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If you've been diagnosed with schizophrenia, you may worry that you'll have to spend a lot of time in the hospital, and that you won't be able to live a normal life.

Schizophrenia does have a big effect on your life. But everyone is different. Some people have long periods of time when they are free from symptoms, or only have lingering, annoying symptoms (called background symptoms) that don't stop them getting on with their life. Other people need more time in the hospital and are ill for more of the time.

You'll probably need to keep taking medication, even when you are well, to keep your symptoms under control.

People are often diagnosed for the first time because they've had a period of psychotic symptoms, where they lose touch with reality. (As well as psychotic symptoms, schizophrenia can give you what doctors call negative symptoms, such as feeling withdrawn and depressed.)

During a psychotic episode, you may be too ill to work or look after yourself properly. You might be at risk of harming yourself or, much less commonly, other people. You may need to go into the hospital for treatment.

A psychotic episode can last for a few weeks or months. The average stay in the hospital is less than a month.¹ Some people stay for just a few days while others stay for many months.

Once you have recovered from a psychotic episode, you may have a few lingering symptoms. You might still hear voices, for example. But they might not stop you going about your life more or less normally.¹

Doctors call the pattern of symptoms a person has the course of their illness. This varies a lot from one person to another. These are some of the patterns of schizophrenia you might have:

• Having a single bout of schizophrenia symptoms, with no times when your symptoms come back (relapses), which is a complete recovery. Unfortunately, this happens for only about 1 in 8 people with schizophrenia.²
• Recovering from the first bout of schizophrenia symptoms, but with one or more relapses at a later date. In between episodes of full-blown illness, you might be completely better, or partly better. If you are partly better you may still have some background symptoms.
• Getting a bit worse with each relapse and not recovering completely.
• Having bouts of schizophrenia symptoms that get less and less serious as you get older.

Antipsychotics work to bring symptoms under control for most people. But they don't work for 1 to 2 people in 10 treated with standard antipsychotics.³ These people may need to take a newer antipsychotic called clozapine, which works differently from other antipyschotics.

If you needed to go into the hospital for treatment, you are likely to need to be readmitted because of schizophrenia symptoms. Doctors call this a relapse. Doctors estimate that about half the people who are treated in the hospital for schizophrenia need to go back into the hospital within two years because of a relapse. Around one-quarter of the people treated once in the hospital for schizophrenia won't need to go back because of schizophrenia.¹

No-one can say for certain what will happen to you. But some people seem to have fewer relapses and to recover more completely from episodes of schizophrenia.⁴

You are more likely have fewer relapses and recover more quickly if you:⁴

• Are a woman
• Get treatment with antipsychotics quickly
• Remember to take your antipsychotics every day.

Other things that can also mean you have fewer relapses and get better quickly are if you:⁴

• Became unwell suddenly, rather than gradually getting more symptoms
• Can see that your symptoms are part of an illness
• Have symptoms that clear up quickly with treatment
• Are well between the episodes of schizophrenia
• Were older when the illness first started
• Were doing well at school or work before you were ill
• Don't have a family history of schizophrenia.

Some people with schizophrenia seem to have more relapses and not recover completely in between them. You're likely to have more problems from schizophrenia if you:¹

• Have a long period of psychotic symptoms without treatment
• Have little support from your family or friends
• Are going through stressful life events, like being homeless or if you've had a relationship that's finished
• Live somewhere where people are harsh and critical about you.

When you are ill, you may not be able to care for yourself or make decisions about what sort of care you want. But you can plan for this while you are well. Your psychiatrist can help you make this plan, which is sometimes called an advance directive.

This could include:

• Who should be told about your condition (for example friends or family members)
• Where you want to go for treatment, if you need to be looked after in the hospital or clinic
• Which drugs you want to be given.

The plan can be kept with your medical records. It can then be used if you have a relapse.

Some people need to be treated in the hospital while they are having a relapse. Sometimes people have to be taken to the hospital for treatment against their wishes. There are state-controlled rules about this.

In the long term, having schizophrenia can make it more likely that a person will:⁵

• Have problems with alcohol and illegal drugs
• Suffer from anxiety and depression
• Be homeless
• Smoke and get illnesses that come from smoking.

Because of the problems that come from having schizophrenia, around 1 in 20 people who have schizophrenia commit suicide. ⁵

This all sounds very depressing. But remember that you are an individual. Nobody can say what will happen to you. With good support and treatment, you may be able to live a full, independent life.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.