Schizophrenia is a complex and multidimensional psychiatric disorder that leads to impairments in an individual’s perception of reality. Frequently misunderstood in society, this disorder is not limited solely to psychotic symptoms; it also causes significant disturbances in cognitive, emotional and behavioral domains. The illness typically begins in late adolescence or early adulthood and often follows a chronic course.

Clinically, schizophrenia is characterized by positive symptoms such as delusions, hallucinations, disorganized speech and disorganized behavior; negative symptoms such as blunted affect, social withdrawal and loss of motivation; and cognitive symptoms such as attention deficits and memory impairments. The disorder significantly affects an individual’s social relationships, functioning and quality of life.

What Are the DSM-5 Diagnostic Criteria for Schizophrenia?

The diagnosis of schizophrenia is established according to the criteria of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association.

According to the DSM-5, the following criteria must be met for a diagnosis of schizophrenia:

• The individual must exhibit at least two of the following symptoms for a period of at least one month:
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Markedly disorganized or catatonic behavior
  5. Negative symptoms (blunted affect, loss of motivation, etc.)
• At least one of these symptoms must be delusions, hallucinations or disorganized speech.
• The total duration of symptoms must be at least six months.
• During this period, there must be a significant decline in the individual’s social, occupational or personal functioning.
• The symptoms cannot be attributed to another medical condition or substance use.

What Are the Symptoms of Schizophrenia?

The diversity of schizophrenia symptoms is one of the main factors complicating the diagnosis and treatment of the disorder. Symptoms are grouped into three main categories: positive, negative and cognitive.

1. Positive Symptoms of Schizophrenia

The most common positive symptoms are delusions and hallucinations. Delusions are false, fixed beliefs; for example, the person may believe that they are being followed or that their thoughts are being stolen. Hallucinations are most often auditory; the individual may hear voices that do not exist in reality. Disorganized speech and disorganized behavior arise from disturbances in the flow of thought and make social interactions difficult.

2. Negative Symptoms of Schizophrenia

These include emotional unresponsiveness, alogia (poverty of speech content), avolition (lack of motivation), withdrawal, avoidance behaviors, indifference and lack of initiative.

3. Cognitive Symptoms of Schizophrenia

Cognitive symptoms include impairments in attention, memory and executive functions (planning, decision-making and organizational skills); this makes it difficult to carry out daily life tasks.

What Are the Causes of Schizophrenia?

The causes of schizophrenia have been explained over the years in scientific publications as the interaction of numerous biological and environmental factors. It has been understood that not a single cause but the combination of multiple factors plays a role in the development of this disorder.

Genetic factors are the most prominent source of risk. Individuals with a family history of schizophrenia, particularly in first-degree relatives, have a significantly increased risk. Concordance rates are 40–50% in monozygotic twins and 10–15% in dizygotic twins. Prenatal maternal infections (for example: toxoplasma gondii), birth complications and perinatal hypoxia may influence brain development and increase risk. Psychosocial factors are also of great importance; childhood trauma, neglect, physical or emotional abuse, social isolation, migration and urban life have been associated with the development of schizophrenia.

From a neurobiological perspective, the dopamine hypothesis is prominent. According to the dopamine hypothesis, an increase in dopamine levels particularly in the mesolimbic system is associated with positive symptoms. Moreover, dysfunction of glutamate (NMDA) receptors has been shown to contribute particularly to cognitive and negative symptoms.

What Are the Risk Factors for Schizophrenia?

Recognizing the risk factors that predispose to schizophrenia is important both for planning preventive mental health services and for monitoring individuals at high risk.

In addition to genetic predisposition, maternal malnutrition during pregnancy, viral infections during gestation, premature birth and low birth weight are among the perinatal complications that increase risk. Intense cannabis use during adolescence may trigger psychotic symptoms in predisposed individuals. Growing up in environments of low socioeconomic status, immigration, urbanization, family conflicts and loneliness have also been associated with the development of schizophrenia. The illness tends to begin earlier in men and its clinical course is generally more severe.

