What is typical schizophrenic behavior?

Schizophrenia

Schizophrenia is a brain disorder classified as a psychosis, which means that it affects a person’s thinking, sense of self, and perceptions. The disorder typically becomes evident during late adolescence or early adulthood.

Signs and symptoms of schizophrenia include false perceptions called hallucinations. Auditory hallucinations of voices are the most common hallucinations in schizophrenia, but affected individuals can also experience hallucinations of visions, smells, or touch (tactile) sensations. Strongly held false beliefs (delusions) are also characteristic of schizophrenia. For example, affected individuals may be certain that they are a particular historical figure or that they are being plotted against or controlled by others.

People with schizophrenia often have decreased ability to function at school, at work, and in social settings. Disordered thinking and concentration, inappropriate emotional responses, erratic speech and behavior, and difficulty with personal hygiene and everyday tasks can also occur. People with schizophrenia may have diminished facial expression and animation (flat affect), and in some cases become unresponsive (catatonic). Substance abuse and suicidal thoughts and actions are common in people with schizophrenia.

Certain movement problems such as tremors, facial tics, rigidity, and unusually slow movement (bradykinesia) or an inability to move (akinesia) are common in people with schizophrenia. In most cases these are side effects of medicines prescribed to help control the disorder. However, some affected individuals exhibit movement abnormalities before beginning treatment with medication.

Some people with schizophrenia have mild impairment of intellectual function, but schizophrenia is not associated with the same types of physical changes in the brain that occur in people with dementias such as Alzheimer disease.

Psychotic disorders such as schizophrenia are different from mood disorders, including depression and bipolar disorder, which primarily affect emotions. However, these disorders often occur together. Individuals who exhibit strong features of both schizophrenia and mood disorders are often given the diagnosis of schizoaffective disorder.

Frequency

Schizophrenia is a common disorder that occurs all over the world. It affects almost 1 percent of the population, with slightly more males than females developing the disorder.

Causes

Variations in many genes likely contribute to the risk of developing schizophrenia. In most cases, multiple genetic changes, each with a small effect, combine to increase the risk of developing the disorder. The ways that these genetic changes are related to schizophrenia are not well understood, and the genetics of this disease is an active area of research. The genetic changes can also interact with environmental factors that are associated with increased schizophrenia risk, such as exposure to infections before birth or severe stress during childhood.

Deletions or duplications of genetic material in any of several chromosomes, which can affect multiple genes, are also thought to increase schizophrenia risk. In particular, a small deletion (microdeletion) in a region of chromosome 22 called 22q11 may be involved in a small percentage of cases of schizophrenia. Some individuals with this deletion have other features in addition to schizophrenia, such as heart abnormalities, immune system problems, and an opening in the roof of the mouth (cleft palate), and are diagnosed with a condition called 22q11.2 deletion syndrome.

Learn more about the genes and chromosome associated with Schizophrenia

Additional Information from NCBI Gene:

Inheritance

The inheritance pattern for schizophrenia is usually unknown. The risk of developing schizophrenia is somewhat higher for family members of affected individuals as compared to the general public; however, most people with a close relative who has schizophrenia will not develop the disorder themselves.

Other Names for This Condition

Dementia praecox

Additional Information & Resources

Genetic Testing Information

Genetic Testing Registry: Schizophrenia

Patient Support and Advocacy Resources

Disease InfoSearch
National Organization for Rare Disorders (NORD)

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Research Studies from ClinicalTrials.gov

