What are some facts about schizophrenia

Schizophrenia: signs, forms, therapy


"Something is wrong here". It may be years before family members and friends notice the signs of schizophrenia. In the early stages, those affected speak of a changed experience or disturbing thoughts. They hear voices that are not real, move reflexively, and react extremely to other people.

People who suffer from schizophrenia often fulfill the prejudices of a madman and also suffer from the stigma of our society. Schizophrenia is a mental disorder in which the thoughts and perceptions of those affected are changed.

People who suffer from schizophrenia,
often fulfill the prejudices of a madman
and must also pass under the stigma
our society suffer.

Feelings, language, the experience of oneself and the perception of the environment differ greatly from the experience of healthy people. Everyday and professional tasks are no longer manageable. Often those affected do not accept that they are mentally ill and refuse treatment.

Diagnosing schizophrenia: numbers, facts and risk factors

Schizophrenias are widespread worldwide, not all that rare - and curable. In Germany, around 19 new cases per 100,000 inhabitants are diagnosed each year; d. H. With a population of 82.3 million in Germany, around 15,600 newly diagnosed schizophrenia cases can be expected each year.

Around one in one hundred Germans experiences a schizophrenic episode at least once in their life. Mostly in their early 20s, as big tasks and changes are pending in this phase of life.

Around one in a hundred Germans experienced it
at least once in his life one
schizophrenic episode.

A first psychological crisis is very treatable: in more than 80 percent of cases, the symptoms recede completely. Schizophrenia occurs in poor and rich countries and different cultures. The risk of developing some form of schizophrenia once in a lifetime is around one percent. The disease can occur at any age, most often it begins before the age of 35.

  • Worldwide, around one in 100 people will develop schizoid personality disorder before the age of 45
  • Schizophrenia usually occurs between the ages of 15 and 35 (in men between the ages of 16 and 25 and in women between the ages of 23 and 36)
  • Schizophrenic patients have a suicide rate of up to ten percent
  • Schizophrenia affects people from all countries, classes and cultures equally often
  • Schizophrenia is a structural and functional disorder of the brain

Genetic factors contribute to about 80% of the susceptibility to illness. Schizophrenia can also emerge from early childhood damage in brain development

  • due to infections and diseases during pregnancy
  • Complications during childbirth
  • Meningitis,
  • Alcohol or drug abuse by the mother during pregnancy
  • Drug use during puberty.

Genetic factors are considered to be the most important evidence of the risk of developing schizophrenia. Family, adoption and twin studies show that the likelihood of developing schizophrenia

  • in the case of first-degree relatives to 5% to 15%,
  • in identical twin siblings of a schizophrenic patient is increased to 45% to 50% compared to 1% in the general population.

The fact that the risk of disease in identical twins is not 100% makes it clear that other causes must also be involved in the development of the disease.

Cocaine and Co. are acute risk factors and possible causes

Illegal drugs such as cocaine, LSD, the psilocybin contained in certain mushrooms and especially cannabis products (hashish, marijuana) can trigger the disease (prematurely) or lead to recurrence. Against this background, it is to be viewed with concern that in the period from 1993 to 2004 the proportion of those with cannabis experience in the age group of 12 to 25 year olds almost doubled to 31%.

Definition of schizophrenia or schizoid personality disorder

The term schizophrenia was coined at the beginning of the 20th century. The term, which comes from the Greek, is made up of the parts of the word schizo (= "split") and phren (= "spirit" or "psyche").

Schizophrenia is called a severe mental disorder. Those affected suffer from massive changes in their thoughts, feelings and perceptions at times. Their behavior also changes dramatically and often appears bizarre or frightening to outsiders. People with schizophrenia do not have a split personality, as is widely believed.

People with schizophrenia don't have any
split personality, how many
Is accepted.

You don't have multiple personalities that come out in turns, as is the case with Dissociative Identity Disorder. Experts consider schizophrenia to be one of the endogenous psychoses: a disease that "arises from within" without any identifiable causes or in connection with specific experiences. People who suffer from schizophrenia perceive and process reality very differently than healthy people.

