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About this leaflet
This leaflet may be helpful if:
- you have a diagnosis of
- you think you might have
- you know someone with this
- you just want to know more
- what it is like to have
- what causes it
- what can help
- how to help yourself
- information for
Why do we use the “S” word?
‘Schizophrenia’ is a word that makes many
people uneasy. The media regularly uses it – inaccurately and
unfairly – to describe violence and disturbance. So,
it's hardly surprising that many people find this diagnosis
unhelpful. It can feel as though someone has judged you to be
violent and out of control – when you clearly are not.
We still use the word 'schizophrenia'
because a better one has not been agreed for the pattern of
symptoms and behaviours described here. Even if you don’t find the
word helpful, we hope that the information in this leaflet can
still be useful.
What is schizophrenia?
A disorder of the mind that affects how
you think, feel and behave. Its symptoms are often
called either ‘positive’ or ‘negative’.
These are unusual experiences. Many people
have them from time to time and they need not be a problem. In
schizophrenia, they tend to be much more intense, troublesome,
pre-occupying and distressing.
A hallucination happens when you hear, smell,
feel or see something - but it isn't caused by anything
(or anybody) around you. The commonest one is hearing voices.
What do voices sound like?
They sound utterly real. They usually seem to
be coming from outside you, although other people can’t hear them.
You may hear them coming from different places, or they may seem to
come from a particular place or thing. Voices can talk to you
directly or talk to each other about you – it can be like
over-hearing a conversation. They can be pleasant, but are often
rude, critical, abusive or just plain irritating.
How do people
react to them?
You may try to ignore them, talk back to them
– or even shout back at them if they are particularly loud or
irritating. You may feel that you have to do what they tell you,
even if you know you shouldn't. You may wonder if they are they
coming from hidden microphones, from loudspeakers, or the spirit
Where do they come from?
Voices are not imaginary – you really do hear
them - but they are created by the mind. Scans have shown that the
part of the brain that 'lights up' when you hear voices is the
same area that is active when you talk, or form words in your mind.
The brain seems to mistake some of your thoughts, or ‘inner
speech’, for voices coming from outside you.
Do other people
You can also hear voices in severe
depression. They tend to be simpler, repeating the same
negative or critical word or phrase over and over again.
You can also hear voices which don't
interfere with your life. They may be pleasant, or not very loud,
or only happen from time to time. These voices do not usually call
for any kind of treatment.
Other kinds of
You may see things that aren't there, or may
smell or taste things that aren't there. Some people have
uncomfortable or painful feelings in their body, or feelings of
being touched or hit.
A delusion happens when you believe something
– and are completely sure of it – while other people think you have
misunderstood what is happening. It's as though you see
things in a completely different way from everyone else. You
have no doubts, but other people see your belief as mistaken,
unrealistic or strange. If you do try to talk about your ideas with
someone, your reasons don’t make sense to them, or you can’t
explain – you ‘just know’. It's an idea, or set of ideas, that
can't be explained as part of your culture, background or
How does it
- It may suddenly dawn on you
that at last you really understand what is going on. This may
follow weeks or months when you have felt that there has been
something wrong, but that you couldn’t work out what it was.
- A delusional idea can be a
way of explaining hallucinations. If you hear voices that talk
about you, you may explain it to yourself with the idea that a
government agency is tracking you.
These are ideas that make you feel persecuted
or harassed. They may be:
- unusual – it feels as though
MI5 or the government is spying on you. You may think that others
are influencing you with special powers or technology.
- everyday - you start to
believe your partner is unfaithful. You are convinvinced by odd
details that seem to have nothing to do with sex or not being
faithful. Other people can't see the connection.
- upsetting – feeling
persecuted is obviously upsetting for you. It can also be
distressing for the people you see as your persecutors, especially
if they are close to you, like your family.
You start to see special meanings in ordinary,
day-to-day events. It feels as though things are specially
connected to you – that radio or TV programmes are about you, or
that someone is telling you things in odd ways, for example,
through the colours of cars passing in the street.
- Delusions may, or may not,
affect the way you behave.
