Schizophrenia

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.

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.

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.

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 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.   

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.