Schizophrenia: Symptoms, Diagnosis and Treatment

Schizophrenia is a long-term mental health condition that can affect how a person thinks, perceives the world, experiences emotions and manages everyday life. It is often associated with psychosis, which can involve hearing voices, developing strongly held beliefs that other people do not share, or becoming unable to judge reliably what is happening around you.

Those experiences are only part of schizophrenia. Some people struggle more with motivation, concentration, emotional expression, relationships or maintaining ordinary routines. Symptoms can fluctuate considerably: a person may experience an acute episode of psychosis and later have long periods when symptoms are much better controlled.

Schizophrenia is also one of the most misunderstood diagnoses in mental health. It does not mean having a “split personality”, and most people with schizophrenia are not violent. Stigma can sometimes be almost as damaging as the illness itself, making people reluctant to seek help, disclose symptoms or return to work and education.

Treatment can make a major difference. Antipsychotic medicines are commonly used to reduce psychotic symptoms, while cognitive behavioural therapy, family intervention, social support, physical-health care and help with education or employment can all form part of recovery. Getting help quickly after a first episode of psychosis is particularly important.

What is schizophrenia?

Schizophrenia is classified as a psychotic disorder. The term describes a pattern of symptoms affecting perception, beliefs, thinking, motivation and functioning over time.

There is no single symptom that automatically means someone has schizophrenia. Diagnosis depends on the overall pattern, how long symptoms have been present, how they affect life and whether another condition explains them better.

Possible symptoms include:

• hearing voices or experiencing other hallucinations;
• strongly held unusual beliefs or delusions;
• disorganised or difficult-to-follow thinking;
• reduced motivation;
• social withdrawal;
• difficulty expressing emotion;
• problems concentrating or organising thoughts;
• decline in work, study or self-care.

Symptoms often first become prominent in late adolescence or early adulthood, although schizophrenia can begin later.

Schizophrenia is not the same as psychosis

Psychosis describes a state in which a person’s perception or interpretation of reality becomes substantially altered.

Psychosis can occur in:

• schizophrenia;
• schizoaffective disorder;
• bipolar disorder;
• severe depression;
• drug- or alcohol-related conditions;
• postpartum psychosis;
• some neurological and medical illnesses.

Someone experiencing their first episode of psychosis therefore does not automatically have schizophrenia.

Is schizophrenia a split personality?

No. The word is sometimes incorrectly interpreted as meaning a person has multiple personalities.

Schizophrenia and dissociative identity disorder are entirely different conditions. Schizophrenia primarily involves disturbances in thinking, perception and behaviour rather than separate identities.

Is schizophrenia lifelong?

It can be a long-term condition, but its course varies substantially.

Some people experience one or several episodes with long periods of good functioning between them. Others need ongoing treatment and support because symptoms remain persistent or frequently recur.

Recovery does not necessarily mean that every symptom disappears permanently. It can mean symptoms are manageable enough for the person to have relationships, independence, meaningful activity, work or education and a life they value.

What are the symptoms of schizophrenia?

Symptoms are often grouped into positive symptoms, negative symptoms and cognitive difficulties. These terms can sound judgemental, but “positive” simply means something has been added to ordinary experience, while “negative” means an ordinary function has been reduced.

Positive symptoms

Positive symptoms include:

• hallucinations;
• delusions;
• disorganised thinking or speech;
• unusual or severely disorganised behaviour.

These symptoms often become most noticeable during an acute psychotic episode.

Negative symptoms

Negative symptoms can include:

• reduced motivation;
• less interest in social contact;
• reduced emotional expression;
• speaking less;
• difficulty enjoying activities;
• neglect of washing, eating or other self-care;
• difficulty beginning or sustaining ordinary tasks.

These symptoms can be mistaken for laziness or deliberate withdrawal. They may actually be among the most disabling parts of the illness.

