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Schizophrenia

NationalInstituteofMentalHealth
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

Contents
Whatisschizophrenia?...........................................................................1
Whatarethesymptomsofschizophrenia?...........................................2
Positivesymptoms...............................................................................2
Negativesymptoms..............................................................................3
Cognitivesymptoms.............................................................................4
Whendoesschizophreniastartandwhogetsit?.................................4
Arepeoplewithschizophreniaviolent?.................................................5
Whataboutsubstanceabuse?................................................................5
Whatcausesschizophrenia?..................................................................6
Howisschizophreniatreated?................................................................8
Antipsychoticmedications.................................................................8
Psychosocialtreatments................................................................... 11
Howcanyouhelpapersonwithschizophrenia?.................................14
Whatistheoutlookforthefuture?........................................................15
Citations...................................................................................................16
Formoreinformationonschizophrenia................................................18

NationalInstituteofMentalHealth
Schizophrenia
What is schizophrenia?
Schizophreniaisachronic,severe,anddisablingbraindisorderthat
hasaffectedpeoplethroughouthistory.About1percentofAmericans
havethisillness.
1
Peoplewiththedisordermayhearvoicesotherpeopledonthear.They
maybelieveotherpeoplearereadingtheirminds,controllingtheir
thoughts,orplottingtoharmthem.Thiscanterrifypeoplewiththe
illnessandmakethemwithdrawnorextremelyagitated.
Peoplewithschizophreniamaynotmakesensewhentheytalk.They
maysitforhourswithoutmovingortalking.Sometimespeoplewith
schizophreniaseemperfectlyfineuntiltheytalkaboutwhattheyare
reallythinking.
Familiesandsocietyareaffectedbyschizophreniatoo.Many
peoplewithschizophreniahavedifficultyholdingajoborcaringfor
themselves,sotheyrelyonothersforhelp.
Treatmenthelpsrelievemanysymptomsofschizophrenia,butmost
peoplewhohavethedisordercopewithsymptomsthroughouttheir
lives.However,manypeoplewithschizophreniacanleadrewarding
andmeaningfullivesintheircommunities.Researchersaredeveloping
moreeffectivemedicationsandusingnewresearchtoolstounderstand
thecausesofschizophrenia.Intheyearstocome,thisworkmayhelp
preventandbettertreattheillness.

N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 2
What are the symptoms of
schizophrenia?
Thesymptomsofschizophreniafallintothreebroadcatego-
ries:positivesymptoms,negativesymptoms,andcognitive
symptoms.
Positive symptoms
Positivesymptomsarepsychoticbehaviorsnotseenin
healthypeople.Peoplewithpositivesymptomsoftenlose
touchwithreality.Thesesymptomscancomeandgo.
Sometimestheyaresevereandatothertimeshardlynotice-
able,dependingonwhethertheindividualisreceiving
treatment.Theyincludethefollowing:
Hallucinationsarethingsapersonsees,hears,smells,orfeels
thatnooneelsecansee,hear,smell,orfeel.Voicesarethe
mostcommontypeofhallucinationinschizophrenia.Many
peoplewiththedisorderhearvoices.Thevoicesmaytalkto
thepersonabouthisorherbehavior,orderthepersontodo
things,orwarnthepersonofdanger.Sometimesthevoices
talktoeachother.Peoplewithschizophreniamayhearvoices
foralongtimebeforefamilyandfriendsnoticetheproblem.
Othertypesofhallucinationsincludeseeingpeopleorobjects
thatarenotthere,smellingodorsthatnooneelsedetects,and
feelingthingslikeinvisiblefingerstouchingtheirbodieswhen
nooneisnear.
Delusionsarefalsebeliefsthatarenotpartofthepersons
cultureanddonotchange.Thepersonbelievesdelusions
evenafterotherpeopleprovethatthebeliefsarenottrueor
logical.Peoplewithschizophreniacanhavedelusionsthat
seembizarre,suchasbelievingthatneighborscancontrol
theirbehaviorwithmagneticwaves.Theymayalsobelieve
thatpeopleontelevisionaredirectingspecialmessagesto
them,orthatradiostationsarebroadcastingtheirthoughts
aloudtoothers.Sometimestheybelievetheyaresomeone
else,suchasafamoushistoricalfigure.Theymayhavepara-
noiddelusionsandbelievethatothersaretryingtoharm
them,suchasbycheating,harassing,poisoning,spyingon,
orplottingagainstthemorthepeopletheycareabout.These
beliefsarecalleddelusionsofpersecution.




