Learn about schizophrenia, signs to look for, and treatment options.
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Found in: Mental Health Conditions
Date: September 2022

About schizophrenia

Schizophrenia is a mental health condition where people experience psychosis – hallucinations (seeing, hearing, feeling, tasting or smelling things that aren’t there), delusions (beliefs that are not in line with reality), and unusual patterns of thinking or speaking.

Schizophrenia can also affect your mood and make it difficult to relate to people and do everyday activities. The symptoms and experiences of schizophrenia will be different for everyone.

Schizophrenia is not well understood by many in our society. Movies and TV shows have led many people to think schizophrenia means you have a ‘split personality’. In fact, having multiple identities is not a symptom of schizophrenia; it is related to a rare condition called dissociative identity disorder (DID).

Likewise, there is a mistaken belief that people with schizophrenia are dangerous. The truth is that the huge majority of people with schizophrenia will never be violent. Sadly, they are more likely to be the victims of violence. 

Because of these misunderstandings, and the stigma attached to a diagnosis of schizophrenia, it can be hard to seek help – but it’s really important that you do. There are effective treatments for schizophrenia, and, with the right support, most people will live well and recover. 'Recovery’ does not necessarily mean all of your symptoms have disappeared. Instead, it means you are able to live well, with or without symptoms. This will mean something different to each person.


Signs to look for (symptoms)

The experience of schizophrenia is different for everyone, and you may find your symptoms change over time. 

Schizophrenia symptoms are usually categorised as either ‘positive’ or ‘negative’. This does not mean they are ‘good’ or ‘bad’. Positive symptoms are things that schizophrenia may add to your life, such as hallucinations and delusions. Negative symptoms are things it may take away, such as energy and problem-solving skills.

Positive symptoms include hallucinations, delusions and disorganised thinking and speech. These are all types of psychosis.

  • Hallucinations – this is when you hear, see, feel, taste or smell something that is not there. Hearing voices is the most common hallucination. These voices might talk about or to you and might command you to do things. 
  • Delusions – unusual beliefs that are real to you but not to those around you. You may experience ‘paranoid delusions’, believing that other people want to harm you (e.g. that the government is trying to hunt you down). Or you may believe you have extraordinary abilities (e.g. being able to read people’s minds).
  • Disorganised thinking and speech – you may feel your thoughts are racing, and friends may notice that you constantly change the topic of conversation, go off on tangents, are easily distracted, or laugh at irrational times. You may speak in an unusual way, perhaps using words that only you understand.

Negative symptoms may include:

  • low energy
  • losing interest in things that used to be important or enjoyable to you
  • finding it hard to concentrate 
  • losing motivation to do everyday things, such as having a shower or doing the dishes
  • feeling disconnected from your emotions
  • wanting to avoid other people
  • changes in your sleep.

Both the positive and negative symptoms of schizophrenia can be very distressing. They might make it hard for you to maintain relationships or do the day-to-day things you used to do, such as go to work.

However, not everybody sees these experiences as a problem. For some people, hearing voices or seeing visions is a source of comfort and meaning, rather than distress. For example, you might feel you are communicating with your ancestors, and this might have deep spiritual significance for you.

In fact, these experiences are relatively common: research suggests that about 1 in 10 of us has heard voices before, and many people have beliefs that others may describe as false or delusional. Despite this, only 1 in 100 people will be diagnosed with schizophrenia. That’s because a psychiatrist is only likely to diagnose you with schizophrenia if your symptoms are causing you distress and preventing you from living well.

When do symptoms begin, and how long do they last?

Schizophrenia most often begins between the ages of 15 and 30 years. It tends to start slightly earlier in men than in women.

Symptoms may develop slowly, with the ability to function in everyday life declining over a number of years.

The onset of schizophrenia can also be quite quick. Someone who has previously been healthy and coped well with their usual activities and relationships can develop psychosis over a number of weeks.

You may have a small number of psychotic episodes during your life, with periods of feeling ‘normal’ in between, or you may have episodes that last a long time with few breaks in between.

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

' Finding peace can be difficult and near impossible at times. My symptoms get the better of me. Staying close to what works and helps me is key. Whether its going for a walk, spending time with whanau or relaxing with some good music. All these things take care of me and offer solace in this struggle. '

– Individual with lived experience of schizophrenia

What causes schizophrenia?

The exact cause of schizophrenia is unknown and is usually different for different people. Researchers believe that these factors can increase your chances of developing schizophrenia:

  • Genetics – 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 trauma – if you had an extremely stressful experience while you were growing up, such as being abused or neglected, you may be more likely to develop schizophrenia.
  • Stressful life events – things like being out of work, losing a loved one, becoming homeless or being abused could trigger schizophrenia.
  • Drug and alcohol use – some people develop schizophrenia after using drugs, especially cannabis and synthetic cannabinoids (although researchers don’t yet know for sure whether the drugs directly cause the condition). Non-prescription drugs and alcohol can make symptoms worse for those who already have schizophrenia, and can interfere with some medications.
  • Differences in brain chemistry – studies have shown that chemicals in the brain behave differently in some people with schizophrenia. Researchers are trying to learn more about this. Antipsychotic medications, which are often used to treat schizophrenia, can help correct certain chemical imbalances.

It’s important to remember that even though some of these factors are out of your control, such as your genetics and stressful experiences in your past, there are many things you can do now to support your recovery and your long-term wellbeing. The first step is to talk to your doctor or another person you trust who can support you to reach out for help.