Cognitive symptoms

Some people experience problems with:

• attention;
• working memory;
• planning;
• processing information;
• organising complex tasks;
• switching between activities.

These difficulties can affect study, employment, medication routines and independent living even when hallucinations and delusions are well controlled.

Mood symptoms

Depression and anxiety are common in people with schizophrenia. Some people also experience hopelessness, shame or fear related to psychotic experiences.

Suicide risk is higher than in the general population, particularly after a first episode, after hospital discharge or when someone feels that their future has been permanently damaged.

Low mood should therefore be assessed and treated in its own right rather than assumed to be an inevitable part of schizophrenia.

Hallucinations, delusions and disorganised thinking

Psychotic symptoms can feel completely real to the person experiencing them. Telling someone simply that their experience is “nonsense” or demanding that they admit it is false is rarely helpful.

Hallucinations

A hallucination is a perception occurring without an external source.

The most familiar example is hearing voices. A person may hear:

• one or several voices;
• voices speaking directly to them;
• voices discussing them;
• critical or insulting voices;
• comforting voices;
• commands telling them to do something.

Hallucinations can also involve:

• seeing people, shapes or objects;
• feeling touched when nobody is there;
• smelling unexplained odours;
• experiencing unusual tastes.

Not everyone who hears a voice has schizophrenia. Voice hearing can occur with trauma, severe mood disorders, neurological illness, drug use and in some people who do not have a psychiatric disorder.

Delusions

A delusion is a strongly held belief that remains fixed despite evidence that other people would usually consider convincing.

Examples may include believing:

• someone is monitoring or following you;
• ordinary television programmes contain secret messages specifically for you;
• your thoughts are being inserted, removed or broadcast;
• a person or organisation intends to harm you without credible evidence;
• you possess exceptional supernatural powers;
• your body has changed in an impossible way.

Culture and religion matter when assessing beliefs. A belief should not be labelled delusional merely because it differs from the clinician’s own worldview.

Disorganised thinking

Thinking can become difficult to organise during psychosis.

A person may:

• jump rapidly between unrelated subjects;
• give answers that are difficult to follow;
• lose their train of thought;
• create unusual words;
• speak in sentences that become increasingly disconnected.

Severe disorganisation can make it difficult to communicate needs, follow instructions or remain safe.

Lack of insight

Some people do not recognise that their experiences are symptoms of illness.

This is not necessarily stubbornness. Psychosis itself can affect the ability to evaluate one’s own beliefs and experiences.

A person who genuinely believes that doctors are part of a conspiracy may understandably resist treatment. Building trust and reducing fear can be more effective than confrontation.

What causes schizophrenia?

There is no single cause. Schizophrenia appears to develop through a combination of biological vulnerability and environmental influences.

Researchers have identified roles for genetics, brain development, neurotransmitter systems, stress and environmental exposures, but none provides a complete explanation on its own.

Genetics

Schizophrenia can run in families, which shows that genetic factors contribute.

However, there is no single “schizophrenia gene”. Many genetic variants appear to influence risk, each usually having a small effect.

Having a relative with schizophrenia does not mean someone will inevitably develop the condition. Most relatives do not.

Brain development and signalling

Differences involving brain circuits and chemical signalling systems, including dopamine, are associated with schizophrenia.

The usefulness of antipsychotic medicines that affect dopamine supports the importance of these pathways, but schizophrenia cannot be reduced to a simple “chemical imbalance”.

Pregnancy and early development

Some factors affecting early brain development have been associated statistically with later schizophrenia risk, including certain pregnancy, birth and early-development complications.

These factors change probability rather than determining an individual person’s future.

Stress and difficult life experiences

Severe stress can contribute to the timing of a psychotic episode in someone who is vulnerable.

Associations have also been found between psychosis and:

• childhood trauma;
• social isolation;
• migration-related stress;
• discrimination;
• urban adversity;
• major life disruption.

