What Causes Schizophrenia?

If you know someone with schizophrenia, you probably want to know why they have it. The truth is, doctors don’t know what causes this mental illness.

Research shows it takes a combination of genetics and your environment to trigger the disease. Knowing what increases the chances can help you put together a better picture of your odds of getting schizophrenia.

Is Schizophrenia Genetic?

Think of your genes as a blueprint for your body. If there’s a change to these instructions, it can sometimes increase your odds for developing diseases like schizophrenia.

Doctors don’t think there’s just one “schizophrenia gene.” Instead, they think it takes many genetic changes, or mutations, to raise your chances of having the mental illness.

They do know that you’re more likely to get schizophrenia if someone in your family has it. If it’s a parent, brother, or sister, your chances go up by 10%. If both your parents have it, you have a 40% chance of getting it.

What Are Your Chances of Getting Schizophrenia Genetically?

Your chances are greatest — 50% — if you have an identical twin with the disorder.

But some people with schizophrenia have no history of it in their family. Scientists think that in these cases, a gene may have changed and made the condition more likely.

Genetic Causes of Schizophrenia

Many genes play a role in your odds of getting schizophrenia. A change to any of them can do it. But usually it’s several small changes that add up and lead to a higher risk. Doctors aren’t sure how genetic changes lead to schizophrenia.

Environmental Triggers

Genetic changes can interact with things in your environment to boost your odds of getting schizophrenia. If you were exposed to certain viral infections before you were born, research suggests that your chances may go up. This could also be true if you didn’t get proper nutrition while your mother was pregnant with you, especially during her first 6 months of pregnancy. These are both theories, but they haven’t been proven by scientific studies.

Studies show that taking certain mind-altering drugs called psychoactive or psychotropic drugs, such as methamphetamine or LSD, can make you more likely to get schizophrenia. Some research has shown that marijuana use has a similar risk. The younger you start and the more often you use these drugs, the more likely you are to have symptoms like hallucinationsdelusions, inappropriate emotions, and trouble thinking clearly.

The Role of Brain Chemistry and Structure in Schizophrenia

Scientists are looking at possible differences in brain structure and function in people with and people without schizophrenia. In people with schizophrenia, they found:

  • Spaces in the brain, called ventricles, were larger.
  • Parts of the brain that deal with memory, known as the medial temporal lobes, were smaller.
  • There were fewer connections between brain cells.

People with schizophrenia also tend to have differences in the brain chemicals called neurotransmitters. These control communication within the brain.

Studies of brain tissue in people with schizophrenia after death even show that their brain structure is often different than it was at birth.

Additional Risk Factors for Schizophrenia

  • An older father
  • Problems with your immune system, like inflammation or an autoimmune disease
  • Taking mind-altering drugs as a teen
  • Complications during pregnancy or birth such as:
    • Low birth weight
    • Premature labor
    • Exposure to toxins, bacteria, or viruses
    • Lack of oxygen during birth
  • Living in a low-income urban area

Bipolar type one

Bipolar Type 1 is considered the most severe form of this illness.

According to the DSM 5, Bipolar I Disorder is characterized by one or more manic episode or mixed episodes (mixed episodes involve mania and depression) accompanied by episodes of depression alone (without mania or hypomania).

This is the most distinguishing, defining element of Bipolar I, (i.e. at least one truly manic episode).

A person may display psychotic symptoms such as delusions of grandeur or hallucinations.

In these cases, the condition is described as Bipolar Disorder I with psychotic features.

Bipolar I episodes of mania are so severe and debilitating that some experts use the term “raging Bipolar”.

A key point is “the symptoms are severe enough to disrupt the patient’s ability to work and socialize.”

Someone suffering from Bipolar I can have great difficulty functioning. You could have trouble holding down a job or maintaining a healthy relationship and typical, every day interactions with family and friends.1

Some symptoms you might experience during a manic episode include:

1. Decreased need for sleep.

2. Racing thoughts.

3. Pressured speech.

4. Excess energy or excessive hyperactivity.

5. Increased involvement in reckless or risky behavior.

6. Grandiosity or inflated self-esteem.

7. Becoming easily distracted or unable to finish one task or activity.

It is the tendency to become involved in risky or reckless behaviors that makes a manic episode the most dangerous to a patient. Driving carelessly, spending excessively and engaging in unsafe and reckless sex can have serious consequences that just do not matter to you at the time.

In a severe manic episode a person can lose all touch with reality. Left untreated a manic episode can last anywhere from a few days to several years of recurring episodes. Most of the time these symptoms will last for a few weeks or a few months.

The key difference between Bipolar I and Bipolar II is the presence of mania versus hypomania. It is important to understand this distinction in detail.

Bipolar I mania is often followed by a depressive episode. It can come within days or not pop up for several weeks or months.

During a depressive episode you may feel drained, in deep despair, guilty for no reason, worthless and irritable.

BP_Type_1

Activities you normally enjoy will hold no interest. You may experience sudden weight loss or weight gain and uncontrollable crying spells. At your lowest moment you may even have thoughts of suicide.

