Schizophrenia is a psychotic disorder characterized by positive, negative and cognitive symptoms. Positive symptoms include hallucinations (hearing voices or seeing visions), delusions (beliefs held strongly by the patient but not shared by people around them) and thought disorder (for example conversation jumping from one thought to a completely unrelated thought). Social isolation and withdrawal are examples of negative symptoms. Cognitive symptoms are very common and include problems in concentration and task planning. Schizophrenia is a long term condition and life expectancy is reduced by around 20 years compared to the general population. About two thirds of the excess mortality can be attributed to CVD and a third to suicide. The symptoms of schizophrenia often result in major social or occupational disturbance. For example few patients with schizophrenia are in employment.


Schizophrenia is not a common illness, affecting approximately one person in a hundred at some point in their lives. There are probably around 250,000 people living with schizophrenia in the UK. This means that the typical primary care practice will possibly have between 70 and 100 patients with schizophrenia on their SMI register. Onset tends to be when patients are in their teens to early twenties, and although schizophrenia is equally common in men and women, men tend to develop the illness when they are younger than women. This may be explained by certain female hormones having a protective effect against schizophrenia.


Fifty percent of the cause of schizophrenia can be attributed to genetics. The othercauses of schizophrenia may include problems at the time of birth, life stress, and substance misuse (particularly cannabis use). One of the most powerful arguments for the ban of cannabis is to try and prevent schizophrenia in people with a genetic susceptibility to the illness.

Early detection of schizophrenia

Making a diagnosis of schizophrenia requires symptoms to be present for at least a month. Early detection and treatment by the primary care team is essential in order to ensure that patients are effectively treated as quickly as possible. GPs or practice nurses are frequently the patient’s first point of contact with a health professional. Intervening early can improve the outcome of the illness and can reduce the risk of suicide. Early schizophrenia often starts with increasing social isolation (not coming out of the bedroom) and deterioration in intellectual functioning.

Early Intervention Teams

Most secondary care mental health providers offer some form of early intervention service for patients with suspected psychosis.


Schizophrenia is a long term condition that requires treatment with antipsychotic medication to stabilize psychosis and prevent relapse of symptoms. Although many patients express a desire to come off medication, good adherence is essential to ensure effective management of the illness and psychosocial recovery. Antipsychotics are generally divided into two groups, typical and atypicals. Typical antipsychotics are effective against psychosis for about 8 out of 10 patients but are associated with distressing movement side effects (restlessness, stiffness, dystonia) some of which can be irreversible (tardive dyskinesia). Newer atypical antipsychotics are as effective as the typicals but are associated with fewer movement side effects. Atypical antipsychotics have a different side effect profile that may include sedation, weight gain and sexual dysfunction.
Whilst antipsychotic medication is the foundation for the treatment of schizophrenia, talking treatments, particularly some forms of CBT and behavioural family therapy, may confer additional benefit in terms of symptom control.