On this page we offer some initial answers to questions families commonly ask about schizophrenia.

Our Resources page lists more sources you can refer to.

You can also view or download a free copy of our Coping Skills for Carers book, a manual specifically written for the families and carers of people living with schizophrenia.

Introducing schizophrenia

Schizophrenia is a serious and chronic mental disorder which alters the way a person perceives reality and impairs their everyday functioning.

Symptoms may include delusions and hallucinations as well as disordered thinking and behaviour. The impact of the illness is deeply personal, affecting almost all aspects of an individual’s life. Schizophrenia can interfere with a person’s ability to think clearly, express emotions, make decisions, care for themselves and relate to others.

Schizophrenia is a complex and highly variable illness. It is known as a spectrum disorder because it can manifest in many different ways. The symptoms, pattern and severity of the illness vary from person to person, and are influenced by the timing and nature of the treatment received. Each individual will develop their own particular trajectory. Each case is unique.

Schizophrenia is divided into stages or phases with symptoms presenting in different ways in each phase. Symptoms in the early or prodromal phase may remain undetected until more severe symptoms develop in a first acute episode or psychotic break, requiring hospital treatment. The stabilisation and residual phases which follow may be interspersed with further active phases throughout the course of the illness. The intensity of the symptoms often reduces over time.

Schizophrenia is classified as a psychotic disorder, as psychosis, or losing touch with reality, is a key diagnostic feature of the illness.

It is not true that schizophrenia refers to a split personality – this is an unfortunate but common misconception which needs to be dispelled.

The precise cause of schizophrenia is not known. Some people are believed to be more at risk due to an interplay between genetic and environmental factors.

It is thought that genetic factors create an inherent susceptibility or predisposition to developing schizophrenia. Environmental factors, such as certain stressors during pregnancy, birth and early childhood, may contribute to abnormal brain development.

The actual onset of the illness may be triggered by a precipitating event, such as marijuana use, extreme stress, or a traumatic head injury, or may have no apparent trigger.

It is generally agreed that schizophrenia has natural causes and is a biological disease of the brain.

Abnormalities in brain structure, chemistry and functioning cause the abnormal behaviour evident in schizophrenia. Internal communication pathways, connections and interactions in the brain are disrupted by the illness, so that the brain has difficulty with processing stimuli and selecting an appropriate response. This unreliable brain messaging contributes to the distressing symptoms experienced.

When a patient “hears voices”, for example, they are unable to distinguish internal from external stimuli and believe what they are experiencing to be real whereas others know it is not.

No, it is not. The illness has natural causes and it is no one’s fault. This applies equally to the person who has schizophrenia and to their family members . It is not the person’s fault and they did not deliberately do anything to cause their illness. Nor did anyone in the family bring about the illness through their behaviour. Family members should neither feel guilty themselves, nor should they blame their relative for having schizophrenia.

Although a number of associated risk factors have been identified, it is not possible to know ahead of time who will get schizophrenia, No one is immune.

Schizophrenia affects about 1% of the population throughout the world, and is found in all races, cultures and classes. Most often it begins in late adolescence or early adulthood. Onset can be abrupt, in the form of a sudden acute psychotic episode, or gradual, when behaviour changes are noticed more slowly as the brain disorder becomes evident.

The usual age of onset for males, in their late teens to early twenties, is a few years earlier than that for females, where it is likely to start in their twenties or thirties. It is very rare for someone over 40 to get the illness for the first time. Somewhat more males than females are affected by schizophrenia.

Signs and symptoms

The first signs and symptoms of schizophrenia tend to develop slowly over a few years, and may be mistaken for normal signs of adolescence, or interpreted as symptoms of other conditions such as depression. It is often not until the first acute episode of schizophrenia takes place that this early, or prodromal, phase is recognised and diagnosed.

Common early warning signs include:

  • Withdrawal from social life or family activities
  • Becoming silent, listless or depressed
  • Loss of interest in work or studies
  • Disturbed waking and sleeping patterns
  • Neglecting personal grooming and hygiene
  • Inappropriate or dulled emotions
  • Restlessness, increased irritability
  • Difficulty concentrating or paying attention
  • Illogical and confused thoughts
  • Making odd or irrational statements
  • Unrealistic anxiety about everyday situations
  • Imaginary fears and suspicions
  • Hearing voices, seeing imaginary phenomena

People often wait too long before taking their family member to a doctor for an assessment because of family resistance, ignorance, fear of stigma, or “hoping it will go away”. It has been shown that early diagnosis and treatment lead to more favourable outcomes in the long term, as the illness does not have a chance to establish itself as firmly, relapses are less likely and less intense, and brain and behaviour changes can be mitigated at an early stage.

