Schizophrenia

Schizophrenia is a mental illness often characterised by psychosis, which affects around 1 in 100 people globally (Rethink Mental Illness, 2020; Mind 2021). Schizophrenia usually develops from the ages of 15–35 years (Royal College of Psychiatrists, 2018).

Treatment and support are commonly given within secondary care services, such as community mental health teams (NHS, 2023). Treatment often involves symptom management, which may include prescription of medications, recovery and relapse prevention, with family and social support underpinning care where possible.

Symptoms of schizophrenia are classified as positive, negative and cognitive (Table 1). The symptoms can affect a person’s wellbeing and their ability to function in all spheres of life.

Negative symptoms are less notable

The aetiology of schizophrenia is not currently clear. There are various hypotheses around this, such as evolutionary theories, but these often lack empirical evidence (Rantala et al, 2022).

The incidence of schizophrenia appears to correlate with a westernised lifestyle (Rantala et al, 2022). There is a strong body of evidence showing that schizophrenia has a high hereditability with paradoxical low reproductive success (Rantala et al, 2022). Further research into genetic causes is ongoing, with some progress being noted around common genetic variant associations (Singh et al, 2022). Experience of trauma throughout the lifespan and problem substance use are also associated with an increased incidence of schizophrenia (National Institute for Health and Care Excellence, 2014).

Other potential causes that are being researched include microbe infection, chronic stress, genotypes, gut dysbiosis and issues of neuroinflammation (Rantala et al, 2022).

Diagnosis is currently made on the basis of a thorough assessment guided by either the International Classification of Diseases (ICD-11), produced by the World Health Organization, or the Diagnostic and Statistical Manual (DSM-5), produced by the American Psychiatric Association. Significant research and advances are being made in developing diagnosis through brain scanning, but further study is required in this area (Rethink Mental Illness, 2020).

The presence of psychotic symptoms does not equate to schizophrenia, although it is a key feature of the condition.

Other diagnoses, which may be differential or occur in addition to schizophrenia, include:

• physical health issues such as sepsis or epilepsy
• medication side effects
• difficulties related to substance use
• post-traumatic stress disorder
• grief reaction
• obsessive compulsive disorder
• delusional disorder
• autism
• depression
• bipolar disorder
• personality disorder (National Institute for Health and Care Excellence, 2014; Rethink Mental Illness, 2020)

A recovery-based approach to the management and treatment of schizophrenia should always be taken, and the support of caregivers and family should be used where appropriate (World Health Organization, 2022).

Treatment may be offered within primary care to a degree, but specialist assessment should be sought and often will be used throughout the person’s life. Specialist community teams include early intervention services, crisis and intensive home treatment teams and community mental health teams.

Although admission to hospital for psychiatric care is not optimal, it may be required to best support a person during the more acute phases of their illness or where a high level of additional support and/or monitoring is required (eg medication changes).

Longer-term care and treatment will often be required and should take a multidisciplinary approach, as many areas of a person’s life can be impacted by the illness, including physical health, social wellbeing and finances (Correll

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages:

1.1 mental health and wellbeing status

Part 2: Procedures for the planning, provision and management of person-centred nursing care

11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation

Correll CU, Schooler NR. Negative symptoms in schizophrenia: a review and clinical guide for recognition, assessment, and treatment. Neuropsychiatr Dis Treat. 2020;16:519-534. https://doi.org/10.2147/NDT.S225643

Lean M, Fornells-Ambrojo M, Milton A et al. Self-management interventions for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2019;214(5):260-268. https://doi.org/10.1192/bjp.2019.54

Mind. Schizophrenia. 2021. https://www.mind.org.uk/information-support/types-of-mental-health-problems/schizophrenia/about-schizophrenia/ (accessed 4 March 2024)

National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. 2014. https://www.nice.org.uk/guidance/cg178 (accessed 4 March 2024)

NHS. Overview – schizophrenia. 2023. https://www.nhs.uk/mental-health/conditions/schizophrenia/overview/ (accessed 4 March 2024)

Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014;39(9):638-645

Rantala MJ, Luoto S, Borráz-León JI, Krams I. Schizophrenia: the new etiological synthesis. Neurosci Biobehav Rev. 2022;142:104894. https://doi.org/10.1016/j.neubiorev.2022.104894

Rethink Mental Illness. Schizophrenia. 2020. https://www.rethink.org/media/4690/schizophrenia-factsheet.pdf (accessed 4 March 2024)

Royal College of Psychiatrists. Schizophrenia. 2018. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/schizophrenia (accessed 4 March 2024)

Singh T, Poterba T, Curtis D et al. Rare coding variants in ten genes confer substantial risk for schizophrenia. Nature. 2022;604(7906):509-516.