Schizophrenia in adults
This page provides you with information about schizophrenia in adults.
The psychiatric services in Central Denmark Region treat schizophrenia in these teams:
- Aarhus University Hospital – Psychiatry in Skejby: Psychosis Research Unit –Psychiatric Clinic 1 and Psychiatric Clinic 2
- Regional Mental Health Services Horsens: Team for Psychoses and Team for Newly- Discovered Schizophrenia
- Regional Mental Health Services Central Denmark Region: Team for Psychotic Disorders (Viborg and Skive) and Psychosis Team (Psykiatriens Hus in Silkeborg)
- Regional Mental Health Services Randers: Psychiatric Clinic 2 and Psychiatric Clinic, Rønde
- Regional Mental Health Services Gødstrup: Team for Psychotic Disorders
What is schizophrenia?
Schizophrenia is a mental disorder. It is characterised by changes in the way you perceive yourself, others and the world. This is called having a psychosis. Typical signs of schizophrenia may be that you:
- Hear voices
- See things that others cannot see
- Perceive the world differently from others
- Lack energy
- Have difficulty taking initiatives
- Have difficulty planning and performing tasks.
In addition, you may periodically have anxiety and a tendency towards depression. The disorder can therefore make it difficult to have a well-functioning student life, working life and family life. However, there are also people with schizophrenia who recover and function well in an everyday life with family and work.
Facts about schizophrenia
- Every year, approximately 500 Danes are diagnosed with schizophrenia
- Schizophrenia is seen slightly more often in men than in women
- The disorder is almost equally widespread in all cultures, social levels and countries
- The disorder most often starts in early adulthood
- The disorder often affects women a little later than men.
A disorder with many myths
Some believe that people with schizophrenia have multiple personalities. However, a split personality is not a feature of schizophrenia. There have previously also been other myths about schizophrenia. For example, it was believed that schizophrenia:
- was due to ‘poor upbringing’
- was the parents’ fault
- was chronic and untreatable.
It was also believed that people with schizophrenia were either brilliant or unintelligent. It is also commonly thought that people with schizophrenia were criminals and dangerous.
What we know today
Today we know that schizophrenia is a disorder of the brain. Research has also shown:
- that the disease is due to both heredity and environment. This means our genes and the surroundings in which we live.
- that people with schizophrenia are just as intelligent as other people
- that people with schizophrenia are no more criminal than others. But, during a psychosis, people with schizophrenia may become aggressive and worked up if, for example, they experience that others are persecuting them
- that schizophrenia may have different courses. Some remain ill throughout their lives. Others recover completely.
The period before the disorder appears
Before the onset of the disease, there is often a period in which you begin to function more poorly. This can be both socially and at work. The period can last from months to years. Maybe you isolate yourself and lose interest in the things you otherwise loved. This period is called the prodromal period. This is followed by the actual outbreak of the disorder.
Course of the disorder
The actual course of the disorder can be divided into three phases:
- The acute phase
A phase characterised by anxiety, chaos and psychotic symptoms.
- The stabilisation phase
You start treatment and gradually get better. You need to recognise that you have a disorder and learn to live with it.
- The maintenance phase
You need to work on maintaining the good results achieved, and perhaps improve even further.
Unfortunately, some people experience a recurrence. A recurrence means a return to the acute phase. This usually happens because you have stopped taking your medication, are exposed to significant strain or stress or start substance abuse.
It is therefore important that you continue with your treatment to prevent more psychoses. If you become psychotic again, the treatment will take longer. There is also a risk that you will not fully recover again.
You can recover
It is possible to get better. The concept of recovery is based on this mindset. Recovery is a process in which you use the knowledge you have about your disorder to get better.
It is not necessarily the goal that you get completely rid of your symptoms. Instead, you need to learn some strategies for how to deal with them so that they take up as little space as possible in your everyday life.
It is important to remember that your quality of life and functional level do not necessarily go hand in hand. You may very well have a good life even if your functional level is not as high as if you were well.
Why do some people develop schizophrenia?
Schizophrenia is a disorder of the brain. It may occur if you have genes that entail a risk of developing the disorder. However, there is no single explanation for why people develop schizophrenia.