It is advisable to take your loved one for an assessment as soon as possible if schizophrenia is suspected.

Psychosis is a condition which affects the way the brain processes information, causing a person to lose touch with reality. It is not an illness in itself, but a symptom of another illness or condition. Psychotic symptoms include delusions, hallucinations, talking incoherently and agitation. The person with the condition is usually not aware of their behaviour.

In schizophrenia, psychotic symptoms are experienced most strongly during acute psychotic episodes and are absent or not as intense during other phases of the illness.

Apart from mental illnesses such as schizophrenia or bipolar disorder, a number of other conditions can give rise to psychosis. These include physical illness or injury, substance use or abuse, extreme stress or trauma, and cultural phenomena.

A person experiencing psychotic symptoms should be carefully assessed to determine the possible causes. It is not a foregone conclusion that they have schizophrenia.

Historically, the symptoms of schizophrenia have been grouped into three categories:

  • Positive symptoms
  • Negative symptoms
  • Cognitive symptoms

Not every person with schizophrenia will have all the symptoms. The different types of symptoms occur with different intensity in the different phases of the illness and respond differently to treatment.

Positive symptoms

These symptoms are called positive not because they are “good”, but because they are “added on” to normal behaviour. They become present as a result of the illness and are generally absent in healthy individuals. They are strongest in acute episodes, or full-blown schizophrenia, and are treated with antipsychotic medication.

Positive symptoms include:

  • Delusions
  • Hallucinations
  • Disordered thought and speech
  • Disordered or catatonic behaviour.

Delusions are fixed false beliefs that have no basis in reality, and do not make sense in the context of a person’s culture. Types of delusion include, for instance, persecutory or paranoid delusions (“People are trying to harm me”; “Others are out to get me”); delusions of reference (“A person on the television is sending me a special personal message”); delusions of grandeur (“I am an important historical figure”; “I have special powers”); and delusions of control (“I am being controlled by outside forces”; “Someone is inserting thoughts into my mind”; “My thoughts are being broadcast to other people”).

Hallucinations are false sensory perceptions which occur in the absence of any external physical stimulus causing those sensations. Hallucinations can occur in any of the five senses. By far the most common are auditory hallucinations (hearing voices or sounds that others cannot hear), followed by visual hallucinations (seeing people or things that others cannot see).

Disordered or disorganised thought and speech. Disorganised thinking processes become evident in changed speech patterns, which can seriously impair verbal communication.

Disorganised behaviour. Disorganised behaviours are not goal-directed, and don’t make sense or fit into their context. They range from simple problems with self-care tasks like brushing teeth, to unpredictable and bizarre, socially inappropriate outbursts. The person may show random, untriggered agitation, shout at people for no apparent reason or laugh at inappropriate times or without any reason. They may dress in a dishevelled or unusual way, behave oddly or show childlike behaviour.

Catatonic behaviour. In catatonia, a person’s reaction to their surroundings becomes remarkably decreased. They may engage in purposeless and excessive movements, such as pacing up and down or walking in circles. Adopting strange postures or “freezing” in a certain position are other examples of catatonic behaviour.

Negative symptoms

These symptoms are called negative not because they are “bad”, but because they “take away from” or diminish normal behaviour shown by healthy individuals. Some medications may help reduce the symptoms, although it is possible that medication side effects could produce similar symptoms.

Negative symptoms include:

  • Restricted emotional expression
  • Lack of motivation and initiative
  • Diminished social drive
  • Reduced speech
  • Loss of pleasure in activities

They are sometimes referred to as the 5 A’s, namely:

  • Affect flattening
  • Avolition
  • Asociality
  • Alogia
  • Anhedonia

Affect flattening. A person with flattened or blunted affect appears emotionless or shows a very limited range of emotions, for example, an inexpressive or blank face, flat voice, avoiding eye contact.

Avolition or Apathy. The person shows a lack of motivation and initiative and a loss of volition or the will to do things. For example, sitting still for long periods of time, without showing any interest in work or other activities.

Asociality. This refers to a diminished social drive, social isolation, or withdrawal. For example, avoiding contact with family and friends, shutting oneself in one’s room, changing sleeping patterns to be awake at night and asleep in the day, when others are not around.

Alogia is also called poverty of thought and speech. The person struggles to choose words and speaks much less than before. For example, speaking in a monotone, only giving monosyllabic answers to questions.

Anhedonia refers to a loss or decrease of pleasure or interest in activities previously enjoyed, for example, hobbies, work, studies or recreational activities.

