Schizophrenia — understanding psychosis
Schizophrenia is a severe mental illness characterised by psychosis — experiences outside shared reality — plus negative and cognitive symptoms affecting daily function.
~1% lifetime prevalence — equal men and women — men often earlier onset.
Symptoms
Positive (added experiences)
- Hallucinations — hearing voices most common — may comment, command, or converse
- Delusions — fixed false beliefs — persecution, reference, grandeur, control
- Disorganised thinking — speech jumps, neologisms
- Disorganised behaviour — unpredictable actions
Negative (loss of function)
- Flat affect — reduced facial expression
- Avolition — lack of motivation
- Anhedonia — no pleasure
- Social withdrawal
Cognitive
- Working memory, attention, processing speed — often overlooked — affect employment
Prodrome and first episode
Months before psychosis:
- Withdrawal, school/work decline
- Odd beliefs, suspiciousness
- Sleep disturbance
First episode psychosis (FEP) — Early Intervention services — critical window — better outcomes with prompt antipsychotics + therapy
Causes
Multifactorial:
- Genetic — ~10% risk if first-degree relative
- Dopamine dysregulation — antipsychotic rationale
- Neurodevelopmental — prenatal infection, complications
- Cannabis — especially high THC in adolescence — increases risk
- NOT bad parenting or weak character
Treatment
Antipsychotics:
- First episode — low dose, monitor metabolic side effects
- Clozapine — after 2 failed trials — gold standard for resistant psychosis — blood monitoring
Psychological:
- CBTp — CBT for psychosis
- Family intervention — reduce expressed emotion
- Relapse prevention — early signs diary
Social:
- Supported employment/education
- CPA care programme approach
Living with schizophrenia
Recovery model — symptoms managed, meaningful life possible
Side effects matter:
- Weight gain, metabolic syndrome — annual health checks
- Tardive dyskinesia — long-term movement disorder — discuss with psychiatrist
Advance statements — preferences when unwell
Crisis
Phone 999 if immediate danger
Crisis team — GP or 111 referral
Sectioning (Mental Health Act) — only when necessary — least restrictive care preferred
Common questions about schizophrenia
- What are the symptoms of schizophrenia?
- Psychosis — hallucinations (commonly auditory), delusions (paranoid or bizarre beliefs), thought disorder — speech hard to follow. Negative symptoms — reduced expression, apathy, social isolation. Cognitive difficulties — concentration, memory. Symptoms vary between people and over time — not everyone has all features.
- Is schizophrenia the same as split personality?
- No — completely different condition. Schizophrenia involves psychosis — losing touch with shared reality. Dissociative identity disorder (historically called split personality) is rare and distinct. The name schizophrenia means split mind in Greek — refers to fragmented thinking, not multiple personalities.
- How is schizophrenia treated on the NHS?
- Antipsychotic medication — risperidone, olanzapine, aripiprazole, clozapine for treatment-resistant cases. Psychological therapies — CBT for psychosis, family intervention. Early Intervention in Psychosis teams for first episode — up to 3 years. Community mental health team for ongoing care. Hospital admission if acutely unwell.
- Can people with schizophrenia work and have relationships?
- Yes — many do with stable treatment and support. Outcomes vary — some recover well after first episode, others have relapses. Stigma and side effects of medication can be barriers — vocational support and peer groups help. Realistic goals with care plan.
- What triggers a relapse in schizophrenia?
- Stopping antipsychotics without medical advice is commonest cause. Stress, sleep loss, substance use (especially cannabis and stimulants), and major life events. Relapse prevention plans — recognise early warning signs, contact care coordinator promptly.