Schizophrenia

Schizophrenia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Schizophrenia Schizophrenia Introduction Symptoms Causes Diagnosis Treatment Living with Introduction Schizophrenia is a long-term mental health condition that causes a range of different psychological symptoms, including: hallucinations hearing or seeing things that do not exist delusionsunusual beliefs not based on reality that often contradict the evidence muddled thoughts based on hallucinations or delusions changes in behaviour Doctors often describe schizophrenia as a psychotic illness.This means sometimes a person may not be able to distinguish their own thoughts and ideas from reality. Read more about the symptoms of schizophrenia . Why does schizophrenia happen? The exact cause of schizophrenia is unknown. However, most experts believethe condition is caused by a combination of genetic and environmental factors. It is thought certain things make you more vulnerable to developing schizophrenia, andcertain situations cantrigger the condition. Read more about the causes of schizophrenia . Who is affected? Schizophrenia is one of the most common serious mental health conditions. About1 in 100 people will experience schizophrenia in their lifetime, with many continuing to lead normal lives. Schizophrenia is most often diagnosed between the ages of 15 and 35. Men and women are affectedequally. There is no single test for schizophrenia. It is most often diagnosed after an assessment by a mental health care professional, such as a psychiatrist. It is important that schizophrenia is diagnosed as early as possible, as the chances of recovery improve the earlier it is treated. Read more about diagnosing schizophrenia . How is schizophrenia treated? Schizophrenia is usually treated with a combination of medication and therapyappropriate to each individual. In most cases, this will be antipsychoticmedicines and cognitive behavioural therapy (CBT). People with schizophrenia will usually receive help from a community mental health team (CMHT), which will offer day-to-day support and treatment. Many people recover from schizophrenia, although they may have periods when symptoms return (relapses). Support and treatment can helpreduce the impactthe condition hason your life. Read more about treating schizophrenia. Living with schizophrenia If schizophrenia is well managed, it is possible to reduce the chances of severe relapses. This can include: recognising the signs of an acute episode taking medication as prescribed talking to others about the condition There are many charities and support groups offering help and advice on living with schizophrenia. Most peoplefind it comfortingtalking to others with a similar condition. Read more about living with schizophrenia . Symptoms Changes in thinking and behaviour are the most obvious signs of schizophrenia, but people can experience symptoms in different ways. The symptoms of schizophrenia are usually classified into one of two categoriespositive or negative. positive symptoms  represent a change in behaviour or thoughts, such as hallucinations or delusions negative symptoms  represent a withdrawal or lack of function that you would usually expect to see in a healthy person; for example, people with schizophrenia often appear emotionless, flat and apathetic The conditionmay develop slowly. The first signs of schizophrenia, such as becoming socially withdrawn and unresponsive or experiencing changes in sleeping patterns, can be hard to identify. This is because the first symptoms often develop during adolescence and changes can be mistaken for an adolescent phase. People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no positive symptoms. This is known as acute schizophrenia. If you are experiencing symptoms of schizophrenia, see your GP as soon as possible.The earlier schizophrenia is treated, the more successful the outcome tends to be. Read more information about how schizophrenia is diagnosed . Positive symptoms of schizophrenia Hallucinations A hallucination is when a person experiences a sensation but there isnothing ornobody there to account for it. It can involve any of the senses, but the most common is hearing voices. Hallucinations are very real to the person experiencing them, even though people around themcannot hear the voices or experience the sensations. Research using brain-scanning equipment shows changes in the speech area in the brains of peoplewith schizophreniawhen they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices. Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive orannoying. The voices might describe activities taking place, discuss the hearers thoughts and behaviour, give instructions, or talk directly to the person. Voices may come from different places orone place in particular, such as the television. Delusions A delusion is a beliefheld with complete conviction, even though it is based on a mistaken, strange or unrealistic view. It may affect the way people behave. Delusions can begin suddenly, or may develop over weeks or months. Some people develop a delusional idea to explain a hallucination they are having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions. Someone experiencing a paranoid delusion may believethey are being harassed or persecuted. