Schizophrenia / Psychotic Disorders

What is Schizophrenia?

Schizophrenia is a long-term mental disorder that affects how a person thinks, feels, and behaves.  Signs and symptoms of schizophrenia are variable and include changes in perception, emotion, cognition, thinking, and behavior. A diagnosis of schizophrenia requires continuous signs of the disturbance for at least 6 months, during which time the individual’s level of functioning is markedly below their norm in work, interpersonal relations, or self-care. When the onset is in childhood or adolescence, the person fails to achieve an expected level of interpersonal, academic, or occupational functioning. The 6-month period must include at least two of the symptoms below that are active for a significant portion of time during a period of 1 month. At least one of these must be from the first three in the list:

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms, such as diminished emotional expression

A diagnosis of schizophrenia requires ruling out schizoaffective disorder and depressive or bipolar disorder with psychotic features. In addition, the symptoms cannot be attributable to the physiological effects of a substance (e.g., a drug of abuse or medication) or another medical condition.


  • The lifetime prevalence of schizophrenia in the United States is about 1 percent.
  • Schizophrenia is equally prevalent in men and women. Onset of the illness, however, is earlier in men than in women. The peak ages of onset are 10 to 25 years for men and 25 to 35 years for women.
  • Individuals with schizophrenia have a higher mortality rate from accidents and natural causes than the general population.
  • Patients with a diagnosis of schizophrenia are reported to account for 15 to 45 percent of homeless Americans.
  • Substance abuse is common among people with schizophrenia. The lifetime prevalence of any drug abuse (other than tobacco) is greater than 50 percent.
What is Schizoaffective Disorder?

Schizoaffective disorder has features of both schizophrenia and mood disorders. A diagnosis of schizoaffective disorder is given with the following requirements:

  • An uninterrupted period of illness during which time there is a major mood episode (major depressive or manic) concurrent with symptoms of schizophrenia.
  • Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.
  • Symptoms that meet the criteria for a major mood episode present for the majority of the illness, whether active or residual.
  • Symptoms are not attributable to the effects of a substance (e.g., a drug of abuse or medication) or another medical condition.
What is Schizophreniform Disorder?

The symptoms of schizophreniform are similar to those of schizophrenia; however, with schizophreniform disorder, they last less than 6 months (but at least 1 month). Patients with this disorder return to their baseline level of functioning after the disorder has resolved. If the disorder lasts longer than 6 months, it is diagnosed as schizophrenia.

A diagnosis of schizophreniform disorder must rule out schizoaffective disorder and depressive or bipolar disorder with psychotic features. In addition, symptoms cannot be attributable to the effects of a substance (e.g., a drug of abuse or medication) or another medical condition.

What is Brief Psychotic Disorder?

The symptoms of “brief psychotic disorder” are similar to those of schizophrenia; however, they last less than 1 month (but at least 1 day). Patients with this disorder can return to their baseline functioning after the disorder has resolved. If this disorder last longer than 30 days, then it is diagnosed as schizophreniform disorder or schizophrenia based on the duration of symptoms.

A diagnosis of brief psychotic disorder must rule out depressive or bipolar disorder with psychotic features, as well as psychosis due to the effects of substance (e.g., a drug of abuse or medication) or another medical condition.

Does substance abuse make Schizophrenia symptoms worse?

Yes. All drugs of abuse (other than tobacco), are associated with poor function in schizophrenia patients. Alcohol abuse increases risk of hospitalization and, in some patients, may increase psychotic symptoms. Studies show that individuals reporting high levels of cannabis use are at a sixfold increased risk of schizophrenia compared with nonusers. The use of amphetamines, cocaine and other illicit drugs have a marked ability to increase psychotic symptoms.

Can a person with Schizophrenia get better?

A reasonable estimate is that 20 to 30 percent of all schizophrenia patients are able to lead somewhat normal lives with treatment. About 20 to 30 percent of patients continue to experience moderate symptoms, and 40 to 60 percent of patients remain significantly impaired by their disorder for their entire lives.

