Schizophrenia Basics: Delusions, Hallucinations & Onset

Schizophrenia is a mental disorder that is characterized by hallucinations (auditory, visual, olfactory, or tactile) and delusions. It is usually treated with a combination of antipsychotic medications and psychotherapy.

What is Schizophrenia?

Schizophrenia is a serious mental illness characterized by a person experiencing a combination of delusions and hallucinations. Because these delusions and hallucinations feel as real as the world around them, a person with untreated schizophrenia can sometimes have trouble distinguishing actual reality from this altered reality that their brain is telling them.

In spite of advances in the understanding of its causes, course, and treatment, schizophrenia continues to be a condition that has been challenging to researchers, clinicians, and those who suffer from it. It is easier for the average person to cope with the idea of cancer than it is to understand the odd behavior, hallucinations, or strange ideas of the person with this condition. People with schizophrenia suffer from some of the greatest prejudice, stigma, and discrimination associated with any mental illness, according to the National Institute of Mental Health (2018).

As with most mental disorders, the causes of schizophrenia are still pretty poorly understood. Friends and family commonly are shocked, afraid or angry when they learn of the diagnosis. People often imagine a person with psychosis as being more violent or out-of-control than a person who has another kind of serious mental illness. But these kinds of prejudices and misconceptions can usually be readily corrected.

This disorder is better understood as a mental illness that requires ongoing — most often lifetime — treatment. Demystification of the illness, along with recent insights from neuroscience and neuropsychology, gives new hope for finding more effective treatments for an illness that previously carried a grave prognosis.

Schizophrenia is characterized by a broad range of unusual behaviors that cause profound disruption in the lives of people suffering from the condition, as well as in the lives of the people around them. This condition can strike anyone without regard to gender, race, social class, or culture and is typically first diagnosed in a person’s 20s.

According to Simeone et al. (2015) the 12-month prevalence rate of schizophrenia is 0.33 percent (with a range of between 0.26 – 0.51 percent). The median estimate of lifetime prevalence is 0.48 percent (with a range of between 0.34 – 0.85 percent). The American Psychiatric Association (2013) places the lifetime prevalence rate of schizophrenia to “be approximately 0.3% – 0.7%”.

Symptoms of Schizophrenia

The symptoms of this condition are fairly easy to recognize, because they stand out so distinctly from a person’s usual behavior. In order for a diagnosis to be made, the person must suffer from two more of the following for at least one month:

  • Delusions
  • Hallucinations
  • Incoherent speech or speech that quickly switches topics with little continuity
  • Problems in their behavior, such as inexplicable agitation or silliness, to catatonic behavior
  • Negative symptoms characterized by a lack of any emotional expression and/or a lack of purposeful activity (e.g., just sitting with no interest in going to work, school, or engaging in any activities)

Delusions are fixed beliefs that don’t change, even when the person is given evidence their beliefs are not based in reality. People can have a variety of delusions, ranging from persecutory (“people are going to harm me”) and referential (“people are sending me secret signals”) to grandiose (“I am wealthy and famous and known around the world”), erotomanic (“I know that person is in love with me”), nihilistic (“the end of the world is coming!”), and somatic (“my liver can transform any poison into a harmless substance”). Delusions may also be considered bizarre if they have no connection to reality in the same kind of culture the person was raised in.

Hallucinations, according to the American Psychiatric Association (2013), are experiencing something in one’s perception, but without the necessary external stimuli being available — like seeing something that isn’t really there. These unreal perceptions can occur in any of a person’s senses, but most often occur as auditory hallucinations.

Causes & Diagnosis

Schizophrenia has been a condition that has puzzled researchers for decades in trying to unravel its mysteries. It is one of the most-studied types of mental illness, both to try and better understand its causes and to create more effective treatments.

Schizophrenia tends to run in families, pointing to potential genetic, biological, and developmental risk factors. Like most types of mental illness, the causes of this condition are likely complex and multi-faceted, and today at least, not well understood. The neurotransmitters most implicated by research include dopamine, serotonin, glutamate, and GABA acetylcholine (Janicak et al., 2014).

Genetic copy number variants also appear to be important in our understanding of the causes of this condition. Certain types of chromosomal abnormalities involving deletions or duplications appear to create a greater risk for a person developing this condition. But while we have many clues about the possible causes of this diagnosis, researchers are still uncertain about its exact cause.

Learn more: Causes of schizophrenia

Schizophrenia is most often formally diagnosed by a mental health specialist, such as a psychiatrist, psychological, or clinical social worker. The diagnosis is usually made in a person’s early adulthood, when the person experiences their first psychotic episode that most often includes bizarre delusions or hallucinations.

Schizophrenia Treatment

There are many successful treatments available for schizophrenia, focusing on a set of antipsychotic medications and finding the right ones with the right balance. Because each person reacts to different psychiatric medications in a different way, it’s usually important for someone with this condition to work closely with a psychiatrist with experience in treating schizophrenia.

In addition to medications, many people with schizophrenia also benefit from some form of psychotherapy or social support treatment. There are a variety of other treatments for schizophrenia that may be helpful. Finding and following daily routines can be helpful for an individual grappling with this disorder, and getting support from friends and family can be an important component in recovery.

While schizophrenia is treatable, relapses can and do occur. A person with schizophrenia is generally maintained on treatment throughout most of their adult life.

Living With & Managing Schizophrenia

There is much that goes into living with schizophrenia, as it can be a difficult condition to manage. Professionals usually seek to help keep individuals out of the hospital and prevent a future psychotic episode or relapse. Some people turn to substance abuse in order to help quell the symptoms of this disorder.

Acknowledging the condition for what it is, finding appropriate treatment, and then sticking to that treatment plan can be helpful. But a person with this diagnosis may have difficulty understanding that they are affected and may need the help and support of family members to get into an effective treatment program. They may also need such support long-term to stay on treatment and find additional social and occupational resources to help their recovery be successful. Maintaining daily routines is one important key to many people’s success with this condition over the long term.

Helping Someone with Schizophrenia

A person with schizophrenia has unique challenges throughout their life. They can often benefit from the support and encouragement of friends and family, who understand that the symptoms of the disorder don’t diminish the unique personality and strengths of the individual. People with schizophrenia need such support just as much as someone dealing with diabetes or cancer. But far too often, family members and friends are afraid of people with this condition, because the symptoms can be difficult to comprehend and make sense of. And when a person with schizophrenia isn’t undergoing treatment (or treatment isn’t sufficient), the symptoms can worsen.

Knowledge and education can go a long ways in helping people understand that schizophrenia, while unique, also shares a lot in common with other mental disorders. Most importantly, the person suffering from it needs our support and empathy in not only getting treatment initially, but throughout their lifetime.


Getting Help

There are effective treatments available, but the first step in seeking help is often the hardest. Many times a person with schizophrenia doesn’t feel like anything is wrong — they don’t recognize their own behaviors or thoughts as being bizarre or seemingly out of the ordinary. Often a family member will work to help find treatment for the person who is suffering. This can be a difficult and process fraught with challenges, however, since a person needs to consent to treatment (unless they are an imminent threat of harm to themselves or others).

Many people find it helpful to start with a mental health specialist to begin the process. Such professionals are trained to recognize the symptoms of schizophrenia and make an accurate diagnosis, ruling out other possible diagnoses or problems that may be causing the symptoms. You can check out our online support group, or review other online resources available for this disorder.

Take action: Find a local treatment provider
More Resources & Stories: Schizophrenia on OC87 Recovery Diaries

Article retrieved from PsychCentral on August 14, 2019 at 0010EDT.