This does not mean schizophrenia is simply caused by stress or poor parenting.

Cannabis

Cannabis use is associated with increased risk of psychosis, particularly with frequent use and high-THC products.

The relationship is complex. Not everyone who uses cannabis develops psychosis, and not everyone with schizophrenia has used cannabis.

For someone who has already experienced psychosis, continued cannabis use can increase the likelihood of symptom recurrence and hospital admission.

Other drugs

Amphetamines, cocaine, synthetic cannabinoids and some hallucinogenic drugs can cause psychotic symptoms.

Sometimes the symptoms resolve as the substance leaves the body. In other cases, drug exposure may trigger a longer-lasting episode in someone who was already vulnerable.

Alcohol

Alcohol intoxication, withdrawal and long-term heavy use can produce hallucinations, confusion and other psychiatric symptoms.

Substance use must therefore be discussed honestly during assessment. It affects diagnosis, medication safety and relapse prevention.

How is schizophrenia diagnosed?

There is no blood test, brain scan or questionnaire that confirms schizophrenia.

Diagnosis is made after a detailed specialist assessment of symptoms, their duration and their impact, while considering alternative explanations.

NHS guidance says someone experiencing psychosis is likely to be referred urgently to a specialist service, which may include an early intervention in psychosis team, community mental health team or crisis service.

What happens during an assessment?

The clinician may ask about:

• hallucinations and unusual beliefs;
• changes in thoughts or speech;
• mood;
• sleep;
• daily functioning;
• work or education;
• relationships;
• self-care;
• alcohol and drug use;
• physical health;
• medicines;
• family history;
• traumatic experiences;
• risk of self-harm, suicide or harm to others.

With consent, relatives or partners may provide useful information about changes the person has not recognised themselves.

Physical examination and investigations

Tests are used mainly to look for other explanations or establish a baseline before treatment.

Depending on the situation, assessment may include:

• physical examination;
• blood count;
• kidney and liver tests;
• blood glucose or HbA1c;
• thyroid tests;
• vitamin or nutritional tests;
• drug screening;
• ECG;
• neurological examination.

Brain imaging may be arranged when symptoms, examination or history suggest a neurological or structural cause. Routine scanning is not required simply to diagnose schizophrenia.

Other diagnoses considered

Psychotic symptoms can occur with:

• bipolar disorder;
• severe depression with psychotic features;
• schizoaffective disorder;
• substance-induced psychosis;
• postpartum psychosis;
• delirium;
• epilepsy;
• autoimmune encephalitis;
• brain injury or neurological disease;
• some endocrine or metabolic conditions.

The diagnosis may therefore remain provisional during a first episode while the pattern becomes clearer.

Can schizophrenia be diagnosed after one hallucination?

No. A single unusual experience does not establish schizophrenia.

Duration, severity, other symptoms, functioning, substance use, physical health and alternative explanations all matter.

Can online tests diagnose schizophrenia?

No. Online screening questions may encourage someone to seek help, but they cannot establish whether an experience represents psychosis or what is causing it.

First-episode psychosis and why early treatment matters

The first sustained episode of psychosis can be frightening for the person and everyone around them.

Before obvious hallucinations or delusions appear, family members may notice changes such as:

• social withdrawal;
• rapid decline in school or work performance;
• sleeping at unusual times;
• neglecting hygiene;
• becoming unusually suspicious;
• speaking in increasingly hard-to-follow ways;
• appearing preoccupied or responding to things nobody else can hear;
• stopping ordinary hobbies;
• unexplained fear or agitation.

These changes do not prove psychosis, but a substantial decline alongside unusual experiences deserves assessment.

Early intervention in psychosis services

NICE recommends that people with a first episode of psychosis are assessed without delay by an early intervention service where available.

These teams can provide:

• psychiatric assessment;
• antipsychotic treatment;
• CBT for psychosis;
• family intervention;
• physical-health monitoring;
• employment and education support;
• substance-use support;
• relapse planning.