What is the treatment for Schizophrenia?

Antipsychotic medications are the mainstay of treatment for schizophrenia. Approximately 70 percent of patients treated with any antipsychotic achieve remission. Antipsychotics can be categorized into two main groups: the older conventional antipsychotics, which are known as first-generation antipsychotics, and the newer drugs, which are known as second-generation antipsychotics or serotonin dopamine antagonists.

Benzodiazepines are also effective for treating agitation during acute psychosis. The use of benzodiazepines may also reduce the amount of antipsychotic that is needed to control psychotic symptoms.

Psychosocial Therapies

In addition to antipsychotic medications, research has shown that psychosocial interventions, including psychotherapy, can improve outcomes. Patients with schizophrenia benefit more from the combined use of antipsychotic drugs and psychosocial treatment than from either treatment used alone. Psychosocial therapies include a variety of methods to increase social abilities, self-sufficiency, practical skills, and interpersonal communication in schizophrenia patients.

Different types of therapy that have shown success in treating schizophrenia patients include:

  • Social skills training, also known as behavioral skills training.
  • Family therapy, which educates family members about schizophrenia and how best to support the patient.
  • Cognitive behavioral therapy, used to improve cognitive distortions, reduce distractibility, and correct errors in judgment.
  • Long-term psychotherapy, based on the patient perceiving a reliable and trustworthy relationship with a therapist who has faith in the patient’s potential as a human, no matter how disturbed, hostile or bizarre the patient may be at times.
  • Personal therapy, which uses social skills and relaxation exercises, education, self-reflection, self-awareness, and exploration of vulnerability to stress.
  • Dialectical behavior therapy, which combines cognitive and behavioral therapies in both individual and group settings.
  • Vocational therapy, used to help patients regain old skills or develop new ones.
  • Art therapy, which provides an outlet for a patient’s constant bombardment of imagery.
  • Cognitive training, which utilizes computer-generated exercises to improve cognition and working memory.
What is Delusional Disorder?

A diagnosis of “delusional disorder” is given when a person experiences one or more delusions within a period of 1 month or longer. Apart from the impact of the delusion(s), functioning is not markedly impaired, and behavior is not obviously bizarre or odd. If manic or major depressive episodes have occurred, they have been brief compared to the duration of the delusional periods. The diagnosis requires that major schizophrenic features are not present, and the delusion(s) is not attributable to the physiological effects of a substance, another medical condition, or other mental disorder such as body dysmorphic disorder or obsessive-compulsive disorder.

Types of delusional disorders include:

  • Erotamanic type – when the delusion is that another person is in love with the individual.
  • Grandiose type – when the delusion is having some great (but unrecognized) talent or insight, or having made some important discovery.
  • Jealous type – when the delusion is that the individual’s spouse or lover is unfaithful.
  • Persecutory type – when the delusion involves the belief that the individual is being conspired against, cheated, spied on, followed, poisoned or drugged, harassed, or obstructed in the pursuit of long-term goals.
  • Somatic type – when the individual believes that he or she has a physical defect or medical problem when none exists.
  • Mixed type – when no one delusional theme predominates.
  • Unspecified type – applies when the dominant delusional belief cannot be clearly determined.
What is Schizotypal (Personality) disorder?

Schizotypal personality disorder involves an acute discomfort with, and reduced capacity for, close relationships, as well as eccentric behavior and distorted cognition or perception, indicated by at least five of the following:

  • “Ideas of reference,” i.e., feeling that events or circumstances apply to them personally. Examples include feeling that strangers are talking about them, believing that events have been deliberately contrived for them, or thinking that posts on social network websites have hidden meanings pertaining to them.
  • Odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
  • Unusual perceptual experiences, including bodily illusions.
  • Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
  • Suspicious or paranoid thinking.
  • Inappropriate or constricted affect.
  • Behavior or appearance that is odd, eccentric, or peculiar.
  • Lack of close friends or confidants other than first-degree relatives.

Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

Is Schizophrenia a genetic disease?

Yes, genetics do play a role in schizophrenia. First-degree biological relatives of people with schizophrenia have a 10 times greater risk for developing the disease than the general population.

While schizophrenia tends to run in families, no single gene is thought to be responsible. It's more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes does not necessarily mean that a person will develop schizophrenia.

What are the causes of Schizophrenia?

The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition. Some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode.

Factors involved in the development of schizophrenia include:

  • Brain development. Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains.
  • Imbalanced brain chemistry. Research suggests schizophrenia may be caused by an imbalance of neurotransmitters, which may involve excess dopamine or excess serotonin. Other theories implicate the roles of norepinephrine, GABA, neuropeptides, glutamate, and acetylcholine.
  • Pregnancy and birth complications. Research has shown that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as a low birthrate, premature labor, or exposure to influenza or maternal starvation.
  • Age of birth father. Some data indicate that the age of the father when a child is born has a correlation with the development of schizophrenia. In studies of schizophrenia patients with no family history of the illness on either their mother’s or father’s side, those born from fathers older than the age of 60 were vulnerable to developing the disorder.
  • Drug abuse. While drugs do not directly cause schizophrenia, studies have shown that drug misuse increases the risk of developing schizophrenia. Certain drugs, particularly cannabis, cocaine LSD or amphetamines, may trigger symptoms of schizophrenia in people who are susceptible. Research has shown that teenagers and young adults who use cannabis regularly are more likely to develop schizophrenia in later adulthood.
  • Stressful events. While stress does not cause schizophrenia, stressful events can trigger its development in someone already vulnerable to it. Leading psychological triggers are stressful life events such as death of a loved one, job loss, home loss, divorce, end of a relationship, or physical/sexual/emotional abuse.
Besides Schizophrenia, what are other types of psychotic disorders?

Other types of psychotic disorders with their own diagnosis include:

  • Substance/Medication-Induced Psychotic Disorder
  • Psychotic Disorder Due to Another Medical Condition
  • Catatonia Associated with Another Mental Disorder
  • Catatonic Disorder Due to Another Medical Condition
  • Unspecified Catatonia
  • Other specified Schizophrenia Spectrum and Other Psychotic Disorder
  • Unspecified Schizophrenia Spectrum and Other Psychotic Disorder
What is Catatonia?

Catatonia is abnormal movement and behavior arising from a  isturbed mental state. It may involve repetitive or purposeless overactivity. Behaviors associated with catatonia include:

  • Stupor
  • Catalepsy (trance or seizure with a loss of sensation and consciousness accompanied by rigidity of the body)
  • Mutism (little or no verbal response)
  • Negativism (opposition or no response to instructions or external stimuli)
  • Posturing (bizarre or inappropriate body position or attitude for an extended period of time)
  • Mannerism (odd, circumstantial caricature of normal actions)
  • Stereotypy (repetitive, frequent, non-goal-directed movements)
  • Agitation, not influenced by external stimuli
  • Grimacing
  • Mimicking another’s speech
  • Mimicking another’s movements
Can medications and illicit drugs cause a psychotic disorder?

Yes. A diagnosis of “substance/medication-induced psychotic disorder” may be given to a person who experiences delusions and/or hallucinations soon after substance intoxication or withdrawal, or after exposure to a medication. The substance or medication must be capable of producing the delusions and/or hallucinations, and the disturbance cannot be better explained by another psychotic disorder. A diagnosis of substance/medication-induced psychotic disorder requires that the drug effects cause significant distress or impairment in social, occupational, or other important areas of functioning.

Drugs that may cause delusions or hallucinations and have their own diagnostic coding for this psychotic disorder include alcohol, cannabis, phencyclidine, inhalants, sedatives, hypnotics, anxiolytics, amphetamines, cocaine, other hallucinogen, or other known or unknown substance.

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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