What causes schizophrenia, signs to look for, how a doctor tests for schizophrenia and treatment options.
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Found in: Mental Health Conditions
Date: November 2019

About Schizophrenia

People with schizophrenia go through patches where it is hard to think clearly, manage their emotions, distinguish what is real and what is not, and relate to others. They may have times when they lose contact with reality. This can all be very frightening, both for the person and their whānau and friends.

Schizophrenia most often begins between the ages of 15 and 30 years, occurring for the first time slightly earlier in men than in women. Schizophrenia happens in approximately the same numbers across all ethnic groups in the world.

The onset of schizophrenia can be quite quick. Someone who has previously been healthy and coped well with their usual activities and relationships can develop psychosis (loss of contact with reality) over a number of weeks. Symptoms may also develop slowly, with the ability to function in everyday life declining over a number of years.

The course of schizophrenia is different for everyone.

Everyone experiences schizophrenia differently and most will make a reasonable recovery, going on to lead a fulfilling life. About one third of people experiencing schizophrenia will have ongoing problems, perhaps with continuing symptoms such as hearing voices.

The effects of the illness do reduce with time.

With early, effective, recovery-oriented treatment and care (including knowing how to look after yourself well), schizophrenia can be successfully managed.

As you get older, you might find the signs and symptoms of schizophrenia lessen.

It's very important to get a diagnosis and treatment as early as possible. Schizophrenia can be effectively treated and you can recover. The earlier effective treatment is started, the better your chances of recovery. 

Recovery is not defined as the complete absence of symptoms, but living well with or without symptoms – and will have a different meaning for each person.

If you think you have schizophrenia, or you are worried about a loved one, it's important to talk to your doctor, or someone else you can trust as a first step to getting the important help you or they need.


Signs to look for (symptoms)

The symptoms of schizophrenia can vary between individuals and, over time, within an individual. They are often divided into two categories – psychotic symptoms and mood symptoms.

Psychotic symptoms

These symptoms are not there all the time and occur when you are having a severe, or acute episode. They include the following:

  • Delusions – an unusual belief that seems quite real to you, but not to those around you. A delusional person is convinced their belief is true. An example might be they strongly believe the Government is trying to hunt them down.
  • Thought disturbances – how you process thoughts or your ability to concentrate and maintain a train of thought may be affected. For example, you may feel your thoughts are racing and friends may notice you constantly changing the topic of conversation or that you are easily distracted or may laugh at irrational times. Your speech may become quite disorganised and you may use made up words that only you understand.
  • Hallucinations – this is when someone hears, sees, feels or smells something that is not there. Hearing voices that others cannot hear or when there is no-one else in the room is very typical of psychosis. Sometimes these voices will talk about or to you. They will sometimes command you to do things. For some, these voices can be inside their head; occasionally they may seem to come from within their body.

Mood symptoms

These could include:
  • Loss of motivation, interest or pleasure in things. Everyday tasks such as washing up become difficult.
  • Mood changes – You'll tell friends you're feeling great or never better. However, your ‘happy’ behaviour will be recognised as excessive by friends or family. You may also be quite unresponsive and be unable to express joy or sadness.
  • Social withdrawal –people may notice that you become very careless in your dress and self-care, or have periods of seeming to do little and periods of being extremely active.

Other symptoms include subtle difficulties with tasks like problem-solving or you may show signs of depression – commonly experienced by people with schizophrenia.

The strongest feature of schizophrenia is loss of insight – the loss of awareness that the experiences and difficulties you have are the result of your illness. It is a particular feature of psychotic illnesses.

What causes schizophrenia?

The exact cause of schizophrenia is unknown and are usually different for different people.

There is a genetic (inherited) component to schizophrenia. If someone in your family/whānau has schizophrenia, you and your relatives have an increased chance of developing it – about a one in 10 chance. 

Childhood stresses and trauma, such as abuse, have been shown to be linked to increased chance of developing mental illnesses in adults.