Early treatment can reduce distress and may improve longer-term outcomes.

How should you talk to someone who may be psychotic?

Stay calm and focus on the person’s distress rather than winning an argument about what is real.

It is usually better to say:

“I can see that this feels frightening to you. I’m not experiencing it in the same way, but I want to help you feel safe.”

rather than:

“That is ridiculous. None of this is happening.”

You do not need to agree with a delusion in order to treat the person respectfully.

When someone refuses help

Psychosis can reduce insight, and someone may refuse treatment because they believe services are part of the threat.

If they are not in immediate danger, contact their GP, mental health team or NHS 111 for advice.

If there is immediate serious risk, call 999.

How is schizophrenia treated?

Treatment usually combines medication with psychological and social support.

NICE recommends that someone with a first episode of psychosis is offered an oral antipsychotic medicine together with individual CBT and family intervention.

Antipsychotic medicines

Antipsychotics mainly reduce hallucinations, delusions and severe disorganisation.

Commonly used medicines include:

• aripiprazole;
• risperidone;
• olanzapine;
• quetiapine;
• amisulpride;
• haloperidol;
• other medicines selected according to the individual.

No one antipsychotic is best for everyone. Choice depends on likely benefits, previous response, physical health and the side effects the person most wants to avoid.

How quickly do antipsychotics work?

Sleep, agitation and anxiety may improve before hallucinations or delusions do.

Psychotic symptoms can take several weeks to respond fully. Lack of immediate improvement does not necessarily mean the medicine will not work.

Long-acting injections

Some antipsychotics can be given as long-acting injections every few weeks or months.

They may suit someone who:

• prefers not to take tablets every day;
• has difficulty remembering medication;
• has experienced repeated relapse after stopping tablets;
• wants a more consistent medicine level.

A long-acting injection is not automatically a punishment or a sign of more severe illness. Some people simply find it more convenient.

Clozapine

Clozapine is an antipsychotic used when schizophrenia has not responded adequately to at least two appropriate antipsychotic trials.

It can be particularly effective for treatment-resistant schizophrenia but requires regular blood monitoring because it can rarely reduce infection-fighting white blood cells.

Other important risks include:

• constipation;
• weight gain;
• diabetes and lipid changes;
• excessive saliva;
• seizures;
• inflammation of the heart muscle.

Severe constipation, fever, chest pain or unexplained illness while taking clozapine requires prompt medical advice.

Cognitive behavioural therapy for psychosis

CBT does not involve simply telling someone that their beliefs are wrong.

Therapy may help the person:

• understand triggers;
• reduce distress from voices;
• examine different interpretations of experiences;
• improve coping strategies;
• reduce avoidance;
• identify early warning signs of relapse.

Family intervention

Family intervention provides education, problem-solving and communication support for the person and people close to them.

It can help families understand psychosis, reduce conflict and develop plans for early signs of relapse.

The aim is not to blame relatives. Modern schizophrenia treatment explicitly rejects old theories that families cause the illness.

Occupational and social support

Recovery may require help with:

• housing;
• benefits and finances;
• returning to education;
• finding or keeping employment;
• daily routines;
• relationships;
• substance use;
• social isolation.

NICE recommends supporting people towards meaningful education and employment rather than assuming schizophrenia prevents them from participating.

Antipsychotic side effects and physical health

Antipsychotic medicines can be extremely useful, but side effects matter and should be discussed openly.

A person should not be expected simply to tolerate severe side effects because the medicine is controlling psychosis.

Weight gain and metabolic changes

Some antipsychotics can increase appetite and contribute to:

• weight gain;
• higher blood glucose;
• type 2 diabetes;
• raised cholesterol and triglycerides.

The risk varies substantially between medicines.

Before treatment, NICE recommends checking measurements such as weight, waist circumference, pulse, blood pressure and relevant blood tests, followed by continuing physical-health monitoring.

