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Schizophrenia is a serious, long-term mental illness. It can make you lose touch with reality. You can usually keep the symptoms under control by taking medications. But you'll probably have some symptoms that don't go away. You will probably also have times when all your symptoms come back (doctors call this a relapse).

If you have schizophrenia, your brain works differently to other people's brains. This affects your thoughts, emotions and the way you behave. You may go through periods when you find it hard to figure out what's really happening and what you are imagining. Doctors call this psychosis.

If you have schizophrenia, you may lose touch with reality, and have beliefs that couldn't be true (delusions) and imaginary experiences that seem real (hallucinations).

• Schizophrenia symptoms can cause you problems because they make you behave differently from how you normally would.
• There is no cure for schizophrenia. But long-term treatment with antipsychotics can help control your symptoms.^{1 2}
• Being treated with antipsychotics allows many people with schizophrenia to lead independent lives.
• Antipsychotics all have side effects. But you can work with your doctor to try and stop side effects from becoming a problem.

If someone in your family has schizophrenia, you may find it very hard to cope with their illness. Schizophrenia puts a lot of strain on families and relationships. We hope you will find that this information helps you to understand the causes and symptoms of schizophrenia, and the treatments available. Your doctor may be able to help you find support groups, which can support and advise you.

How your brain works

To understand what happens in schizophrenia, it's useful to know how your brain works.

Your brain controls everything you do. Your brain allows you to think, to speak, to move your body and remember things. It's also responsible for the things your body does automatically, such as breathing and digesting food.

Your brain is made up of billions of nerve cells that share information with each other. These cells are organized in chains. They are not actually joined together, but they sit close to each other with a space between them called a synapse.

Nerve cells allow your brain to receive, process and send information.

• Tiny electrical signals travel from one nerve cell to the next with the help of chemicals called neurotransmitters.
• To reach nerve cells throughout your body, these electrical signals travel from your brain to your spinal cord. This is a tube of nerves that runs down your back from your brain. It sits inside the bones that make up your spine.
• Once an electrical signal reaches your spinal cord, it can then travel along nerves to your arms, legs and elsewhere in your body.

Different parts of your brain have different jobs to do. Some areas control your muscles and how you move. Some change the signals from your eyes into pictures and the signals from your ears into sounds.

Other areas are responsible for matching up and comparing the information you receive from the outside world with your memories. This is how we experience our moods and emotions, such as pleasure, fear or anger.

No one fully understands what causes schizophrenia. But you might find it helpful to know some of the theories that doctors and researchers have about why people have schizophrenia.

Doctors think that people with schizophrenia have different levels of neurotransmitters than other people.³ Drugs can be used to change the levels of neurotransmitters in people's brains. Some of the drugs that work for schizophrenia reduce the amount of the neurotransmitter dopamine.

Doctors also think that if you have schizophrenia, some parts of your brain are not working normally and that the different parts can't communicate with each other properly.⁴ Brain scans show that some people with schizophrenia have slightly different brains compared to people who don't have schizophrenia.³

If parts of your brain can't communicate properly, or if some areas of your brain aren't working in the way they should, your brain will have trouble dealing with information. When your brain can't deal with information properly, your understanding of the world can change a lot. It may be hard to know what's real and what isn't. You may get symptoms like hearing voices that aren't really there.

Your thoughts and emotions depend on what you think is happening around you. If you have schizophrenia it can have a big effect on the way you think and the way you feel. Having schizophrenia can make you isolated and lonely. Some of the symptoms can be very frightening. And it can be hard to get on with normal life when you have trouble working out what is real and what isn't.

Before drugs called antipsychotics were introduced to treat schizophrenia in the 1950s, many people with schizophrenia spent years in the hospital. However, with antipsychotics (and the other treatments now available that help people deal with schizophrenia), most people can keep their symptoms under control most of the time. Now, with help, people with schizophrenia have a much better chance of living active lives, outside the hospital.⁵

It's very important to have good support from your doctors, and from friends and family. But schizophrenia puts a big strain on the people who care for you. It can be hard to have good relationships with other people, because of the way schizophrenia makes you feel and behave.

You may want to share the information on these pages with your close friends and family. It may help them to understand what you're going through and why you behave the way you do.

There are a lot of myths and misunderstandings about schizophrenia. Some people think it means you have a split personality. That isn't true. And, some people think having schizophrenia means you will behave in a violent or dangerous way. It's true that some people may be violent when they are having schizophrenia symptoms. But most people with schizophrenia do not harm other people.⁶

These myths and misunderstandings can make life even more difficult for people with schizophrenia.

Doctors don't know for certain why some people have schizophrenia. But, if you have a close relative with schizophrenia, you are more likely to have it yourself. Schizophrenia seems to run in families. But not everyone who has close relatives with schizophrenia gets it themselves.

• If you don't have a relative with schizophrenia, your chances of getting it are 1 in 100.⁷
• If you have a close relative (a parent, a brother or a sister) with schizophrenia, your chances of developing it yourself are about 1 in 10.⁷
• The chances are even higher if you have an identical twin who has schizophrenia. If your twin has schizophrenia, the chances that you will have it are nearly 1 in 2.⁷

So, the genes you get from your parents play an important part in making you more likely to get schizophrenia. But doctors think your experiences are also important. These include the very early experiences in your life, like your time in the womb, your birth and your early childhood. But these things probably only have an effect if you already have genes that make you more likely to get schizophrenia.

Some studies have shown that you may be more likely to get schizophrenia if you:⁷

• Didn't get enough nutrients as you were growing in your mother's uterus
• Had a difficult birth: for example, if you didn't get enough oxygen while your mother was in labor
• Were slow to develop as a baby or young child: for example, if you learned to walk or talk later than expected
• Were born in a city, rather than the countryside
• Were born in winter or early spring
• Were born to a mother who had an infection like flu when she was pregnant
• Had parents who were immigrants
• Smoke a lot of marijuana.

All of these things can make you more likely to get schizophrenia. They may affect the way your brain develops. But doctors also believe that, once you are vulnerable to getting schizophrenia, your symptoms can be started off by things that happen to you, like becoming stressed.³ Stressful situations may also bring on symptoms in people who have had schizophrenia for some time, but who haven't been having symptoms (doctors call this a relapse).

Things that can bring on symptoms include:³

• Being under lots of stress from studying or working, or because of family or relationship problems
• Being isolated, with little or no social support from friends and family
• Using drugs or alcohol
• Stopping your antipsychotics.

If your child has schizophrenia, you may worry that it's happened because of the way you brought up your child. But you shouldn't feel guilty. There's no evidence that the way a person is brought up makes them more or less likely to get schizophrenia.

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.