Schizophrenia can be a frightening experience on its own. Unfortunately, it's often misunderstood, in part due to misinformation and sensational stories in the media that says people with schizophrenia are dangerous, should be locked up, or that they should have no rights and dignity. These public perceptions can leave people scared to talk about their experiences and seek help. The truth is that many people learn how to manage schizophrenia with the right tools and supports. It’s time to learn the facts about schizophrenia and see it for what it is: a mental illness that can be effectively treated.
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What does schizophrenia look like?
Schizophrenia is made up of the following symptoms:
Hallucinations: Sensations that feel very real to you but don't exist in reality. Hallucinations can relate to any of your senses (such as hearing, sight, touch, taste, smell), but hearing voices is most common for people with schizophrenia. Experiences with hallucinations can vary a lot. At times, voices or other experiences can feel friendly or supportive. At other times, voices or other experiences can feel scary, such as saying cruel things or telling the person with schizophrenia to do something harmful. In the early stages of the illness, people may experience a milder form of hallucinations like hearing a murmur or a quiet voice in the background. At this stage, people may feel like something isn't quite right but may not be able to pinpoint exactly what's wrong.
Delusions: Strong beliefs that aren't based in reality. People who experience delusions are firm in their beliefs and find it hard to consider other sides even when there is evidence against the belief. Common delusions focus around persecution (believing someone is out to get you or someone is spying on you), grandiosity (believing you have special powers or abilities), relationships (such a believing a famous person is secretly in love with you or believing a romantic partner must be cheating on you), or physical illness (such as believing you are sick even when your doctor can't find anything wrong).
Cognitive symptoms: Most people living with schizophrenia will experience cognitive (thinking) symptoms. They include reduced attention span and difficulties with memory, reasoning, judgment, problem-solving, decision-making, planning, and managing different parts of daily life. This group of symptoms most strongly predicts the outcome and severity of the illness someone experiences.
Disorganized speech: Schizophrenia affects the way people think and talk. People may mix up words, switch topics, go on long unrelated tangents, or find it hard to directly respond to questions or prompts. It can be hard for others to follow along or make sense of the conversation.
Disorganized behaviours: People with schizophrenia may move in different ways. They may seem very restless and agitated, or feel like they have to move around a lot even when they are working on a task that requires more concentration. Other people may not react or move much at all.
Negative symptoms: This is a group of symptoms that "takes away" from your usual motivations, interests, and goals. You may find that nothing makes you feel happy or good, quit activities or hobbies you used to enjoy, no longer show emotions, or want to be alone most of the time. While many people associate hallucinations or delusions with schizophrenia, these negative symptoms make it hard for many people to go about their usual lives.
Schizophrenia is episodic and follows a course—symptoms rarely just come out of nowhere. In the early warning stage, also called the prodome, symptoms may be vague and slowly worsen over time. People feel "off," distracted, anxious, or irritable. They may have a hard time concentrating and feel disconnected from others. A common experience during this time is a new and intense interest in philosophy, religion, the supernatural, or mystical experiences. Sensations may feel different, such as feeling like colours are brighter than usual or normal sounds are overwhelming. In the next stage, full symptoms like hallucinations and delusions start. This is called the acute or active phase. When the acute phase ends, people enter the recovery or residual phase. Some symptoms may continue into this phase, often similar to the symptoms in the prodome, but they are easier to manage. Many people can get back to their usual activities at this time.
Some people only experience one episode of psychosis in their life while others may experience many episodes. After each episode, the symptoms of the recovery phase can be harder and harder to manage. This is why it's so important to seek help and stick to a treatment plan—treatment helps you feel better sooner and stay well in the future.
Who does it affect?
Schizophrenia affects about 1% of Canadians. It isn't known exactly what causes schizophrenia, but it's likely a combination of several factors, such as the way your genetics, your environment, and your life experiences interact.
Young people: Schizophrenia is most likely to start when people are in their teens and twenties, with men more likely to experience schizophrenia at an earlier age than women. Some younger people can experience schizophrenia, though this isn't very common. Schizophrenia can also come up when people are older, usually between the ages of 40 and 60.
Families: If a close family member (like a parent or sibling) experiences schizophrenia, you experience an increased risk of schizophrenia. While there is more to schizophrenia than your genes, genetics are a major risk factor. For that reason, it's a good idea to be careful with drugs like cannabis, hallucinogens, and amphetamines if a close family member has schizophrenia.
Could I have schizophrenia?
While schizophrenia looks different from person to person, it always changes your abilities and personality. Because it is so different for each person, you may experience some or all of the symptoms below.