Movement side effects

Possible symptoms include:

• stiffness;
• tremor;
• slowed movement;
• muscle spasms;
• restlessness or inability to sit still;
• involuntary facial or body movements.

Akathisia—intense internal restlessness—is particularly important because it may be mistaken for anxiety or agitation from the illness itself.

Report new abnormal movement promptly so medication can be reviewed.

Sexual and hormonal effects

Some antipsychotics raise prolactin, a hormone that can cause:

• reduced libido;
• erectile difficulties;
• breast enlargement or tenderness;
• milk production;
• changes in periods;
• fertility problems.

These effects should not be dismissed as embarrassing or unimportant.

Sleepiness

Some medicines are sedating, particularly when treatment begins.

Do not drive or operate machinery when sleepy or cognitively impaired.

Changing dose timing or selecting another medicine may help, but changes should be discussed with the prescriber.

Heart rhythm and blood pressure

Antipsychotics can sometimes affect:

• heart rhythm;
• blood pressure when standing;
• heart rate.

An ECG may be appropriate when there is heart disease, relevant family history, interacting medication or use of a medicine known to affect QT interval.

Neuroleptic malignant syndrome

This is a rare but potentially life-threatening reaction to antipsychotic medicine.

Possible symptoms include:

• high temperature;
• severe muscle stiffness;
• confusion;
• rapid pulse;
• heavy sweating;
• reduced consciousness.

Seek emergency medical help if these symptoms develop.

Do not stop antipsychotics suddenly

Stopping abruptly can lead to withdrawal symptoms and increase the risk of rapid relapse.

If treatment is causing unacceptable side effects, ask for a medication review. The safer answer may be a gradual reduction, another antipsychotic or management of the specific side effect.

Relapse, recovery and living with schizophrenia

Schizophrenia does not remove a person’s ambitions, personality or ability to have a meaningful life.

Recovery is individual. Someone may prioritise:

• living independently;
• returning to university;
• employment;
• parenting;
• relationships;
• creative work;
• reducing voices;
• avoiding hospital admission;
• improving physical health.

Early warning signs of relapse

Relapse can sometimes be recognised before full psychosis returns.

Possible warning signs include:

• sleep becoming disrupted;
• increasing suspicion;
• withdrawing from other people;
• becoming preoccupied with unusual meanings;
• hearing faint or occasional voices again;
• neglecting medication;
• increasing cannabis or alcohol use;
• decline in self-care;
• increasing irritability or agitation.

A personalised relapse plan can specify what the person, family and care team should do when these signs appear.

Medication adherence

People stop medicine for understandable reasons, including:

• side effects;
• feeling recovered;
• not believing the diagnosis;
• forgetfulness;
• stigma;
• costs or access problems;
• wanting to feel more emotionally alive.

Discussing these concerns honestly is more effective than describing the person as “non-compliant”.

Sleep

Major sleep disruption can precede relapse. A stable routine can support mental health, although insomnia itself may require treatment.

Several antipsychotics also alter sleep, so new excessive sedation or insomnia should be reviewed.

Cannabis and recreational drugs

Continuing cannabis after psychosis is associated with poorer outcomes and higher relapse risk.

Reducing or stopping use can be difficult, particularly when the person feels cannabis reduces anxiety or boredom. Dual-diagnosis services can address substance use and psychosis together.

Alcohol

Heavy alcohol use can worsen:

• sleep;
• medication adherence;
• impulse control;
• depression;
• physical health.

It may also interact with sedating medication.

Physical health

People with severe mental illness have higher rates of cardiovascular disease, diabetes and smoking-related illness.

Regular physical-health checks are therefore an essential part of schizophrenia treatment, not an optional extra.

Monitoring may include:

• weight and waist measurement;
• blood pressure;
• blood glucose or HbA1c;
• cholesterol;
• smoking;
• diet and physical activity;
• sexual health;
• dental health.

