Schizophrenia

Schizophrenia is a serious mental illness that can interfere with a person’s ability to think clearly, manage emotions, make decisions and relate to others. It is frequently a complex, long-term medical illness. The exact prevalence of schizophrenia is difficult to measure. However, previous estimates for schizophrenia and related psychosis disorders ranged from 0.25% to 0.64% of U.S. adults, with a newer estimate for schizophrenia spectrum conditions at 1.2% of U.S. adults. Although schizophrenia can occur at any age, the average age of onset tends to be in the late teens to the early 20s for men, and the late 20s to early 30s for women. It is uncommon for schizophrenia to be diagnosed in a person younger than 12 or older than 40. It’s important to be aware that with early diagnosis and treatment, it is possible to live well with schizophrenia.

Causes

Research suggests that schizophrenia may have a combination of possible causes, some of which include:

• Genetics. Schizophrenia isn’t caused by just one genetic variation, but a complex interplay of genetics and environmental influences. Heredity does play a strong role — your likelihood of developing schizophrenia is more than 6 times higher if you have a close relative, such as a parent or sibling, with the disorder. It’s important to know that most people who have a first degree relative (parent or sibling) with schizophrenia will not develop the condition.
• Environment. Exposure to viruses or malnutrition before birth, particularly in the first and second trimesters, has been shown to increase the risk of schizophrenia.  These environmental stressors are thought to activate genetic risks; this process and is called epigenetics. Recent research also suggests a relationship between autoimmune disorders and the development of psychosis.
• Brain chemistry. Problems with certain brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neurotransmitters allow brain cells to communicate with each other. Networks of neurons are likely involved as well.
• Substance use. Some studies have suggested that taking mind-altering drugs during teen years and young adulthood can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana increases the risk of psychotic incidents and the risk of ongoing psychotic experiences. The younger a person is and the more frequently they use marijuana, the greater the risk.

Related Conditions

People with schizophrenia may have additional illnesses. These may include:

• Substance use disorders / Dual Diagnosis
• Posttraumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Major depressive disorder

Successfully treating schizophrenia often improves these related illnesses. And successful treatment of substance misuse, PTSD or OCD usually improves the symptoms of schizophrenia. These co-occurring diagnoses require a more tailored treatment plan so be sure to ask your health care provider about how multiple conditions can be addressed.

Reviewed and updated December 2025

Symptoms

Symptoms of schizophrenia often begin during the teenage and young adult years, when it can be especially difficult to diagnose schizophrenia. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability — common and nonspecific adolescent behavior. Other factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop schizophrenia, this stage of the disorder is called the “prodromal” period.

It’s important to be aware that symptoms of schizophrenia can occur at any age, and regardless of age, it’s essential to get a comprehensive medical evaluation to obtain the most accurate diagnosis. It’s also important to know that an accurate diagnosis often takes time. It’s not uncommon for people to receive a different diagnosis initially until the health care professional learns more about what a person is actually experiencing. This can be frustrating for the person and their family.

Schizophrenia symptoms typically fall into three major categories: positive symptoms, negative symptoms, and cognitive issues/disordered thinking. For a diagnosis of schizophrenia, some of the following symptoms are present in the context of reduced functioning (difficulty with daily tasks, relationships, and school/work life) for at least 6 months:

• Positive symptoms add experiences that are generally absent.
  • Hallucinations are a common positive symptom. These include a person hearing voices, seeing things, or smelling things that others can’t perceive. A hallucination is very real to the person experiencing it and may be confusing for a loved one to witness. The voices in a hallucination can be critical or threatening but are not always. Voices may involve people that are known or unknown to the person hearing them.
  • Delusions are another positive symptom. These are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.
• Negative symptoms stop or reduce feelings, emotions, and behaviors that are typically present
  • Negative symptoms include being emotionally flat or speaking in a dull, disconnected way. People with negative symptoms may have difficulty starting or following through with activities, showing interest in life, or sustaining relationships. Negative symptoms are sometimes confused with clinical depression.
• Cognitive issues/disorganized thinking impact a person’s thought processes and memory.
  • People with cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts or complete tasks. People with schizophrenia also often experience anosognosia, or “lack of insight.” This means the person is unaware that they have the illness, which can make engaging in treatment more difficult.