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend. Some people who experience delusions find different meanings in everyday events or occurrences. They may believepeople on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing on the street. Confused thoughts (thought disorder) People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme. People sometimes describe their thoughts as misty or hazy when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand. Changes in behaviour and thoughts A persons behaviour may become more disorganised and unpredictable, and their appearance or dress may seem unusual to others. People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason. Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else. Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind. Some people feel their body is being taken over and someone else is directing their movements and actions. Negative symptoms of schizophrenia The negative symptoms of schizophrenia can oftenappear several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia. Symptoms during the prodromal period usually appear gradually and slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene. It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else. Negative symptoms experienced by people living with schizophrenia include: losing interest and motivation in life and activities, including relationships and sex lack of concentration, not wanting to leave the house, and changes in sleeping patterns being less likely to initiate conversations and feeling uncomfortable with people, or feeling there is nothing to say The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes be mistaken for deliberate laziness or rudeness. Causes The exact causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition. Current thinking is that some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, its not known why some people develop symptoms while others dont. Increased risk Things that increase the chances of schizophrenia developing include: Genetics Schizophrenia tends to run in families, but noone gene is thought to be responsible. Its more likelythat different combinations of genes make people more vulnerable to the condition. However, having these genes doesnt necessarily mean you will develop schizophrenia. Evidence the disorder is partly inherited comes from studies of twins. Identical twins share the same genes. Inidentical twins, if one twin develops schizophrenia, the other twin has a one in two chance of developing it too. This is true even if they are raised separately. In non-identical twins, who have different genetic make-ups, when one twin develops schizophrenia, the other only has a one in seven chance of developing the condition. While this is higher than in the general population (where the chance is about 1 in a 100), it suggests genes are not the only factor influencing the development of schizophrenia. Brain development Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains. These changes arent seen in everyone with schizophrenia andcan occur in people who dont have a mental illness. But they suggestschizophrenia may partly be a disorder of the brain. Neurotransmitters These are chemicals that carry messages between brain cells. There is a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia. Research suggestsschizophrenia may be caused by a change in the level of two neurotransmitters: dopamine and serotonin. Some studies indicatean imbalance between the two may be the basis of the problem. Others have found a change in the bodys sensitivity to the neurotransmitters is part of the cause of schizophrenia. Pregnancy and birth complications Research has shown that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as a low birth weight, premature labour, or a lack of oxygen (asphyxia) during birth. It may be that these things have a subtle effect on brain development. Triggers Triggers are things that can cause schizophrenia to develop in people who are at risk. These include: Stress The main psychological triggers of schizophrenia are stressful life events, such as a bereavement, losing your job or home, a divorce or the end of a relationship, or physical, sexual, emotional or racial abuse. These kinds of experiences, though stressful, do not cause schizophrenia, but can trigger its development in someone already vulnerable to it. Drug abuse Drugs do not directly cause schizophrenia, but studies have shown drug misuse increases the risk of developing schizophrenia or a similar illness. Certain drugs, particularly cannabis, cocaine, LSDor amphetamines, may trigger symptoms of schizophrenia in people who are susceptible. Using amphetamines or cocaine can lead to psychosis and can cause a relapse in people recovering from an earlier episode. Three major studies have shown teenagers under 15 who use cannabis regularly, especially skunk and other more potent forms of the drug, are up to four times more likely to develop schizophrenia by the age of 26. Want to know more? Mind: what causes schizophrenia? Rethink Mental Illness: Schizophrenia Royal College of Psychiatrists: cannabis and mental health Diagnosis There is no single test for schizophrenia. The condition is usually diagnosed after assessment by a specialist in mental health. If you are concernedyou may be developing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be. Your GP will ask about your symptoms and check they are not the result of other causes, such as recreational drug use. Community mental health team (CMHT) If a diagnosis of schizophrenia is suspected, your GP should refer you promptly to your local community mental health team (CMHT). CMHTs are made up of different mental health professionals who support people with complex mental health conditions. A member of the CMHT team, usually a psychiatrist or a specialist nurse, will carry out a more detailed assessment of your symptoms. They will also want to know your