Work and education

Some people need substantial time away during an acute episode. Others can continue studying or working with adjustments.

Useful support may include:

• gradual return;
• reduced workload temporarily;
• clear written instructions;
• regular check-ins;
• flexible appointment time;
• occupational-health support;
• supported employment programmes.

Employment can be part of recovery rather than something that must wait until every symptom has disappeared.

How can family and friends help?

Supporting someone with psychosis can be frightening and exhausting, particularly during a first episode.

Family members often ask whether they should challenge unusual beliefs, monitor medication or force someone to seek help.

Listen without reinforcing a delusion

You can acknowledge the emotion without agreeing with the belief.

For example:

“That sounds terrifying. I don’t believe the neighbours are monitoring us, but I can see you feel unsafe. Let’s contact someone who can help.”

Avoid mocking, laughing or deliberately provoking the person to prove that a belief is false.

Reduce stimulation during distress

If someone is frightened or agitated:

• speak slowly;
• use short sentences;
• reduce noise and crowds;
• avoid several people questioning them simultaneously;
• give physical space;
• avoid unexpected touching;
• keep exits unobstructed.

Ask directly about safety

It is appropriate to ask:

• “Are the voices telling you to hurt yourself?”
• “Do you feel you might hurt someone?”
• “Have you thought about suicide?”
• “Do you have a plan?”

Asking does not put the idea into someone’s head. It helps identify risk.

Know the crisis plan

Keep the numbers for:

• the care coordinator;
• community mental health team;
• crisis-resolution team;
• NHS 111;
• GP;
• 999 for immediate danger.

If the person has a written relapse or crisis plan, follow it.

Look after yourself as a carer

Carers may experience sleep loss, guilt, fear, financial stress and social isolation.

NICE recommends supporting carers as part of schizophrenia care. Ask the mental health team about a carer’s assessment, family intervention and local support.

Frequently asked questions about schizophrenia

What is schizophrenia?

Schizophrenia is a mental health condition involving changes in perception, beliefs, thinking, motivation and functioning. Psychosis is common but not the only part of the condition.

What are the first signs?

Possible early signs include social withdrawal, declining work or school performance, sleep changes, unusual suspicion, neglect of self-care and emerging hallucinations or unusual beliefs.

What is psychosis?

Psychosis is a state in which perception, thoughts or beliefs become significantly disconnected from shared reality. Schizophrenia is one possible cause.

Does psychosis always mean schizophrenia?

No. Psychosis can occur with bipolar disorder, severe depression, substance use, postpartum illness and several medical or neurological conditions.

Does schizophrenia mean multiple personalities?

No. Schizophrenia and dissociative identity disorder are different conditions.

Are people with schizophrenia dangerous?

Most are not violent. People with psychosis are often more vulnerable to harm themselves or being harmed by other people. Risk rises in particular situations such as severe untreated psychosis, substance misuse or previous violence and should be assessed individually.

Do people with schizophrenia know they are ill?

Some do and some do not. Insight can change over time and may be reduced during acute psychosis.

Can schizophrenia start suddenly?

Yes, but many episodes are preceded by weeks or months of subtler changes in behaviour, sleep, motivation and social functioning.

What age does schizophrenia begin?

It most often becomes apparent in late adolescence or early adulthood, although it can begin later.

Can children get schizophrenia?

Childhood-onset schizophrenia is rare. Psychotic symptoms in children require specialist assessment because several developmental and medical conditions can produce unusual experiences.

Is schizophrenia genetic?

Genes contribute to risk, but there is no single schizophrenia gene and having a relative with the condition does not mean someone will inevitably develop it.

Can stress cause schizophrenia?

Stress alone does not fully cause schizophrenia, but severe stress may contribute to psychosis in someone who is already vulnerable.

Can trauma cause schizophrenia?

