Understanding Schizophrenia: Symptoms, Myths and Treatment

Schizophrenia is a complex mental health condition that affects millions of people worldwide. Despite its prevalence, there are still misconceptions around the condition. In honour of World Schizophrenia Awareness Day on May 24th, this post aims to contribute to the de-stigmatisation of this condition by explaining the symptoms, signs to watch for, common myths, and pathways for treatment and support.

Symptoms of schizophrenia

There are essentially five groups of symptoms that describe schizophrenia, and a person must show indicators in at least two of these categories for a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

1. Delusions: These are beliefs that are firmly held but do not exist in reality. For example, a person may believe: i) they are being followed or watched, ii) they have special abilities or talents that set them apart from others, iii) their thoughts are being broadcasted to the outside world, iv) their thoughts or actions are controlled by external forces, v) they have a serious illness despite evidence to the contrary, vi) characters on TV are communicating directly with them, or that news events, songs on the radio, or even patterns in public situations (eg, advertisements or registration plates) are personally significant and intended specifically for them.

2. Hallucinations: These are sensory experiences that are perceived as real, but are created within the mind. They can occur in any of the senses, but auditory hallucinations (esp. hearing voices or sounds) are the most common. Hallucinations can also be visual (seeing things that aren't there), tactile (feeling like something is touching the skin), olfactory (smelling odours that have no physical source), and gustatory (tasting things that aren’t present).

3. Disorganised speech: People with schizophrenia may show disorganised thinking which is often reflected in their speech. For example, they may frequently deviate to unrelated topics, link different thoughts based on sounds rather than logic, and mix words with no rational structure. Disorganisation makes it challenging for individuals to convey thoughts clearly and engage in meaningful social interactions.

4. Grossly disorganised or catatonic behaviour: Disorganised behaviour involves unusual actions that disrupt daily activities and social interactions. For example, individuals may wear heavy clothing in hot weather or show unpredictable emotional responses (eg, laugh at inappropriate times). Catatonic behaviour includes extreme lack of movement and speech, excessive motor activity without purpose, maintaining rigid postures for long periods, or mimicking others' actions and speech.

5. Negative symptoms: These involve a significant decrease in emotional expression, speech, motivation, pleasure, and social engagement. Symptoms include affective flattening (minimal facial emotion and vocal tone variation), alogia (reduced speech output), avolition (lack of motivation to perform basic activities), anhedonia (reduced ability to enjoy activities), and social withdrawal (increased isolation).

Signs to watch for

Recognising the early signs of schizophrenia is critical for timely intervention and treatment. Some common signs to watch for include:

- Social withdrawal or isolation

- Marked decline in academic or occupational performance

- Unusual or paranoid beliefs, or references to experiences that don’t seem plausible

- Changes in speech patterns or behaviour

- Difficulty in maintaining personal hygiene or self-care

- Decline in motivation or emotional expression

* It's important to note that experiencing one or more of these signs does not necessarily indicate schizophrenia, but may warrant further evaluation by a mental health professional.

Common myths about schizophrenia

Despite increased awareness and understanding of various mental health issues, several myths persist about schizophrenia. Here are some common misconceptions:

Myth 1: People with schizophrenia are violent and dangerous

It is very unfortunate that many incidents of violent behaviour in the community, as reported in the media, mention a diagnosis of schizophrenia. The most recent incident occurred several weeks ago when a man stabbed and killed six people with a knife inside Bondi Junction Westfield. The father of the man told police his son had schizophrenia. Schizophrenia is not a cause and such reports fail to capture a range of other potential influences. For example, traits of antisocial personality disorder or a history of conduct disorder in childhood are often present in a person who commits such a crime. The use of alcohol and illicit drugs are also significantly linked to violent behaviour. Factors like these are typically not considered by journalists, which is understandable as they are not experts in mental health, but by this very token, journalists should refrain from implicating a causal link between crime and a single mental health condition they do not have a full grasp of, like schizophrenia. In line with respected lived experience ambassadors for schizophrenia, like Cameron Solnordal, it’s critical we work towards destigmatising schizophrenia.