A distinction is made between the acute and the chronic phase of the disease:

  • In acute schizophrenia, there are phenomena such as hearing voices and paranoia. At this stage, patients refuse to be assigned any illness.
  • In chronic schizophrenia, the restriction of certain functions and emotionality predominates. It manifests itself through social withdrawal, diminishing (leisure) interests, impoverishment of speech, lack of feelings, drive disorders and neglect of the outside.

Schizoid symptoms: as varied as feelings, fear and delusion

Schizophrenia begins in around three quarters of cases with a preliminary stage that can last for several years and only later develops into fully developed schizophrenia. The following symptoms of illness can occur as part of schizophrenia:

I disorder:

In the case of an ego disorder, the boundary between the environment and the "I" becomes blurred. Affected people experience themselves and their environment as unreal and strange. The distinction between what is one's own and what is foreign is disturbed. Sick people believe, for example, that outsiders can read, influence or even "take away" their thoughts. Some patients report that they feel manipulated, remote-controlled or even hypnotized from the outside.

Disturbances of emotional impulses (disturbed affectivity):

The mood is often characterized by fluctuations, e.g. by the simultaneous or immediately alternating occurrence of extreme moods and feelings. In connection with acute episodes and delusional experiences, there is often a strong fear or depressed mood.

With chronic illness there is often a "flattening of affect", i.e. the emotional state is indifferent, those affected feel empty inside. The facial expression is rigid, gestures and facial expressions impoverished, eye contact is avoided.

The disturbed affectivity is also expressed
in social withdrawal from, the person concerned
seems uninterested, joyless and is
unable to sense closeness.

The disturbed affectivity is also expressed in social withdrawal, the person affected appears less interested, joyless and is unable to feel closeness. When the mood is uplifted, folly, lack of distance and a ruthless disinhibition can prevail. In schizophrenic patients, the emotional expression and the current situation often do not match (e.g. being amused at terrible events). Facial expressions / gestures and mood do not match either.

Cognitive disorders:

Cognitive disorders are recognizable impairments in the areas of attention, concentration and memory. They are a central component of the clinical picture of schizophrenia and often affect the majority of those affected in a severe and disabling manner.

Thinking and speech disorders:

Thinking appears disheveled, incoherent and devoid of internal logic. As a result, the linguistic utterances are becoming increasingly bizarre, words are mixed up, the sentence structure is destroyed, words are invented. Thoughts and the flow of speech can be accelerated or slowed down. Sometimes their statements do not fit the topic. The thoughts suddenly tear off and the conversation loses its meaning.


In the case of delusion, the person concerned develops pathological misconceptions that deviate from reality. The delusions are so real for him that he sticks to them steadfastly, does not check them against reality and cannot be corrected by others. Almost all circumstances can become delusional.

Almost all living conditions can
Become the subject of delusion.

The person concerned feels persecuted (paranoia) or in some other serious way impaired (e.g. intoxication mania), seriously ill (hypochondriac mania) or religiously or politically called for a major task (megalomania). Individual delusional ideas are not always easy to distinguish from reality. Delusional perception is the wrong assignment of meaning to what is going on in the environment.


Hallucinations are disorders of perception in which the person concerned perceives things without actually being there. These disorders can involve all the senses - in schizophrenia there are mainly acoustic hallucinations, less frequent touch hallucinations and only rarely visual hallucinations.

If the voices are experienced as the perception of one's own thinking, one speaks of the making of thoughts. There are also "dialogical voices", i.e. the person concerned thinks he is listening to conversations about himself. "Commentary voices", which can come from a part of the body, for example, describe all the patient's actions. "Imperative (requesting) voices" give the person concerned instructions for action.

Psychomotor abnormalities (catatonic symptoms):

There is a reduction in drive in terms of activity, spontaneity and initiative. The emotional responsiveness and the spontaneous affection and communication skills decrease. When fully conscious, the patient can be completely immobile and unresponsive (stupor).

If, on the other hand, there is strong motor excitement, this can manifest itself from stereotypical movements to aimless aggressiveness. When dealing with schizophrenics, it can happen that everything is repeated or understood, and the opposite or generally what is ordered is automatically carried out (stereotypes).