Trauma is associated with increased psychosis risk but does not explain every case. Trauma-related symptoms and schizophrenia can also coexist.

Can cannabis cause schizophrenia?

Frequent high-THC cannabis use is associated with increased psychosis risk. Cannabis may contribute to illness in susceptible people and can worsen relapse risk after psychosis.

Can alcohol cause psychosis?

Yes. Severe intoxication, withdrawal and long-term heavy alcohol use can cause hallucinations or psychotic symptoms.

Can schizophrenia be diagnosed with a brain scan?

No. Scans can help investigate another suspected neurological cause but do not confirm schizophrenia in an individual.

Is there a blood test?

No. Blood tests are used to exclude alternative causes and monitor physical health and medication safety.

Can schizophrenia be cured?

There is no guaranteed cure, but many people achieve substantial improvement and long-term recovery with appropriate treatment and support.

Do hallucinations always go away with treatment?

Not always. Some people stop hearing voices completely, while others continue to hear them but find them quieter, less distressing or easier to ignore.

Do antipsychotics work?

They can significantly reduce psychotic symptoms and relapse risk for many people, although response and side effects vary.

Do antipsychotics change your personality?

They should not erase personality. Sedation, emotional flattening or other unwanted changes should be discussed with the prescriber because the dose or medicine may need adjusting.

Are antipsychotics addictive?

They do not usually produce craving or intoxication in the way addictive drugs do. Abrupt withdrawal can nevertheless cause symptoms and raise relapse risk, so reduction should be medically supervised.

How long do people take medication?

This varies. Treatment commonly continues after an episode to reduce relapse risk, and some people benefit from long-term medication. Decisions should be reviewed individually with the specialist.

What if medication does not work?

The specialist should review diagnosis, adherence, dose, duration, substance use and other factors. Clozapine may be considered when two appropriate antipsychotic treatments have not produced sufficient improvement.

What is clozapine?

Clozapine is an antipsychotic used mainly for treatment-resistant schizophrenia. It requires regular blood monitoring and careful physical-health checks.

Can therapy help schizophrenia?

Yes. CBT for psychosis and family intervention are recommended alongside medication and can reduce distress, improve coping and help prevent relapse.

Can someone work with schizophrenia?

Yes. Some people work continuously, while others need time away during episodes. Supported employment and workplace adjustments can help.

Can someone live independently?

Many can. The amount of support required varies from none or occasional help to supported accommodation and regular community care.

Can someone with schizophrenia have relationships and children?

Yes. Schizophrenia does not prevent someone from having meaningful relationships or becoming a parent. Pregnancy and medication planning should involve specialist advice.

What are negative symptoms?

They are reductions in ordinary functions such as motivation, emotional expression, speech and social interest. They are not evidence that someone is deliberately lazy or uncaring.

Why does someone stop washing or cleaning?

Negative symptoms, depression, cognitive difficulties or severe psychosis can make initiating ordinary self-care extremely difficult.

Can voices tell someone to hurt themselves?

Yes. Command hallucinations can occur. Any voice instructing someone to harm themselves or another person needs urgent risk assessment.

Should you argue with someone’s delusion?

Usually not aggressively. Acknowledge that the experience feels real and distressing without pretending you share the belief.

When should the GP be contacted?

Contact a GP urgently for first-time hallucinations, delusions or behaviour suggesting psychosis. Early specialist treatment is important.

When should NHS 111 be contacted?

Use NHS 111 for urgent mental health support when symptoms are escalating and immediate 999-level danger is not present.

When should 999 be called?

Call 999 when there is immediate serious risk of suicide, violence, severe confusion, dangerous behaviour, a medical emergency, overdose or inability to keep the person safe.

Can people recover from schizophrenia?

Yes. Recovery can include major symptom improvement, long periods without relapse, meaningful relationships, work, education and increasing independence. The course varies, so a diagnosis should never be presented as the end of someone’s future.