Myth 2: Schizophrenia is also known as ‘split personality’ or ‘multiple personalities’

‘Schizophrenia’ has erroneously been called ‘split personality’, and this is misleading on several levels. To begin, the term ‘split personality’ does not exist in psychiatry. Another condition (formerly known as ‘multiple personality disorder’), is now referred to as ‘dissociative identity disorder’ (DID) and is a distinctively independent condition that describes a person who has two or more separate identities, which formed in childhood to cope with trauma. These identities may have their own behaviours, memories, and ways of viewing the world, and a person with DID will often have significant gaps in memory for periods of time. Unlike DID, the symptoms of schizophrenia constitute a detachment from reality, not a fragmentation of identity, and a person with schizophrenia has no memory loss for events in which their symptoms were present.

Myth 3: Illicit drugs like cannabis can cause schizophrenia

The belief that illicit drugs like cannabis can cause schizophrenia is a complex and debated topic in mental health research. Cannabis and other illicit drugs can increase the risk of psychotic episodes in those already predisposed to schizophrenia, but they do not conclusively cause it. Schizophrenia is a multifaceted condition influenced by a combination of genetic, environmental, and neurobiological factors. Cannabis might act as a trigger in vulnerable individuals, but it is not considered a direct cause of schizophrenia.

Myth 4: Schizophrenia is caused by trauma or personal weakness

As per above, schizophrenia is a complex mental health condition in which a combination of genetic predisposition factors, environmental stressors, and neurobiological processes play a significant role in its development. It is not solely caused by trauma or personal weakness. Stressful events and difficulties in coping with various life challenges can possibly trigger episodes in those already predisposed to schizophrenia.

Pathways for treatment and support

Effective treatment for schizophrenia often involves a combination of medication, psychological therapy, and psychosocial interventions.

1. Medication: Antipsychotic medications are commonly prescribed to alleviate symptoms like delusions, hallucinations and disorganised thinking. There are two main classes of antipsychotics: typical (first-generation) and atypical (second-generation). Atypical antipsychotics are often preferred due to their reduced risk of side effects such as extrapyramidal symptoms. However, the choice of medication depends on the individual's symptom profile, medical history, and tolerability.

2. Psychological therapy: Cognitive-Behaviour Therapy (CBT) can help individuals to challenge delusional beliefs, hallucinations, and improve coping skills. Family therapy can also help educate family members about the illness, improve communication, and provide support for both the individual with schizophrenia and their loved ones.

3. Psychosocial interventions: These address the functional impairments associated with schizophrenia and focus on helping individuals regain or improve their independence and quality of life. These interventions may include:

   - Vocational rehabilitation: Assisting individuals in obtaining and maintaining employment.

   - Social skills training: Teaching interpersonal and communication skills to improve social functioning.

   - Supported housing: Providing safe and stable housing options for individuals who may struggle with independent living.

   - Assertive community treatment (ACT): Delivering mental health services in community settings which includes case management, medication management, and psychosocial support.

- Recreational therapy: Engaging individuals in structured activities that promote social and physical skills, manage symptoms, and enhance cognitive function. Activities like group sports, art sessions, or music therapy (just to name a few) help to build confidence, reduce stress, and connect with others in the community.

- Peer support: Connecting with others who have lived experience with the condition can provide validation, encouragement, and practical advice for coping with symptoms and challenges.

For more information about schizophrenia, including resources for supporting someone with schizophrenia, connecting with others who have schizophrenia (or connecting with others who are supporting someone with schizophrenia), and updates on research into this condition, the following links may be helpful:

• Helping Someone with Schizophrenia
• Peer Support Groups (Schizophrenia & Psychosis Actional Alliance)
• Mental Health First Aid: Schizophrenia
• Health Direct
• NeuRA

Dr. Carissa Coulston-Parkinson is a Clinical Psychologist with specialist knowledge in the areas of depression, bipolar disorder, anxiety, schizophrenia, intellectual disability, personality disorders, traumatic brain injury and neurological conditions.