- It can be hard to talk to
other people about them – you realise that they won't
- If you feel that other
people are trying to harm or harass you, you will probably just
keep to yourself. If you feel really threatened, you may want to
hit back in some way.
- You may try to escape your
feelings of persecution by moving from place to place. After a few
days or weeks in a new place though, the feelings just come
Muddled thinking (or ‘thought disorder’)
You find it harder to concentrate – it's more
and more difficult to:
- finish an article in the newspaper or watch a TV programme to
- keep up with your studies at college
- keep your mind on your job at work.
Your thoughts wander. You drift from idea to
idea – but there's no clear connection between them. After a minute
or two you can’t remember what you were originally trying to think
about. Some people describe their thoughts as being ‘misty’ or
‘hazy’ when this is happening. When your thoughts are disconnected
in this way, it can be hard for other people to understand you.
Feelings of being controlled
You feel that:
- your thoughts have suddenly
disappeared – as though someone has taken them out of your
- your thoughts feel as though
they are not yours – it's as though someone else has put them into
- your body is being taken over,
or that you are being controlled like a puppet or a robot.
Some people explain these experiences by
thinking it's the radio, television or laser beams, or that a
device has been implanted in them. Other people blame witchcraft,
angry spirits, God or the Devil.
- You start to lose your normal
thoughts, feelings and motivations.
- You lose interest in life.
Your energy, emotions and ‘get-up-and-go’ just drain away. It’s
hard to feel excited or enthusiastic about anything.
- You can’t concentrate.
- You don't bother to get up
or go out of the house.
- You stop washing or tidying,
or keeping your clothes clean.
- You feel uncomfortable with
People can find it hard to understand that
negative symptoms are really symptoms – not just laziness. This can
make it difficult for both you and your family. Your family feel
that you just need to pull yourself together. You can’t explain
that … you just can’t. Negative symptoms are less dramatic than
positive symptoms, but can be really hard to live with.
Does everyone with schizophrenia have all these
No. You can hear voices and have negative
symptoms, but may not have delusional ideas. Some people with
delusional ideas seem to have very few negative symptoms. If you
only have thought disorder and negative symptoms, they may not be
recognised for years. Other aspects include:
Loss of "insight"
It feels as though everyone else is wrong,
that they just can’t understand the things that you can. You feel
that the problem is with the rest of the world, not with you.
- If you develop schizophrenia for the first time, there is a
roughly 50-50 chance that you will feel depressed, often
before you get more obvious symptoms.
- Around 1 in 7 people with continuing symptoms will become
depressed. This can be mistaken for negative symptoms.
- Antipsychotic medication has been blamed – but research
suggests that it actually helps depression in schizophrenia.
- If you have schizophrenia and feel depressed, make sure that you
tell someone and that they take you seriously.
How common is schizophrenia?
It affects around 1 in every 100 people over
the course of their life.
Who gets it?
It affects men and women equally and seems to
be more common in city areas and in some ethnic minority groups. It
is rare before the age of 15, but can start at any time after this,
most often between the ages of 15 to 35.
What causes schizophrenia?
We don’t yet know for sure. It is probably a
combination of several different things, which will be different
for different people.
Although only 1 in 100 people get
schizophrenia, about 1 in 10 people with schizophrenia have a
parent with the illness.
An identical twin has exactly the
same genetic make-up as his or her brother or sister, down to the
smallest piece of DNA. If one identical twin has schizophrenia,
their twin has about a 50:50 chance of having it too.
Non-identical twins have a different
genetic make-up to each other. If one of them has schizophrenia,
the risk to the other twin is just slightly more than for any other
brother or sister. These findings are much the same even if twins
are adopted and brought up in different families.
1 in 100
1 in 10
1 identical twin (same genetic make up)
1 in 2
1 non-identical twin (different genetic make
1 in 8
Brain scans show that there are differences in
the brains of some people with schizophrenia – but not in others.
Where this is the case, it may be that parts of the brain have not
grown normally because of:
- a problem during birth that
stops the baby’s brain from getting enough oxygen
- a virus infection during the
early months of pregnancy.
