Schizophrenia | Mate wairua tuakoi

Myth: Schizophrenia means the person has a split personality 

Fact: Split or multiple personality disorder is an extremely rare condition that has nothing to do with psychosis.

Myth: People with schizophrenia are aggressive violent people 

Fact:  With good care and treatment people with schizophrenia are no more violent than any other members of the community.   

Myth: Schizophrenia is caused by bad parenting

Fact: There is not one cause that is responsible for a person developing schizophrenia. Experts agree that a combination of genetics, substance use, stress and other risk factors are involved.

Myth: People with schizophrenia are lazy

Fact: Psychosis or its treatment can affect a person's energy levels and motivation. This might mean that the person has difficulty doing things, not that they’re lazy.

Myth: People with schizophrenia are ‘stupid’

Fact: People with schizophrenia may have trouble remembering things, it does not mean they are not intelligent.

Myth: Psychosis results from a personality weakness or character flaw

Fact: Psychosis can happen to anyone, their personality or will power have nothing to do with it. 

It is not exactly known how or why schizophrenia develops, but it is generally accepted that a combination of factors plays a role. Some people may be more vulnerable than others.

Things that may increase the risk of developing or triggering schizophrenia include the following:

• Genetics – relatives of a person who suffers from schizophrenia may be slightly more vulnerable than others. However, most people who have a relative with schizophrenia do not develop the condition themselves.
• Life events – your childhood experience, including abuse and trauma, can be an important factor.
• Stress – it is most often during big life changes or after serious events that people experience the first signs of schizophrenia.
• Drug abuse – certain drugs, particularly cannabis(external link), cocaine, LSD or amphetamines, may trigger symptoms of schizophrenia in some people. 

Sometimes symptoms come on quickly, but mostly people’s behaviour changes gradually. Early changes may include:

• having trouble keeping up at school or work
• isolation from friends and whānau
• giving up hobbies or activities
• hearing sounds, like voices, that others can't hear
• getting a bit paranoid.

Not everyone who has some or all of these symptoms will go on to develop schizophrenia, but these symptoms may be a warning sign. Recognising that something is not right and getting help early can help you get better faster.  

The symptoms of schizophrenia vary between people and you may have different symptoms at different times. Three different types of symptoms are commonly reported:

• psychotic symptoms – also called ‘positive’ symptoms because they are new and unusual
• mood and motivation symptoms – also called ‘negative’ symptoms because they refer to the loss of normal behaviours and emotions
• thinking and memory problems – also called ‘cognitive’ symptoms. 

Positive symptoms may include the following:

• Hallucinations – you may hear, see, taste, smell or feel things that are not there. Hearing voices no one else can hear is the most common hallucination. The voices may threaten, frighten or command you to do harmful acts. Some people hear reassuring or neutral voices.
• Delusions – you may develop unusual and strongly held beliefs. You may think you have special powers, that you are being watched or spied upon or that your thoughts are being shared with others. Such delusions cannot be changed by logical argument or evidence that supports a different point of view.
• Disordered thoughts – you may have trouble connecting ideas into a logical sequence or may jump rapidly from one topic to another, which makes it difficult to hold a conversation. This may also be accompanied by inappropriate emotional responses (where your words and moods do not match), and you may laugh when speaking of a serious or frightening event. 

Negative symptoms may include the following:

• Lack of motivation – you may find doing ordinary tasks such as washing, cooking or planning ahead very difficult. Solving everyday problems may become a chore.
• Social withdrawal – you may find it difficult to be with other people or to communicate with others.
• Changes in mood – you may appear anxious, panicky, depressed or in an abnormally good mood. Your emotions may be flattened, eg, you may appear quite ‘wooden’.
• Loss of awareness that the experiences and difficulties you have are the result of a mental health issue. 

Cognitive symptoms may include the following:

• Problems with memory or concentration – this can make it difficult to do your daily tasks, perform your job or keep up with your education. 