Today, schizophrenia is understood in terms of the stress vulnerability model. This means that some people are particularly vulnerable. Therefore, they develop schizophrenia more easily if they are subject to strains and stresses.
There is a greater risk of developing schizophrenia if you are related to someone who also has it. The risk is higher if this is a close relative – for example parents or siblings.
We know that the risk of developing schizophrenia is:
- 1% in the general population
- 4% in a grandchild of a person with schizophrenia
- 10% in siblings of a person with schizophrenia
- 13% in children of a person with schizophrenia
- 46% in children of two parents with schizophrenia
Several genes are of importance to the development of the disorder. Depending on which genes you have, you may have a greater or lower vulnerability to the disorder.
However, it is not certain that you develop schizophrenia even if you have the genes that entail a risk of developing the disorder. Some strains and stresses are generally required before the onset of the disorder.
Stress and strains
Before the onset of the disorder, the person has often been exposed to some kind of stress. Stress may be many things. It is not just a question of being too busy.
Stress and strains may be:
May occur already in the foetal state if, for example, the mother does not have a sufficiently healthy diet. Lack of oxygen during childbirth may also increase the baby’s risk of developing schizophrenia later on. The major hormonal changes during puberty may also cause the disorder to develop.
May, for example, be getting or breaking up with a boyfriend or girlfriend or a death.
May be both positive and negative events. For example taking an exam, starting a new job or moving away from home.
Such strains are common. A person only develops the disorder if he or she also has a special susceptibility.
What happens in the brain?
The brain consists of billions of nerve cells. They send signals to each other via neurotransmitters. People with schizophrenia have disturbances in certain areas of the brain where the neurotransmitter dopamine is active. Other disturbances of the brain are also seen. Researchers are still trying to determine the significance of these.
Schizophrenia may manifest itself in many ways
The disorder usually develops insidiously. However, it may also have a very sudden onset. Some have experienced difficulties already in childhood. This may, for example, be that they have always had difficulty socialising with others.
The symptoms may be severe and debilitating. But they may also be light and almost insignificant.
Some of the symptoms of schizophrenia are:
- Language disturbances
You can read more about these and other disturbances below.
In hospital, you may hear your doctor use the words ‘positive symptoms’. This is simply another name for psychotic symptoms.
If you have psychotic symptoms, you have a perception of reality that does not correspond to that of others. This may, for example, be expressed by:
- Impact and control experiences
Hallucinations are when the brain incorrectly perceives a sensory impression that is not actually present.
Hallucinations may occur in relation to all the senses:
Sense of hearing
Many hear sounds or voices talking about them.
Sense of taste
Things may, for example, taste rotten or of petrol.
Sense of sight
For example, they can see people or things others do not see
Sense of smell
For example, they may experience smelling toxic gas.
Sense of touch
They may, for example, experience that someone is touching them.
Impact and control experiences
They may experience that their thoughts can be heard by others. Some also feel that other people can transfer their thoughts to them and that the actions and thoughts from others can be inflicted on them. This gives them a feeling that their actions and thoughts are not their own – but those of others
Delusions are notions that only make sense to the afflicted person. They are not shared by others and cannot be corrected. Many delusions are characterised by inverted logic. This means that everything confirms the delusion. Any experience which would dispel the delusion for other people will serve as evidence to the afflicted person that the delusion is real.
Different types of delusions
The most common delusions. This means that you experience being watched and pursued. For example, you may feel that you are being pursued by the CIA because you have valuable knowledge.
Delusions of grandeur
For example, you can be convinced that you have a mission to save the world. It may also be that you feel that TV and radio address you directly with special messages.
Delusions about the body
You may also have a delusion that your body has changed. Perhaps your head is about to fall off, your organs are moving around your body or your body is dissolving. You may also get a notion that you suffer from serious illnesses.
Loss of abilities
Many experience a loss of previous abilities. You consequently cannot do the same as you could before. These losses can make it hard to conduct a normal everyday life, including that you lack an overview and energy.
In hospital, you hear your doctor use the words ‘negative symptoms’. This is just another term for loss of abilities.