NAMI has partnered with the Foundation of the National Institute of Health and many other public and private entities to create the Accelerated Medicines Partnership for Schizophrenia (AMP-SCZ). This collaborative international research effort seeks to biologically identify at risk individuals who are developing psychosis to help create biomarkers to improve diagnosis and early intervention.

Reviewed and updated December 2025

Schizophrenia is a complex illness and can be difficult to diagnose. One of the things that can make diagnosis difficult is that there are other conditions that can sometimes cause a person to have schizophrenia-like symptoms, even if they don’t actually have schizophrenia. Conditions like brain tumors, thyroid problems, drug use and other medical conditions must be ruled out by a health care professional before an accurate diagnosis of schizophrenia can be made. The difficulty of diagnosing schizophrenia is also complicated by the fact that many people who are diagnosed do not believe that anything is wrong with them, or that they even are experiencing the condition. An accurate diagnosis is essential to ensure that people receive the most effective treatment and support, and waiting to get this diagnosis can be frustrating for the person and their family.

Without a single physical or lab test (like a blood pressure reading, glucose test or x-ray) that can diagnosis schizophrenia, it is necessary to rely on a health care professional to rule out other medical conditions – including other mental illnesses – and evaluate the symptoms and the course of a person’s illness over 6 months to help obtain the most accurate diagnosis.

To be diagnosed with schizophrenia, a person must have 2 or more of the following symptoms, each present for a significant portion of time during a 1-month period, with signs of reduced functioning (difficulty with daily tasks, relationships, and school/work life) persisting for at least 6 months:

• Hallucinations
• Delusions
• Disorganized speech or thinking
• Disorganized or catatonic behavior
• Negative symptoms (such as reduced emotional expression, lack of interest or motivation)

Note: Cognitive difficulties — such as problems with attention, working memory, or decision-making — are also common in schizophrenia, but they are not among the core diagnostic criteria. These symptoms can nonetheless have a major impact on daily functioning and quality of life.

Delusions or hallucinations alone can often be enough to lead to a diagnosis of schizophrenia. Identifying symptoms as early as possible greatly improves a person’s ability to manage the illness, reduce psychotic episodes, and live in recovery. People who receive appropriate care including a combination of medication and psychotherapy during their first psychotic episode typically have fewer subsequent hospital admissions and may require less time to control symptoms than those who don’t receive immediate help.  Psychotherapy, family support, and other psychosocial services help people strengthen coping skills, work toward recovery and build insight.

Remember, getting a correct diagnosis takes time. The “movie” of a person’s life is more likely to yield a correct diagnosis than a “snapshot” or single interview. Regularly working with a team of people you trust increases your chances both of getting the right diagnosis and of a treatment plan tailored to your individual needs.

Cultural Considerations

Research shows that Black and Latino individuals are more likely to be misdiagnosed with schizoaffective or other psychotic disorders. Factors such as provider bias and limited access to culturally responsive care can all contribute to this disparity. Working with a mental health professional who understands your cultural background and values can help ensure an accurate diagnosis and effective treatment.

Reviewed and updated December 2025

Early or first-episode psychosis (FEP) refers to when a person first shows signs of losing contact with reality. Acting quickly to connect a person with the right treatment during early psychosis or FEP can be life-changing and radically alter that person’s future. Don’t wait to take the first step and prepare yourself with information by reviewing these tip sheets:

• Early Psychosis: What’s Going on and What Can You Do?
• Encouraging People to Seek Help for Early Psychosis
• Early Intervention: How Can You Support Someone Who is Experiencing Early Psychosis

Effective treatment for schizophrenia is comprehensive and integrates medication, psychotherapy, psychosocial support, and physical health management. Collaboration among psychiatrists, therapists, peer specialists, and primary care providers with the person and their family is key to recovery. Getting treatment as early as possible after symptoms begin can make a big difference in symptom severity and recovery. It is important to work with a health care professional to develop a treatment plan that works best for you.