Many people who experience an episode of psychosis recover quite quickly and will not have another episode. However, in some cases, psychosis can be a sign of an on-going or long-term mental health problem.

Some people with symptoms of psychosis may turn out to have depression, bipolar disorder or anxiety for instance. If you have had symptoms of psychosis and problems with day-to-day activities for 6 months or longer, and all other possible conditions have been ruled out, your psychiatrist may make a diagnosis of schizophrenia.   

Early diagnosis and treatment

Specialised early interventions (as provided by Early Intervention in Psychosis services in New Zealand for adolescents and young adults) help you get better faster and return to your regular life sooner. Check who can provide early intervention services in your area(external link).

Various treatments, therapies and community supports are available to help people with schizophrenia manage their condition and live their lives to the full. 

Medication

This can be used to reduce the intensity of distressing experiences. Medication can also be used to help you stay well after the signs of psychosis have reduced or gone away.

Antipsychotic medicines are the main group of medications used to treat schizophrenia. The goal of treatment with antipsychotics is to effectively manage your symptoms at the lowest possible dose.

It is difficult to predict how well a particular person will respond to a particular antipsychotic medicine. You and your psychiatrist may need to try different medicines, doses or combinations over time. Read more about antipsychotics. 

Talking therapies

Talking therapies, such as psychology sessions or counselling, can help you learn coping strategies, address problems with motivation, regain confidence or cope with stress.

The focus of psychological therapy or counselling is on education and support for you to understand what is happening to you, to learn coping strategies and to pursue a path of recovery. Sessions help you gain the confidence and belief in yourself that is critical to recovery. 

Examples of talking therapies are:

• Cognitive-behavioural therapy (CBT) teaches how behaviours, thoughts and mood influence each other. Sessions may be held on a one-to-one basis, sometimes include partners or family or are held in a group.
• Relapse prevention – to help you identify early warning signs of relapse and prolong periods of remission.
• Family therapy can help both you and your family.
• Social skills training focuses on improving your communication and social interactions and your ability to fully participate in daily activities.

Other supports

• Vocational support programmes can help people with schizophrenia complete training, find a job and obtain self-sufficiency.
• Support from whānau and friends can be very important for the health and wellbeing of people with schizophrenia. It is important for families to be well informed and supported themselves. 
• Social and life skills support – occupational therapists or social workers can help with day-to-day issues or connect you with useful community services. They can also help you prepare for, find and keep jobs.
• Peer support groups – being around other people who've had similar experiences can help you feel less alone and better understood. 
• Certain complimentary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all shown to have some effect in alleviating mental distress. 

Hospital-based treatment

Occasionally there may be times when a stay in hospital will be helpful. This may be when you need a place away from stresses, your medications need a major review or you need other treatments that can only be delivered in hospital. A stay in hospital may be the best way to keep you safe, get proper nutrition and adequate sleep.  

The Mental Health Act

In some cases, if you do not agree to receive treatment, but your doctors consider your treatment crucial for your wellbeing and safety, they may make an application to have you assessed under the Mental Health (Compulsory Assessment and Treatment) Act 1992. Read about the compulsory assessment process(external link).  

You always have the right to be treated with respect and to have things explained to you in a way and language that you understand. You can ask for family, whānau or friends to support you while you are assessed and during your treatment. Read more about your rights as a mental health patient(external link). 

It's really important to look after your physical wellbeing. Being in good physical health will also help your mental health. Make sure to be physically active, remain or become fit, and eat a healthy diet. Read about how you can care for yourself with schizophrenia.

Learn to recognise your early warning signs 

These might include:

• everyday things like going off your food, feeling anxious or not sleeping
• not changing your clothes, cleaning your flat or cooking for yourself
• feeling a bit suspicious or fearful or starting to worry about people’s motives
• starting to hear voices quietly or occasionally
• finding it difficult to concentrate. 