It is important to remember that these symptoms are not your personality. They are signs of illness. You are still the same as before you became ill. Among other symptoms, you may experience:
Your emotions become less ‘strong’. For example, it may become difficult to feel real joy, sadness and anger.
Lack of initiative and passivity
You may have difficulties taking an initiative and getting started with tasks. Many people with schizophrenia have fewer interests and less energy.
Deterioration of contact
You may have difficulty understanding and reading other people’s intentions and aims.
You may start isolating yourself. For example, the idea of giving someone a hug may become unpleasant or downright frightening.
Opposing thoughts and feelings may arise. This may make it difficult to make decisions. One moment, you may want to go to the cinema – the next, the idea of going to the cinema will seem appalling.
The symptoms are not signs of laziness. They are instead signs of illness.
Changes in language and thoughts
The way you think and talk may change. Your language may become less expressive, with words and sentences that only make sense to yourself. For example, you may give words a new meaning or create new words that do not exist. Your language can become so disturbed that others cannot understand what you are saying at all.
You may also take what other people say very literally. For example, if somebody says, “I’m dying of laughter!”, you may take that to mean that the person in question is actually dying.
Many people with schizophrenia also experience that thoughts are churning around in their heads and that it is difficult to keep hold of them. Others may find that their thoughts suddenly come to a complete standstill.
The assurance we normally have in relation to who we are, who other people are and what the world is like may vanish. You may, for example, be convinced that all other people are actors who only want to fool you, and that the world is false and merely a stage. You may also experience that things change colour or that your sense of time changes.
75-80% of people suffering from schizophrenia have problems with:
It can be difficult to stay concentrated for an extended period of time. For example, they may have problems going to school. They also become confused more easily.
They may need longer time to perform everyday tasks.
They may have difficulty planning, performing and keeping track of things like cooking, trips and finances.
They may, for example, have problems learning new things, and may forget to keep appointments.
Symptoms may affect everyday life
All these symptoms may make many things more difficult in everyday life. It may, for example, become difficult to hold onto a job and to be together with other people. Some may find it difficult to meet even basic needs such as food, sleep and hygiene.
Being afflicted by illness may make some persons think that it would be easier not to exist. They may perhaps also think about taking their own life. If you have suicidal thoughts, it is important to seek help so that you can feel better again. You can seek help here.
Referred – now what?
If you have been referred for an examination for schizophrenia, you must:
- await a notice calling you in for an examination from one of our departments in your e-Boks or mailbox
- participate in a clarifying consultation – preferably together with your relatives
- be prepared that you may have to go through several different examinations before the doctors can say whether you have schizophrenia.
You will be called in for an examination at one of these clinics depending on your place of residence:
- Aarhus (Skejby): Psychiatric Clinic 1 and Psychiatric Clinic 2
- Herning (Gødstrup): The Psychosis Clinic
- Horsens: Team for Psychoses and Team for Newly-Discovered Schizophrenia
- Randers: Psychiatric Clinic 2
- Viborg-Skive: Team for Psychotic Disorders (Viborg and Skive) and Psychosis Team (Psykiatriens Hus in Silkeborg)
Preparation before examination
Being examined at a hospital can be a nerve-wracking experience. This is completely normal. You do not have to prepare anything before your meeting with us. However, it may be a good idea to make an agreement with a relative who knows you well to come along so he or she can give you support.
A typical examination
Together, we will find out which examinations and consultations you need and this will always be based on your particular case. However, some things recur in several patients.
You start with a consultation with a doctor or nurse. Here you explain your symptoms and your family or other relatives talk about your difficulties.
You may need further examinations, as schizophrenia is a complicated diagnosis that differs from person to person. This may, for example, be:
- a consultation about your cognitive function. That is how you understand and function in the outside world
- a consultation about diet, smoking, alcohol and exercise, because your lifestyle may have an impact on your health.
For a diagnosis of schizophrenia to be made, your symptoms must have lasted for at least a month. The diagnosis is your psychiatrist’s working tool. It is used to find the best treatment for precisely you. It is important to remember that you are not your diagnosis. Your diagnosis is a snapshot of your disorder.