How Is Schizophrenia Diagnosed?

The diagnosis of schizophrenia is based not only on the presence of symptoms but also on their duration, severity and impact on functioning. The diagnostic process requires systematic clinical evaluation.

First, a detailed psychiatric assessment is conducted. DSM-5 diagnostic criteria are used as the basis. In the differential diagnosis, organic disorders, neurological diseases and substance-induced psychotic disorders must be ruled out. If necessary, auxiliary tests such as brain imaging (CT, MRI), thyroid and vitamin levels and toxicology screening may be employed. Diagnosis is difficult during the prodromal period; however, early intervention may be possible through signs such as attention problems, social withdrawal and performance decline.

How Is Schizophrenia Treated?

Schizophrenia is a psychiatric disorder that can be controlled with appropriate treatment and support. Although full “recovery” is not always possible, symptoms can be greatly reduced and quality of life significantly improved. Treatment of schizophrenia is usually long-term and requires a multidimensional approach.

1. Pharmacological Treatment

The cornerstone of schizophrenia treatment is antipsychotic medication. These drugs are particularly effective in reducing positive symptoms (delusions, hallucinations, disorganized thinking, etc.).

Antipsychotics are divided into two groups:

• Typical (first-generation) antipsychotics: Drugs such as haloperidol and chlorpromazine. They are more effective on positive symptoms but carry a higher risk of side effects (for example, movement disorders).
• Atypical (second-generation) antipsychotics: Drugs such as risperidone, olanzapine, quetiapine and aripiprazole. They affect both positive and negative symptoms and are generally better tolerated.

Medication selection is individualized and requires regular psychiatric follow-up. Treatment adherence is crucial for symptom control and prevention of relapses.

2. Psychotherapy and Psychoeducation

In addition to pharmacological treatment, psychotherapeutic approaches are an important part of schizophrenia management:

• Cognitive Behavioral Therapy (CBT): Helps develop coping skills for delusions and hallucinations.
• Psychoeducation: Provides information about the illness for both the patient and their family. Enhances awareness in symptom management, crisis handling and treatment adherence.
• Therapies to Improve Relationship and Communication Skills: Contribute to the recovery of social functioning.

3. Family Support and Counseling

Educating and involving the family in the process enhances treatment success. Support provided to family members:

• Facilitates early recognition of relapses,
• Increases resilience against stigmatization,
• Makes appropriate interventions in crisis situations easier.

4. Community-Based Mental Health Services

The aim in schizophrenia treatment is to enhance the individual’s participation in social life. For this purpose:

• Patients are monitored through structures such as Community Mental Health Centers (CMHC),
• Vocational rehabilitation, social skills training and supported employment programs are implemented,
• The goal is to reduce hospitalizations and to promote integration into community life.

5. Hospitalization (If Necessary)

In some cases (for example, first episode, severe psychotic periods, suicide risk), short-term hospitalization may be required. During hospitalization, symptoms are stabilized, safety is ensured and appropriate medication adjustments are made.

Effects of Schizophrenia on Daily Life

Schizophrenia is a psychiatric disorder that causes serious difficulties in nearly every aspect of an individual’s life. After receiving the diagnosis, many individuals may lose their jobs, be unable to continue their education and experience significant disruptions in social relationships.

Cognitive impairments, attention deficits and lack of motivation make it difficult to perform daily tasks. Personal care is often neglected; hygiene, nutrition and adherence to medication may become problematic. Social isolation is common and this situation paves the way for comorbid psychiatric disorders such as depression and anxiety.

Especially in the early stages of the illness, the risk of suicide is high. Research indicates that approximately 5% of individuals diagnosed with schizophrenia die by suicide. Moreover, schizophrenia may shorten life expectancy by 15–25 years.

For all these reasons, the treatment of schizophrenia requires not only medical interventions but also a holistic approach that includes social, psychological and economic dimensions.