Schizophrenia is a serious mental illness characterized by recurrent psychosis. Delusions and hallucinations are common symptoms. The cause of schizophrenia is not clear, but heredity is the biggest risk factor. There is no cure, but with proper treatment, symptoms can be relieved.


Schizophrenia usually affects people between the ages of 18 and 35. It affects about 1 percent of the population. Some people think that schizophrenia is a “split personality” (dissociative identity disorder) — but they are two different disorders. Symptoms tend to be vague at first and take a long time to develop – which is why children with schizophrenia are rarely talked about.


The exact cause of schizophrenia is unknown. Medical researchers believe several factors can contribute, including:


  • biological
  • genetic
  • environmental.


Studies show that the biggest risk factor is heredity and that several genes contribute to the risk of being affected. It may also involve brain trauma during the fetal or infant period. Various environmental factors also seem to increase the risk of schizophrenia – those who are more susceptible to stress and/or physical or mental stress may be factors. Sleep deprivation, nutritional deficiencies, alcohol or drug abuse can also create a greater vulnerability to schizophrenia.


Schizophrenia researchers are trying to find out what is going on in the brain to identify changes in the central nervous system. The brain’s 100 billion nerve cells communicate using neurotransmitters and the substance dopamine appears to be central to schizophrenia. The focus of research is also on the mechanisms behind disease development – genes, environment and other risk factors.


Schizophrenia is a complex disease that usually develops over a long period of time and eventually leads to recurrent psychoses. The symptoms vary from person to person. Early signs can be a feeling that you are mentally changing at the same time as you are having sleeping disorders, memory and concentration problems. Many people forget about personal hygiene and find it difficult to do work or study. Isolating from family and friends is also typical. Depression and suicidal thoughts are common.


Those who are affected often feel changes in their personality and experience reality in a different way. It is usually difficult to distinguish between real events and one’s own thoughts. “Hearing voices” in their own head is a clear feature – they may think that someone is demanding different actions from them or commenting on their own state of illness. They may feel controlled, monitored or persecuted.  Some feel that they have special powers or are specially selected to do something important; others become inactive and introverted.


Positive symptoms


“Positive” symptoms of schizophrenia are behaviors that aren’t typical in otherwise healthy individuals. These behaviors include:


  • Hallucinations. Hallucinations are experiences that appear real but are created by your mind. They include seeing things, hearing voices, or smelling things others around you don’t experience.
  • Delusions. A delusion occurs when you believe something despite evidence or facts to the contrary.
  • Thought disorders. These are unusual ways of thinking or processing information.
  • Movement disorders. These include agitated body movements or strange postures.


Negative symptoms


Negative symptoms of schizophrenia interrupt a person’s typical emotions, behaviors, and abilities. These symptoms include:


  • disorganized thought or speech, where the person changes topics rapidly when speaking or uses made-up words or phrases
  • trouble controlling impulses
  • odd emotional responses to situations
  • a lack of emotion or expressions
  • loss of interest or excitement for life
  • social isolation
  • trouble experiencing pleasure
  • difficulty beginning or following through with plans
  • difficulty completing normal everyday activities


Cognitive symptoms


Cognitive symptoms of schizophrenia are sometimes subtle and may be difficult to detect. However, the disorder can affect memory and thinking.


These symptoms include:


  • disorganized thinking, such as trouble focusing or paying attention
  • poor “executive functioning,” or understanding information and using it to make decisions
  • problems learning information and using it
  • lack of insight or being unaware of their symptoms

Schizophrenia and other disease symptoms

People with schizophrenia have an increased risk of suffering from other diseases, both physical and mental. It may be mental illness, such as personality disorders, or cardiovascular disease and metabolic syndrome, which may be the result of taking antipsychotic drugs.


To determine schizophrenia, a medical examination is required. The investigation includes a physical examination, blood tests and MRI. A psychiatric assessment confirms psychotic symptoms, differing perceptions of reality and difficulties in functioning socially and professionally over a certain period of time. The overall symptom picture shows what type of schizophrenia you have.


There is no treatment to cure schizophrenia, but antipsychotic drugs and other interventions can reduce delusions and hallucinations, shorten the acute episodes and prevent relapse. Getting help with sleep and creating regular routines are an important part of treatment. Other treatment options are psychotherapy and counselling. Often, support from social services is also needed. Knowledge of the disease and social training provide better conditions for recovery.


The earlier you receive treatment, the greater are the chances of relieving the symptoms and having a normal everyday life. The risk of new psychoses usually diminishes over time, but this requires you to take your medicine, have regular contact with doctors and get the support you need.

What you and your relatives can do

f you have previously suffered from psychosis or have been diagnosed with schizophrenia, you can reduce the risk of relapse by always taking your medication and trying to minimize the stress of everyday life. Good sleep routines and avoiding alcohol and drugs are also important. Regular contact with both psychiatry and regular care providers can help to recognize early signs of psychosis and check your health, as well as maintain weight and control blood pressure.


When there is a sign of psychosis, it is always good to seek care as soon as possible – early treatment can relieve the problems during acute episodes. Pay attention to warning signals:


  • delusions and hallucinations
  • the person stops taking his or her medication
  • stress
  • sleeping problems
  • conflicts with other people
  • drug or alcohol abuse.


In the context of a psychosis, it can be difficult to treat a person with schizophrenia. Therefore, it can sometimes help to make a crisis plan together with doctors and relatives, so that everyone knows what procedure to follow at the signs of psychosis. For example, the patient can give someone permission to decide if they need care – often it is easier for relatives to see warning signals than the person who is on their way into a psychosis.


If someone is not doing well on their medication or wants to stop taking medicine, it is important they consult their doctor instead of adjusting the dose of medication themself. Sometimes another type of medication may be needed to improve symptoms.

When to consult a doctor

If you suspect you have schizophrenia or are on the verge of psychosis, it is important to seek urgent medical attention – either with a doctor or a psychiatric clinic. Early treatment provides better conditions for managing acute episodes.


If you hear voices urging you to perform various actions, you should turn to a psychiatric emergency room or, alternatively, a regular emergency room. If you have thoughts of suicide or you are afraid to harm others, you should also seek urgent care.


Relatives who are concerned that a person wants commit suicide or harm someone else should contact a doctor immediately. Sometimes a doctor may decide on compulsory care if there is reason to be very worried about a person’s state.

How APPOTEK can help

In the case of psychosis, you should seek treatment in a psychiatric emergency room.


If you or your relatives are concerned about your problems or need advice and information about schizophrenia, we at APPOTEK can help you. A doctor or psychologist can make an individual assessment based on your symptoms during the care meeting. You can then be prescribed treatment or referred for further treatment. We can also offer continuous follow-up and visits to psychologists and doctors. To detect and treat schizophrenia, a physical examination is required in combination with a psychiatric investigation.


Valeria Chernikova, Neurologist, M.D.