Try to avoid things that can make your symptoms worse

These can include:

• stressful situations such as spending too much time with people (although being with people can be helpful)
• using street drugs or alcohol
• feeling anxious about bills, but not asking for help or advice
• getting in to disagreements with family, friends or neighbours.           

Do things that you enjoy

• Make time regularly for hobbies, music, sport or social activities.
• Learn about mindfulness, how to manage stress or find a yoga class. 

Find out what is helpful when you hear voices

This can include:

• spending time with other people
• keeping busy
• listening to music or podcasts, or watching movies or TV series
• reminding yourself that your voices can’t harm you
• reminding yourself that your voices don’t have any power over you and can’t force you to do anything you don’t want to. 

Find more support

• Join a peer support group for people with similar experiences to yours.
• Find someone you trust who can tell you when they notice a return of your symptoms.
• See your family doctor, your contact person at community mental health services or your psychiatrist or psychotherapist.
• Have a look at the support groups around the country(external link).
• Contact Supporting Families(external link) who provide support for families and whānau. 

If you need urgent help:

• Free call or text 1737(external link) any time, 24 hours a day to speak to a trained counsellor
• In crisis? Crisis contact details(external link) Mental Health Foundation, NZ  

Learn more about schizophrenia and your medication

• Talk to your nurse, mental health worker, psychiatrist 
• Talk to someone else with schizophrenia
• Ask for written information about your diagnosis and treatment
• Ask about other options, if your medication is not working as well as you would like. 

Take care of your physical health

It is important you look after yourself as best you can:

• Eat lots of fresh vegetables and fruit
• Try to quit smoking
• Be physically active, even if it's only 20 minutes out walking every day – regular vigorous exercise (double your pulse rate for 20 minutes 3 times a week) can help improve your mood
• Avoid street drugs. 

Your care manager, GP and your psychiatrist can help you by:

• showing you easy ways how you can eat better and be physically active
• monitoring your weight and how your heart is working
• helping you to cut down or quit smoking.

Apps reviewed by Healthify

You may find it useful to look at some Mental health and wellbeing apps.

For ongoing support, see your family doctor, your contact person at community mental health services or your psychiatrist or psychotherapist. There are also support groups around the country(external link). See also Mental health support for families – Yellow Brick Road(external link), who help families and whānau to provide the best possible support for their loved one and look after their own wellbeing. 

If you need urgent help:

• free call or text 1737(external link) any time, 24 hours a day to speak to a trained counsellor
• contact your nearest crisis team: Crisis contact details(external link) Mental Health Foundation, NZ  

Video: I Am Living with Voices - I Am Debra Lampshire

This is the story of Debra Lampshire who, after making a shocking discovery at age six, began hearing voices. This video may take a few moments to load.

(external link)

(TVNZ, NZ, 2019)

Video: Schizophrenia | Talking about mental health - Episode 18

Alice, Brian, Jamie, Martin and Louise all talk about the reality of living with schizophrenia - from the at first strange symptoms they have experienced to the stigma and discrimination they feel people with the diagnosis face. This video may take a few moments to load.

(Mind, the mental health charity, UK, 2016)

Video: Surviving schizophrenia

Elyn Saks, Debra Lampshire and Paris Williams are all world experts on mental health. They’re using their personal experiences and working in their respective fields to debunk the myths and stigma surrounding schizophrenia. This video may take a few moments to load.

(Attitude, NZ, 2016)

Video: Living with schizophrenia

People, families and health professionals talk about living with schizophrenia. This video may take a few moments to load.

(LEAP Institute, US, 2013)

Video: I Am Not A Monster: Schizophrenia | Cecilia McGough | TEDxPSU

Young adulthood is a common time for symptoms of schizophrenia to appear. Cecilia, a student at Penn University shares her experience of being diagnosed and the importance of providing support to ensure people get the medical help they need. This video may take a few moments to load.

(TEDx Talks, US, 2017)