S CH I Z OP H R E N I A 3
Voices
ARE THE MOST
COMMON TYPE OF
HALLUCINATION IN
SCHIZOPHRENIA.
Thought disorders are unusual or dysfunctional ways
of thinking. One form of thought disorder is called dis-
organized thinking. This is when a person has trouble
organizing his or her thoughts or connecting them logically.
They may talk in a garbled way that is hard to understand.
Another form is called thought blocking. This is when a
person stops speaking abruptly in the middle of a thought.
When asked why he or she stopped talking, the person may
say that it felt as if the thought had been taken out of his or
her head. Finally, a person with a thought disorder might
make up meaningless words, or neologisms.
Movement disorders may appear as agitated body move-
ments. A person with a movement disorder may repeat
certain motions over and over. In the other extreme, a
person may become catatonic. Catatonia is a state in which
a person does not move and does not respond to others.
Catatonia is rare today, but it was more common when
treatment for schizophrenia was not available.
2
Negative symptoms
Negative symptoms are associated with disruptions to nor-
mal emotions and behaviors. These symptoms are harder
to recognize as part of the disorder and can be mistaken for
depression or other conditions. These symptoms include the
following:
Flat affect (a persons face does not move or he or she
talks in a dull or monotonous voice)
Lack of pleasure in everyday life
Lack of ability to begin and sustain planned activities
Speaking little, even when forced to interact.
People with negative symptoms need help with everyday
tasks. They often neglect basic personal hygiene. This may
make them seem lazy or unwilling to help themselves, but
the problems are symptoms caused by the schizophrenia.




N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 4
Cognitive symptoms
Cognitivesymptomsaresubtle.Likenegativesymptoms,
cognitivesymptomsmaybedifficulttorecognizeaspartof
thedisorder.Often,theyaredetectedonlywhenothertests
areperformed.Cognitivesymptomsincludethefollowing:
Poorexecutivefunctioning(theabilitytounderstand
informationanduseittomakedecisions)
Troublefocusingorpayingattention
Problemswithworkingmemory(theabilitytouse
informationimmediatelyafterlearningit).
Cognitivesymptomsoftenmakeithardtoleadanormallife
andearnaliving.Theycancausegreatemotionaldistress.
When does schizophrenia start and
who gets it?
Schizophreniaaffectsmenandwomenequally.Itoccurs
atsimilarratesinallethnicgroupsaroundtheworld.
Symptomssuchashallucinationsanddelusionsusuallystart
betweenages16and30.Mentendtoexperiencesymptoms
alittleearlierthanwomen.Mostofthetime,peopledonot
getschizophreniaafterage45.
3
Schizophreniararelyoccurs
inchildren,butawarenessofchildhood-onsetschizophrenia
isincreasing.
4,5
Itcanbedifficulttodiagnoseschizophreniainteens.Thisis
becausethefirstsignscanincludeachangeoffriends,adrop
ingrades,sleepproblems,andirritabilitybehaviorsthatare
commonamongteens.Acombinationoffactorscanpredict
schizophreniainupto80percentofyouthwhoareathigh
riskofdevelopingtheillness.Thesefactorsincludeisolating
oneselfandwithdrawingfromothers,anincreaseinunusual
thoughtsandsuspicions,andafamilyhistoryofpsychosis.
6
Inyoungpeoplewhodevelopthedisease,thisstageofthe
disorderiscalledtheprodromalperiod.