How your GP or health professional tests for schizophrenia (diagnosis)

If you’re experiencing the signs of schizophrenia, it’s a good idea to talk to your GP or health professional.

Once you have spent some time talking to them, they will refer you to a psychiatrist qualified to diagnose and treat people with this condition. 

Psychiatrists diagnose schizophrenia when a person has some or all of the typical symptoms described above. For this reason it is important the psychiatrist gets a full picture of the difficulties you have had, both from you and your family/whānau or others who know you well.

Before schizophrenia can be diagnosed, the symptoms or signs must have been present for at least six months, with symptoms of psychosis for at least one month.

It is very important to seek help early.

The assessment process

We know issues, like stress, difficult relationships, and other emotional difficulties, can affect the way people feel. 

It can be very helpful (if the person is comfortable with it) for family members or friends to be present in these meetings.

An assessment will be looking for information such as:

  • the main problem that you’re experiencing, and its effect on everyday activities
  • recent events that might be important, and events in the past
  • your strengths (e. is working, is good at art)
  • previous contact with doctors, psychiatrists and the health care system
  • medical history and current medications
  • whether you’re at risk of self-harm, or of harming others
  • your current state of mind
  • what has been done so far to help you.

During these early meetings, health professionals might be able to give a name – or perhaps several names – to what’s happening for you. This ‘diagnosis’ is a useful short-hand way of describing the illness or other problems but making an exact diagnosis can be very difficult and might take some time. 

Unlike physical illnesses, which can be diagnosed with the help of blood tests and x-rays, mental and emotional disorders can only be recognised by how people are thinking, feeling and behaving. 

These experiences are more difficult to determine as ‘symptoms’ of distress. Keep in mind your diagnosis may change over time.

Treatment options

The best treatments for schizophrenia involve a number of important components, each of which can be tailored to your needs and what you’re experiencing.  The main components are psychosocial (talking) therapies and medication, with complementary therapies if they are right for you.

Talking therapies and counselling (psychosocial treatments)

Talking therapies are effective in the treatment of schizophrenia, especially for the treatment of depressive symptoms. Sessions may be held on a one to one basis, sometimes include partners or family, or be held in a group.

The focus of psychological therapy or counselling is on education and support for you to understand what is happening to you, to learn coping strategies and to pursue a path of recovery. 

Sessions help you regain the confidence and belief in yourself that is critical to recovery.

All types of therapy/counselling should be provided in a manner which is respectful to you and with which you feel comfortable and free to ask questions. 

It should be consistent with and incorporate your cultural beliefs and practices.


In treating schizophrenia, medicines are most often used for making your mood more stable and for helping with depression (anti-depressants). 

If you are prescribed medication, you are entitled to:
  • know the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for
  • and understand the side effects.

Finding the right medication can be a matter of trial and error.  There is no way to predict exactly how medicines will affect you but it is worth persevering to find what medication works best for you.

Getting cultural support

Cultural support may also be an important part of your care. Having a positive cultural identity is good for our mental wellbeing - strengthening connections with your culture can also help keep your mind strong. 

People who have used cultural support before say this helped them feel better as it gave them a greater sense of belonging and connection with their community. It also made them feel more comfortable and supported than when care was provided by clinicians only. 

Most areas of New Zealand have services to assist cultural support. Maori services are available, with Pasifika nations,  Asian and Muslim services growing.

Other strategies to help schizophrenia

General coping strategies that can help you with your symptoms:

  • Talk to your therapist/doctor about treatment options and stick with treatment
  • Try to maintain a stable schedule of meals and sleep times
  • Engage in mild activity or exercise to help reduce stress
  • Set realistic goals for yourself
  • Break up large tasks into small ones, set some priorities, and do what you can, as you can
  • Try to spend time with other people and confide in a trusted friend or family member
  • Tell others about events or situations that may trigger symptom
  • Expect your symptoms to improve gradually, not immediately
  • Identify and seek out comforting situations, places, and people
  • Continue to educate yourself about schizophrenia realising that everyone is different.