Exclusion of physical illness
Before the diagnosis of schizophrenia can be made, it must be ruled out that there is a physical cause of your symptoms. This may, for example, be epilepsy.
If you have previously had cramps or serious head injuries, special attention will therefore be paid to whether it may be the cause of the symptoms. This can be ruled out through a number of examinations, including scans of your head.
What types of schizophrenia are there?
There are various types of schizophrenia depending on which symptom is dominant:
- Paranoid schizophrenia, which especially involves persecutory delusions and also often hearing hallucinations
- Hebephrenic schizophrenia, where there is behaviour, with unpredictable mood swings, aimless and incongruous behaviour and/or incoherent speech.
- Catatonic schizophrenia, where movement disturbances are predominant.
- Undifferentiated (mixed) schizophrenia, where there are traits from one or more of the above types, but these being sufficient for one of these diagnoses.
- Simple schizophrenia, where there are no psychotic symptoms, but a gradual decline in the ability to cope with the demands of society, accompanied by an impaired functional level. This is a very difficult and controversial diagnosis because so many other factors come into play.
Two-year course of treatment
In Central Denmark Region, one of the courses of treatment that you may be offered is two years of intensive treatment.
The treatment is handled by a multidisciplinary team that uses a wide range of treatment forms. The treatment will focus on a number of factors, including that you:
- establish a secure contact with a regular therapist
- get antipsychotic medication
- receive education in your disorder and in how to prevent recurrence
- get psychological treatment
- receive support for a return to work/training/education/employment
The treatment will always be based on your problems and how you can best be helped. An attempt will also be made to look at the overall picture. Because if the very basic conditions are not in order (for example housing and finances), it can be almost impossible to focus on getting better.
When you receive treatment from us, we will do our best to make you feel heard, understood and respected.
The purpose of pharmacological treatment is to alleviate or eliminate your symptoms. This especially concerns the psychotic symptoms. The medication is also used to dampen anxiety, agitation and aggressions.
Schizophrenia is treated with a type of medication called antipsychotics. There are different types of antipsychotics.
It varies from person to person which drug works best and also causes the fewest side effects. It may therefore be necessary to change medication for you to achieve the best effect and the fewest possible side effects.
Read more about antipsychotics, side effects and prevention of recurrence here.
Education about schizophrenia disorder
Education about mental disorders is also called psychoeducation. Here, you and your relatives will receive education in relevant matters concerning schizophrenia.
Psychoeducation is often conducted in groups. Here, together with others suffering from the disorders, you will acquire knowledge about symptoms, causes, treatment, social services and early signs of a new psychosis.
It is important to acquire this knowledge because schizophrenia is shrouded in a lot of myths. Psychoeducation is designed to increase your understanding of your disorder and way of being, and to help create realistic expectations about the future.
Most often, cognitive therapy forms the basis for the psychological treatment of schizophrenia.
In cognitive therapy, your therapist – together with you – focuses on examining and trying out alternative ways of thinking and acting in given situations. Here you identify your problem areas and the thoughts and feelings that are associated with these problems. Depending on the problems, thoughts and feelings you identify, you will work with new solution models and strategies.
A crisis plan is one of the first things on which the cognitive therapy will focus. It contains agreements on what you should do if you feel bad. You also work on how you can cope with signs of recurrence.
Social therapy and support options
Social therapy may include the involvement of your family, workplace, educational institution and municipal caseworkers. Your needs for support must be clarified. This may, for example, be housing allowance, mentor scheme and the like.
You may also need help to cope with practical tasks at home, help to manage your finances and support to get out among others.
Treatment for substance abuse
Many people with schizophrenia also have substance abuse problems. The substance abuse most often consists of alcohol or hashish. But a number of people with schizophrenia also use other drugs such as amphetamines or cocaine. If you have substance abuse problems, it is important to acquire knowledge about how it affects your disease.
Importance of substance abuse to the treatment
Intoxicants counter the effect of the medication used in the treatment of schizophrenia. Intoxicants also aggravate the psychosis, for example by increasing the effect of dopamine in the brain.
At the same time, the substance abuse can be experienced as a relief and a way to forget that you are ill. For some, the substance abuse environment is the only place in which they feel welcome, regardless of the problems they have.