ClinicalTrials.gov

Catalog of Genes and Diseases from OMIM

Scientific Articles on PubMed

PubMed

References

Barker V, Bois C, Johnstone EC, Owens DG, Whalley HC, McIntosh AM, Lawrie SM. Childhood adversity and cortical thickness and surface area in a population at familial high risk of schizophrenia. Psychol Med. 2016 Mar;46(4):891-6. doi: 10.1017/S0033291715002585. Epub 2015 Dec 14. Citation on PubMed
Debost JP, Larsen JT, Munk-Olsen T, Mortensen PB, Meyer U, Petersen L. Joint Effects of Exposure to Prenatal Infection and Peripubertal Psychological Trauma in Schizophrenia. Schizophr Bull. 2017 Jan;43(1):171-179. doi: 10.1093/schbul/sbw083. Epub 2016 Jun 24. Citation on PubMed
Escudero I, Johnstone M. Genetics of schizophrenia. Curr Psychiatry Rep. 2014 Nov;16(11):502. doi: 10.1007/s11920-014-0502-8. Citation on PubMed
Farrell MS, Werge T, Sklar P, Owen MJ, Ophoff RA, O’Donovan MC, Corvin A, Cichon S, Sullivan PF. Evaluating historical candidate genes for schizophrenia. Mol Psychiatry. 2015 May;20(5):555-62. doi: 10.1038/mp.2015.16. Epub 2015 Mar 10. Citation on PubMed or Free article on PubMed Central
Giusti-Rodriguez P, Sullivan PF. The genomics of schizophrenia: update and implications. J Clin Invest. 2013 Nov;123(11):4557-63. doi: 10.1172/JCI66031. Epub 2013 Nov 1. Citation on PubMed or Free article on PubMed Central
Gulsuner S, Walsh T, Watts AC, Lee MK, Thornton AM, Casadei S, Rippey C, Shahin H; Consortium on the Genetics of Schizophrenia (COGS); PAARTNERS Study Group; Nimgaonkar VL, Go RC, Savage RM, Swerdlow NR, Gur RE, Braff DL, King MC, McClellan JM. Spatial and temporal mapping of de novo mutations in schizophrenia to a fetal prefrontal cortical network. Cell. 2013 Aug 1;154(3):518-29. doi: 10.1016/j.cell.2013.06.049. Citation on PubMed or Free article on PubMed Central
Kavanagh DH, Tansey KE, O’Donovan MC, Owen MJ. Schizophrenia genetics: emerging themes for a complex disorder. Mol Psychiatry. 2015 Feb;20(1):72-6. doi: 10.1038/mp.2014.148. Epub 2014 Nov 11. Citation on PubMed
Purcell SM, Moran JL, Fromer M, Ruderfer D, Solovieff N, Roussos P, O’Dushlaine C, Chambert K, Bergen SE, Kahler A, Duncan L, Stahl E, Genovese G, Fernandez E, Collins MO, Komiyama NH, Choudhary JS, Magnusson PK, Banks E, Shakir K, Garimella K, Fennell T, DePristo M, Grant SG, Haggarty SJ, Gabriel S, Scolnick EM, Lander ES, Hultman CM, Sullivan PF, McCarroll SA, Sklar P. A polygenic burden of rare disruptive mutations in schizophrenia. Nature. 2014 Feb 13;506(7487):185-90. doi: 10.1038/nature12975. Epub 2014 Jan 22. Citation on PubMed or Free article on PubMed Central
Schizophrenia Working Group of the Psychiatric Genomics Consortium. Biological insights from 108 schizophrenia-associated genetic loci. Nature. 2014 Jul 24;511(7510):421-7. doi: 10.1038/nature13595. Epub 2014 Jul 22. Citation on PubMed or Free article on PubMed Central
Sekar A, Bialas AR, de Rivera H, Davis A, Hammond TR, Kamitaki N, Tooley K, Presumey J, Baum M, Van Doren V, Genovese G, Rose SA, Handsaker RE; Schizophrenia Working Group of the Psychiatric Genomics Consortium; Daly MJ, Carroll MC, Stevens B, McCarroll SA. Schizophrenia risk from complex variation of complement component 4. Nature. 2016 Feb 11;530(7589):177-83. doi: 10.1038/nature16549. Epub 2016 Jan 27. Erratum In: Nature. 2022 Jan;601(7892):E4-E5. Citation on PubMed or Free article on PubMed Central
Sullivan PF, Daly MJ, O’Donovan M. Genetic architectures of psychiatric disorders: the emerging picture and its implications. Nat Rev Genet. 2012 Jul 10;13(8):537-51. doi: 10.1038/nrg3240. Citation on PubMed or Free article on PubMed Central

Overview — Schizophrenia

Doctors often describe schizophrenia as a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality.