S CH I Z OP H R E N I A 5
Are people with schizophrenia
violent?
Peoplewithschizophreniaarenotusuallyviolent.Infact,
mostviolentcrimesarenotcommittedbypeoplewith
schizophrenia.
7
However,somesymptomsareassociated
withviolence,suchasdelusionsofpersecution.Substance
abusemayalsoincreasethechanceapersonwillbecome
violent.
8
Ifapersonwithschizophreniabecomesviolent,
theviolenceisusuallydirectedatfamilymembersandtends
totakeplaceathome.
Theriskofviolenceamongpeoplewithschizophreniais
small.Butpeoplewiththeillnessattemptsuicidemuch
moreoftenthanothers.About10percent(especiallyyoung
adultmales)diebysuicide.
9,10
Itishardtopredictwhich
peoplewithschizophreniaarepronetosuicide.Ifyou
knowsomeonewhotalksaboutorattemptssuicide,help
himorherfindprofessionalhelprightaway.
PeopleWITH
SCHIZOPHRENIA
ARENOT USUALLY
VIOLENT.
What about substance abuse?
Somepeoplewhoabusedrugsshowsymptomssimilarto
thoseofschizophrenia.Therefore,peoplewithschizophre-
niamaybemistakenforpeoplewhoareaffectedbydrugs.
Mostresearchersdonotbelievethatsubstanceabusecauses
schizophrenia.However,peoplewhohaveschizophreniaare
muchmorelikelytohaveasubstanceoralcoholabuseprob-
lemthanthegeneralpopulation.
11
Substanceabusecanmaketreatmentforschizophrenialess
effective.Somedrugs,likemarijuanaandstimulantssuch
asamphetaminesorcocaine,maymakesymptomsworse.
Infact,researchhasfoundincreasingevidenceofalink
betweenmarijuanaandschizophreniasymptoms.
12,13
Inaddi-
tion,peoplewhoabusedrugsarelesslikelytofollowtheir
treatmentplan.
Schizophrenia and smoking
Addictiontonicotineisthemostcommonformofsub-
stanceabuseinpeoplewithschizophrenia.Theyare
addictedtonicotineatthreetimestherateofthegeneral
population(75to90percentvs.25to30percent).
14

N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 6
Therelationshipbetweensmokingandschizophreniais
complex.Peoplewithschizophreniaseemtobedrivento
smoke,andresearchersareexploringwhetherthereisabio-
logicalbasisforthisneed.Inadditiontoitsknownhealth
hazards,severalstudieshavefoundthatsmokingmaymake
antipsychoticdrugslesseffective.
Quittingsmokingmaybeverydifficultforpeoplewith
schizophreniabecausenicotinewithdrawalmaycausetheir
psychoticsymptomstogetworseforawhile.Quitting
strategiesthatincludenicotinereplacementmethodsmay
beeasierforpatientstohandle.Doctorswhotreatpeople
withschizophreniashouldwatchtheirpatientsresponseto
antipsychoticmedicationcarefullyifthepatientdecidesto
startorstopsmoking.
What causes schizophrenia?
Expertsthinkschizophreniaiscausedbyseveralfactors.
Genes and environment.Scientistshavelongknown
thatschizophreniarunsinfamilies.Theillnessoccursin
1percentofthegeneralpopulation,butitoccursin
10percentofpeoplewhohaveafirst-degreerelativewith
thedisorder,suchasaparent,brother,orsister.Peoplewho
havesecond-degreerelatives(aunts,uncles,grandparents,or
cousins)withthediseasealsodevelopschizophreniamore
oftenthanthegeneralpopulation.Theriskishighestforan
identicaltwinofapersonwithschizophrenia.Heorshehas
a40to65percentchanceofdevelopingthedisorder.
15
Weinheritourgenesfrombothparents.Scientistsbelieve
severalgenesareassociatedwithanincreasedriskofschizo-
phrenia,butthatnogenecausesthediseasebyitself.
16
In
fact,recentresearchhasfoundthatpeoplewithschizo-
phreniatendtohavehigherratesofraregeneticmutations.
Thesegeneticdifferencesinvolvehundredsofdifferent
genesandprobablydisruptbraindevelopment.
17
Otherrecentstudiessuggestthatschizophreniamayresult
inpartwhenacertaingenethatiskeytomakingimportant
brainchemicalsmalfunctions.Thisproblemmayaffectthe