Drugs and alcohol
Sometimes, street drugs seem to bring on
Amphetamines can give you psychotic symptoms,
but they usually stop when you stop taking the amphetamines. We
don’t yet know whether these drugs, on their own, can trigger off a
long-term illness, but they may do if you are vulnerable.
It can be easy to use drugs or alcohol to cope
with symptoms, but this usually makes things worse.
- The heavy use of cannabis seems to double the risk of
developing schizophrenia. New research has shown that the stronger
forms of cannabis, such as skunk, may increase this risk.
- It’s more likely if you start using cannabis in your early
- If you have smoked it frequently (more than 50 times) during
your teens, the effect is even stronger – you are 6 times more
likely to develop schizophrenia.
Difficulties often seem to happen shortly
before symptoms get worse. This may be a sudden event like a car
accident, bereavement or moving home. It can be an everyday
problem, such as difficulty with work or studies. Long-term stress,
such as family tensions, can also make it worse.
At one time people thought that communication
problems in the family could cause schizophrenia. This doesn’t seem
to be the case. However, if you have schizophrenia, family tensions
can certainly make it worse.
As with other mental disorders, schizophrenia
is more likely if you were deprived or physically or sexually
abused as a child.
What about violence in schizophrenia?
A few people with schizophrenia do become
violent – they usually hurt themselves but sometimes hurt other
people. This can be caused by feelings of persecution or voices
telling them to do it – often a combination of the two. It is much
more likely if the person has used drugs or alcohol.
Many people with schizophrenia now never have
to go into hospital and are able to settle down, work and have
For every 5 people with schizophrenia:
- 1 will get better within five years of
their first obvious symptoms
- 3 will get better, but will have times when
they get worse again
- 1 will have troublesome symptoms for long
periods of time.
What will happen without treatment?
If you just hear voices, don't mind them and
they don't interfere with your life, you probably may not need any
special help. However, if the voices become too loud or unpleasant
(or if other symptoms develop), then you should talk it over with a
Suicide is more common in schizophrenia –
particularly if someone has symptoms, has become depressed, is not
getting treatment or is getting less help than they used to.
The evidence is beginning to suggest that if
schizophrenia is treated early:
- you are less likely to have to come into hospital
- you are less likely to need intensive support at home
- if you do come into hospital, you will spend less time
- you are more likely to be able to work and live
If you have the symptoms of
schizophrenia for the first time, you should start medication as
soon as possible.
You may not need to come into hospital, but
you will need to see a psychiatrist and a community mental health
team. They will usually be able to plan your treatment with you at
home. Even if you do have to come into hospital, it will only be
until you are well enough to manage at home.
This can help the most disturbing symptoms of
the illness – but it is not the whole answer. It is usually an
important step which can make other kinds of help possible. Other
important parts of recovery are support from families and friends,
psychological treatments and services such as supported housing,
day care and employment schemes.
Why take medication?
Medication reduces the
effects of the symptoms on your life. Medication should:
- weaken delusions and hallucinations gradually, over a period of
a few weeks;
- help your thoughts to be clearer;
- increase your motivation and ability to look after yourself –
although too much medication (or the wrong medication for you) can
have the opposite effect.
How is it taken?
- As tablets, capsules, or syrup. It’s hard for anybody to
remember to take tablets several times a day, so there are now some
that you only need to take once a day.
- If you find it hard to take tablets every day, you may find it
easier to take antipsychotic
medication as an injection every 2, 3 or 4 weeks.
These are called depot injections and are given by a nurse.
How well does medication work?
- About 4 in 5 people get help from them. They control the
symptoms, but do not get rid of them. You have to go on taking the
medication to stop the symptoms from coming back.
- Even if the medication helps, the symptoms may come back. This
is much less likely to happen if you carry on taking medication,
even when you feel well.
How long will I have to take medication
- Most psychiatrists will suggest that you take medication for a
- If you want to reduce or stop your medication, discuss this
with your doctor.
- Reduce your medication gradually. If you do this, you can
notice any symptoms returning before you become really unwell
What happens when I stop taking medication?