How your doctor determines if you have schizophrenia (diagnosis)

It’s very important to get a diagnosis and treatment as early as possible. Schizophrenia can be effectively treated, and you can recover and live a fulfilling life, whether or not some of your symptoms continue. The earlier effective treatment is started, the better your chances of recovery.

If you are concerned or suspect you may have schizophrenia, the first step is to talk to your GP about what you’ve been experiencing. They may then refer you to a psychiatrist, who can carry out an assessment for schizophrenia.

During the assessment, the psychiatrist will want to get the full picture of what you’ve been experiencing, including:

  • 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.g. if you are working, if you are good at art)
  • previous contact with doctors, psychiatrists and the health care system
  • medical history and current medications
  • family history
  • whether you’re at risk of self-harm, or of harming others
  • your current state of mind
  • your drug and alcohol use
  • what has been done so far to help you
  • what further supports you might need.

It can be really helpful to have a family/whānau member, or someone else who knows you well, come to your appointment. They can support you and help the psychiatrist understand what is going on. 

Both your GP and the specialist will want to rule out other possible causes of your symptoms. There are many medical conditions that can lead to psychosis (e.g. urinary tract infections, epilepsy, hypothyroidism or Parkinson’s disease). Drug and alcohol use, or withdrawing from these substances, can cause similar symptoms, as can some medications.

There are also several mental health conditions, in addition to schizophrenia, that can cause psychosis: severe depression, bipolar disorder, schizoaffective disorder, certain personality disorders, postpartum psychosis, and more. Your psychiatrist will have all these possibilities in mind as they work to determine the right diagnosis for you. 

If your symptoms have lasted for at least six months, with symptoms of psychosis for at least one month, and are having a major impact on your life, you may be diagnosed with schizophrenia.

Getting a diagnosis feels different for everyone. You may be relieved, happy, scared, surprised, embarrassed, angry, sad, or have mixed emotions. It can be helpful to remember that schizophrenia is not who you are; it is just a term that can help you get the right kind of support. Having a diagnosis can give a name to what you experience and offer a way through it with treatment, so you can lead a fulfilled life.

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 talking therapies and medication.

Talking therapies

Talking therapies are effective in the treatment of schizophrenia. Sessions may be held on a one-to-one basis or include partners or family/whānau.

Cognitive behavioural therapy (CBT) is the main type of therapy used to treat schizophrenia. During CBT, your therapist will help you identify patterns of thought and behaviour that are unhelpful to you. They will work with you to change these patterns and learn new ways of coping with challenges such as psychosis, stress, depression, social anxiety, side effects from medication and anything else you are experiencing.

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.


If you are prescribed medication, it will likely be an ‘atypical antipsychotic’ (e.g. olanzapine, quetiapine, risperidone or aripiprazole) to treat psychotic symptoms, such as hallucinations. You may also be prescribed other medications alongside these, to manage things like anxiety or poor sleep.

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
  • whether your current dose could change over time 
  • possible side effects (both short and long term)
  • possible interactions with other medications, drugs or alcohol
  • what the process of stopping them could look like.

The side effects of antipsychotic medication can be uncomfortable, and some people will want to stop taking them as a result. If this is how you feel, it’s important that you talk to your doctor before you make changes to your medication yourself. They can help you come up with a plan, which might involve finding a way to better manage side effects, safely changing how much medication you take, changing to a new medication, or stopping altogether.

If you are pregnant or breastfeeding, medication may still be an option. Talk to your doctor about what is right for your situation.   

' My whānau were always there for me. Always ready to hear about the strange things happening in my mind. What was going on scared me. But to have the rock of my family helped me through. I didn’t understand all the unusual thoughts and perceptions that were playing out in my mind but to have a solid foundation beneath me, helped me to pull through. '

– Individual with lived experience of schizophrenia

Other strategies to support recovery

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

They are not treatments for schizophrenia, but they may enhance your life and help you to maintain wellbeing. 

In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It’s also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. 

Being in good physical health will also help your mental health.

Avoiding drugs and alcohol

Alcohol and non-prescription drugs may help you feel better in the short term, but in the long term, they can have a major effect on your mental health, making psychotic symptoms worse and reducing your chances of recovery.

It is important that you avoid cannabis if you have experienced psychosis before, as it can cause a relapse.

If you are struggling with drug or alcohol abuse, talk to your doctor about accessing support – there is a lot of help available.

Having a ‘Wellbeing Plan’

Many people find that having a written plan, developed together with your GP/psychiatrist, can help you feel you’re in control if psychosis or other symptoms of schizophrenia 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 them 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. 

As part of your plan, you could choose to create an ‘advance directive’. This is a formal document where you state what treatments you do or do not consent to receiving in the future.

Other ways to support your own wellbeing

Other people with schizophrenia have found these strategies help with their symptoms:

  • try to maintain a stable schedule of meals and sleep times – having a routine through the day is helpful
  • engage in mild activity or exercise to help reduce stress and anxiety
  • set realistic goals for yourself, and reward yourself when you reach them
  • 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 symptoms
  • expect your symptoms to improve gradually, not immediately
  • identify and seek out comforting situations, places, and people
  • join a support group
  • try to regularly do activities you enjoy and get satisfaction from
  • keep in regular contact with your mental health team or GP
  • continue to educate yourself about schizophrenia, realising that everyone is different.

Thanks to Dr Paul Skirrow, on behalf of the NZ College of Clinical Psychologists, and Chloe Shaw of the Mental Health Foundation's lived experience group for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.