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Schizophrenia: symptoms, treatment and family support

Alanoud AlturkiMedical review: Tatmeen team9 min read
يدان تمسكان قائمة مصورة، وبجانبها علبة أدوية مقسمة وتقويم وصورة أسرة على خلفية زرقاء.
Article contents
  1. When is help urgent?
  2. What symptoms will a clinician ask about?
  3. What does assessment involve?
  4. What causes schizophrenia?
  5. Treatment: reducing symptoms and returning to everyday life
  6. How do you talk to someone who hears voices or feels threatened?
  7. What helps families with continuing care?
  8. Frequently Asked Questions
  9. Sources and references
  10. Writer and reviewer

Schizophrenia is a mental health condition that can affect thinking, perception, emotions and everyday functioning1. A person may experience hallucinations or beliefs they find difficult to reconsider. They may also struggle to organize their speech or start daily tasks. Schizophrenia does not mean having two personalities, and an unusual behavior or a single symptom cannot establish the diagnosis. Treatment and support can reduce symptoms and help people regain greater independence2.

If you notice a change in yourself or someone close to you, start by describing what is happening and seeking an appropriate assessment. You do not need to settle the name of the condition before asking for help.

When is help urgent?

What is happening now? What to do
Immediate danger to life or inability to maintain safety, wanting to harm yourself or someone else, voices telling someone to cause harm, severe agitation, rapidly worsening hallucinations, sudden confusion, or speech that does not make sense Get immediate medical help. In Saudi Arabia, call 997 for an ambulance, or ask someone else to take you to an emergency department if it is safe to do so. Do not drive yourself.
New or unexplained hallucinations, new intense or persistent beliefs that cause concern or affect daily life, or a clear change in thinking and functioning, while safety can be maintained Seek a prompt medical assessment, especially if this is the first episode. A doctor or health center can help arrange specialist assessment. If you do not know where to go or cannot reach your team, call 937 for guidance on finding an available medical assessment service. Do not put this off until a routine follow-up appointment.
A known diagnosis and a stable condition, or early signs that symptoms are returning Follow the care plan and contact the treating team about changes. If symptoms become severe or safety cannot be maintained, get immediate help.

Sudden confusion can result from an acute physical illness; it is not necessarily schizophrenia. Do not wait for a routine mental health appointment to have it assessed. 937 provides consultation6 while safety can be maintained. Do not use it to delay an emergency ambulance call5.

What symptoms will a clinician ask about?

Experiences vary from person to person. Three groups of difficulties1 are useful to understand:

  • Changes in perception and thinking: hearing voices other people cannot hear, feeling that ordinary messages are directed specifically at you, or firmly believing someone is watching7 or wants to harm you. Organizing thoughts and speech may also become difficult. These are examples of experiences that can be psychotic symptoms; a person's fears or opinions are not automatically signs of illness. Differing opinions or beliefs shared within the person's culture12 do not by themselves establish illness.
  • Reduced motivation and engagement: less initiative or speech, less interest in activities, withdrawal or difficulty expressing emotions. Clinicians call some of these “negative symptoms” because usual abilities or responses are reduced. The term does not mean the person is bad or deliberately lazy.
  • Problems with attention and memory: following a conversation, remembering an appointment or organizing a task with several steps may be difficult. These problems deserve support even when hallucinations improve.

Withdrawal, poor sleep or low motivation alone do not establish schizophrenia. Hallucinations and psychosis can occur with other conditions7, including bipolar disorder and severe depression, or with some physical illnesses, medicines and substances. A clinician needs the full picture.

What does assessment involve?

There is no single blood test or home test that confirms schizophrenia. Diagnosis involves specialist assessment of symptoms, their course and their impact, while considering other possible causes. Follow-up may be needed8 before the diagnosis becomes clear; seeking help does not mean a specific diagnosis will be settled at the first visit.

You can prepare a few short notes:

  • When did the change begin? What specific example did you notice, beyond saying “their behavior is strange”?
  • How have sleep, eating, study or work, and self-care changed?
  • Have there been clear episodes of unusually elevated mood and energy, or severe depression?
  • What medicines or substances have been used, and have these changed recently?
  • What troubles the person most, and what help are they willing to accept now?

Assessment covers physical and mental health. The clinician may request tests8 according to the situation. Be open about medicines and substance use7; this information helps identify the cause and choose care safely.

What causes schizophrenia?

No single cause has been identified. Research points to an interaction between genetic and environmental factors1 and life experiences. Having a relative with schizophrenia does not mean other family members will develop it. Heavy cannabis use2 is also associated with increased risk. These are factors that help explain risk, not a way to blame the person or their family or diagnose an individual.

Treatment: reducing symptoms and returning to everyday life

A care plan is built around the person's needs and goals. It may combine medication, psychological treatment9, and family and social support. Care does not end when hallucinations settle. Returning to study or work2, organizing the day and maintaining relationships also deserve attention.