Again, possible consequences mean nothing to the afflicted person. These depressive episodes can last for years, which is why Bipolar I is often mistaken for chronic depression.

Many people with Bipolar I Disorder can enjoy periods where they don’t experience any symptoms in between episodes. These individuals are often able to go about their life, work, participate in family life, and socialize like anyone else. A minority of patients have rapid-cycling symptoms between mania and depression. In extreme cases symptoms of mania and depression can even alternate in the same day.2

Causes of Bipolar Disorder.

The exact cause of Bipolar Disorders is not precisely understood. It seems to be a combination of 3 things:

1. Genetics.

2. Chemical imbalances in the brain.

3. Stress and triggering events that somehow “activate” an inherited or genetic predisposition to the disorder.

Are Bipolar I and Bipolar II treated differently?

When you go for an assessment, just like with any other illness, you will be asked about family history. A close relative such as a parent with suspected or diagnosed bipolar disorder greatly increases the likelihood other family members also having the illness.

If you are concerned, take a Bipolar test.

So far, there does not seem to be any way to prevent the illness, but you can prevent some episodes of mania or depression once a doctor establishes that you do in fact have Bipolar I Disorder.

Bipolar I almost always requires the person to take medication for effective management. Don’t worry – stability and sanity is SO worth it!3

The key factor is stabilization. Regular therapy, a healthy diet, exercise and – MOST OF ALL – mood stabilizing medications such as
lithium can greatly reduce the frequency and severity of Bipolar I episodes.

Narcolepsy

Recognising narcolepsy

Disrupted sleep-wake cycle

Narcolepsy is a rare neurological condition that affects the brain’s ability to regulate the normal sleep-wake cycle. Narcolepsy is estimated to affect about 1 person in 2,500. That means that in the UK there are approximately 30,000 people who have narcolepsy, though it is believed that the majority have not been diagnosed.

Normal sleep takes the form of a regular pattern of REM (Rapid Eye Movement) and non-REM stages. During a fully night’s sleep, every 90 minutes or so a normal sleeper experiences several minutes of REM sleep, during which dreaming occurs, before switching back to non-REM sleep.

Fragmented night-time sleep

In people with narcolepsy, however, the nocturnal sleep pattern is much more fragmented and typically involves numerous awakenings. When falling asleep at night, or during the day, people with narcolepsy may rapidly enter REM sleep, leading to unusual dream-like phenomena such as hallucinations.

Daytime sleepiness and cataplexy

The most common symptom of narcolepsy is excessive daytime sleepiness (EDS), brought about by an irresistible need to sleep at inappropriate times throughout the day. Many people with narcolepsy also experience cataplexy, a temporary involuntary loss of muscle control, usually in response to strong emotions.

It is usually the onset of EDS that is the first sign that a person has narcolepsy. However, there are other conditions that can cause EDS and it is important that medical advice is obtained as soon as possible (see Seeking medical help).

Living with narcolepsy

Effects on daily life

Narcolepsy can have an effect on almost all aspects of your daily life including educationemployment and your ability to drive, and also relationships and emotional health. Although there is at present no cure for narcolepsy, and some treatments are often only partially effective, there are strategies that can help you to manage your symptoms and enable you to lead as full a life as possible.

Some suggestions …

Take a look at our suggestions for dealing with some of the commonest issues that people with narcolepsy face:

You are not alone!

Because narcolepsy is a rare condition, in normal life many people with narcolepsy may never meet anyone else with the condition. That does not mean that you are alone.

Narcolepsy UK encourages people with narcolepsy to interact with each other and to share their experiences. Through social media, events and our conferences, we aim to help people with narcolepsy support each other. You can also get in touch with us directly, either through the Contact Us page of this website, or by calling our helpline.

Supporting a person with narcolepsy

Many ways to help

If you know someone who has narcolepsy, for instance if you are a parent or other family member or friend, or a colleague or employer, there are many ways in which you can support that person and help them deal with the effects of their condition.

Learn and understand

First, by learning what narcolepsy is, what the symptoms are, and the ways that the condition is treated and managed, you will gain a greater understanding of that person’s needs.

As a parent, for instance, you will soon appreciate not only the direct effects that narcolepsy has, as a result of symptoms such as excessive daytime sleepiness and cataplexy, but also the indirect effects on mental and emotional well-being that can result from the diagnosis of such a debilitating lifelong condition.

Teachers can make a difference

If you are involved in the education of a person with narcolepsy, please visit our Narcolepsy and Education page to read our suggestions for helping to enable a student with narcolepsy to realise their full potential, and to download our guides to Narcolepsy and Education and our Narcolepsy Guide for Teachers.

Support at work is critical

Similarly, if you have a colleague or employee with narcolepsy, please visit our Narcolepsy and Work page to learn how you can help that person be a productive member of your team, and to download our guides to Narcolepsy and Work and our Narcolepsy Guide for Employers.

