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JAMA Patient Page
October 1, 2019

Schizophrenia

Author Affiliations
  • 1UT Health San Antonio, San Antonio, Texas
  • 2Cook County Health and Hospital System, Chicago, Illinois
JAMA. 2019;322(13):1322. doi:10.1001/jama.2019.11073

Schizophrenia is a psychiatric disorder that affects approximately 1% of people worldwide.

People with schizophrenia often have hallucinations, which are false perceptions that occur when a stimulus is not actually present. Types of hallucinations include auditory, visual, and tactile hallucinations. Auditory hallucinations are the most common and may be experienced as hearing people talking. Auditory hallucinations can be stressful to the person experiencing them. For example, the voices may cause difficulty with concentration, they may insult the person experiencing them, or they may tell the person to do something that the person does not want to do.

Delusions are another common symptom of schizophrenia. Delusions are false beliefs that are held even though there is evidence that they are not true. Like hallucinations, delusions have the potential to be quite distressing to the person experiencing them. One type of delusion is a paranoid delusion, in which a person believes that they are being persecuted. For example, the person may believe that someone is attempting to stalk or poison them.

Other symptoms of schizophrenia include disorganized speech, poor hygiene, decreased motivation, difficulty expressing emotions, and decreased interest in socializing with friends and family. Cognitive symptoms, such as those that interfere with working memory, frequently cause disability. People with schizophrenia can experience symptoms of mania, depression, or anxiety. Additionally, people with schizophrenia may have problems with using illicit drugs, alcohol, and cigarettes. Symptoms associated with other psychiatric disorders as well as use of illicit substances tend to worsen schizophrenia.

Causes, Diagnosis, and Treatment

Environmental and genetic factors play a role in the development of schizophrenia. A doctor diagnoses schizophrenia by interviewing and observing the patient and by obtaining information about the patient’s current and past symptoms. Because patients with schizophrenia sometimes struggle to describe their symptoms, obtaining information from family and friends is often essential.

The doctor may prescribe an antipsychotic medication. Antipsychotic medications are particularly helpful in decreasing hallucinations and delusions. Potential side effects include restlessness, muscle spasms, abnormal movements, and weight gain. If a patient experiences unwanted side effects, the doctor may change the medication, adjust the dosage, or add another medication to control the symptoms. Because many patients have poor adherence to oral medication, injections that last for multiple weeks are often recommended to patients to avoid relapse.

While medication is the foundation of treatment, a doctor may also recommend individual or group therapy to help a patient understand and cope with schizophrenia. People with schizophrenia have better outcomes with family support. Family education, therapy, or attending a support group are often recommended. Some people with schizophrenia need more care than can be provided by a psychiatrist outside of the hospital, so they may need a hospital stay to help them improve. With treatment, many patients with schizophrenia are able to live independently in the community.

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Owen MJ, Sawa A, Mortensen PB. Schizophrenia. Lancet. 2016;388(10039):86-97. doi:10.1016/S0140-6736(15)01121-6

Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry. 2017;74(7):686-693. doi:10.1001/jamapsychiatry.2017.1322

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