Schizophrenia subtypes: they don't fit into any drawer

Depending on the prevalence of certain symptoms, a distinction can be made between subtypes, which can, however, merge into one another during the course of the disease. There is simply no suitable drawer for schizophrenia. Nevertheless, the subtypes only describe one manifestation of the symptoms. A clear classification or prognosis of the patients in one of the three subtypes is therefore often not possible.

Paranoid schizophrenia

Paranoid schizophrenia is the most common form of the disorder. The most striking symptoms in the acute phase are delusions and hallucinations.

Hebephrenic schizophrenia

In this form of schizophrenia, thinking, emotions and drive are particularly severely impaired. The emotional disturbances in Hebephrenic schizophrenia lead to distant and often inappropriate behavior. For many patients, thinking appears incoherent and illogical. What has been said is then no longer understandable for outsiders.

The emotional disturbances in hebephrenic
Schizophrenia lead to a lack of distance
and often inappropriate behavior.

Conversely, in acute phases it also happens that those affected no longer speak at all. In an acute phase, the patient's mood can be both euphoric (manic) and depressed (depressed). This switch can be mistaken for symptoms of bipolar disorder.

Catatonic schizophrenia

Psychomotor disorders are particularly typical of catatonic schizophrenia. The patients make strange movements, for example with their hands, arms or legs. They bend their bodies or walk around aimlessly.

In these moments the patients are very aroused. Catatonic schizophrenia occurs only rarely today - possibly because modern drugs work better than previously used preparations.

The causes of schizophrenia on a scale from "possible to likely"

According to the current state of science, experts assume that various aspects must come together in order to trigger schizophrenia.

  • Hereditary component: The predisposition to this mental illness, but not schizophrenia itself, appears to be hereditary.
  • Susceptibility: Many patients cannot adequately shield themselves from environmental influences. This can be caused and exacerbated by a wide variety of factors, such as a genetic predisposition, brain trauma, traumatic experiences in childhood, stress or drug use.
  • Changes in brain structure: Clinical studies show that the brain structure of schizophrenics is different from that of healthy people. How sensitive these abnormalities, e.g. in the limbic system - which is also responsible for our emotional behavior - affect the disease, has to be further researched.
  • Messenger substances: The hormonal messenger substance dopamine seems to play a central role in the brain. Messenger substances transmit signals from one nerve cell to another. In people suffering from schizophrenia, an excess of the messenger substance dopamine can be detected. Other messenger systems (for example the serotonin system) also seem to be involved in the thought disorders.

However, the onset of the disease only occurs when life events occur that the person concerned can no longer cope with internally. Drug use can also be a trigger for schizophrenia. Often several factors have to work together.

Drug use can also be a trigger
of schizophrenia.

During a psychosis, the brain releases too much of the neurotransmitter dopamine. This literally opens all locks and floods the brain with information and stimuli. It can no longer distinguish between important and unimportant, between real and fake. Perception is disturbed, hallucinations occur.

However, the specific causes of schizophrenia have not yet been fully clarified. Persistent stress or drug use can be responsible for the fact that psychosis actually occurs during a crisis.

Those affected often have other mental illnesses such as depression or addiction. Very many young patients with schizophrenia consume cannabis (new scientific findings suggest that cannabis can trigger schizophrenia or accelerate the onset of the disease if there is a hereditary burden). Physical complaints such as constipation or diarrhea as well as palpitations and impaired mental performance can also be observed in some patients.

Schizophrenia symptoms take time, and so does diagnosis.

A prerequisite for the diagnosis of schizophrenia is that the symptoms described have persisted for at least four weeks or more. The doctor will ask about this in a detailed discussion. Some of the symptoms are not even noticed by those affected.

Relatives or other caregivers can often provide information on this. Additional examinations are important to rule out diseases with similar symptoms, such as a certain metabolic disorder or alcohol and drug abuse.

