Schizophrenia — understanding psychosis

Schizophrenia is a severe mental illness characterised by psychosis — experiences outside shared reality — plus negative and cognitive symptoms affecting daily function.

~1% lifetime prevalence — equal men and women — men often earlier onset.

Symptoms

Positive (added experiences)

  • Hallucinations — hearing voices most common — may comment, command, or converse
  • Delusions — fixed false beliefs — persecution, reference, grandeur, control
  • Disorganised thinking — speech jumps, neologisms
  • Disorganised behaviour — unpredictable actions

Negative (loss of function)

  • Flat affect — reduced facial expression
  • Avolition — lack of motivation
  • Anhedonia — no pleasure
  • Social withdrawal

Cognitive

  • Working memory, attention, processing speed — often overlooked — affect employment

Prodrome and first episode

Months before psychosis:

  • Withdrawal, school/work decline
  • Odd beliefs, suspiciousness
  • Sleep disturbance

First episode psychosis (FEP) — Early Intervention services — critical window — better outcomes with prompt antipsychotics + therapy

Causes

Multifactorial:

  • Genetic — ~10% risk if first-degree relative
  • Dopamine dysregulation — antipsychotic rationale
  • Neurodevelopmental — prenatal infection, complications
  • Cannabis — especially high THC in adolescence — increases risk
  • NOT bad parenting or weak character

Treatment

Antipsychotics:

  • First episode — low dose, monitor metabolic side effects
  • Clozapine — after 2 failed trials — gold standard for resistant psychosis — blood monitoring

Psychological:

  • CBTp — CBT for psychosis
  • Family intervention — reduce expressed emotion
  • Relapse prevention — early signs diary

Social:

  • Supported employment/education
  • CPA care programme approach

Living with schizophrenia

Recovery model — symptoms managed, meaningful life possible

Side effects matter:

  • Weight gain, metabolic syndrome — annual health checks
  • Tardive dyskinesia — long-term movement disorder — discuss with psychiatrist

Advance statements — preferences when unwell

Crisis

Phone 999 if immediate danger

Crisis team — GP or 111 referral

Sectioning (Mental Health Act) — only when necessary — least restrictive care preferred

Common questions about schizophrenia

What are the symptoms of schizophrenia?
Psychosis — hallucinations (commonly auditory), delusions (paranoid or bizarre beliefs), thought disorder — speech hard to follow. Negative symptoms — reduced expression, apathy, social isolation. Cognitive difficulties — concentration, memory. Symptoms vary between people and over time — not everyone has all features.
Is schizophrenia the same as split personality?
No — completely different condition. Schizophrenia involves psychosis — losing touch with shared reality. Dissociative identity disorder (historically called split personality) is rare and distinct. The name schizophrenia means split mind in Greek — refers to fragmented thinking, not multiple personalities.
How is schizophrenia treated on the NHS?
Antipsychotic medication — risperidone, olanzapine, aripiprazole, clozapine for treatment-resistant cases. Psychological therapies — CBT for psychosis, family intervention. Early Intervention in Psychosis teams for first episode — up to 3 years. Community mental health team for ongoing care. Hospital admission if acutely unwell.
Can people with schizophrenia work and have relationships?
Yes — many do with stable treatment and support. Outcomes vary — some recover well after first episode, others have relapses. Stigma and side effects of medication can be barriers — vocational support and peer groups help. Realistic goals with care plan.
What triggers a relapse in schizophrenia?
Stopping antipsychotics without medical advice is commonest cause. Stress, sleep loss, substance use (especially cannabis and stimulants), and major life events. Relapse prevention plans — recognise early warning signs, contact care coordinator promptly.

Sources

How we reviewed this page

Medically reviewed by Dr Neil Singh, MBChB, nMRCGP

General Practitioner · GMC 7039648

Dr Neil Singh is a General Practitioner based in Yorkshire with over a decade of experience working in UK primary care.

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