Schizophrenia James Tighe, clinical nurse research fellow Few conditions are as misunderstood as schizophrenia. Misleading media reports have led to the perception that people with the illness pose a serious threat to others. But this is a damaging misrepresentation.

In this article

What are the symptoms? How common is it? What's the course of the disease?

What support is available? What can I do to help myself?

What professional help is available? Myth busting

It's important to start by saying what schizophrenia is not. It isn't:

• split or multiple personality
• caused by parents or the way someone was brought up
• untreatable
• a guarantee that a person will be violent
• a guarantee that a person will be in a hospital for life

It's a very distressing condition both for the person with the illness and their family - but there is hope. About a quarter of people who develop schizophrenia make a complete recovery. There have been major advances in managing the condition in recent years - and people with schizophrenia can go on to live fulfilled lives and form lasting relationships.

Warning signs

If you're worried that a friend or relative may have schizophrenia, take a look at the first warning signs suggesting onset of the illness.

Warning signs may include:

• social withdrawal and isolation
• excessive fatigue or sleepiness, or sleep disruption
• loss of concentration
• dropping out of activities, loss of motivation
• apparent indifference even to important events
• decline in academic or physical performance
• loss of interest in personal hygiene or fashion sense
• purposeless activity
• bizarre or inappropriate behaviour
• preoccupation with spiritual matters
• incoherent illogical speech

If the illness first appears as a crisis state or aggression, try to keep calm, don't try to intervene, argue, criticise or rationalise. Avoid eye contact or physically touching them. Quietly express sympathy for their feelings, turn off distractions such as the TV or radio, and call for emergency medical help. Get further advice on dealing with a crisis state from www.world-schizophrenia.org/publications/15-crisis.html.

Symptoms of schizophrenia are divided into positive and negative types. Positive symptoms occur in the acute, or initial phase; negative symptoms occur in the long-term phase.

Hallucinations
These are where a person sees, hears, feels, tastes or smells something that has no external reality.
False beliefs (delusions)
These are very firmly held and cannot be shaken by any logical argument. They're often unusual and not a reflection of reality. Often a person will draw conclusions from their delusions, leading to other (secondary) delusions. These are often about people or organisations being out to get them (paranoid or persecutory delusions).
Problems with thinking
Thoughts can be a rapid, disordered stream tumbling through the mind (pressure of thought). This can happen on its own or be associated with a sudden emptying of the mind (thought blocking). There can also be delusions about thoughts: that they're being broadcast to everyone, or being implanted or removed. The form of thoughts may also be altered. Some people will take abstract ideas - for instance, "people in glass houses shouldn't throw stones" - literally. Others may become preoccupied with vague, mystical ideas, but the connections between their ideas may not be logical.
Moods
These can change quickly and seem inappropriate. The range of moods may also seem altered.

It's not surprising, given everything that's happening to the person experiencing the symptoms that they can become preoccupied, easily distracted and withdrawn. Different people will experience different patterns of symptoms, with different degrees of severity.

There's almost always a failure by the person experiencing the symptoms to understand that they're ill.

Delusions and hallucinations may continue, but the person will be able to keep these separate from other beliefs and everyday social interaction. Insight may well remain a problem , with the person needing to be convinced repeatedly that their symptoms really are due to illness.

There are often some symptoms left over from the positive phase but they're less intense. The person's range of mood will often remain restricted and there may be some delusions or hallucinations still present. Again, different people will experience different patterns and degrees of severity of symptoms.

This can make depressing reading for anyone who has a friend or relative who's been diagnosed with schizophrenia. But it's important to restate two important points:

• There are degrees of severity, not everyone with schizophrenia will fulfil this rather frightening picture.
• There are psychological therapies and medications that can make a big difference to the outcome of the condition.

About one per cent of people will develop schizophrenia in their lifetime. There's a higher rate of diagnosing the condition in the Afro-Caribbean community in the UK. Whether this reflects a higher actual incidence of schizophrenia, or the misinterpretation of behaviour by psychiatrists from a different culture, is a matter of debate.

There does seem to be a genetic element to schizophrenia. Ten to 15 per cent of people with a parent, brother or sister with schizophrenia will go on to develop the condition. For children with two parents with schizophrenia, about 40 per cent will develop it.

These rates seem to hold whether they were brought up by their parents or adopted.

Men are more likely to develop schizophrenia between the ages of 15 and 35, with a peak of risk in their 20s. Women are also most at risk in their 20s but, while their risk in their 20s isn't as great as that of men, it doesn't reduce as quickly past their 20s and in later life, so their risk then begins to exceed that of men.

Once they've developed schizophrenia, 20 to 25 per cent of people will never have another acute relapse, 20 to 25 per cent will have more than one acute phase but be stable in between on medication, and 40 to 50 per cent will have a chronic, long-term phase.

There's a higher risk of a suicide attempts among younger patients at the beginning of their first acute phase.

There are many organisations specifically for people diagnosed with schizophrenia and their partners, friends and families. See our Useful contacts section for details.