The symptoms will usually come
back – not immediately, but usually within 3 – 6 months.
You can find more information about antipsychotic medication
on our website.
Getting back to normal
Schizophrenia can make everyday life hard to
deal with. This may or may not be due to the symptoms. Sometimes
you may just get out of the habit of doing things for yourself. It
can be difficult to get back to doing ordinary things like washing,
answering the door, shopping, making a phone call or chatting with
Psychological (or talking) treatments
Cognitive Behavioural Therapy (CBT)
This can be done by clinical psychologists,
psychiatrists or nurse therapists. It helps you to:
- concentrate on the problems that you find most difficult. These
could be thoughts, hallucinations or feelings that you are being
- look at how you tend to think about them – your ‘thinking
- look at how you react to them – your ‘behaving habits’.
- look at how your thinking or behaving habits affect you.
- work out if any of these thinking or behaving habits are
unrealistic or unhelpful.
- work out more helpful ways of thinking about these things or
reacting to them.
- try out new ways of thinking and behaving.
- see if these work. If they do, to help you use them regularly.
If they don’t, to find better ones that do work for you.
This kind of therapy can help you to feel
better about yourself and to learn new ways of solving problems. We
now know that CBT can
also help you to control troublesome hallucinations or delusional
ideas. Most people have between 8 and 20 sessions, each lasting
about 1 hour. To help the symptoms of schizophrenia, you may need
to carry on with ‘booster’ courses from time to time.
Counselling and supportive psychotherapy
These can help you to:
- get things off your chest
- talk things over in more depth
- get some help with the daily problems of life.
These try to help you and your family cope
better with the situation. They can be used to discuss information
about schizophrenia, how best to support someone with schizophrenia
and how to solve the practical problems that can crop up.
Around 10 meetings are held over a period of about 6
Support from the Community Mental Health Team (CMHT) or
Early Intervention Team
- A mental health worker from
your local team (your care coordinator) should see you
regularly.Community psychiatric nurses can give you time to talk
and can help sort out problems with medication.
- Occupational therapists can:
- help you to be clear what
your skills are and what you can do
- show you how to improve
things you aren’t doing so well
- work out ways of helping you
to do more for yourself
- help you to improve your
social skills (how to get on with other people).
- There may be help for families, with regular meetings for a
while.These can help the family to:
- learn more about the illness and treatment
- sort out some of the practical problems of day to day
- The psychiatrist will usually organise your medication and take
responsibility for your overall care.
- The care coordinator is
responsible for making sure that you get the care you need.
- Vocational rehabilitation or
recovery workers can help you to get back into work, education or
some sort of activity that you find rewarding.
How treatments compare
- Apart from clozapine, there seem to
be few differences in the effectiveness of any of the
antipsychotics. Which antipsychotics you start with will need
to be discussed fully with your doctor, taking into account
their possible side-effects.
- It is also not possible to
say in advance whether one antipsychotic will work better for
you than another. You may need to try one antipsychotic and see how
you get on with it. If it doesn't help you, or if the side-effects
are a problem, your psychiatrist will help you to find one that
- Clozapine does seem to work
better than other antipsychotics for some people. However, its
side-effects can be dangerous, so it can only be
prescribed by a specialist after other treatments have failed. If
you have had both a ‘typical’ antipsychotic and an ‘atypical’
antipsychotic for 8 weeks without real help from either,
clozapine may be worth trying.
- CBT seems to be helpful in
people who are taking medication, but we don’t know how well it
works if someone is not taking medication. It may be particularly
helpful in very early schizophrenia.
- If you want further
information about treatments, see the NICE guidelines (listed
- If you are unhappy with your
treatment, you can ask for a second opinion from another
You may not be working, or may be unable to go
back to work. Even so, it’s good to get out and do something every
Many people go regularly to a day hospital,
day centre, or community mental health centre. These have a number
of things you can do – keep fit, creative pursuits like painting
and pottery, education or getting back to work activities. You can
get active again and spend some time with other people.