Therapy for schizophrenia is based on three pillars

Once the diagnosis has been made after the examinations, an individual overall therapeutic concept is first drawn up with the aim of alleviating the symptoms of the disease and enabling the patient to lead a life that is as self-determined as possible. It used to be assumed that drugs and alcohol aggravate psychosis, but cannot trigger it. In the meantime, one is no longer so sure - also because people consume much higher doses today.

Pillar 1: Medicines balance the imbalance in the neurotransmitters in the brain. It should serve as protection against further acute attacks.

Pillar 2: It contributes to the strengthening of the personality. Here, patients can develop self-help strategies and train social skills.

Pillar 3: It should lead back to a life that is as independent as possible. Supervisors and therapists motivate those affected, for example, to make contacts - for example in meeting places.

How the pillars are weighted in each individual case depends on the phase of the disease and the individual treatment goal.In many cases, treatment is initially provided in a psychiatric-psychotherapeutic clinic or day clinic, or on an outpatient basis if the course is milder. A treatment essentially consists of three pillars:

1. Medicines

Medicines are usually used in the acute episode. Above all, they have a beneficial effect on psychotic symptoms such as delusions and hallucinations. Which drug is selected must be decided on an individual basis. It cannot be predicted with certainty whether it will help in individual cases or whether it will be necessary to switch to another drug.

Whether and how long medication is necessary should be decided on an individual basis. Depending on the situation, they are used for a few years or even permanently. In any case, it should be discussed with the doctor beforehand whether medication can be discontinued.

2. Psychoeducation and psychotherapy

It is important that those affected - and, if possible, their relatives - receive as well-founded information as possible about the disease. This so-called psychoeducation should enable patients, among other things, to better understand the disease, to recognize signs of a relapse and to react to it.

It is important that those affected - and if possible
also their relatives - as well-founded as possible
Get information about the disease.

The aim is the trusting cooperation between those affected and the therapist in order to promote a self-responsible way of dealing with the disease.In addition to improving the symptoms, psychotherapy can support those affected in their ability to participate in social activities and to do a satisfactory job.

3. Sociotherapy and rehabilitation

Sociotherapeutic methods help patients back into a life that is as independent as possible. Supervisors and therapists motivate those affected, for example, to structure their daily routine in a meaningful way, to do all the necessary everyday tasks such as shopping and cooking. They help patients to actively shape their free time, not to isolate themselves, but to make contacts - for example in meeting places.

An important goal is that patients use suitable offers of help in the long term. As far as possible, those affected should find their way back to work. Occupational rehabilitation measures can be helpful here. A self-help group can also have a stabilizing effect in the long term.

Help! I am a loved one

The disease not only changes the life of the person affected. Relatives are often helpless at the beginning of the diagnosis and have many questions. You should seek professional help and support early on. Advice and help are offered, for example, by self-help groups for relatives of the mentally ill.

  • Stay in contact and cultivate the relationship, even if the sick person withdraws from their social environment.
  • Actively approach the sick person: show understanding and feelings, offer support and accompany them to visits to the doctor.
  • Creating a positive atmosphere, open interaction and a lot of understanding have a positive effect on the further course of the disease.
  • Getting support: If necessary, do not hesitate to seek help from therapy yourself to protect your health

Against the stigma

Unfortunately, those affected and their relatives still have to fight against discrimination and prejudice - for example that all people with schizophrenia are less intelligent, violent or unpredictable. Not least because of this, sufferers keep the diagnosis of "schizophrenia" to themselves. For fear of being “stamped” because of their illness, of being devalued and disadvantaged by others, they withdraw. Even though you yourself often know very little about the causes, consequences and treatment options for your mental illness.

Many avoid the opportunity to talk to doctors, specialists or in a clinic about their personal experiences and thoughts. Others, on the other hand, emphasize that only the diagnosis enabled them to understand their situation better, to take their own complaints seriously and to seek help.

In recent years, various initiatives have aimed to overcome the stigma of schizophrenia in order to educate about the disease and to stand up for those affected and their families. An example is “BASTA - the alliance for mentally ill people”. called. It is part of the global Open the Doors program for people with schizophrenia.