Schizophrenia

Schizophrenia is a serious mental illness that affects thinking, emotions and behaviour. It is the most common form of psychosis.

Over a lifetime, about 1 in 100 people will develop schizophrenia. It is most likely to start between the ages of 15 and 35 years, but can sometimes occur in younger children. The illness might last for a long time and can be very disabling.

We don’t yet know for sure. It is probably a combination of several different things, which will be different for different people.

Genes

Similar genetic ‘risk factors’ are involved in whether someone develops schizophrenia, severe depression or bipolar disorder. There are also environmental risk factors, and these can interact with genetic risk factors to increase or decrease someone's risk of developing these conditions.

For example, someone might have genetic risk factors that mean they are more likely to develop schizophrenia. However, if they grow up or live in a stable and positive environment this may protect them from developing a serious mental illness.

Having a parent with the condition

Having a parent with a serious mental illness like schizophrenia is the strongest known risk factor for someone developing a serious mental illness. Children with a parent who has a serious mental illness have a 1 in 3 chance of developing a serious mental illness themselves.

Although only 1 in 100 people get schizophrenia, about 1 in 10 people with schizophrenia have a parent with the illness.

Twin studies

An identical twin has exactly the same genetic make-up as their other twin, 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.

Brain damage

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 schizophrenia.

Amphetamines can give someone psychotic symptoms, but they usually stop when they 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 someone is vulnerable.

Some people start using drugs or alcohol to cope with symptoms, but this can make things worse.

Cannabis

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 someone starts using cannabis in their early teens.

If someone has smoked it frequently (more than 50 times) during their teens, the effect is even stronger – they are 6 times more likely to develop schizophrenia.

Stress

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 school. Long-term stress, such as family tensions, can also make it worse.

Family problems

At one time people thought that communication problems in the family could cause schizophrenia. This doesn’t seem to be the case. However, if someone has schizophrenia, family tensions can certainly make it worse.

A difficult childhood

As with other mental disorders, schizophrenia is more likely if someone was deprived or physically or sexually abused as a child.

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.

When thinking about the causes of developing schizophrenia, it is important to remember that lots of different things are involved, and that no one risk factor causes schizophrenia.

Schizophrenia affects everybody differently. There are two groups of symptoms, which are described as ‘positive’ and ‘negative’. This doesn’t mean some are good and some are bad; more that some are about ‘doing’ things or experiencing symptoms and some are about ‘not doing’ things (see below). Young people with schizophrenia often have a mixture of the two.

Sometimes, the illness develops slowly and can be hard to spot, although some young people become unwell very quickly.

Positive symptoms

• Strange beliefs or delusions are very strongly held beliefs that are not only untrue, but can seem quite bizarre. The young person may believe that they are someone different, a world leader or celebrity for example, or they may believe that other people are ‘out to get them’. They will believe this is true no matter what you say.
• Thought disorder is when someone is not thinking straight and it is hard to make sense of what they are saying. Their ideas may be jumbled up, but it is more than being muddled or confused.
• Hallucinations are when someone sees, hears, smells or feels something that isn’t really there. The most common hallucination that people have is hearing voices. In schizophrenia, hallucinations are totally real to the person having them. This can be very frightening and can make them believe that they are being watched or picked on. People who are having these experiences may act strangely. For example, they may talk or laugh to themselves or appear to be talking to somebody that you can’t see.

Negative symptoms

The young person suffering from schizophrenia can become withdrawn and appear unemotional. They seem to lose interest, stop washing regularly and can spend a lot of time on their own.

They may not be able to carry on with their normal activities, and usually find it difficult to concentrate on work or study.

Other symptoms

Some young people can become frustrated and angry even towards their own family. Others may take drugs or drink alcohol to feel better. Some find the symptoms so distressing that they want to self-harm.

Despite how they are described in the media, people suffering from schizophrenia are not more dangerous or violent than anyone else. However, they may come across as worrying and unpredictable, especially when they feel frightened by their strange experiences.

