Schizophrenia: A Plain-English Guide

Reading time: about 5 minutes. General education only, not medical advice.

What is it?

Schizophrenia is a serious, long-term health condition that affects how a person thinks, feels and sees the world. At times, people with schizophrenia may lose touch with what others see as reality. This is called psychosis.

Schizophrenia does not mean "split personality," and most people with it are not violent. In fact, they are more likely to be harmed by others. It is nobody's fault. Signs often start between the late teens and early thirties. With treatment and support, many people manage their symptoms, and some recover well. People with schizophrenia can work, study, have relationships and live meaningful lives.

Common signs and experiences

Doctors often group the signs into three kinds.

Psychotic signs (things that are added to experience):

  • hallucinations: hearing, seeing or feeling things others don't, most often hearing voices
  • delusions: strong beliefs that aren't based on reality, such as feeling watched or controlled
  • confused thinking or speech that is hard for others to follow

Negative signs (things that are reduced):

  • less motivation or interest in daily life
  • less emotion showing in the face or voice
  • pulling away from friends and family
  • less speech

Thinking (cognitive) signs:

  • trouble paying attention or remembering things
  • trouble planning or making decisions

Before a first episode, there may be slow changes, such as poor sleep, worry, or falling behind at school or work.

How it's diagnosed

There is no single test. A psychiatrist or other mental health professional talks with the person and often with family. They look at the signs and how long they have lasted. Medical tests, such as blood tests or a brain scan, may be used to rule out other causes like drug use, infections or other illnesses. Getting help early, at the first episode of psychosis, is linked with better outcomes.

Usual treatments today

  • Medication. Antipsychotic medicines are the main treatment. They can reduce hallucinations and delusions. They come as daily tablets or as long-acting injections. Side effects can include weight gain, sleepiness and changes in blood sugar and cholesterol, so regular health checks matter.
  • Talking therapy. Cognitive behavioural therapy for psychosis (CBTp) can help people cope with symptoms. Family therapy helps loved ones understand and support.
  • Practical support. Help with jobs, education, housing and social skills.
  • Coordinated specialty care. Many areas have early-intervention teams that bring all of these together for people having their first episode.

Where metabolic health fits in

Metabolism is how the body turns food into energy. Mitochondria are tiny parts inside our cells that make most of that energy. The brain is one of the body's biggest users of energy.

Researchers are looking at metabolism in schizophrenia for several reasons:

  • People with schizophrenia have higher rates of diabetes, obesity and heart disease, and on average they live shorter lives. Some antipsychotic medicines add to these risks.
  • Some studies suggest brain cells may handle energy (such as glucose, a sugar) differently in schizophrenia, and that mitochondria may be involved.
  • This raises a question: could improving metabolism help both physical and mental health?

The ketogenic diet (very low-carb, high-fat) changes the brain's main fuel from glucose to ketones, made from fat. A small pilot study at Stanford tested this diet in adults with schizophrenia or bipolar disorder who also had metabolic problems. Over four months, many had better weight and blood markers, and some had better psychiatric scores. But it was small and had no comparison group. There are also case reports, which are stories about single patients, but these can't show that a diet works.

This is emerging research, not established treatment, and it is not a cure. Diet changes are being studied as an add-on to usual care, never as a replacement for medication.

Safety first. Do not start a ketogenic or other therapeutic diet on your own. These diets can change how some medicines work, including mood stabilisers and diabetes medicines. They can cause side effects, and they may not be safe for everyone, for example during pregnancy or with some kidney, liver or eating problems. In studies, people were followed by doctors and dietitians.

When to get help

If you or someone you know is hearing voices, holding unusual beliefs, or withdrawing from life, see a doctor soon. Early help matters. Get urgent help if someone may hurt themselves or others, or is having thoughts of suicide.

  • US: call or text 988 (Suicide & Crisis Lifeline), or chat at 988lifeline.org.
  • Emergency: call 911 or go to the nearest emergency room.
  • Outside the US: contact your local emergency number.

Latest research on schizophrenia

Disclaimer

This page is for general education only. It is not medical advice, and it is not a diagnosis or treatment plan for anyone. We are not able to review anyone's situation. Metabolic psychiatry is a young field, and research summaries here may be incomplete or out of date, so please read the original sources. Always talk with your own doctor, psychiatrist or other qualified clinician before changing a diet, starting a supplement, or starting, stopping or changing any medication. Stopping psychiatric medication suddenly can be dangerous. Read the full disclaimer.

If you are in crisis in the US, call or text 988. For emergencies, call 911.

Sources