Symptoms of schizophrenia can include:

hallucinations – hearing or seeing things that do not exist outside of the mind
delusions – unusual beliefs not based on reality
muddled thoughts and speech based on hallucinations or delusions
losing interest in everyday activities
not wanting to look after yourself and your needs, such as not caring about your personal hygiene
wanting to avoid people, including friends
feeling disconnected from your feelings or emotions

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People with schizophrenia do not have a split personality. Schizophrenia does not usually cause someone to be violent.

When to get medical advice

If you’re experiencing symptoms of schizophrenia, see a GP as soon as possible. The earlier schizophrenia is treated, the better.

There’s no single test for schizophrenia. It’s usually diagnosed after an assessment by a mental health care professional, such as a psychiatrist.

Causes of schizophrenia

The exact cause of schizophrenia is unknown. But most experts believe the condition is caused by a combination of genetic and environmental factors.

It’s thought that some people are more vulnerable to developing schizophrenia, and certain situations can trigger the condition such as a stressful life event or drug misuse.

Treating schizophrenia

Schizophrenia is usually treated with a combination of medicine and therapy tailored to each individual.

In most cases, this will be antipsychotic medicines and cognitive behavioural therapy (CBT).

People with schizophrenia usually receive help from a community mental health team, which can offer day-to-day support and treatment, depending on the needs of each individual.

Many people recover from schizophrenia, although they may have periods when symptoms return (relapses).

Support and treatment can help reduce the impact the condition has on daily life.

Living with schizophrenia

If schizophrenia is well managed, it’s possible to reduce the chance of severe relapses.

This can include:

recognising the signs of an acute episode
taking medicine as prescribed
talking to others about the condition

There are many charities and support groups offering help and advice on living with schizophrenia.

Most people find it comforting talking to others with a similar condition.

More in Schizophrenia

Page last reviewed: 13 April 2023
Next review due: 13 April 2026

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Schizophrenia

Schizophrenia is a mental health problem. Symptoms include hearing, seeing, smelling or tasting things that are not real (hallucinations); false ideas (delusions); disordered thoughts and problems with feelings, behaviour and motivation. The cause is not clear. In many people symptoms come back (recur) or persist long-term but some people have just one episode of symptoms that lasts a few weeks. Treatment includes medication, talking treatments and social support.

Schizophrenia

What is schizophrenia?

Schizophrenia is a serious mental health condition that causes disordered ideas, beliefs and experiences. In a sense, people with schizophrenia lose touch with reality and do not know which thoughts and experiences are real and which are not.

Some people misunderstand schizophrenia. For instance, it has nothing to do with a split personality. Also, the vast majority of people with schizophrenia are not violent.

You should be aware that some people feel that schizophrenia should be abolished as a concept. They believe that the term is unscientific, stigmatising and not addressing the root causes of serious mental distress. However, many members of the medical profession still find the term schizophrenia useful.

Schizophrenia develops in about 1 in 100 people. It can occur in men and in women. The most common ages for it first to develop are 15-25 in men and 25-35 in women.

Schizophrenia symptoms

There are many possible symptoms. Healthcare professionals often class the symptoms as ‘positive’ and ‘negative’. Positive symptoms are those that show abnormal mental functions. Negative symptoms are those that show the absence of a mental function that should normally be present.

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Positive schizophrenia symptoms