Coordinated Specialty Care (CSC) is a successful model that combines all the best treatments for people in the first years of psychosis and has been shown to improve outcomes. CSC is available in almost 400 programs at the time of this update. If there is an opportunity to get early support and care, see if one of these innovative programs is right for you or your family member. Learn more and find your closest treatment facility using the resources below:

• SAMHSA Early Serious Mental Illness Treatment Locator
• Early Psychosis Intervention Network (EPINET) Clinic Map

There is no cure for schizophrenia, but it can be treated and managed in several ways, often in combination:

• Antipsychotic medications
• Psychotherapy, such as cognitive behavioral therapy and assertive community treatment and supportive therapy
• Self-management strategies and education

Recovery while living with schizophrenia is often seen over time, and involves a variety of factors including self-learning, peer support, school and work, and finding the right supports and treatment.

Medication

Medication is an essential part of treating schizophrenia. Antipsychotic medications help reduce symptoms such as delusions, hallucinations, and disorganized thinking. Working closely with a health care professional to find the right medication and dose can make a significant difference in recovery. Because medications can cause side effects, it’s important to have regular check-ins with your health care professional to monitor how you’re feeling and make adjustments as needed.

Types of Antipsychotics

Antipsychotic medications fall into two main groups:

• First-generation (typical) antipsychotics — are effective in treating psychosis but may cause movement-related side effects like muscle stiffness or tardive dyskinesia.
  • Chlorpromazine (Thorazine)
  • Fluphenazine(Proxlixin)
  • Haloperidol(Haldol)
  • Loxapine(Loxitane)
  • Perphenazine (Trilafon)
  • Thiothixene (Navane)
  • Trifluoperazine (Stelazine)

• Second-generation (atypical) antipsychotics — such as risperidone, olanzapine, aripiprazole, and quetiapine — are generally less likely to cause movement problems but may increase the risk of weight gain and metabolic changes, including diabetes. Nutrition, exercise, and regular medical follow-up can help manage these effects.
  • Aripiprazole(Abilify)
  • Asenapine(Saphris)
  • Clozapine(Clozaril)
  • Iloperidone(Fanapt)
  • Lurasidone(Latuda)
  • Olanzapine(Zyprexa)
  • Paliperidone (Invega)
  • Risperidone (Risperdal)
  • Quetiapine(Seroquel)
  • Xanomeline and Trospium (Cobenfy)
  • Ziprasidone(Geodon)

Long-Acting Injectables (LAIs)

For people who prefer not to take daily oral medications, long-acting injectable (LAI) formulations, given every few weeks or months, are available and can be a convenient and effective option. LAIs help ensure consistent medication levels in the body and can lower the risk of relapse.

Clozapine

It’s important to specifically mention one medication — Clozapine (Clozaril) — a unique second-generation antipsychotic. It is mentioned specifically because it is the only FDA-approved medication for treatment-resistant schizophrenia (TRS). It is also the only FDA-approved medication to reduce suicidality in people living with schizophrenia. Clozapine has additional blood monitoring requirements and side effects, but remains an underutilized resource for people who have not responded to treatment with at least 2 different antipsychotic medications. Clozapine has been shown to be the most effective medication in these cases.

With the help of families and individuals sharing their experiences, NAMI and other advocacy organizations successfully advocated for a reduction in paperwork and process to access clozapine at the FDA in 2025. This announcement signaled the removal of the risk evaluation and mitigation strategy (REMS) process, which eliminates some of the barriers to clozapine use.

Collaborative Medication Management

Finding the right medication can take time. Some people may need to try more than one medication or dose before finding what works best. Shared decision-making, involving the person, the health care professional and the family, to discuss the benefits, side effects, and personal goals, can help make treatment more effective and sustainable over time.