S CH I Z OP H R E N I A 7
partofthebraininvolvedindevelopinghigherfunctioning
skills.
18
Researchintothisgeneisongoing,soitisnotyet
possibletousethegeneticinformationtopredictwhowill
developthedisease.
ScientistsARE
LEARNING MORE
ABOUT BRAIN
CHEMISTRY AND
ITS LINK TO
SCHIZOPHRENIA.
Despitethis,teststhatscanapersonsgenescanbebought
withoutaprescriptionorahealthprofessionalsadvice.Ads
forthetestssuggestthatwithasalivasample,acompany
candetermineifaclientisatriskfordevelopingspecific
diseases,includingschizophrenia.However,scientists
dontyetknowallofthegenevariationsthatcontributeto
schizophrenia.Thosethatareknownraisetheriskonlyby
verysmallamounts.Therefore,thesegenomescansare
unlikelytoprovideacompletepictureofapersonsriskfor
developingamentaldisorderlikeschizophrenia.
Inaddition,itprobablytakesmorethangenestocausethe
disorder.Scientiststhinkinteractionsbetweengenesandthe
environmentarenecessaryforschizophreniatodevelop.
Manyenvironmentalfactorsmaybeinvolved,suchasexpo-
suretovirusesormalnutritionbeforebirth,problemsduring
birth,andothernotyetknownpsychosocialfactors.
Different brain chemistry and structure. Scientists
thinkthatanimbalanceinthecomplex,interrelatedchemi-
calreactionsofthebraininvolvingtheneurotransmitters
dopamineandglutamate,andpossiblyothers,playsarole
inschizophrenia.Neurotransmittersaresubstancesthat
allowbraincellstocommunicatewitheachother.Scientists
arelearningmoreaboutbrainchemistryanditslinkto
schizophrenia.
Also,insmallwaysthebrainsofpeoplewithschizophrenia
lookdifferentthanthoseofhealthypeople.Forexample,
fluid-filledcavitiesatthecenterofthebrain,calledven-
tricles,arelargerinsomepeoplewithschizophrenia.The
brainsofpeoplewiththeillnessalsotendtohavelessgray
matter,andsomeareasofthebrainmayhavelessormore
activity.

N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 8
Studiesofbraintissueafterdeathalsohaverevealeddiffer-
encesinthebrainsofpeoplewithschizophrenia.Scientists
foundsmallchangesinthedistributionorcharacteristicsof
braincellsthatlikelyoccurredbeforebirth.
3
Someexperts
thinkproblemsduringbraindevelopmentbeforebirthmay
leadtofaultyconnections.Theproblemmaynotshow
upinapersonuntilpuberty.Thebrainundergoesmajor
changesduringpuberty,andthesechangescouldtrigger
psychoticsymptoms.Scientistshavelearnedalotabout
schizophrenia,butmoreresearchisneededtohelpexplain
howitdevelops.
How is schizophrenia treated?
Becausethecausesofschizophreniaarestillunknown,treat-
mentsfocusoneliminatingthesymptomsofthedisease.
Treatmentsincludeantipsychoticmedicationsandvarious
psychosocialtreatments.
Antipsychotic medications
Antipsychoticmedicationshavebeenavailablesincethe
mid-1950s.Theoldertypesarecalledconventionalor
typicalantipsychotics.Someofthemorecommonly
usedtypicalmedicationsinclude:
Chlorpromazine(Thorazine)
Haloperidol(Haldol)
Perphenazine(Etrafon,Trilafon)
Fluphenazine(Prolixin).
Inthe1990s,newantipsychoticmedicationsweredevel-
oped.Thesenewmedicationsarecalledsecondgeneration,
oratypicalantipsychotics.
Oneofthesemedications,clozapine(Clozaril)isaneffective
medicationthattreatspsychoticsymptoms,hallucinations,
andbreakswithreality.Butclozapinecansometimescausea
seriousproblemcalledagranulocytosis,whichisalossofthe
whitebloodcellsthathelpapersonfightinfection.People
whotakeclozapinemustgettheirwhitebloodcellcounts
checkedeveryweekortwo.Thisproblemandthecostof