personal history and current circumstances. To make a diagnosis, most mental healthcare professionals use a diagnostic checklist. Schizophrenia can usually be diagnosed if: you have experienced one or more of the following symptoms most of the time for a monthdelusions, hallucinations,hearing voices, incoherent speechor negative symptoms, such as a flattening of emotions your symptoms have had a significant impact on your ability to work, study or perform daily tasks all other possible causes, such as recreational drug use or bipolar disorder, have been ruled out Related illnesses Sometimes it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, a psychiatrist may have reason to believe you have a related mental illness. There are severalrelated mental illnesses similar to schizophrenia. Your psychiatrist will askhow your illness has affected you so they can confidently confirm you have schizophrenia and not another mental illness, such as: bipolar disorder (manic depression) people with bipolar disorder swing from periods of mania (elevated moods and extremely active, excited behaviour) to periods of deep depression; some people also hear voices or experience other kinds of hallucinations, or may have delusions schizoaffective disorder this is often described as a form of schizophrenia because its symptoms are similar to schizophrenia and bipolar disorder, but schizoaffective disorder is a mental illness in its own right; it may occur just once in a persons life orrecur intermittently, often when triggered by stress. You should also be assessed for post-traumatic stress disorder and other conditions,suchasdepression, anxiety and substance misuse. Getting help for someone else As a result oftheir delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe there is nothing wrong with them. It is likelysomeone who has had acute schizophrenic episodes in the past will have been assigned a care co-ordinator. If this is the case, contact the persons care co-ordinator to express your concerns. If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative or other loved one to persuade them to visit their GP. In the case of a rapidly worsening schizophrenic episode, you may need to go to the accident and emergency (A&E) department, where a duty psychiatrist will be available. If a person who is having an acute schizophrenic episode refuses to seek help, their nearest relative can request that a mental health assessment is carried out. The social services department of your local authority can advisehow to do this. In severe cases of schizophrenia, people can be compulsorily detained in hospital for assessment and treatmentunder the Mental Health (Scotland) Act 2015 . After diagnosis If you or a friend or relative are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn. It is important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available. Treatment Community mental health teams Most people with schizophrenia are treated by community mental health teams (CMHTs). The goal of the CMHT is to provideday-to-day support and treatment while ensuring you have as much independence as possible. A CMHT can be made up of and provide access to: social workers community mental health nurses a nurse with specialist training in mental health conditions occupational therapists pharmacists counsellors and psychotherapists psychologists and psychiatrists the psychiatrist is usually the senior clinician in the team After your first episode of schizophrenia, you should initially be referred to an early intervention team.These specialist teams provide treatment and support, and are usually made up of psychiatrists, psychologists, mental health nurses, social workers and support workers. Care programme approach (CPA) People with complex mental health conditions, such as schizophrenia, are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs. There are four stages to a CPA: assessment  your health and social needs are assessed care plan a care plan is created to meet your health and social needs care co-ordinatorappointed  acare co-ordinator, sometimes known as a key worker, is usually a social worker or nurse, and is your first point of contact with other members of the CMHT reviews your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed Not everyone uses the CPA. Some people may be cared for by their GP, while others may be under the care of a specialist. You will work together with your healthcare team to develop a care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency. Your care plan should includea combined healthy eating and physical activity programme and, if you smoke,supportfor giving up. Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan. Want to know more? Rethink Mental Illness: Care programme approach fact sheet (PDF, 483kb) Acute episodes People who have serious psychotic symptoms asthe result of an acute schizophrenic episode may require a more intensive level of care than a CMHT can provide. These episodes are usually dealt with by antipsychotic medication and special care. Crisis resolution teams (CRT) One treatment option is to contact a home treatment or crisis resolution team (CRT). CRTs treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis. Without the involvement of the CRT, these people would require treatment in hospital. The CRT aims to treat people in the least restrictive environment possible, ideally in or near their home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre. CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis from occurring. Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis. Voluntary and compulsory detention More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it is necessary. People can also be compulsorily detained at a hospital under the Mental Health (Scotland) Act 2015 . It is only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder, such as schizophrenia, and if detention is necessary: in the interests of the persons own health and safety toprotect others People with schizophrenia who are compulsorily detained may need to be kept in locked wards. All people being treated in hospital will stay only as long as is absolutely necessaryfor them toreceive appropriate treatment and arrange aftercare. An independent panel will regularly review your case and progress. Once they feel you are no longer a danger to yourself and others, you will be discharged from hospital. However, your care team may recommendyou remain in hospital voluntarily. Advance statements If it is felt there is a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement. An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to includecontact details for your care co-ordinator. If you want to make an advance statement, talk to your care co-ordinator, psychiatrist or GP. Antipsychotics Antipsychotics are usually recommended as the initial treatment forthe symptoms of an acute schizophrenic episode. They work by blocking the effectof the chemical dopamineon the brain. Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, butmay take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts. Its important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you. Antipsychotics can be taken orally (as a pill) or given as an injection (known as a depot). Several slow-release antipsychotics are available.These require you to haveone injection every two to four weeks. You may only needantipsychotics until your acute schizophrenic episode has passed. However, most people take medication for one or two years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent. There are two main types of antipsychotics: typical antipsychotics  the first generation of antipsychoticsdeveloped during the 1950s atypical antipsychotics  newer-generation antipsychoticsdeveloped in the 1990s The choice of antipsychotic should be made following a discussion between you and your psychiatrist about the likely benefits and side effects. Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and the severity will differ from person to person. The side effects of typical antipsychotics include: shaking trembling muscle twitches muscle spasms Side effects of both typical and atypical antipsychotics include: drowsiness weight gain, particularly with some atypical antipsychotics blurred vision constipation lack of sex drive dry mouth Tell your care co-ordinator, psychiatristor GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicinesthat will help you deal with the side effects. If you do not benefit from one antipsychotic medication after taking it regularly for several weeks, an alternative can be tried. It is important that you work with your treatment team to find the right one for you. Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP.If you stop taking them,you couldhave a relapse of symptoms. Your medication should be reviewed at least once a year. Want to know more? Mind: antipsychotics Royal College of Psychiatrists: depot medication Psychological treatment Psychological treatment can help people with schizophrenia cope with the symptoms of hallucinations or delusions better. They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment. Psychological treatments for schizophrenia work best when they are combined with antipsychotic medication. Common psychological treatments include: Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to replace this thinking with more realistic and useful thoughts. For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts. Most people will requirebetween 8 and 20 sessions of CBT over the space of6 to 12 months. CBT sessions usually last for about an hour. Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist. Family therapy Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family. Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetingsover a period of around six months. Meetings may include: discussing information about schizophrenia exploring ways of supporting somebody with schizophrenia deciding how to solve practical problems that can be caused by the symptoms of schizophrenia If you think you and your family could benefit from family therapy, speak toyour care co-ordinator or GP. Arts therapy Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia. Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others. Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people. NICE recommendsthat arts therapies are provided by an arts therapistregistered with the Health and Care Professions Council who has experience of working with people with schizophrenia. Want to know more? Mind: understanding talking treatments Living with As well as monitoring your mental health, your healthcare team and GP should monitor your physical health. A healthy lifestyle,including a balanced diet with lots of fruits and vegetables and regular exercise, is good for you and can reduce your risk of developing cardiovascular disease or diabetes . You should also try to avoid too much stress and get a proper amount of sleep. You should have a check-up with your GP at least once a year to monitor your risk of developing cardiovascular disease or diabetes. This will include recording your weight, checking your blood pressure, and any appropriate blood tests. Stop smoking Rates of smokingin people