A typical course of treatment
Your treatment will be tailored specifically to your needs. But there are some things that are typical of a course of treatment for schizophrenia. A 2-year course of treatment may, for example, include:
- Psychotherapy – consultation with contact person and/or contact doctor
- Group sessions, for example psychoeducation, with other schizophrenia sufferers
- Individual family consultation and/or multifamily group session
- Medication follow-up and control of side effects
- Network meetings and follow-up on treatment as needed.
This is just one example. Your needs will always be assessed individually. When you participate in the course of treatment, we expect you to show up and participate actively.
Treatment facilities in Central Denmark Region
Your treatment takes place in one of our clinics. This means without hospitalisation:
Aarhus (Skejby): Psychiatric Clinic 1 and Psychiatric Clinic 2
Herning (Gødstrup): The Psychosis Clinic
Horsens: Team for Psychoses and Team for Newly-Discovered Schizophrenia
Randers: Psychiatric Clinic 2
Viborg-Skive: Team for Psychotic Disorders (Viborg and Skive) and Psychosis Team (Psykiatriens Hus in Silkeborg)
If you have severe symptoms or your condition deteriorates periodically, you may be admitted to one of our wards until you feel better.
In Central Denmark Region, you may be admitted to these wards which treat schizophrenia
Aarhus (Skejby): Ward 6
Aarhus (Skejby): Ward 7
Aarhus (Skejby): Ward 8
Aarhus (Skejby): Ward 10
Herning (Gødstrup): Ward 2
Horsens: Ward O1
Horsens: Ward O2
Randers: Ward A
Viborg: Ward for psychotic disorders (P0)
Most patients with schizophrenia voluntarily undergo a well-functioning course of treatment. If your condition deteriorates seriously, a compulsory admission may, however, become relevant.
Deterioration most often occurs because you stop taking the necessary medication or because of substance abuse that aggravates the psychosis.
After the course of treatment
It may be difficult to say when you have ‘concluded’ the pharmacological part of your treatment.
If you are hospitalised, we will conduct a discharge consultation with you when you are to be discharged. Here we will discuss your transition from being hospitalised to your future situation. You can read more about this on our page ‘From admission to discharge’.
It is completely individual what we plan together with you. We work with the municipality on providing the support you need in your own home. It may also be offers such as housing allowance or home help. The municipality is responsible for this, and we participate by recommending what you need.
For many, it is possible to return to an everyday life similar to the one they had before the outbreak of the disorder. Whether you can still attend your studies, hold down your job, take care of your house or the like varies greatly from person to person.
What can be done to prevent schizophrenia?
It is important to prevent recurrence of the disorder. This is especially important because we know that the more recurrences you have, the harder it is to recover. In many ways, prevention is about reducing stimuli and demands after a psychotic episode.
An important element in prevention of recurrence is the involvement of your family in your treatment. With knowledge about your disorder, your family can help ensure tranquillity and stability in your life.
Involving the rest of your network is also important. This may be other important people that you know, for example at your place of study or work. What is demanded of you must be adapted so that the relevant considerations are taken. This may, for example, be to submit an application for a mentor to advise and offer guidance about educational and work-related challenges.
What can you do yourself if you are suffering from schizophrenia?
Learn about your disorder
It is important to learn how to tackle your symptoms. All people who are diagnosed with schizophrenia are offered education about their disorder.
Be aware of your early signs
The signs are personal. This means that all people have different early signs. Early signs of a new psychosis may be that you become more irritable, isolated yourself and sleep less before a deterioration of your disorder.
Prepare a crisis plan
During the good times, you can write down your early signs together with your therapist. You will then know when to seek medical advice or other help. It is also a good idea for you to agree, together with your closest relatives, who you should talk to if you become aware of signs. It is important in this connection that your relatives know the signals that indicate that you are at risk of having a recurrence.
Make a note of what benefits you when you are feeling bad. The cards may contain notes on what you need to do when you are in a difficult situation. The card may, for example, state: “When I am overwhelmed by voices, I should go for a walk or take my sedative”. It is a good idea to have the cards on you at all times. You may also be able to limit the voices if you become engaged in other activities. This could, for example, be music, a bicycle ride or a good chat.
