What is schizophrenia? Early warning signs, behavioral traits, at-risk groups, and treatment

How Does a Person with Schizophrenia Act?

Those with schizophrenia are often mischaracterized as violent, unstable individuals—but this is a false and harmful stereotype. When a person with schizophrenia has their symptoms under control, especially with assistance from medication and therapy, many individuals are able to thrive.

Kate Hanselman, Psychiatric Mental Health Nurse Practitioner (PMHNP) at Thriveworks explains that “When symptoms are untreated, people with schizophrenia may experience hallucinations and delusions, experiencing the world in very different ways than others. This can lead to the perception of images, sounds, or smells that others do not experience, or thoughts and beliefs that are not grounded in reality.” 

These hallucinations aren’t psychedelic in nature—they’re often confusing and abstract, and someone with schizophrenia may dedicate disproportionate amounts of time toward understanding them. 

Hanselman also notes that “for someone experiencing hallucinations, it can be hard to differentiate between these and reality, which can be terrifying and confusing. This sometimes erratic or confusing behavior, while challenging for others to understand, can be easier to understand when considering that it is often an appropriate response to the person’s perceived experience.”

What Are 5 Common Causes of Schizophrenia?

Schizophrenia is a deeply complex disorder; one that researchers are still striving to understand completely. Currently, there’s no singular cause of schizophrenia, but factors that are thought to influence its development include:  

• Genetic risk factors: Unfortunately, our bodies don’t always replicate DNA properly, which means that if a deletion or duplication of material in our chromosomes occurs, this can affect the way certain genes are expressed. This can increase one’s risk of developing schizophrenia. 
• Structural changes in the brain: Brain scans of people with schizophrenia have shown detrimental changes to certain areas of the brain, specifically their prefrontal and medial temporal lobe regions associated with memory.
• Chemical changes in the brain: Schizophrenic individuals may have low levels of serotonin and glutamate. These chemicals are neurotransmitters that help regulate our mood and emotions. 
• Pregnancy or birth complications: Children of mothers that suffered from metabolic disturbances or substance use during pregnancy may be at increased risk. 
• Previous drug use: Alcohol and certain drugs, especially stimulants and psychedelics, have the potential to trigger acute psychosis if misuse occurs.Some potential chemicals include amphetamines, ketamine, phencyclidine (PCP), and LSD.

What Are the 14 Early Signs of Schizophrenia?

The early warning signs of schizophrenia often begin between the ages of 16 and 30, but may rarely occur in children. Treatment is rarely sought immediately, as an episode of psychosis might be mistaken for a panic attack, or a random event by parents or adults. People of all ages may also worry about being stigmatized, especially if they’re experiencing hallucinations. 

Early warning signs of schizophrenia may involve: 

1. Delayed Childhood Development

Signs of schizophrenia in children include motor development issues or delays, speech and language impediments, and poor social skills. A child with schizophrenia also may not show normal emotional responses to stimuli around them. 

2. Academic or professional issues

Someone with schizophrenia may become overwhelmed by their symptoms, and as a result, they start to withdraw from their obligations, avoiding contact with other people—and refusing to go to school or work. 

3. Suspiciousness of Others

People with schizophrenia may be overly suspicious of other people, without having any basis for being so. For example, they might be convinced that their family or friends don’t like them and want to harm them. They might even think that a large organization such as the FBI, police department, or CIA is hunting them down— known as a “delusion of reference.”

4. Inappropriate Social Behavior 

Inappropriate social behavior, or an inability to read social cues, may be an early sign of schizophrenia. This might involve talking over other people, being unable to maintain eye contact, standing too close to others, or making inappropriate sexual comments or advances.

5. Moving Slowly 

Especially during an episode, schizophrenia symptoms may present themselves as uncoordinated movements or catatonia—a motionless state. A person with catatonia is typically unresponsive and can remain in a single posture for hours.

6. Flat or Expressionless Gaze 

Before the onset of an episode, or during a schizophrenic state, someone with schizophrenia may have a blank, seemingly emotionless expression on their face. Other people may show a blank facial expression while speaking. 

7. Mood Swings 

Someone with schizophrenia may experience mood swings without cause, jumping from happiness and contentment to being severely agitated or even depressed. Due to hallucinations caused by this mental health condition, their mood swings might be set off by imaginary fears of being hunted by enemies or being manipulated via mind control. 

8. Associative Problems 

Someone with schizophrenia may have difficulty connecting thoughts together rationally. They may not understand the principle of cause and effect, such as their emotions dictating their behavior. 

9. Disorganized Thinking 

Disorganized thinking is another early warning sign of schizophrenia. The person may struggle to comprehend information and solve problems. He or she may also withdraw socially, act inappropriately for the situation, and behave in a bizarre fashion.

10. Decline in Personal Hygiene 

A person with untreated schizophrenia may stop caring about keeping up their appearance or properly cleaning themselves. This might be due to simply being distracted, or something as complex as believing that bathing and grooming will attract bad luck or unseen entities, or that it will wash away their identity. 

11. Disorganized Speech (Trouble Communicating) 

One of the most common signs of schizophrenia includes trouble speaking or communicating both verbally and non-verbally. They might forget what they wanted to say mid-sentence. Speaking in a monotone and avoiding eye contact with others is also common. 

12. Inability to Maintain Relationships 

Someone with schizophrenia might have trouble maintaining relationships, constantly fighting with loved ones over their erratic behavior and beliefs. Considering the complex nature of schizophrenia, their friends and family may not be aware of what they’re suffering from, which can isolate the schizophrenic individual further. 

13. Changes in Behavior and Personality 

As their schizophrenia becomes more severe, someone might become anxious, terrified, or hostile—and with their mind occupied, they may lose interest in activities, hobbies, and relationships that they used to enjoy.

