug abuse
  • traumatic experiences
  • developmental disorders in the womb or in childhood

A psychosis is often associated with major life changes, such as divorce, moving home or starting work. Schizophrenia is also more likely to occur in a family atmosphere where children are often criticized and constantly told what they can and cannot do.

How common is schizophrenia?

It is estimated that about 1 in every 100 people will develop schizophrenia at some point in their lives. Slightly more men than women are affected.

Schizophrenia is most statistically likely among people with a low socio-economic status and those who are single. However, loss of social status and loneliness are often consequences of the illness itself.

About one out of every 100 people will be diagnosed with schizophrenia at some point in their life.

What is the outlook for someone with schizophrenia?

The first acute episode usually occurs between the ages of 15 and 35. An increase in unexplained symptoms over several years is often an indication of the disease. Potential precursors include, for example, depression, moodiness, restlessness, self-doubt, difficulties concentrating or anxiety. In many cases, there are unexpected problems at school or in college. Many people in the early stages of schizophrenia neglect their appearance or withdraw from their social environment.

On average, the first acute psychotic episode occurs a few years earlier in men than in women. The reason for this is unknown. Schizophrenia very rarely starts in childhood.

Around a quarter of those affected only experience a single acute psychotic episode. Around 60 out of every 100 have a relapse within two years of their first acute psychotic episode. It can take weeks or months for an acute psychosis to subside.

People often continue to experience the effects of an episode of psychosis for a long time, even if they have no symptoms. What they have experienced can unsettle them and affect their feeling of self-worth. However, some are able return to their daily routine and live a normal life after a psychotic phase. Others are permanently affected and need intensive support.

On average, people with schizophrenia die around ten years earlier than the rest of the population. In particular, life expectancy is lower for those who have frequent relapses. There are many reasons for this. For example, they may have addictions and consume more alcohol, nicotine and drugs. They are also more likely to have infections, heart disease or diabetes. These types of physical conditions may be due to their lifestyle but may also be side effects of anti-psychotic medication. If schizophrenia is well treated, life expectancy rises.

Around 5% of those affected take their own life. This is more common in young men having their first acute psychotic episode or people who have had a severe form of the illness for a long period. Critical periods are untreated psychotic phases and the period immediately following discharge from hospital.

How is schizophrenia diagnosed?

Schizophrenia is only diagnosed if the typical symptoms have been present for more than a month. More weight is given to symptoms such as delusions or persistently hearing voices. Signs such as confused speech, becoming hyperactive for no reason or hallucinations other than hearing voices are less important for the diagnosis, as these are less typical of schizophrenia.

Doctors will talk to the person affected and possibly also their loved ones to determine whether they are really suffering from schizophrenia. The person’s behavior is also observed. Physical and neurological examinations are performed to rule out other potential causes of the symptoms. Similar symptoms may be caused, for example, by disorders of the nervous system or alcohol and drug abuse.

Important: It is not always easy to tell the difference between typical symptoms of schizophrenia and a person’s normal behavior or understandable reactions to certain experiences. In adolescents, it may be difficult to distinguish between major developmental problems and potential schizophrenia.

Certain symptoms of schizophrenia can also occur under the influence of drugs or in people with other conditions such as depression or anxiety disorders. All of this means that a careful examination by a specialized psychiatrist is a very important part of the diagnostic process.

How is schizophrenia treated?

Treatment for a person with schizophrenia should be centered around their needs. However, this is only possible to a limited extent if they are experiencing their first acute psychotic episode. Designing and planning treatment with the patient based on their individual needs is more likely to succeed once the acute psychosis has subsided. Providing fast, effective treatment increases the chances of a positive outlook for schizophrenia.

The following actions can be taken and support provided:

Support from a person’s social environment

Family, friends and acquaintances can provide emotional support for the person, help them with their everyday routine and ensure they have more stability in their life.

Medication

Anti-psychotic medication can help resolve acute symptoms and make relapses less likely in the long term. However, medication can have distressing side effects.

Psychotherapy

This can reduce symptoms and help the person to better manage their illness. Common forms include cognitive behavioral therapy and family therapy. Psychotherapy can be helpful in all phases of the disease, even during an acute psychosis.

Psychoeducation

This involves training people with schizophrenia and their loved ones in key aspects of the symptoms, treatment and management of the disease. Psychoeducation also provides an opportunity to share experiences with other people who have schizophrenia.

Sociotherapy

This type of therapy can help people to reconnect with their professional and social lives and to live as independently as possible. Sociotherapy can sometimes also alleviate the symptoms.

Treatment options for schizophrenia include support from family and friends, medication, psychotherapy, psychoeducation and sociotherapy.

People with schizophrenia may receive inpatient or outpatient care. Treatment is often provided in a psychiatric hospital during an acute phase. People affected by schizophrenia often do not realize that they are experiencing acute psychosis and may refuse treatment. Compulsory admission to a psychiatric hospital may be the only option in these cases.

People with schizophrenia can sign a treatment contract with doctors to cover this type of situation. This may, for example, specify what action is to be taken if they experience an acute psychosis. This allows them, for example, to agree with doctors how medication is to be administered and how compulsory admission is to be handled if it cannot be avoided. It also allows them to specify what other types of support they want to receive. It may also be advisable to draw up an advance health care directive (“living will”) and a lasting power of attorney for health and welfare to cover this type of situation. This states who is authorized to make decisions if the person affected does not have the capacity to do so.

Where can I find more information about schizophrenia?

The “Telefonseelsorge” crisis hotline provides support to people with schizophrenia when they are experiencing acute problems and helps arrange further assistance. Various advisory services are also available for people with schizophrenia.

The Federal Association of Psychotherapists (Bundespsychotherapeutenkammer) provides a therapist search on its website. The appointment service centers of the Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen) help people with schizophrenia make an appointment at a specialist or psychotherapy practice.

The first point of contact is usually the family doctor, even in cases of potential schizophrenia or acute psychosis.

  • Leucht S, Vauth R, Olbrich HM, Jäger M. Schizophrenien und andere psychotische Störungen. In: Psychische Erkrankungen – Klinik und Therapie. München: Urban und Fischer; 2015. 
  • Owen MJ, Sawa A, Mortensen PB. Schizophrenia. Lancet 2016; 388(10039): 86-97. Aufgerufen am 14.06.2020.
  • Robert Koch-Institut (RKI). Schizophrenie. 15.07.2010. (Gesundheitsberichterstattung des Bundes; Band 50). Aufgerufen am 14.06.2020.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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