Delusions. These are false beliefs that a person has and most people from the same culture would agree that they are wrong. Even when the wrongness of the belief is explained, a person with schizophrenia is convinced that they are true. For example, a person with schizophrenia may believe such things as:
- Neighbours are spying on them with cameras in every room; or
- A famous person is in love with them; or
- People are plotting to kill them; or
- There is a conspiracy about them.
- Hallucinations. This means hearing, seeing, feeling, smelling, or tasting things that are not actually there. Hearing voices is the most common. Some people with schizophrenia hear voices that provide a running commentary on their actions, argue with them, or repeat their thoughts. The voices often say things that are rude, aggressive, and unpleasant, or give orders that must be followed. Some people with schizophrenia appear to talk to themselves as they respond to the voices. People with schizophrenia believe that the hallucinations are real.
- Disordered thoughts. Thoughts may become jumbled or blocked. Thought and speech may not follow a normal logical pattern. For example, some people with schizophrenia have one or more of the following:
  - Thought echo: this means the person hears his or her own thoughts as if they were being spoken aloud.
  - Knight’s-move thinking: this means the person moves from one train of thought to another that has no apparent connection to the first.
  - Some people with schizophrenia may invent new words (neologisms), repeat a single word or phrase out of context (verbal stereotypy), or use ordinary words to which they attribute a different, special meaning (metonyms).
  - Thought insertion: the person believes that the thoughts in their mind are not their own and that they are being put there by someone else.
  - Thought withdrawal: the person believes that their thoughts are being removed from their mind by an outside agency.
  - Thought broadcasting: the person believes that their thoughts are being read or heard by others.
  - Thought blocking: the person experiences a sudden interruption of the train of thought before it is completed, leaving a blank. The person suddenly stops talking and cannot recall what he or she has been saying.
  Negative schizophrenia symptoms
  - Lack of motivation. Everything seems an effort — for example, tasks may not be finished, concentration is poor, there is loss of interest in social activities and the person often wants to be alone.
  - Few spontaneous movements and much time doing nothing.
  - Facial expressions do not change much and the voice may sound monotonous.
  - Changed feelings. Emotions may become flat. Sometimes the emotions may be odd, such as laughing at something sad. Other strange behaviours sometimes occur.
  Negative symptoms may make some people neglect themselves. They may not care to do anything and appear to be wrapped up in their own thoughts. Negative symptoms can also lead to difficulty with education, which can contribute to difficulties with employment. For families and carers, the negative symptoms are often the most difficult to deal with. Persistent negative symptoms tend to be the main cause of long-term disability.
  Families may only realise with hindsight that the behaviour of a relative has been gradually changing. Recognising these changes can be particularly difficult if the illness develops during the teenage years when it is normal for some changes in behaviour to occur.
  Other symptoms
  Other symptoms that occur in some cases include difficulty planning, memory problems and obsessive-compulsive symptoms.
  What is the cause of schizophrenia?
  The cause is not known for certain but there are several current ideas. It is thought that the balance of brain chemicals (neurotransmitters) is altered. Neurotransmitters are needed to pass messages between brain cells. An altered balance of these may cause the symptoms. It is not clear why changes occur in the neurotransmitters.
  Inherited (genetic) factors are thought to be important. For example, a close family member (child, brother, sister, parent) of someone with schizophrenia has a 1 in 10 chance of also developing the condition. This is 10 times the normal chance. A child born to a mother and father who both have schizophrenia has a higher risk of developing it but one or more factors appear to be needed to trigger the condition in people who are genetically prone to it. There are various theories as to what these might be. For example:
  - Stress such as relationship problems, financial difficulties, social isolation, bereavement, etc.
  - A viral infection during the mother’s pregnancy, or in early childhood.
  - A lack of oxygen at the time of birth that may damage a part of the brain.
  - Illegal or street drugs may trigger the condition in some people. For example, heavy cannabis usage may account for between 8% and 14% of schizophrenia cases. Many other recreational drugs such as amfetamines, cocaine, ketamine and lysergic acid diethylamide (LSD) can trigger a schizophrenia-like illness.
  Schizophrenia tests
  Blood and urine tests may be done. This will rule out physical causes of the symptoms or drug/alcohol misuse which may cause similar symptoms. People already diagnosed with schizophrenia may also have tests done if they suddenly become worse.
  How is the diagnosis made?
  Some of the symptoms that occur in schizophrenia also occur in other mental health conditions such as depression, mania, and dissociative identity disorder, or after taking some street drugs. Therefore, the diagnosis may not be clear at first. As a rule, the symptoms need to be present for several weeks before a doctor will make a firm diagnosis of schizophrenia.