Comply with your pharmacological treatment
It is important that you comply with your pharmacological treatment for as long as your therapist recommends it. If you have any doubts or reservations about your medication, it is a good idea to talk to your therapist.
Make sure to sleep well and eat a healthy diet
It is important that you have a stable daily rhythm with a good night’s sleep and that you remember your meals. When you are ill, it can be hard to pull yourself together to live a healthy life. But it is important that you get support for even minor changes in your way of life. This may, for example, be eating a little more low-fat food, drinking a little less cola and going for a daily walk.
Exercise and do other activities that interest you
This could help alleviate negative thoughts and alleviate stress and discomfort.
Avoid excessive quantities of alcohol
Alcohol consumption may prevent your treatment from being successful. High alcohol consumption may cause liver damage in the long term.
Include breaks and rest in your everyday routine
It is a great idea to organise your routine so that there is also room for breaks or for leisure activities and other positive experiences.
Set goals that are realistic so that your experience is positive
Take one step at a time and practise lowering your expectations and not rushing things. Pay attention to the small victories, for example that you have washed the dishes. Give yourself time – be patient even if it can be hard.
Use mental training
You can set yourself mental tasks of a suitable degree of difficulty. If you cannot concentrate on reading a book, you might watch a movie or solve a Sudoku.
Life as a relative
Being a relative of a person with schizophrenia can be very burdensome. All sorts of feelings can come into play, including anger, powerlessness and frustrations towards the afflicted person. These feelings may also arise in relation to the treatment system, which cannot always provide the help that the relatives find are needed.
It is an important part of the treatment to involve the relatives so that they can participate in supporting and encouraging the afflicted person. They may also help support the afflicted person in getting started with positive activities. The relatives must have realistic expectations and support the afflicted person in setting achievable goals. It is important for them to become familiar with schizophrenia and to try to understand the changes that occur in a person who develops this disorder.
What can you as a relative do for yourself?
- Familiarise yourself with the disorder; seek out knowledge. The more you know, the better you will be able to help in the right way.
- Participate in education for relatives or seminars for relatives. Here you can establish contact with other relatives of people with schizophrenia.
- Avoid over-involvement. It is important to respect each another as independent individuals and to avoid overstepping the other person’s boundaries.
- Accept that you do not always have the energy to provide the necessary help. We all have a limit for what we can cope with.
- Remember to look after yourself. Give yourself time and permission to find some places or activities where, as a relative, you can ‘recharge your batteries’.
What can you, as a relative, do to help the person suffering from schizophrenia?
Support the treatment
- Provide support for the treatment and the therapist. If there is anything you do not understand, ask. You may participate in one of the consultations with the therapist to hear what is being targeted.
- Pay attention to early signs of a new psychosis. Make an agreement with the afflicted person that you may contact the therapist if symptoms of the disorder occur.
- Leave some space; let go. If you have been the only person from whom the afflicted person would accept help, it may be difficult to let go and trust that others can help in the right way. But it is important that your relationship can be ‘normalised’ again. Therefore, the role of helper must be transferred to the therapist and other professionals. That will give both you and the afflicted person some space away from the disorder and its associated problems.
- Focus on the areas where you can make a difference, and accept that you cannot solve every problem. You cannot do everything! Help where you can. This may, for example, be with practical tasks. Accept that neither you nor others can do things to perfection.
- Solve the problems step by step and lower your expectations. Rome was not built in a day. Change takes time, and patience is important. Tiny steps in the right direction are better than trying to make major changes that end up failing.
- Support the afflicted person. You should try to avoid demanding too much. Express your own views and feelings instead of criticising. Remember also to praise and support the afflicted person for persisting with the treatment.
- Remember: Schizophrenia is nobody’s fault. Self-reproach and recrimination will not change anything. Instead, look ahead.
- Hold on to hope. Help the afflicted person believe that he or she will get better.
- Avoid reproaches. No one grows by being blamed for what they are unable to cope with.
- Many people with schizophrenia have little or no awareness that they are ill. During such periods, it is important not to try to convince the afflicted person of the opposite. You may instead simply support continued contact with the therapist.