Cognitive symptoms

Also known as cognitive deficits or impairments, these symptoms have to do with the way a person thinks. Although not required for a formal diagnosis of schizophrenia, they are usually persistent throughout the various phases of the illness and affect the person’s ability to function, look after themselves, and communicate with others.

Cognitive symptoms include:

  • Difficulty paying attention
  • Certain kinds of memory problems
  • Reduced mental processing speed
  • Impaired “executive function”
  • Impaired illness awareness

Impaired illness awareness, also known as anosognosia, results in lack of insight and is a particularly difficult problem. It is not a choice that the ill person makes, but is a defect of understanding caused by the illness. Lack of insight is one of the most troublesome symptoms of schizophrenia, as a person who is unaware that they are ill does not see the need for treatment, and will often refuse it.

Other symptoms

In addition to positive, negative and cognitive symptoms, there are a number of other more general symptoms often experienced by people with schizophrenia as a result of their overall situation. These include mood disturbances such as distractibility, irritability, confusion, anger, anxiety, fear and depression, sleep disturbances and substance use, especially of tobacco.


There is currently no laboratory, radiological or psychometric test for schizophrenia. An experienced practitioner will need to work towards a diagnosis by performing an assessment based on clinical observations and information gathered from the patient and other sources.

Tests such as blood tests, brain scans, and brain wave pattern tests may be used during the assessment process, but their purpose will be to help rule out medical conditions, such as neurological, metabolic or brain seizure disorders, brain lesions, other brain abnormalities, or the use of street drugs, which may cause similar symptoms to those of schizophrenia.

A diagnosis of schizophrenia relies on a careful clinical assessment by an experienced practitioner, usually a psychiatrist, which will include a full psychiatric evaluation, a medical history and assessment, a physical examination, and a consideration of related factors. A diagnosis cannot be made on the basis of a single symptom at one point in time, but rather on the basis of a characteristic pattern of symptoms over a period of time. As no single symptom is unique to schizophrenia, and symptoms may overlap with those of other psychiatric or medical conditions, alternative causes of the symptoms must be excluded.

Reaching a firm diagnosis may take some time and can be difficult in the early stages of the illness. Sometimes a differential diagnosis, or list of possible illnesses which match the symptoms, is made, and the symptoms are initially treated on the basis of an interim or working diagnosis.

Schizophrenia and bipolar disorder are two major chronic psychiatric disorders, with a similar age of onset, and some symptoms in common. A helpful way of understanding the difference between the two is to think of schizophrenia as a thought disorder, whereas bipolar is a mood disorder.

People with schizophrenia may experience psychotic symptoms, appear to be out of touch with reality, and have difficulties with thinking clearly.

People with bipolar disorder experience strong shifts in energy, mood and activity. Episodes of mania (an elevated, heightened or extremely excited mood) alternate with episodes of depression; while periods of relative stability often separate these two poles.


Scientists have not yet found a cure for the illness, nor a way to prevent it. However, although not curable, schizophrenia is treatable and manageable through a combination of medication, psychosocial rehabilitation and family support. As research into the nature of the illness and new types of antipsychotic medication progresses, the outlook for people living with schizophrenia will continue to improve, especially if it is diagnosed early and treated continuously.

As schizophrenia is a lifelong condition, treatment is likely to be necessary throughout life. Specific treatment interventions will be tailored to the particular phase of the illness.

The aims of treatment are to:

  • Relieve symptoms
  • Prevent relapse
  • Improve functioning
  • Optimise quality of life

The components of an integrated treatment plan are:

  • The right psychiatrist
  • Medication
  • Hospitalisation
  • Psychosocial rehabilitation
  • Family support

The right psychiatrist

It is important to find a psychiatrist with experience in schizophrenia and psychotic disorders. A recommendation from someone with an affected family member can be helpful. A healthy therapeutic alliance between psychiatrist and patient is highly beneficial.


The newer antipsychotic medications are effective for many people and have fewer side effects than the older drugs. Some medications are available in injectable form and need only be given at fortnightly or monthly intervals.


When acutely ill, the affected person is likely to be hospitalised. This provides the clinical setting needed for observation, testing, diagnosis and initiation of medication under supervision by trained staff. Once stabilised, the person will be discharged into the community – often into the care of the family.

Psychosocial rehabilitation

Psychosocial rehabilitation (PSR) complements the medical approach and consists of the range of therapies, services and activities which will help to restore the person’s psychological and social functioning. The aim is to promote independent living and reintegration into the community and workplace as far as realistically possible. The person’s psychiatrist or social worker can advise on locally available options.