  Not all symptoms are present in all cases. Different forms of schizophrenia occur depending upon the main symptoms that develop. For example, people with paranoid schizophrenia mainly have positive symptoms which include delusions that people are trying to harm them. In contrast, some people mainly have negative symptoms and this is classed as simple schizophrenia. In many cases there is a mix of positive and negative symptoms.
  Sometimes symptoms develop quickly over a few weeks or so. Family and friends may recognise that the person has a mental health problem. Sometimes symptoms develop slowly over months and the person may gradually become withdrawn, lose friends, jobs, etc, before the condition is recognised.
  Schizophrenia treatment
  Treatment and care are usually based in the community rather than in hospitals. The National Institute for Health and Care Excellence (NICE) recommends that the patient’s social circumstances be assessed and their family involved as soon as possible. Most areas of the UK have a community mental healthcare team which includes psychiatrists, nurses, psychologists, social workers, etc. A key worker such as a community psychiatric nurse or psychiatric social worker is usually allocated to co-ordinate the care for each person with schizophrenia.
  However, some people need to be admitted to hospital for a short time. This is sometimes done when the condition is first diagnosed so that treatment can be started quickly. Hospital admission may also be needed for a while at other times if symptoms become severe. A small number of people have such a severe illness that they remain in hospital long-term.
  People with schizophrenia often do not realise or accept that they are ill. Therefore, sometimes when persuasion fails, some people are admitted to hospital for treatment against their will by use of the Mental Health Act. This means that doctors and social workers can force a person to go to hospital. This is only done when the person is thought to be a danger to themself or to others.
  Antipsychotic medication
  The main medicines used to treat schizophrenia are called antipsychotics. They work by altering the balance of some brain chemicals (neurotransmitters).
  Psychological treatments
  Cognitive behavioural therapy (CBT)
  Psychological treatments include a variety of talking treatments, in particular CBT. CBT is used as a treatment for various mental health and physical problems and is being increasingly used as a treatment for schizophrenia.
  Family intervention
  This may be offered and consists of about 10 therapy sessions for relatives of patients with schizophrenia. It has been found to reduce hospital admissions and the severity of symptoms for up to two years after treatment.
  Art therapy
  This has been found to be helpful, particularly if you have negative symptoms.
  Social and community support
  This is very important. Often the key worker plays a vital role. However, families, friends and local support groups can also be major sources of help. These organisations have many local groups throughout the UK.
  Encouraging physical health
  It is quite common for people with schizophrenia not to look after themselves so well. Such things as smoking, lack of exercise, obesity and an unhealthy diet are more common than average in people with schizophrenia. Weight gain may be a side-effect of antipsychotic medicines. All these factors may lead to an increased chance of developing heart disease and diabetes in later life.
  Therefore, as with everyone else in the population, people with schizophrenia are encouraged to adopt a healthy lifestyle. Advice includes:
  - Not to smoke.
  - To take regular exercise.
  - To eat healthily.
  What is the outlook?
  - In most cases there are recurring episodes of symptoms (relapses). Most people in this group live relatively independently with varying amounts of support. The frequency and duration of each relapse can vary. Some people recover completely between relapses. Some people improve between relapses but never quite fully recover. Treatment often prevents relapses, or limits their number and severity.
  - In some cases, there is only one episode of symptoms that lasts a few weeks or so. This is followed by a complete recovery, or substantial improvement without any further relapses. It is difficult to give an exact figure as to how often this occurs. Perhaps 2 in 10 cases or fewer.
  - Up to 2 in 10 people with schizophrenia are not helped much by treatment and need long-term dependent care. For some, this is in secure accommodation.
  - Depression is a common complication of schizophrenia.
  - It is thought that up to a third of people with schizophrenia misuse alcohol and/or illegal drugs. Helping or treating such people can be difficult.
  - About 1 in 10 people with schizophrenia end their own life.
  The outlook (prognosis) is thought to be better if:
  - Treatment is started soon after symptoms begin.
  - Symptoms develop quickly over several weeks rather than slowly over several months.
  - The main symptoms are positive symptoms rather than negative symptoms.
  - The condition develops in a relatively older person (aged over 25).
  - Symptoms ease well with medication.
  - Treatment is taken as advised (that is, compliance with treatment is good).
  - There is good family and social support which reduces anxiety and stress.
  - Misuse of illegal drugs or of alcohol does not occur.
  Newer medicines and better psychological treatments give hope that the outlook is improving.