S CH I Z OP H R E N I A 9
bloodtestsmaketreatmentwithclozapinedifficultformany
people.Butclozapineispotentiallyhelpfulforpeoplewho
donotrespondtootherantipsychoticmedications.
19
Scientists
HAVELEARNED
ALOTABOUT
SCHIZOPHRENIA,
BUTMORE
RESEARCH IS
NEEDED TO HELP
EXPLAIN HOW IT
DEVELOPS.
Otheratypicalantipsychoticswerealsodeveloped.None
causeagranulocytosis.Examplesinclude:
Risperidone(Risperdal)
Olanzapine(Zyprexa)
Quetiapine(Seroquel)
Ziprasidone(Geodon)
Aripiprazole(Abilify)
Paliperidone(Invega).
What are the side effects?
Somepeoplehavesideeffectswhentheystarttakingthese
medications.Mostsideeffectsgoawayafterafewdays
andoftencanbemanagedsuccessfully.Peoplewhoare
takingantipsychoticsshouldnotdriveuntiltheyadjustto
theirnewmedication.Sideeffectsofmanyantipsychotics
include:
Drowsiness
Dizzinesswhenchangingpositions
Blurredvision
Rapidheartbeat
Sensitivitytothesun
Skinrashes
Menstrualproblemsforwomen.
Atypicalantipsychoticmedicationscancausemajorweight
gainandchangesinapersonsmetabolism.Thismay
increaseapersonsriskofgettingdiabetesandhighcholes-
terol.
20
Apersonsweight,glucoselevels,andlipidlevels
shouldbemonitoredregularlybyadoctorwhiletakingan
atypicalantipsychoticmedication.

N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 10
Typicalantipsychoticmedicationscancausesideeffects
relatedtophysicalmovement,suchas:
Rigidity
Persistentmusclespasms
Tremors
Restlessness.
Long-termuseoftypicalantipsychoticmedicationsmaylead
toaconditioncalledtardivedyskinesia(TD).TDcauses
musclemovementsapersoncantcontrol.Themovements
commonlyhappenaroundthemouth.TDcanrangefrom
mildtosevere,andinsomepeopletheproblemcannotbe
cured.SometimespeoplewithTDrecoverpartiallyorfully
aftertheystoptakingthemedication.
TDhappenstofewerpeoplewhotaketheatypical
antipsychotics,butsomepeoplemaystillgetTD.People
whothinkthattheymighthaveTDshouldcheckwith
theirdoctorbeforestoppingtheirmedication.
How are antipsychotics taken and how do people
respond to them?
Antipsychoticsareusuallyinpillorliquidform.Someanti-
psychoticsareshotsthataregivenonceortwiceamonth.
Symptomsofschizophrenia,suchasfeelingagitatedandhav-
inghallucinations,usuallygoawaywithindays.Symptoms
likedelusionsusuallygoawaywithinafewweeks.After
aboutsixweeks,manypeoplewillseealotofimprovement.
However,peoplerespondindifferentwaystoantipsychotic
medications,andnoonecantellbeforehandhowaperson
willrespond.Sometimesapersonneedstotryseveralmedi-
cationsbeforefindingtherightone.Doctorsandpatients
canworktogethertofindthebestmedicationormedication
combination,aswellastherightdose.
Somepeoplemayhavearelapsetheirsymptomscomeback
orgetworse.Usually,relapseshappenwhenpeoplestoptak-
ingtheirmedication,orwhentheyonlytakeitsometimes.