The earlier it is recognised that a young person is ill, the better the chances of getting effective treatment. This speeds recovery and reduces the long-term harm. Some people can make a complete recovery.

Even if your child won’t come with you, you might find it helpful to talk to your GP. It is likely that you will be referred to a psychiatrist in a child and adolescent mental health service or an Early Intervention Team or Service (EIS) if this is available locally.

EIS professionals are specialists in working with young people with psychosis. If your child is very unwell, they may need admission to hospital for a period of time until their condition stabilises.

Medications called ‘antipsychotics’ are an important part of the treatment of schizophrenia. They treat the symptoms of the illness, but tend to be more effective with positive symptoms than negative symptoms. Hallucinations and delusions may take weeks and sometimes months to improve. Unfortunately, schizophrenia can recur, and may need long-term treatment.

A number of different antipsychotics are available, and the psychiatrist will advise which is the best for your child. Sometimes, several different drugs will need to be tried to find the most effective for a particular young person..

As with all medication, there can be side-effects. The psychiatrists will advise on these and what can be done to help. The risk of side-effects needs to be balanced against the risk of the damaging effects of the illness on a young person’s life.

Some medicine for the treatment of schizophrenia are 'unlicensed' in children and young people. This does not mean they do not work, but simple that the drug company has not applied for a license. If you are worried about this, you should speak to your doctor or pharmacist.

It is crucial that medication is combined with practical help and support for the young person and their family. This should cover:

Understanding the illness

It is very important that the young person with schizophrenia and their family are helped to understand the condition.

Resuming education, training or starting work

An episode of schizophrenia can interfere with education because it is difficult for a young person to learn when unwell. An important part of recovery is to plan for their future.

Family relationships

Experiencing stress, hostility and criticism can all increase the chance of relapse. Families need help with recognising and reducing these factors, and with how best to support the young person.

As is a normal transition for others of their age, young people with schizophrenia can benefit from leaving home and living independently; the professionals working with them will be able to support the process.

Coping with specific symptoms

Some people with schizophrenia find Cognitive Behavioural Therapy (CBT) helpful in managing hallucinations, in addition to the medicine prescribed.

When Justin was 15, he seemed like a typical teenager at home. Suddenly he stopped going out on his bike, and instead spent long hours in his room on his computer. He did not show any interest in doing the engineering degree at university, his childhood dream. Instead he said he could create his own lab and make amazing discoveries.

I brushed aside this as fantasy, but over next few months he only talked about this more and more, and spent most of his time on the computer exploring science websites, books. He seemed to talk like he knew everything, but it actually none of it made any sense.

He started collecting batteries, wires in his room, staying awake at night, not bothering to talk, eat or sleep. I got really worried when he refused to go to school after shouting at the teacher.

My neighbour told me to go to the GP. She had someone in family with mental illness. I was really scared, felt devastated when our GP referred Justin to the Child and Family Mental Health Service (CAMHS).

It was really difficult at first, even to get Justin to the appointments or to talk. But the mental health nurse and practitioner were very good.

They knew immediately that something was wrong. Once Justin had been put on medication, they met with the school to help him complete his subjects.

Justin was upset and depressed once his strange thoughts went away. He even thought of suicide, but CAMHS were there all the way, never made him feel it was his mistake or that it cannot get better.

They were even there when Justin moved to adult services and supported accommodation. He is in College now, even has a girlfriend. He has had few ups and downs, but schizophrenia doesn’t seem to be as bad as they show in movies.

Young Minds - A charity that offers information to young people about mental health and emotional well-being.

Mind - national mental health charity for England and Wales.

TalktoFrank - for drug induced psychosis.

References

Rutter’s Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.

National Institute of Clinical Excellence (NICE, 2009), Clinical Guidelines, CG82: Core interventions in the treatment and management of schizophrenia in primary and secondary care (update).

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Jenny Forshaw,  Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy..

This resource reflects the best possible evidence at the time of writing.