Schizophrenia: signs and treatment

Schizophrenia is a mental illness. It is serious, but in many cases it is easy to treat. More about symptoms, diagnosis and therapy

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In a nutshell: what is schizophrenia?

Schizophrenia is a mental illness that can manifest itself in very different ways. It influences thinking, perception, action and feelings. Those affected perceive reality in a different way.

There are a variety of possible symptoms. In acute phases, for example, some patients hear voices, develop delusional ideas or perceive their own thoughts as alien. It is wrong to believe that those affected have a split personality.

Schizophrenias are common all over the world. They occur in poor and rich countries and different cultures. The risk of developing some form of schizophrenia once in a lifetime is around one percent. The disease can occur at any age, most commonly it begins in early adulthood before the age of 35.

Schizophrenias can develop in different ways. Sometimes it remains an acute episode, more often a more wavy or chronic course. Usually, schizophrenia is treated with medication and psychotherapy.

Schizophrenia: early detection is important

Schizophrenia may appear before the first acute phase occurs. The symptoms in this preliminary stage are often unspecific. Therefore, they are not always associated with schizophrenia.

Possible early symptoms include:

  • Disturbance of perception and thought processes
  • Restlessness, fears, tense or depressed mood
  • Difficulty concentrating
  • Retreat from friends and family

The symptoms mentioned can also have other causes.

Experts believe that starting therapy early improves the prognosis of schizophrenia. Therefore, early detection centers were set up. They advise - also anonymously.

The offers are aimed in particular at young adults. Anyone who notices changes in themselves - such as concentration problems, sudden distrust of other people or uncanny perceptions - can be advised and examined by specialists there.

There are addresses of early detection centers, for example, on the website of the FeTZ Berlin-Brandenburg:

or at the Competence Network Schizophrenia:

Symptoms: Other possible signs of schizophrenia

The following symptoms can indicate schizophrenia - but do not have to be. Other diseases are also possible causes. Individual symptoms sometimes show up in healthy people without the need for therapy:

  • Thought disorders: concentration and attention are difficult. Thoughts get stuck again and again and abruptly break off. Individual thoughts slide in, disturb the flow of thoughts.
  • Hallucinations: In the acute episode of the illness, sufferers may experience hallucinations. For example, they hear noises or voices that are not actually there, such as the voices of their loved ones. Often these voices comment or criticize, and they may be perceived as threatening. Other types of hallucinations can occur as well.
  • Delusional ideas: Affected people construct delusions that have no real basis, but seem to them to be conclusive. They think, for example, that they are being eavesdropped or followed. Others mistakenly refer to impressions in their environment. For example, they believe they see a hidden message addressed to them in the television program. There are also delusions of grandeur and religious delusions.
  • Ego disorder: those affected experience some areas of their own world of thought as alien, not belonging to themselves. They have the impression that strange thoughts are given to them from outside or that their own thoughts are being withdrawn from them.
  • Drive disorders: Some people affected appear powerless and apathetic, lose interest in their environment and withdraw. In severe cases, those affected can neglect daily eating and personal hygiene.
  • Change in mood: Those affected may no longer show or feel any pronounced emotions. Your mood may be irritable or suspicious. Or they feel incompatible feelings side by side - anger and happiness, love and hate.
  • Movement disorders: Experts refer to conspicuous motor disorders as catatonic symptoms, which have become rare with today's treatment options. For example, patients appear frozen in phases and show no facial expressions (so-called stupor). Such episodes can alternate with phases of severe agitation.

The symptoms described do not have to be present in schizophrenia. They can vary over the course of the disease and from patient to patient.

What are positive and negative symptoms?

Experts differentiate between positive symptoms and negative symptoms - but not in the sense of a rating.

  • Positive symptoms: There is something added that cannot be detected in healthy people - for example delusions or hallucinations.
  • Negative symptoms: Something is missing that would normally be there - for example drive or facial expressions.

There are also so-called cognitive symptoms. They affect thinking - such as the inability to concentrate on facts or to think thoughts through to the end in an orderly manner.

Various sub-forms of schizophrenic diseases have been described. These include:

  • Paranoid-hallucinatory schizophrenia: Dominant symptoms are delusions and hallucinations
  • Hebephrenic schizophrenia: It typically begins in teenagers. Above all, thinking, drive and emotional disorders are in the foreground
  • Catatonic schizophrenia: The main characteristic of catatonic schizophrenia are movement disorders (catatonic symptoms, see above)

However, the various forms are not stable over time. They can alternate with one another, and according to the current state of knowledge, no definable causes can be differentiated.

Some symptoms overlap with those of other mental illnesses, such as mania or severe depression. Then a safe demarcation can be difficult.

Statistically speaking, people with schizophrenia are more likely to suffer from other mental illnesses such as depression and from alcohol or drug addiction. The risk of some physical illnesses such as diabetes or cardiovascular diseases is also increased, as is the risk of suicide.

What are the causes of schizophrenia?

Exactly how schizophrenia develops is not clear. As far as we know today, different factors work together. Presumably, some people already have a certain "susceptibility" to the disease. The following points can play a role:


There is a certain familial predisposition to schizophrenia. This is supported by observations on twins, for example: Identical twins are genetically identical. If one of them falls ill with schizophrenia, the risk for the second increases more clearly than would be the case with genetically different siblings.