Narcolepsy in young people

Onset is often in childhood or early adolescence

Narcolepsy can occur at any stage of life, but the onset is often during childhood or early adolescence. The link between narcolepsy and the Pandemrix swine flu vaccine has led to an upsurge in the number of cases of narcolepsy amongst young people.

Challenges for young people

Narcolepsy in young people presents particular challenges in relation to education and to home and family life. Symptoms of narcolepsy, such as cataplexy and hypnagogic hallucinations, can be terrifying, especially for young children, and excessive daytime sleepiness and its effects may be misinterpreted as laziness or lack of intelligence.

Families have an important part to play …

For family members, it is critically important to understand what narcolepsy is and what impact it has upon the young person with narcolepsy. Only then can they provide the practical and emotional support necessary to enable the young person to realise their full potential.

… and teachers too

Teachers and other education professionals need to understand the condition too, so that they can take appropriate measures, such as allowing time for naps during the day and ensuring that the young person is given additional time for exams

You are not alone!

For young people themselves, getting to know others in the same situation can be enormously beneficial. Through social media, events and our conferences, young people with narcolepsy can make friendships that help them deal with the consequences of their condition, and also give them the chance to help others in a similar situation.

“It was lovely for our daughter to be able to talk about her illness at the network support meeting with people who really understood. She seemed to blossom.”

Schizophrenia

Key facts

  • Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide (1).
  • Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include hallucinations (hearing voices or seeing things that are not there) and delusions (fixed, false beliefs).
  • Worldwide, schizophrenia is associated with considerable disability and may affect educational and occupational performance.
  • People with schizophrenia are 2-3 times more likely to die early than the general population (2). This is often due to preventable physical diseases, such as cardiovascular disease, metabolic disease and infections.
  • Stigma, discrimination and violation of human rights of people with schizophrenia is common.
  • Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective.
  • Facilitation of assisted living, supported housing and supported employment are effective management strategies for people with schizophrenia.

Symptoms

Schizophrenia is a psychosis, a type of mental illness characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include:

  • hallucination: hearing, seeing or feeling things that are not there;
  • delusion: fixed false beliefs or suspicions not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary;
  • abnormal behaviour: disorganised behaviour such as wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt;
  • disorganised speech: incoherent or irrelevant speech; and/or
  • disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language.

Magnitude and impact

Schizophrenia affects 20 million people worldwide but is not as common as many other mental disorders. Schizophrenia also commonly starts earlier among men.

Schizophrenia is associated with considerable disability and may affect educational and occupational performance.

People with schizophrenia are 2 – 3 times more likely to die early than the general population (2). This is often due to physical illnesses, such as cardiovascular, metabolic and infectious diseases.

Stigma, discrimination and violation of human rights of people with schizophrenia is common.

Causes of schizophrenia

Research has not identified one single factor. It is thought that an interaction between genes and a range of environmental factors may cause schizophrenia.

Psychosocial factors may also contribute to schizophrenia.

Services

More than 69% of people with schizophrenia are not receiving appropriate care (3). Ninety per cent of people with untreated schizophrenia live in low- and middle- income countries. Lack of access to mental health services is an important issue. Furthermore, people with schizophrenia are less likely to seek care than the general population.

Management

Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective. However, most people with chronic schizophrenia lack access to treatment.

There is clear evidence that old-style mental hospitals are not effective in providing the treatment that people with mental disorders need and violate basic human rights of persons with mental disorders. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. The engagement of family members and the wider community in providing support is very important.

Programmes in several low- and middle- income countries (e.g. Ethiopia, Guinea-Bissau, India, Iran, Pakistan and United Republic of Tanzania) have demonstrated the feasibility of providing care to people with severe mental illness through the primary health-care system by:

  • training primary health-care personnel;
  • providing access to essential drugs;
  • supporting families in providing home care;
  • educating the public to decrease stigma and discrimination;
  • enhancing independent living skills through recovery-oriented psychosocial interventions (e.g. life skills training, social skills training) for people with schizophrenia and for their families and/or caregivers; and
  • facilitating independent living, if possible, or assisted living, supported housing and supported employment for people with schizophrenia. This can act as a base for people with schizophrenia to achieve recovery goals. People affected by schizophrenia often face difficulty in obtaining or retaining normal employment or housing opportunities.

Human rights violations

People with schizophrenia are prone to human rights violations both inside mental health institutions and in communities. Stigma of the disorder is high. This contributes to discrimination, which can in turn limit access to general health care, education, housing and employment.

WHO response

WHO’s Mental Health Gap Action Programme (mhGAP), launched in 2008, uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is being implemented in more than 100 WHO Member States.

The WHO QualityRights Project involves improving the quality of care and human rights conditions in mental health and social care facilities and to empower organizations to advocate for the health of people with mental disorders.WHO’s Mental Health Action Plan 2013-2020, endorsed by the World Health Assembly in 2013, highlights the steps required to provide appropriate services for people with mental disorders including schizophrenia. A key recommendation of the Action Plan is to shift services from institutions to the community.