S CH I Z OP H R E N I A 11
Somepeoplestoptakingthemedicationbecausetheyfeel
betterortheymayfeeltheydontneeditanymore.Butno
oneshouldstoptakinganantipsychoticmedicationwithout
talkingtohisorherdoctor.Whenadoctorsaysitisokayto
stoptakingamedication,itshouldbegraduallytaperedoff,
neverstoppedsuddenly.
Whenadoctor
SAYSITISOKAY
TOSTOPTAKING
AMEDICATION,
ITSHOULDBE
GRADUALLY
TAPEREDOFF,
NEVERSTOPPED
SUDDENLY.
How do antipsychotics interact with other
medications?
Antipsychoticscanproduceunpleasantordangerousside
effectswhentakenwithcertainmedications.Forthisrea-
son,alldoctorstreatingapatientneedtobeawareofallthe
medicationsthatpersonistaking.Doctorsneedtoknow
aboutprescriptionandover-the-countermedicine,vitamins,
minerals,andherbalsupplements.Peoplealsoneedtodiscuss
anyalcoholorotherdrugusewiththeirdoctor.
Tofindoutmoreabouthowantipsychoticswork,the
NationalInstituteofMentalHealth(NIMH)fundedastudy
calledCATIE(ClinicalAntipsychoticTrialsofIntervention
Effectiveness).Thisstudycomparedtheeffectivenessand
sideeffectsoffiveantipsychoticsusedtotreatpeoplewith
schizophrenia.Ingeneral,thestudyfoundthattheolder
typicalantipsychoticperphenazine(Trilafon)workedas
wellasthenewer,atypicalmedications.Butbecausepeople
responddifferentlytodifferentmedications,itisimportant
thattreatmentsbedesignedcarefullyforeachperson.More
informationaboutCATIEisontheNIMHWebsiteat
http://www.nimh.nih.gov/health/trials/practical/catie/
index.shtml.
Psychosocial treatments
Psychosocialtreatmentscanhelppeoplewithschizophre-
niawhoarealreadystabilizedonantipsychoticmedication.
Psychosocialtreatmentshelpthesepatientsdealwiththe
everydaychallengesoftheillness,suchasdifficultywith
communication,self-care,work,andformingandkeep-
ingrelationships.Learningandusingcopingmechanismsto
addresstheseproblemsallowpeoplewithschizophreniato
socializeandattendschoolandwork.

N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 12
Patientswhoreceiveregularpsychosocialtreatmentalso
aremorelikelytokeeptakingtheirmedication,andthey
arelesslikelytohaverelapsesorbehospitalized.Athera-
pistcanhelppatientsbetterunderstandandadjusttoliving
withschizophrenia.Thetherapistcanprovideeducation
aboutthedisorder,commonsymptomsorproblemspatients
mayexperience,andtheimportanceofstayingonmedica-
tions.Formoreinformationonpsychosocialtreatments,
seethepsychotherapiessectionontheNIMHWebsite
athttp://www.nimh.nih.gov/health/topics/psychotherapies/
index.shtml.
Illness management skills.Peoplewithschizophrenia
cantakeanactiveroleinmanagingtheirownillness.Once
patientslearnbasicfactsaboutschizophreniaanditstreat-
ment,theycanmakeinformeddecisionsabouttheircare.
Iftheyknowhowtowatchfortheearlywarningsignsof
relapseandmakeaplantorespond,patientscanlearnto
preventrelapses.Patientscanalsousecopingskillstodeal
withpersistentsymptoms.
Integrated treatment for co-occurring substance
abuse.Substanceabuseisthemostcommonco-occurring
disorderinpeoplewithschizophrenia.Butordinarysub-
stanceabusetreatmentprogramsusuallydonotaddressthis
populationsspecialneeds.Whenschizophreniatreatment
programsanddrugtreatmentprogramsareusedtogether,
patientsgetbetterresults.
Rehabilitation.Rehabilitationemphasizessocialandvoca-
tionaltrainingtohelppeoplewithschizophreniafunction
betterintheircommunities.Becauseschizophreniausually
developsinpeopleduringthecriticalcareer-formingyears
oflife(ages18to35),andbecausethediseasemakesnor-
malthinkingandfunctioningdifficult,mostpatientsdonot
receivetrainingintheskillsneededforajob.
Rehabilitationprogramscanincludejobcounselingand
training,moneymanagementcounseling,helpinlearningto
usepublictransportation,andopportunitiestopracticecom-
municationskills.Rehabilitationprogramsworkwellwhen