These facilities don't exist in some areas
where there is, perhaps, more emphasis on helping people to be
included in ‘mainstream’ activities for everybody, whether or not
they have had psychological difficulties.
These can help you develop your skills for
work. They will often have contacts with local employers and can
support you when you go back to work.
If you are unwell for a long time, you may
need a specialist rehabilitation service.
These use art activities to help people to:
- find different ways of being with other people
- express and understand feelings they may not have been able to
put into words
- to have the satisfaction of creating something.
These activities are usually done in groups.
This could be a bedsit or flat where there is
someone around to help you with day-to-day problems.
CPA – Care Programme Approach (England & Wales
This is a way of making sure that people with
schizophrenia get appropriate care and support. It involves:
- a care coordinator who is responsible for
organising all the different parts of your care and treatment.
- regular meetings every 3 – 6 months. These
involve you, your care coordinator, your psychiatrist and
any other people who are giving you care or support. This can
include your family or carers.
- a care plan that is checked at the regular
CPA meetings. It is re-written each time and you will have a copy
to approve or change.
- plans are made with you at these meetings
about what to do if you find yourself becoming unwell again,
or run into difficulties.
Carers can have an
assessment of their needs every year.
Learn to recognise
early signs that you are getting unwell, such as:
- everyday things like going
off your food, feeling anxious or not sleeping.
- other people may notice that
you stop bothering to change your clothes, clean your flat or cook
- mild symptoms – you feel a
bit suspicious or fearful or start to worry about people’s motives.
You may start to hear voices quietly or occasionally, or find it
difficult to concentrate.
Try to avoid
things that make you worse, such as:
- stressful situations such as
spending too much time with people (although being with people can
be helpful – see below).
- using street drugs or
- getting anxious about bills,
but not asking for help or advice (see our leaflet on
debt and mental
- disagreements with family,
Make sure you regularly do
something you enjoy.
Find ways of controlling your
- spend time with other
- keep busy
- listen to a personal stereo
(TV and radio also work but may annoy your family or
- remind yourself that your
voices can’t harm you
- remind yourself that your
voices don’t have any power over you and can’t force you to do
anything you don’t want to.
Join a self-help
group for people with similar experiences to yours (see
Get someone you
trust to tell you if you are becoming unwell again.
Learn about schizophrenia and your
- talk it over with your nurse,
mental health worker, psychiatrist - or someone else with
- ask for written information
about your diagnosis and treatment
- if your medication is not working well, ask
about other medications.
Look after your body. People with
schizophrenia have poorer health than others, so it's worth looking
- try to eat a balanced diet,
with lots of fresh vegetables and fruit
- try not to smoke –
cigarettes harm your lungs, your heart, your circulation and
- take some regular exercise,
even if it’s only 20 minutes out walking every day. Regular
vigorous exercise (double your pulse rate for 20 minutes 3 times a
week) can help improve your mood.
If there is an inaccurate or abusive
item about schizophrenia in the press, a radio talk show
or on TV, don’t get depressed, get active. Write a letter, e-mail
them, phone them up and tell them where they are wrong. It does
Avoid street drugs.
For families ...
It can be hard to understand
what is happening if your son or daughter, husband or wife, brother
or sister develops schizophrenia. Sometimes, no-one realises what
What do you see?
Your relative may become odd, distant or just
different from how they used to be. They may avoid contact with
people and become less active. If they have delusional ideas,
they may talk about them but may also keep quiet about them. If
they are hearing voices, they may suddenly look away from you as if
they are listening to something else. When you speak to them, they
may say little, or be difficult to understand. Their sleep pattern
may change so that they stay up all night and sleep during the
In a teenager, you may wonder if this
behaviour is just rebellious. It can happen so slowly that only
when you look back can you see when it started. It can be
particularly difficult to recognise these changes during the
teenage years, when young people are changing so much anyway.
Was it my fault?
You may start to blame yourself and wonder
‘Was it my fault?’ You may wonder if anyone else in the
family is going to be affected, what the future holds, or how they
can get the best help.
Can I talk to the mental health team?