However, the risk of disease is not based on a single gene. It is more likely that many different genes work together. The fact that the predisposition is present does not mean that the disease has to occur. So schizophrenia is not simply "inherited" directly.

Changes in the brain?

Presumably, there is a change in certain brain messenger substances and a change in information processing. For example, harmful influences before or after the birth are discussed as a possible cause. Researchers are also trying to find out whether and which abnormalities can be identified in the brain of sick people - for example by comparing brain images of healthy people and those affected. There are no final results on this yet.

Life events?

External influences can possibly contribute to the disease in people at risk, for example very stressful experiences or severe stress. The use of some drugs, such as hashish or marijuana, may cause schizophrenia to break out earlier, if predisposed to it. However, such factors are not considered to be the sole causes of the disease.


The first point of contact may be the family doctor. If he suspects that it is schizophrenia, he will usually be referred to a specialist in psychiatry and psychotherapy.

The doctor will speak to the patient to get an idea of ​​their symptoms. Communication can be difficult in the acute episode of illness. Due to illness, those affected cannot always be convinced that they are ill and that therapy is advisable.

In conversation with the patient - and if possible also with his relatives - the expert tries to differentiate between other mental illnesses. Psychological tests help assess the patient's memory function or attention.

In order to rule out physical illnesses as the cause, the doctor may take pictures of the brain - for example using magnetic resonance imaging (MRI). Blood tests allow conclusions to be drawn, for example, about thyroid function, liver and kidney health or infections.

The diagnosis is made today in Germany based on the criteria of the International Classification of Diseases of the World Health Organization (ICD-10). It describes nine symptom groups from which the diagnosis can be derived. By definition, a certain combination of symptoms must be detectable for at least one month.

Therapy: This is how schizophrenia is treated

A treatment essentially consists of three components:

1. Medicines (primarily antipsychotics, formerly known as neuroleptics)

2. Psychoeducation and psychotherapy

3. Sociotherapy (concrete help in everyday life)

How the components are weighted in each individual case depends on the phase of the illness and the individual treatment goal. In many cases, treatment is initially provided in a psychiatric-psychotherapeutic clinic or day clinic, with milder courses on an outpatient basis.

1. Medicines

Medicines are usually used in the acute episode. Above all, they have a beneficial effect on psychotic symptoms such as delusions and hallucinations. Negative symptoms and cognitive disorders (see "Symptoms" section) are often less responsive to them.

Which drug is selected must be decided on an individual basis. It cannot be predicted with certainty whether it will help in individual cases or whether it will be necessary to switch to another drug. Before starting therapy, possible side effects should be discussed - depending on the active ingredient, for example movement disorders (dyskinesia) or weight gain.

Acute psychotic episodes can last for several weeks. If the disease is relapsing, there are often months or years between the acute episodes. During this time, symptoms can disappear completely or partially persist. However, the disease can also be more continuous.

Whether and how long medication is necessary should be decided on an individual basis. Depending on the situation, they are used for a few years or even permanently. In any case, it should be discussed with the doctor beforehand whether medication can be discontinued.

2. Psychoeducation and psychotherapy

It is important that those affected - and, if possible, their relatives - receive as well-founded information as possible about the disease. This so-called psychoeducation should enable patients, among other things, to better understand the disease, to recognize signs of a relapse at an early stage and to react quickly to it. The aim is always a trusting cooperation between those affected and therapists in order to promote self-responsible dealing with the disease and to support those affected and their relatives in coping with the disease.

Overall, psychotherapeutic methods are gaining in importance in the treatment of schizophrenia. For example, they help those affected to cope better with stress and conflicts in their everyday lives, to develop workable solutions to problems and to train social skills. Therapists are also trying out new techniques that guide patients, for example, in assessing their own thinking. In the best case, those affected recognize problematic thought traps and can learn, for example, to jump to conclusions less due to illness. In addition to improving the symptoms, psychotherapy can support those affected in their abilities to participate in social activities and to do satisfactory work.

3. Sociotherapy and rehabilitation

Sociotherapeutic methods help patients back into a life that is as independent as possible. Supervisors and therapists motivate those affected, for example, to structure their daily routine in a meaningful way, to do all the necessary everyday tasks such as shopping and cooking. They help patients to actively shape their free time, not to isolate themselves, but to make contacts - for example in meeting places.

Another important goal is that patients also use suitable offers of help in the long term. As far as possible, those affected should find their way back to work. Occupational rehabilitation measures can be helpful here.

Against the stigma

Unfortunately, those affected and their families still have to fight against discrimination and prejudice - for example the misconception that everyone with schizophrenia is less intelligent, violent or unpredictable. Various initiatives have set themselves the goal of educating people about the disease and advocating for those affected and their relatives - for example "BASTA - the alliance for mentally ill people", part of the global "Open the Doors" program:

Prof. Dr. Florian Schlagenhauf

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Consulting expert

Professor Dr. med. Florian Schlagenhauf is a specialist in psychiatry and psychotherapy. Since 2017 he has been Heisenberg Professor at the Clinic for Psychiatry and Psychotherapy of the Charité University Medicine Berlin on the Mitte campus. There he is the medical director of the early detection and therapy center for incipient psychotic illnesses in Berlin-Brandenburg (FeTZ).

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.