S CH I Z OP H R E N I A 13
theyincludebothjobtrainingandspecifictherapydesigned
toimprovecognitiveorthinkingskills.Programslikethis
helppatientsholdjobs,rememberimportantdetails,and
improvetheirfunctioning.
21,22,23
Oncepatients
LEARNBASIC
FACTSABOUT
SCHIZOPHRENIA
ANDITS
TREATMENT,
THEYCAN MAKE
INFORMED
DECISIONSABOUT
THEIRCARE.
Family education. Peoplewithschizophreniaareoften
dischargedfromthehospitalintothecareoftheirfamilies.
Soitisimportantthatfamilymembersknowasmuchas
possibleaboutthedisease.Withthehelpofatherapist,fam-
ilymemberscanlearncopingstrategiesandproblem-solving
skills.Inthiswaythefamilycanhelpmakesuretheirloved
onestickswithtreatmentandstaysonhisorhermedica-
tion.Familiesshouldlearnwheretofindoutpatientand
familyservices.
Cognitive behavioral therapy.Cognitivebehavioral
therapy(CBT)isatypeofpsychotherapythatfocuseson
thinkingandbehavior.CBThelpspatientswithsymptoms
thatdonotgoawayevenwhentheytakemedication.The
therapistteachespeoplewithschizophreniahowtotest
therealityoftheirthoughtsandperceptions,howtonot
listentotheirvoices,andhowtomanagetheirsymptoms
overall.CBTcanhelpreducetheseverityofsymptomsand
reducetheriskofrelapse.
Self-help groups.Self-helpgroupsforpeoplewithschizo-
phreniaandtheirfamiliesarebecomingmorecommon.
Professionaltherapistsusuallyarenotinvolved,butgroup
memberssupportandcomforteachother.Peopleinself-
helpgroupsknowthatothersarefacingthesameproblems,
whichcanhelpeveryonefeellessisolated.Thenetworking
thattakesplaceinself-helpgroupscanalsopromptfamilies
toworktogethertoadvocateforresearchandmorehospital
andcommunitytreatmentprograms.Also,groupsmaybe
abletodrawpublicattentiontothediscriminationmany
peoplewithmentalillnessesface.

N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 14
How can you help a person with
schizophrenia?
Peoplewithschizophreniacangethelpfromprofessional
casemanagersandcaregiversatresidentialordayprograms.
However,familymembersusuallyareapatientsprimary
caregivers.
Peoplewithschizophreniaoftenresisttreatment.Theymay
notthinktheyneedhelpbecausetheybelievetheirdelu-
sionsorhallucinationsarereal.Inthesecases,familyand
friendsmayneedtotakeactiontokeeptheirlovedonesafe.
Lawsvaryfromstatetostate,anditcanbedifficulttoforce
apersonwithamentaldisorderintotreatmentorhospital-
ization.Butwhenapersonbecomesdangeroustohimselfor
herself,ortoothers,familymembersorfriendsmayhaveto
callthepolicetotaketheirlovedonetothehospital.
Treatment at the hospital.Intheemergencyroom,a
mentalhealthprofessionalwillassessthepatientanddeter-
minewhetheravoluntaryorinvoluntaryadmissionis
needed.Forapersontobeadmittedinvoluntarily,thelaw
statesthattheprofessionalmustwitnesspsychoticbehavior
andhearthepersonvoicedelusionalthoughts.Familyand
friendscanprovideneededinformationtohelpamental
healthprofessionalmakeadecision.
After a loved one leaves the hospital.Familyand
friendscanhelptheirlovedonesgettreatmentandtaketheir
medicationoncetheygohome.Ifpatientsstoptakingtheir
medicationorstopgoingtofollow-upappointments,their
symptomslikelywillreturn.Sometimessymptomsbecome
severeforpeoplewhostoptheirmedicationandtreatment.
Thisisdangerous,sincetheymaybecomeunabletocare
forthemselves.Somepeopleenduponthestreetorinjail,
wheretheyrarelyreceivethekindofhelptheyneed.