I'm hearing voices other people tell me they can't hear
I'm seeing things that other people tell me they can't see
I feel immune to any kind of danger; I believe I can save the world
I'm convinced I'm being followed or that someone is spying on me
Something just doesn't feel right—sounds seem louder, colours seem different, I think I see something in my peripheral vision or hear mumbling in the background
I used to like being around other people, but now I'd rather just be by myself
My thoughts take a long time to form, come too fast together, or don't form at all
I have trouble remembering things, concentrating, and making decisions
I often feel confused—it's hard to follow what other people say
Nothing interests me anymore, I don't feel like doing much
I feel overwhelmed
I feel anxious, irritable, angry or sad a lot of the time
If you experience any of these symptoms it's important to talk to your doctor.
What can I do about it?
Symptoms of schizophrenia overlap with other mental illnesses, substance use or withdrawal, and some physical health problems. For that reason, it can take time to determine exactly what's causing the symptoms. It's important to be patient and flexible—your diagnosis may change over time and treatment approach may change as doctors gather more information.
Schizophrenia is treatable. While there is no cure, you can learn how to manage schizophrenia. With treatment and support, many people live well despite schizophrenia and find episodes are farther apart and easier to manage.
An important part of recovery is seeking help early. Schizophrenia can be frightening, and some people are scared to reach out for help. However, early treatment can help you recover faster and reduce the severity of future episodes. In some cases, people who receive treatment early do not experience another episode. Even if you've put off seeking help, now is the best time to talk to a doctor or mental health professional.
Schizophrenia is a serious mental illness, and some people need several different kinds of support to help them feel their best. The following list of treatments and supports may seem long and complicated to manage on your own, but there are people who can help you access and coordinate different care providers. If you're diagnosed with schizophrenia, you may be referred to a community mental health team. Mental health teams include different treatment providers, mental health professionals, and other supports with a case manager who coordinates your care and refers you to other services or programs as needed. If you have just started to experience symptoms of psychosis, you may be referred to an early psychosis intervention (EPI) program, which provides treatments and support for you and your family.
Many people use a combination of medications, psychotherapy, self-management, and other supports in their schizophrenia treatment plan.
Medication: Most people with schizophrenia take medications called antipsychotics. It may take time to find the right medication and the right dose for you. Antipsychotics can have side effects, so it's important to talk to your doctor about what to expect and how you can reduce side effects. Your doctor may also advise that you go in for regular checkups while you take antipsychotics.
Psychotherapy: Different psychotherapies can help you learn new skills, cope with challenges you experience, and support you on your own path to recovery. Cognitive-behavioural therapy can help with symptoms like confused thinking and family-based interventions can help family members manage caregiving and take care of themselves. Cognitive remediation helps improve 'thinking' skills like remembering and using new information.
Occupational and other support: Extra help with job skills, financial management and social skills can help people live independently. You often find these supports in local mental health teams.
Hospitalization and follow-up: If you become every ill with schizophrenia, you may need to go the hospital. Generally the goal is to keep people in hospital only as long as they need to be. If you spend time in hospital, the care team should help you make a plan to continue to see a doctor and other health care providers once you are discharged.
Family support: Schizophrenia impacts the entire family and it's usually best if the entire family is involved in treatment. Family members are often the first to notice changes in behaviour or health, and research suggests that people with schizophrenia see better results when family members participate in treatment, like reminding their loved one to take medication. A family-based therapy or intervention can be very helpful—it can be difficult to watch a loved one experience schizophrenia symptoms, and caregiving can take a toll on loved ones.
Support groups: Support groups, for both people with the illness and loved ones, are a great way to share your experiences and learn from the experiences of others.
Self-help: During and after treatment, there are some things you can do on your own to help keep you feeling better. Regular exercise, eating well, managing stress, spending time with friends and family, keeping in touch with your spirituality, and minimizing the use of alcohol and other drugs can help keep your symptoms from getting worse or coming back. Talking to your doctor, asking questions, and getting enough information to take charge of your own health are also very important.
Where do I go from here?
In addition to talking to your family doctor, check out the resources below for more information on schizophrenia:
Early Psychosis Intervention
Visit www.earlypsychosis.ca to access your local early psychosis intervention (EPI) program and prepare for an assessment. You can also learn more about psychosis, find Dealing with Psychosis: A toolkit for moving forward with your life, learn more about treatments, and learn how to support a family or friend with psychosis.
BC Schizophrenia Society
Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver) for resources and information on schizophrenia and psychosis, including family support groups, respite care, support for children with a parent with a mental illness, and education courses for persons with schizophrenia and their families.
Canadian Mental Health Association, BC Division
Visit www.cmha.bc.ca or call 1-800-555-8222 (toll-free in BC) or 604-688-3234 (in Greater Vancouver) for information and community resources on mental health or any mental illness.
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for our Managing Mental Illnesses series of info sheets, more information, and personal stories about schizophrenia. You'll also find tips and self-tests to help you take control of your mental health.
Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse about symptoms you’re worried about, or talk with a pharmacist about medication questions.
Crisis lines aren't only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (no area code) 24 hours a day to connect to a BC crisis line, without a wait or busy signal.
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.