Families have often been left out of
discussions because of worries about confidentiality. This should
not be the case now. People with schizophrenia are often living
with or being supported by their family. So, their family should
have the information that will allow them to care most effectively.
Even if the person does not want their family to be involved, the
family can still tell the mental health team about what is going
Families deserve the help and information they
need, and mental health teams need to listen to their worries and
Several voluntary organisations concerned with
schizophrenia provide useful information and support (see
What can we do?
Families also need advice. What do they need
to do? Schizophrenia makes you more sensitive to stress, so it is
helpful to avoid arguments and keep calm - perhaps easier said than
Isn't schizophrenia a split personality?
No. Too many people have the idea that someone
with schizophrenia can appear perfectly normal at one moment, and
change into a different person the next. This is not true.
People can misuse the word ‘schizophrenia’ in
two different ways to mean:
- Having mixed or contradictory
feelings about something. This is just part of human nature - a
much better word is ‘ambivalent’.
- That someone behaves in very
different ways at different times. Again, this is just part of
Doesn't schizophrenia make people
People who suffer from schizophrenia are
usually not dangerous. Any violent behaviour is usually
sparked off by street drugs or alcohol. This is similar to the
situation with people who don’t suffer from schizophrenia.
Although there is a higher risk of violent
behaviour if you have schizophrenia, it is very small compared to
the effects of drugs and alcohol in our society. People with
schizophrenia are far more likely to be harmed by other people than
other people are to be harmed by them.
Schizophrenia never gets better
1 in 4-5 people with schizophrenia recover
completely, another 3 out of 5 people with schizophrenia will be
helped or get better with treatment.
This website is all about unfounded or
excessive fears about others.
Helpline: 0300 5000 927
National voluntary organisation that helps people with any
severe mental illness, their families and carers.
Works to improve the wellbeing and quality of life of people
affected by serious mental illness. This includes those who are
family members, carers and supporters.
Publishes a wide range of literature on all aspects of mental
Helpline: 0845 767 8000 (1pm to 11pm every day of the
A national mental health helpline offering emotional support
and practical information for people with mental illness, families,
carers and professionals.
Shine: supporting people with
mental ill health (Ireland)
Fast Facts: Schizophrenia. S Lewis and RW
Living with schizophrenia. N Burton and P
Arsenault, L. et al. (2004) Causal association
between cannabis and psychosis: examination of the evidence.
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Appleby L. et al. (1999) Aftercare and
clinical characteristics of people with mental illness who commit
suicide: a case-control study. Lancet, 353: 1397-1400.
Bebbington P. (2001) Choosing antipsychotic
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Bebbington P. et al. (2004) Psychosis,
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Di Forti M. et al. (2009) High-potency
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Fanous A. et al. (2001) Relationship Between
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Loebel, A. D., Lieberman, J. A., Alvir, J. M.,
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in Psychiatric Treatment, 6, 169-177.
Schizophrenia: core intervention in the
treatment and management of schizophrenia in primary and secondary
care. NICE guidelines, 2009.
Schizophrenia: atypical antipsychotics: the
clinical effectiveness and cost effectiveness of newer atypical
antipsychotic drugs in schizophrenia: NICE guidelines, 2002.
Spencer, E., Birchwood, M. & McGovern D.
(2001) Management of first-episode psychosis. Advances in
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This leaflet is based on the NICE
Produced by the Royal College of Psychiatrists' Public Education
Editor: Dr Philip Timms
User & Carer input: Members of the RCPsych Service User
Recovery Forum and Carers' Forum
This leaflet reflects the best available evidence available at
the time of writing.
© Updated June 2011.
Due for review: June 2013. Royal College of Psychiatrists.
This factsheet may be downloaded, printed out, photocopied and
distributed free of charge as long as the Royal College of
Psychiatrists is properly credited and no profit is gained from its
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. The College
does not allow reposting of its factsheets on other sites, but
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For a catalogue of public education materials or copies of our
leaflets contact: Leaflets Department
Royal College of Psychiatrists, 21 Prescot
Street, London E1 8BB, Telephone: 020 7235
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