Psychotherapy

Psychotherapy can help people better understand their experiences, manage symptoms, and improve quality of life. Therapy is most effective when combined with medication and support from family and community programs.

• Cognitive behavioral therapy for Psychosis (CBTp) helps people recognize and reframe distressing thoughts or beliefs related to psychosis. It teaches coping strategies for dealing with voices, suspicious thoughts, and stress. CBTp is particularly helpful for managing residual symptoms that may persist even with medication.
• Supportive psychotherapyfocuses on helping individuals process their experiences, strengthen coping skills and manage day-to-day challenges. It emphasizes safety, trust and present-focused problem-solving rather than exploring past traumas.
• Cognitive Enhancement Therapy (CET)works to promote cognitive functioning and confidence in one’s cognitive ability. CET involves a combination of computer-based cognitive exercises designed to improve attention, memory and social cognition. This therapy aims to build confidence and restore functioning in areas affected by schizophrenia. This is an active area of research in the field at this time.

Psychosocial Interventions & Models

People who engage in psychosocial therapeutic interventions often see improvement and experience greater mental stability. Psychosocial interventions enable people to compensate for or eliminate the barriers caused by their schizophrenia and learn to live well. They may be more likely to continue taking their medication and less likely to experience a return or worsening of symptoms. Some of the more common psychosocial interventions include:

• Assertive Community Treatment (ACT) is a model that provides comprehensive treatment for people with serious mental illnesses, such as schizophrenia. Unlike other community-based programs that connect people with mental health or other services, ACT provides highly individualized services directly to people with mental illness. Professionals work with people with schizophrenia and help them meet the challenges of daily life. ACT professionals also address problems proactively, prevent crises, and ensure medications are taken.
• Peer support groups, like NAMI Peer-to-Peer and NAMI Connection, encourage people’s involvement in their recovery by helping them work on social skills with others.
• Individual Placement and Support (IPS) is an evidence-based supported employment approach designed to help people with mental illness locate jobs that match their strengths and interests. Once an individual finds a job, IPS programs provide continuous support to overcome obstacles and succeed in the workplace. IPS teams are a partnership between employment specialists, mental health care providers and the person with mental illness. Based on the person’s choice, family or friends may be included in the team. Employment specialists help individuals identify goals and, together with the team, work toward achieving them. To learn more about IPS visit https://ipsworks.org/.

Complementary Health Approaches

Complementary and alternative health approaches including acupuncture, meditation, and nutrition interventions can be part of a comprehensive treatment plan. For example, Omega-3 fatty acids, commonly found in fish oil, have shown some promise for treating and managing schizophrenia. Some research suggests that omega-3 fatty acids may have supportive benefits for brain health, but more evidence is needed before recommending them as a primary treatment.

For resources and developments in research, visit the National Center for Complementary and Integrative Health.

Additional Concerns

Physical Health. Schizophrenia is associated with other health conditions and behaviors, such as diabetes, cardiovascular problems, lung disease, and smoking. It’s important to work with your health care provider to address your mental and physical health. Some antipsychotic medications also add to risk of obesity and diabetes. Coupled with smoking, this poses critical risks to some people. NAMI developed Hearts+Minds to help people reduce their risk of premature cardiac disease.

GLP-1 medications may also be a useful tool to reduce weight gain and other metabolic health risks in people with mental illness, particularly those taking certain antipsychotic medications. Talk with your health care provider to learn more.

Substance Use. People with schizophrenia are at an increased risk for misusing drugs or alcohol. Substance use can make treatments for schizophrenia less effective, make people less likely to follow their treatment plans, and even worsen symptoms.

Reviewed and updated December 2025

Related blog posts

• Power of Connection: Co-facilitating a NAMI Support Group
• Neuroplasticity III: Trusting Myself after Psychosis & Jail

Reviewed and updated December 2025