Schizophrenia is undoubtedly one of the most complex—and, unfortunately, most stigmatized—mental disorders. It fundamentally alters a person’s thinking, feelings, and behavior, distorting their connection with reality. People facing this condition may experience hallucinations, suffer from delusional ideas, and have difficulties communicating, all of which significantly affect their daily lives and relationships with loved ones. But beyond medical symptoms, schizophrenia presents a challenge to society as a whole: to learn to understand it without prejudice and empathetically support those who live with it. Psychologist Estrella González from the López Ibor clinic helped us shed light on this difficult topic.
From Illusion to Reality: What Are Psychotic Symptoms?
To understand the essence of schizophrenia, it is first necessary to examine the concept of psychotic symptoms at its core. Essentially, these are disruptions in the perception of the world around us. A person may begin to see or hear things that do not actually exist (hallucinations), or become firmly convinced of ideas that have no real basis (delusions). Their thinking and behavior can become chaotic. It’s important to understand that while such symptoms may seem frightening, they do not always indicate schizophrenia and are sometimes temporary, arising in various conditions. Therefore, careful medical assessment is absolutely essential.
Symptoms are conventionally divided into several groups. The so-called “positive” symptoms are distortions or excesses of normal functions. These include auditory hallucinations (the most common), delusional beliefs (such as paranoia or grandiosity), as well as disorganized speech and behavior up to catatonia—unusual postures or muscle rigidity. “Negative” symptoms, on the other hand, mean the fading or loss of usual functions: flat affect, where facial expressions and gestures become limited, impoverished speech, inability to enjoy life, and a marked decline in motivation for any activity. Additionally, cognitive impairments—problems with memory, attention, and information processing speed—can occur, significantly interfering with daily life.
When and why: age, risk factors, and early warning signs
Typically, the first signs of the disorder appear between late adolescence and early adulthood, roughly from ages 18 to 35, with men often affected somewhat earlier than women. Although rare, schizophrenia can begin in childhood or, conversely, in old age. In children, its symptoms are easily confused with autism spectrum disorders or ADHD, while in the elderly—with dementia. This makes diagnosis outside the typical age range much more challenging.
The causes of schizophrenia are multifaceted. There is no single determining factor, which helps relieve feelings of guilt for both patients and their families. Experts cite a combination of genetic predisposition, neurochemical imbalances in the brain (linked to dopamine and glutamate), severe psychosocial stress, past trauma, and even the abuse of psychoactive substances, especially cannabis. In the past, different types of schizophrenia were distinguished—paranoid, catatonic, and others. Today, however, the scientific community prefers to speak of ‘schizophrenia spectrum disorders,’ acknowledging that the manifestations of the illness are highly diverse and do not always fit into strict categories.
Early symptoms do not always appear alarming. A person may simply begin to distance themselves from friends and family, seem confused, or develop more rigid thinking. More obvious signs typically emerge later. Prior to an acute psychotic episode, so-called prodromal signals often appear: social withdrawal, declining performance, unusual ideas, anxiety, and irritability. It’s crucial to learn to recognize these individual warning signs in time, so that measures can be taken to try to prevent an escalation.
Diagnosis and living with it: challenges and support
There is no single test for detecting schizophrenia. The diagnosis is made based on prolonged observation, detailed discussions with the patient, and ruling out other possible causes, whether somatic illnesses or drug use. According to diagnostic guidelines, the presence of characteristic symptoms over a certain period is required to confirm the diagnosis, making early detection challenging, especially after the first psychotic episode.
Living with such a diagnosis is fraught with challenges. Paranoid delusions lead to extreme suspicion and make it hard to trust others. Combined with low self-confidence and societal stigma, this makes it very difficult to build any kind of relationship—from professional to personal. Many people with this diagnosis face isolation and difficulties in self-care. However, with proper support and psychoeducation, which helps to combat self-stigma, their quality of life can improve significantly.
Looking ahead: new horizons in treatment and understanding
Fortunately, science is moving forward. Today’s approaches to treatment are becoming increasingly personalized. In addition to medication, psychosocial interventions and cognitive therapies are actively used to help manage symptoms and better adapt to daily life. Researchers are gaining a deeper understanding of the role of neurotransmitters, identifying genetic factors, and developing new antipsychotics with fewer side effects.
One of the most exciting areas has been work with social cognition—the ability to understand the emotions and intentions of others, which is often impaired in schizophrenia. Here, innovative technologies come to the rescue, such as training in virtual reality. In a safe environment, patients can practice social skills by recognizing facial expressions or making decisions in dialogue scenarios. These methods not only improve communication but can also reduce the intensity of certain symptoms. These advances, together with growing public awareness of mental health, are opening the door to a future where people with schizophrenia can feel more understood and integrated into society.
