Schizophrenia is a mental disorder^[17]^[7] characterized variously by hallucinations (typically, hearing voices), delusions, disorganized thinking and behavior,^[10] and flat or inappropriate affect.^[7] Symptoms develop gradually and typically begin during young adulthood and are never resolved.^[3]^[10] There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person.^[10] For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months (according to the DSM-5) or one month (according to the ICD-11).^[10]^[18] Many people with schizophrenia have other mental disorders, especially mood, anxiety, and substance use disorders, as well as obsessive–compulsive disorder (OCD).^[10]

Quick Facts Specialty, Symptoms ...

Schizophrenia

Cloth embroidered by a person diagnosed with schizophrenia
Specialty	Psychiatry^[1]
Symptoms	Hallucinations, delusions, disorganized thinking and behavior, flat or inappropriate affect^[2]^[3]
Complications	Harm to self or others, social isolation, cognitive issues, heart disease, lifestyle diseases,^[4] obesity and type 2 diabetes arising from antipsychotic medication^[5]^[6]
Usual onset	Ages 16 to 30^[3]
Duration	Chronic^[3]
Causes	Environmental and genetic factors^[7]
Risk factors	Family history, cannabis use in adolescence, hallucinogen- or amphetamine-associated psychosis,^[8] problems during pregnancy, childhood adversity, being born or raised in a city^[7]^[9]
Diagnostic method	Based on observed behavior, reported experiences, and reports of others familiar with the person^[10]
Differential diagnosis	Substance use disorder, Huntington's disease, mood disorders (bipolar disorder, major depressive disorder), autism,^[11] borderline personality disorder,^[12] schizophreniform disorder, schizotypal personality disorder, schizoid personality disorder, antisocial personality disorder, psychotic depression, anxiety, disruptive mood dysregulation disorder, sleep paralysis
Management	Counseling, life skills training^[2]^[7]
Medication	Antipsychotics^[7]
Prognosis	20–28 years shorter life expectancy^[13]^[14]
Frequency	~0.32% (1 in 300) of the global population is affected^[15]
Deaths	~17,000 (2015)^[16]

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About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime.^[19] In 2017, there were an estimated 1.1 million new cases and in 2022 a total of 24 million cases globally.^[2]^[20] Males are more often affected and on average have an earlier onset than females.^[2] The causes of schizophrenia may include genetic and environmental factors.^[7] Genetic factors include a variety of common and rare genetic variants.^[21] Possible environmental factors include being raised in a city, childhood adversity, cannabis use during adolescence, infections, the age of a person's mother or father, and poor nutrition during pregnancy.^[7]^[22]

About half of those diagnosed with schizophrenia will have a significant improvement over the long term with no further relapses, and a small proportion of these will recover completely.^[10]^[23] The other half will have a lifelong impairment.^[24] In severe cases, people may be admitted to hospitals.^[23] Social problems such as long-term unemployment, poverty, homelessness, exploitation, and victimization are commonly correlated with schizophrenia.^[25]^[26] Compared to the general population, people with schizophrenia have a higher suicide rate (about 5% overall) and more physical health problems,^[27]^[28] leading to an average decrease in life expectancy by 20^[13] to 28 years.^[14] In 2015, an estimated 17,000 deaths were linked to schizophrenia.^[16]

The mainstay of treatment is antipsychotic medication, including olanzapine and risperidone, along with counseling, job training, and social rehabilitation.^[7] Up to a third of people do not respond to initial antipsychotics, in which case clozapine is offered.^[29] In a network comparative meta-analysis of 15 antipsychotic drugs, clozapine was significantly more effective than all other drugs, although clozapine's heavily multimodal action may cause more significant side effects.^[30] In situations where doctors judge that there is a risk of harm to self or others, they may impose short involuntary hospitalization.^[31] Long-term hospitalization is used on a small number of people with severe schizophrenia.^[32] In some countries where supportive services are limited or unavailable, long-term hospital stays are more common.^[33]