Schizophrenia

Schizophrenia symptoms typically begin in early adulthood and may be preceded by a prodromal period, with changes in the person’s thoughts, mood, and behaviour prior to the start of psychotic symptoms. Early psychosis services focus on an ‘at-risk mental state’, which is characterised by psychotic symptoms short of a full diagnosis.

Initially, patients are usually referred by family members or friends. Many patients have acute treatment in the community, but admission may be considered if the patient is at significant risk of self-neglect or harming themselves or others. The care of patients with more chronic symptoms tends to involve community mental health workers or other professionals.

Antipsychotic medications and psychosocial interventions are effective for most patients, but to varying degrees.

Patients with schizophrenia have a higher mortality than the general population due to physical illness (e.g., cardiovascular diseases and cancers), accidents, and suicide. Suicidal ideation is common and suicide prevention is a key aspect of management. This should include monitoring for depressive symptoms and risk factors of suicide.

Schizophrenia is a mental health condition in which a person’s perception, thoughts, mood, and behaviour are significantly altered.[1]National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. March 2014 [internet publication]. https://www.nice.org.uk/guidance/cg178 It is characterised by ‘positive symptoms’ (e.g., auditory hallucinations, bizarre delusions, and disrupted speech) and ‘negative symptoms’ (e.g., social withdrawal, demotivation, self-neglect, and flat affect).[2]Scottish Intercollegiate Guidelines Network. Management of schizophrenia: a national clinical guideline. March 2013 [internet publication]. https://www.sign.ac.uk/assets/sign131.pdf There are specific diagnostic criteria based on symptom duration and/or presence of particular combinations of positive and negative symptoms.[3]​​​​​American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2023.[4]World Health Organization. International statistical classification of diseases and related health problems (ICD): ICD-11. Sep 2022 [internet publication]. https://icd.who.int/en ​ For more information, see Criteria. 

Psychotic symptoms can, however, be caused by a range of physical and mental illnesses.

It is important to recognise that not all patients with psychosis will develop schizophrenia.[5]National Collaborating Centre for Mental Health. Psychosis and schizophrenia in adults: the NICE guideline on treatment and management. 2014 [internet publication]. https://www.nice.org.uk/guidance/cg178/evidence/full-guideline-490503565  Most people make a good recovery following a first episode of psychosis and it is estimated that up to 20% of patients will make a full recovery.[5]National Collaborating Centre for Mental Health. Psychosis and schizophrenia in adults: the NICE guideline on treatment and management. 2014 [internet publication]. https://www.nice.org.uk/guidance/cg178/evidence/full-guideline-490503565 Many people who have subsequent episodes of psychosis maintain a good quality of life despite symptoms. 

This topic focuses on the diagnosis and management of schizophrenia in adults; ​​the management of schizophrenia in children is beyond the scope of this topic.