Family support

Family support, in tandem with medical and psychosocial support, is a vital part of the person’s treatment plan. By providing a safe place to live and doing their best to create a facilitative emotional and practical environment, the family will give their loved one a stable base for recuperation and further treatment. It is known that family support is effective in reducing the risk of relapse and contributes significantly to positive outcomes for the patient.


The “rule of thirds” has gained general international acceptance. Over their lifetimes:

  • A third of people with schizophrenia are either recovered or improved to the point that they can live and work independently
  • A third are improved but need a strong support network to get by
  • A third show limited improvement, and may have poor response to medication, frequent relapses or need hospitalisation

Outcomes tend to be more favourable when onset is abrupt, or when the person is more mature, than when onset is gradual or at a younger age. A general trend is that symptoms become less severe as the person gets older. It has been shown that with the proper medication and support, the ability of people to live and function relatively well in society is excellent.

In one way or another, an individual diagnosed with schizophrenia will be managing their symptoms and trying to prevent relapse for most of their life. The better they are able to do this, and the more they receive the right kind of support, the more favourable their outlook will be.

It is possible to recover from mental illness. Having recovery as an aspiration can motivate the ill person and their family to do what they realistically can to optimise their quality of life. The following pointers will help clarify what mental health recovery means.

In the mental health context, recovery is understood in a particular way, with the emphasis being on what is called “personal recovery” rather than “clinical recovery”.

Personal recovery means that the person recovers a life worth living; it is distinct from the traditional medical notion of clinical recovery, where a person recovers from an illness and no longer experiences its symptoms.

Recovery from mental illness is not the same as a cure. Individuals may continue to experience symptoms and require ongoing treatment and support.

Personal recovery is a deeply personal process involving much more than recovery from the illness itself. It is when a person takes back control, actively participates in decisions about their treatment, rebuilds a meaningful, satisfying and enjoyable life and contributes to their community – all within the limitations posed by the illness.

It is important, however, that the expectation or hope of recovery should not create additional stress. Every person’s inherent abilities and outcomes will be different. Every person should set their own goals for what recovery means to them, and seek the support they need to help achieve them.


We know that stigma in any aspect of life arises because of ignorance and fear, and commonly results in prejudice, hostility and discrimination. Mental illness remains a taboo subject in our society, and is still regarded as shameful, not talked about openly and not properly understood. The associated stigma can result in the person or their family being avoided and rejected, and can seriously affect the person’s treatment and recovery.

People with schizophrenia are the most stigmatised of the mentally ill. Schizophrenia, as one of the most complex and most misunderstood psychiatric disorders, is widely misrepresented in the media, causing unnecessary confusion and fear. Myths and misconceptions about schizophrenia are propagated in movies, books, the press and in everyday language and conversation; and are seemingly hard-wired in people’s perceptions of the illness.

Public attitudes are hard to change, so families will need to start by changing their own and those of their relatives and friends. Each time a knowledgeable person speaks out about schizophrenia, raises awareness and encourages tolerance, will bring us closer to the day that discrimination against the mentally ill finally becomes socially unacceptable.

The World Health Organisation (WHO) advocates for a world in which mental health care is firmly grounded in a human rights approach. WHO notes that providing community-based mental health care that is both respectful of human rights and focused on recovery is proving successful and cost-effective.

We like this simple version of Rights for People with Mental Illness provided by WHO:

People with mental illness should receive fair treatment and should be accorded certain rights. These include the right:

  • To be treated with respect and dignity
  • To have their privacy protected
  • To receive age and culturally appropriate services
  • To understand available treatment options and alternatives
  • To receive care that does not discriminate on the basis of age, race, or type of illness

Role of the family

The love and support of the family plays an important role in treatment and in the recovery process. Helping and encouraging their loved one to find and stick to the right treatment, obtain benefits, and cope with their symptoms, can make an enormous difference to their prognosis.

But caring for a person with schizophrenia is very challenging. Families must lower their expectations for their loved one while encouraging them to take the next step. They must fight stigma and prejudice where it is encountered but try to retain hope. Families are not superhuman, they need to take care of themselves as well, and they also need support.

Families can keep themselves strong by joining a family support group such as FSS which provides a space for them to work through their grief, become increasingly informed, and reach, hopefully, for a sense of perspective regarding the realities of the ill person.

Growing practical coping skills and providing the best possible support to your loved one will take time and patience.

Click here for FSS’s revised 2022 edition of Coping Skills for Carers. First published by FSS’s predecessor organisation Cape Support for Mental Health in 2008, this manual has provided a welcome source of practical information on a wide range of topics for families and carers of people living with schizophrenia.

Further questions

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