S CH I Z OP H R E N I A 15
Peoplewith
SCHIZOPHRENIA
CANGET
HELPFROM
PROFESSIONAL
CASEMANAGERS
ANDCAREGIVERS
ATRESIDENTIAL
ORDAY
PROGRAMS.
Familyandfriendscanalsohelppatientssetrealisticgoals
andlearntofunctionintheworld.Eachsteptowardthese
goalsshouldbesmallandtakenoneatatime.Thepatient
willneedsupportduringthistime.Whenpeoplewitha
mentalillnessarepressuredandcriticized,theyusuallydo
notgetwell.Often,theirsymptomsmaygetworse.Telling
themwhentheyaredoingsomethingrightisthebestway
tohelpthemmoveforward.
Itcanbedifficulttoknowhowtorespondtosomeone
withschizophreniawhomakesstrangeorclearlyfalsestate-
ments.Rememberthatthesebeliefsorhallucinationsseem
veryrealtotheperson.Itisnothelpfultosaytheyare
wrongorimaginary.Butgoingalongwiththedelusionsis
nothelpful,either.Instead,calmlysaythatyouseethings
differently.Tellthemthatyouacknowledgethateveryone
hastherighttoseethingshisorherownway.Inaddition,
itisimportanttounderstandthatschizophreniaisabiologi-
calillness.Beingrespectful,supportive,andkindwithout
toleratingdangerousorinappropriatebehavioristhebest
waytoapproachpeoplewiththisdisorder.
What is the outlook for the future?
Theoutlookforpeoplewithschizophreniacontinuesto
improve.Althoughthereisnocure,treatmentsthatwork
wellareavailable.Manypeoplewithschizophreniaimprove
enoughtoleadindependent,satisfyinglives.
Continuedresearchandunderstandingingenetics,neu-
roscience,andbehavioralsciencewillhelpscientistsand
healthprofessionalsunderstandthecausesofthedisorder
andhowitmaybepredictedandprevented.Thisworkwill
helpexpertsdevelopbettertreatmentstohelppeoplewith
schizophreniaachievetheirfullpotential.Familiesandindi-
vidualswhoarelivingwithschizophreniaareencouragedto
participateinclinicalresearch.Forup-to-dateinformation
aboutthelatestNIMH-fundedresearchinschizophrenia,
seetheNIMHWebsiteathttp://www.nimh.nih.gov.

N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 16
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N A T I ON A L I N S T I T U T E OF ME N T A L H E A L T H 18
For more information on schizophrenia
VisittheNationalLibraryofMedicinesMedlinePlus
http://medlineplus.gov
EnEspaol,http://medlineplus.gov/spanish
Forinformationonclinicaltrialsforschizophrenia
http://www.nimh.nih.gov/health/trials/index.shtml
NationalLibraryofMedicineClinicalTrialsDatabase
http://www.clinicaltrials.gov
ClinicaltrialsatNIMHinBethesda,MD
http://patientinfo.nimh.nih.govorcall1-888-674-6464
InformationfromNIMHisavailableinmultipleformats.Youcanbrowse
online,downloaddocumentsinPDF,andorderpaperbrochuresthroughthe
mail.IfyouwouldliketohaveNIMHpublications,youcanorderthemonline
athttp://www.nimh.nih.gov.IfyoudonothaveInternetaccessandwishto
haveinformationthatsupplementsthispublication,pleasecontacttheNIMH
InformationResourceCenteratthenumberslistedbelow.
NationalInstituteofMentalHealth
ScienceWriting,Press&DisseminationBranch
6001ExecutiveBoulevard
Room8184,MSC9663
Bethesda,MD20892-9663
Phone:301-443-4513or
1-866-615-NIMH(6464)toll-free
TTY:301-443-8431or
1-866-415-8051toll-free
FAX:301-443-4279
E-mail:nimhinfo@nih.gov
Website:http://www.nimh.nih.gov





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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
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National Institute of Mental Health
NIH Publication No. 09-3517
Revised 2009