14. Lack of Energy 

People with schizophrenia may experience psychomotor retardation, which is accompanied by extreme fatigue, discoordination, and weight loss. Physical symptoms include an inability to get up in the morning and sleeping excessively during the day. In some cases, people with schizophrenia have problems with appetite and weight loss, leading to malnutrition.

Diagnostic Criteria for Schizophrenia

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), schizophrenia is characterized by a range of cognitive, behavioral, and emotional dysfunctions. For a diagnosis to be made, there must be a collection of symptoms present that are associated with impaired occupational as well as social functioning. 

However, individuals with the disorder will vary considerably in many features. The following criteria, as outlined by the DSM-5, must be met in order for schizophrenia to be accurately diagnosed:

• The individual experiences two or more of the following for a significant portion of time during a 1-month period. And at least one of these must be (1), (2), or (3):
  1. Delusions
  2. Hallucinations
  3. Disorganized speech (incoherence or derailment)
  4. Completely disorganized or catatonic behavior
  5. Negative symptoms, such as diminished emotional expression
• For a significant amount of time since the disturbance began, the level of functioning in one or more major areas (e.g., work, interpersonal relations, or self-care) is clearly below the level achieved before onset.
  1. In children or adolescents, there is a failure to achieve the expected level of interpersonal, academic, or occupational functioning.
• Signs of the disturbance continue for 6 months or longer. This period must include at least 1 full month of symptoms that meet the first criteria and may include periods of residual symptoms. During these residual periods, the signs of the disturbance may be manifested only by negative symptoms or by two or more symptoms outlined in the first criteria, only in a lesser form.
• The disturbance cannot be better explained by schizoaffective disorder, depressive, or bipolar disorder because either:
  1. No major depressive or manic episodes have occurred concurrently with the active-phase symptoms or…
  2. If mood episodes have occurred during active phase symptoms, it’s been for a minor amount of time.
• The disturbance cannot be attributed to the physiological effects of a substance (e.g., a drug of abuse or medication) or another medical condition.
• If the individual has a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is only made if delusions or hallucinations as well as the other required symptoms of schizophrenia are present for a month or more.

If someone is diagnosed with schizophrenia before the age of 18, it’s known as early-onset schizophrenia (EOS)—which occurs in 0.23% of the population. Even rarer is childhood-onset schizophrenia (COS), so named because it’s diagnosed before the age of 13.

Who Is at Risk of Developing Schizophrenia?

The features of schizophrenia typically develop between the ages of 18 and 30—very rarely does onset occur before an individual has reached adolescence. The onset may be sudden but people typically report a slow and gradual development of the disorder. 

Near half of individuals with schizophrenia also experience depressive symptoms, in addition to the aforementioned symptoms. There are a few factors that may put an individual at a greater risk of developing schizophrenia. These include:

• Season of birth, which has been linked to the development of schizophrenia. This includes late winter and early spring in some locations and summer for the deficit form.
• Environment type, as schizophrenia and similar disorders are more prevalent among children growing up in an urban environment
• Genetics, pregnancy, birth complications, and prenatal stress have also all been associated with a higher risk of schizophrenia in children
• Heavy cannabis use in adolescence

If you have a history of mental health conditions in your family, you may want to consult with a mental health professional who can help you understand your risk factors, as well as the preventative steps you can take. If a family member has a mental disorder, it does not necessarily mean you will develop the same condition but it may increase your risk.

How Do I Know If I Am Schizophrenic?

If you’re consistently experiencing any of the diagnostic criteria listed above (especially if you’re hallucinating without the influence of drugs or alcohol), you might be suffering from schizophrenia. It’s important to talk with a mental professional to determine the cause of your symptoms. 

Even though men and women have roughly similar rates of schizophrenia, symptoms may develop slightly earlier in men, usually in their mid-20s, to 30s. For women, symptoms may begin presenting in their mid-20s to early 30s.

If you suspect that you’re suffering from schizophrenia, it’s essential to receive treatment in a timely manner. With effective mental health services, you can manage your symptoms and prevent the degenerative nature of schizophrenia from disrupting your lifestyle and ability to be independent.

Treatment Options for Individuals with Schizophrenia

Even in cases where symptoms have lessened or subsided, schizophrenia is best managed with lifelong treatment to ensure that schizophrenia symptoms remain at bay. Treatment may include: 

1. Medication management from a psychiatric provider. The most commonly prescribed drug for those suffering from schizophrenia is an antipsychotic medication. Its goal is to lessen and manage the harmful symptoms that come with the disorder. Other medications such as antidepressants or anti-anxiety medications may also be prescribed.
2. Psychotherapy from a therapist: Psychotherapy is used to help the affected individual develop healthier, more accurate thought patterns. Subcategories of psychotherapy include individual therapy, family therapy, and social skills training, which can all be effective in treating schizophrenic clients while educating their support systems, as well. 

Schizophrenia often requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed. Due to the serious and disruptive effects of this mental health condition, a psychiatrist experienced in treating schizophrenia usually guides treatment. 

The treatment team also may include a psychologist, social worker, psychiatric nurse, and possibly a case manager to coordinate care. The full-team approach is the preferred treatment method, and may be available in clinics with expertise in schizophrenia treatment, offering: 

• Individual therapy. Psychotherapy may help to normalize thought patterns. Also, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their condition.
• Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities.
• Family therapy. This provides support and education to families dealing with schizophrenia.
• Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find, and keep jobs.

Most individuals with schizophrenia require some form of daily living support, whether it’s from a provider, a loved one, or a professional assistant. Some communities even offer programs to help people with schizophrenia find and maintain housing, income, and proper physical and mental health. 

With effective treatment and an engaged support system, people with schizophrenia can (and do) lead successful, meaningful lives.