What can I do to help myself?

You’re the expert in your own mental health and wellbeing. Taking charge of your recovery and doing things that make you feel better, stronger and more in control will help your recovery from depression. 

When you have depression, it can be hard to find the energy or motivation to look after yourself. Start small – return a text message, open a window, close your eyes and listen to the birds singing. Slowly build up to bigger things and try to notice what makes you feel better. 

Make a list of things that feel good and keep it on your phone, your diary or on the fridge. When you’re struggling, check your list and pick one thing you can do right now that might help. 

These may include:
  • Learning about depression and read/listen to stories of other people who have found a way through
  • Learning your particular early warning signs or triggers by keeping a mood diary
  • Identifying and reducing stressful activities
  • Ensuring you are eating healthy food
  • Using relaxation exercises, yoga, meditation or massage
  • Getting enough sleep (this can be difficult for new parents, but sleeping when you can is important)
  • Spending time in nature – even just sitting in the sunshine listening to the birds singing for a few moments can be really helpful
  • Getting some exercise
  • Peer support (e.g. support groups)
  • Support from people with the same background as you (if you feel that is important to you; e.g. age, ethnic group, sexual orientation)
  • Getting support from family/whānau, friends, therapists
  • Humour: comedies on TV, funny movies
  • Cut back on non-prescribed drugs and alcohol
  • Fun: Make sure you regularly do things that you enjoy and that give your life meaning
  • Being kind to yourself and others
  • Practices from your own culture (e.g. Māori or Pasifika therapies)
  • Write a ‘relapse plan’.

Physical Health

It is also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor. Being in good physical health is known to help your mental health. 

Having a “Wellbeing Plan”

Many people find that having a written plan, developed together with your GP/psychiatrist can help you to feel you’re in control if difficult feelings return. 

Make sure others (i.e. family/whānau, partners, and community mental health staff) are aware of your plan and what you’d like to happen if you become unwell.

Plans can detail (in your own words) symptoms, what can trigger these feelings and what things help you. They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support. 

Family/whānau support and involvement

The level of family/whānau support and involvement you need is up to you.  Family/whānau members may be struggling to know how to help. 

If there are specific things that would help you, try asking for them. Say: “it would be really helpful if you helped me fold the laundry/washed the dishes/make me some toast/take the kids out for a bit.”

Remember it may be difficult and distressing for family/whānau and friends to see you feeling so low, and they may need to:
  • seek support for themselves from friends, family/whānau and/or counsellors
  • educate themselves on depression
  • get help with understanding what is happening to you
  • learn to set clear boundaries about behaviour
  • learn to manage their own stress.

Family/whānau can learn to use words that may help you feel supported: 

  • “You are not alone in this. I'm here for you.” 
  • “You may not believe it now, but the way you're feeling will change.” 
  • “I may not be able to understand exactly how you feel, but I care about you and want to help.” 
  • “You are important to me. Your life is important to me.”

One of the biggest barriers to recovery is discrimination. This stops many people from seeking professional help.  

It is also why stopping discrimination and championing understanding, respect, rights, and equality for people with mental illness is just as important as providing the best treatments and therapies.

Myths about schizophrenia

Schizophrenia means the person has a split personality.

NOT TRUE Split or multiple personality is an extremely rare condition that does not cause psychosis. So this statement is untrue. On the other hand, the behaviour of people with acute psychosis does change, but this is due to the illness not to any personality change. When the illness resolves the behaviour returns to normal.

People with schizophrenia are aggressive violent people.

NOT TRUE It is clear that outside times of acute illness, people with schizophrenia are no more violent than any other member of the community. With good care and treatment, risk during times of acute illness can be minimised. However, people with schizophrenia, especially if it’s not treated well, can be violent or victims of violence.

Thanks to Janet Peters, Registered Psychologist, for reviewing this content. Date last reviewed: June 2019

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