Antipsychotic medicines can reduce the intensity and frequency of psychotic symptoms. The doctor discusses benefits and side effects with the person, chooses treatment and monitors their response. Report drowsiness, weight gain, restlessness9 or any other troublesome effect. Ask about physical health monitoring, including weight, blood glucose and lipids as appropriate to the care plan. Do not stop medication or change the dose on your own1; the team can adjust the plan when needed.

If taking medication becomes difficult, start without blame: “What has made it hard to continue?” The reason may be a side effect, fear about medication, feeling it is no longer needed, forgotten doses or difficulty obtaining it. Tell the clinician and agree on support that addresses the reason11: discussing concerns, reminders the person wants, or help with access. Family can help with their agreement; support should not become surveillance or unsupervised dose changes.

Psychological treatment and rehabilitation help with distressing experiences and everyday difficulties. Care may include cognitive behavioral therapy adapted for psychosis9, skills training, support with study or work, education about the condition and family intervention2. Ask what is available and suitable for you. Psychological treatment and medication can be complementary.

Recovery follows different paths2. Symptoms may improve greatly, return at times, or leave some difficulties that need continuing support. It is not reasonable to promise one outcome or assume that the diagnosis has already determined someone's future.

How do you talk to someone who hears voices or feels threatened?

Their experience may feel very real to them. Speak calmly, use clear sentences and listen to what troubles them without ridicule or a long interrogation. You do not need to confirm the belief or turn the conversation into a battle to prove them wrong10.

For example, if they say, “Someone is watching me,” you could respond:

“I understand that this worries you. I can't confirm that someone is watching you, but I want you to be safe. Would you be willing to speak to a doctor, and have me come with you?”

Focus on a step they can accept10: help with sleep or fear, a call to the doctor, or going with someone they trust. If they refuse help1, ask the treating team or a medical consultation service for guidance about the next step, describing what is happening. Danger or severe deterioration calls for urgent help3 whatever the diagnosis. Being respectful does not require tolerating threats or remaining in an unsafe situation.

Most people with schizophrenia are not violent1. Assess safety according to what is actually happening, rather than the stigma attached to the diagnosis.

What helps families with continuing care?

Agree with the person and team on support they find useful. They may want an appointment reminder, help preparing their questions and what they need to bring, or support returning gradually to an activity that matters to them. Respect their privacy and ask whom they want involved in care.

Request a clear plan for returning symptoms9: what changes should prompt a call, whom to contact and what to do in a crisis. Ask for family support1 too. Sharing responsibilities and getting understandable information can make support more sustainable.

For the distinction between “mental” and “psychological,” and the confusion with multiple personalities, read Schizophrenia: understanding the diagnosis and Arabic terminology.

If a child or teenager has possible psychotic experiences, seek prompt assessment from a professional8 experienced in working with their age group. Do not use adult examples to diagnose them.

Frequently Asked Questions

What is schizophrenia, and does it mean having two personalities?

Schizophrenia is a mental health condition that can affect thinking, perception, emotions and everyday functioning. It does not mean having two personalities. A person may experience hallucinations or beliefs they find difficult to reconsider, and may struggle to organize their speech or start daily tasks. An unusual behavior or a single symptom cannot establish the diagnosis.

What are the symptoms of schizophrenia?

Experiences vary from person to person, but three groups of difficulties are useful to understand: changes in perception and thinking, such as hearing voices other people cannot hear or firmly believing someone is watching you; reduced motivation and engagement, such as less initiative or withdrawal; and problems with attention and memory. Withdrawal, poor sleep or low motivation alone do not establish schizophrenia, and no single blood test confirms it. A clinician needs the full picture.

Can schizophrenia be treated?

Treatment and support can reduce symptoms and help people regain greater independence. A care plan may combine antipsychotic medicines, which can reduce the intensity and frequency of psychotic symptoms, with psychological treatment, rehabilitation, and family and social support. Recovery follows different paths: symptoms may improve greatly, return at times, or leave some difficulties that need continuing support. Do not stop medication or change the dose on your own; the team can adjust the plan when needed.

How should I talk to someone who hears voices or feels watched?

Speak calmly, use clear sentences and listen to what troubles them without ridicule or a long interrogation; the experience may feel very real to them. You do not need to confirm the belief or prove them wrong. You could say: “I understand that this worries you. I can't confirm that someone is watching you, but I want you to be safe.” Then focus on a step they can accept, such as a call to the doctor or going with someone they trust.

When are hallucinations or other schizophrenia symptoms an emergency?

Get immediate medical help for immediate danger to life or inability to maintain safety, wanting to harm yourself or someone else, voices telling someone to cause harm, severe agitation, rapidly worsening hallucinations, sudden confusion, or speech that does not make sense. In Saudi Arabia, call 997 for an ambulance, or ask someone else to take you to an emergency department if it is safe to do so. Do not drive yourself. 937 provides consultation while safety can be maintained; do not use it to delay an emergency ambulance call.

Writing and article review

Alanoud AlturkiWritten byAlanoud Alturki

Content writer and researcher at Tatmeen, writing in Arabic and English on mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

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