with schizophrenia are three times higher than in the general population. If you are a smoker, you are at a higher risk of developing cancer, heart disease and stroke. Stopping smoking has clear physical health benefits but it has also been shown to improve the mental health of people with schizophrenia. Research has shown you are up to four times more likely to quit smoking if you use NHS support as well as stop-smoking medicines, such as patches, gum or inhalators. Ask your doctor about this or phone Quit Your Way Scotland on 0800 84 84 84. If you take antipsychotic medicines and want to stop smoking its very important that you talk to your GP and/or psychiatrist before you stop as the dosage of your prescription drugs may need to be monitored and the amount you have to take could be reduced. Want to know more? Healthy eating Rethink Mental Illness: wellbeing and physical health Royal College of Psychiatrists: smoking and mental health Who is available to help me? In the course of your treatment for schizophrenia, you will be involved with many different services. Some are accessed through referral from your GP, others through your local authority. These services may include the following: community mental health teams (CMHTs)  these provide the main part of local specialist mental health services, and offer assessment, treatment and social care to people living with schizophrenia and other mental illnesses trained peer support  this involves the support of someone who has had schizophrenia themselvesand is now stable, andmay be availablethrough your CMHT early intervention teams  these provide early identification and treatment for people with the first symptoms of psychosis; your GP may be able to refer you directly to an early intervention team crisis services specialist mental health teams that help with crises that occur outside normal office hours and allow people to be treated at home for an acute episode of illnessinstead of in hospital acute day hospitals an alternative to inpatient care in a hospital, where you can visit every day or as often as necessary assertive outreach teams  deliver intensive treatment and rehabilitation in the community for people with severe mental health problems and provide rapid help in a crisis situation; staff often visit people at home, act as advocates, liaise with other services (such as your GP or social services), andcan also help with practical problems (such as helping to find housing and work), and daily tasks (such as shopping and cooking) advocates  trained and experienced workers who help people communicate their needs or wishes, get impartial information, and represent their views to other people; they can be based in your hospital or mental health support groups, or you can find an independent advocate to act on your behalf Want to know more? Mind: Mind in your area Rethink Mental Illness: treatment and support Employment and financial support Avoid too much stress, including work-related stress. If you are employed, you may be able to work shorter hours or in a more flexible way. Under the Equality Act 2010 , all employers must make reasonable adjustments for people with disabilities, including people diagnosed with schizophrenia or other mental illnesses. Severalorganisations provide support, training and advice for people with schizophrenia who wish to continue working. Your community mental health team is a good first point of contact to find out what services and support are available for you. Mental health charities such as Mind or Rethink Mental Illness are also an excellent source of information on training and employment. If you are unable to work as a result of your mental illness, you are entitled to financial support, such as Incapacity Benefit. Want to know more? GOV.UK: disability and the Equality Act 2010 GOV.UK: Incapacity Benefit Money Advice Service Talk to others Many people find it helpful to meet other people with the same experiences for mutual support and to share ideas. It is also an important reminder that you are not alone. Charities and support groups allow individuals and families to share experiences and coping strategies, campaign for better services, and provide support. Useful charities, support groups and associations include: Hearing Voices Network Mind Rethink Mental Illness SANE There are also other places that offer support to people with schizophrenia and other mental illnesses. Day centres Even if you do not have a job or are unable to work, it is still important to go out and do everyday things andgive a structure to your week. Many people regularly go to a day hospital, day centre or community mental health centre. These offer a range of activities thatallow you to get active again and spend some time in the company of other people. Work projects These provide training to help you develop your work skills and support you back into work. They often have contacts with local employers. Supported accommodation This could be a bedsit or flat where there is someone around who is trained to support you and help you deal with day-to-day problems. Peer support You may be offeredthe chance tomeet regularlywith a trained peer support worker who has recovered from psychosis or schizophrenia themselves. Want to know more? Mind: housing and mental health What can family, friends and partners do to help? Friends, relatives and partners have a vital role in helping people with schizophrenia recover and make a relapse less likely. It is very important not to blame the person with schizophrenia or tell them to pull themselves together, or to blame other people.It is importa