Schizophrenia and psychotic disorders

Psychotic disorders, which include schizophrenia, are mental illnesses that affect a person’s way of understanding and interacting with the world around them. When someone experiences psychosis, they may have intrusive thoughts or false beliefs, hallucinations, delusions, disorganized speech, or become disconnected from reality. Psychotic disorders such as schizophrenia are some of the most misunderstood and stigmatized illnesses in our society. Although psychosis can be distressing and significantly affect a person’s well-being, psychotic disorders can be treated and, with the right care and supports, people can recover.

What are schizophrenia and psychotic disorders?

Psychosis isn’t a condition on its own but rather a cluster of symptoms. It’s a common feature of schizophrenia and some mood disorders (like bipolar disorder), substance use disorders and developmental and neurological disorders like Alzheimer’s and Parkinson’s diseases.^[i]

Everyone’s experience of psychosis is different. In psychosis, people may feel that things around them seem different or strange. They may experience problems concentrating, thinking, or communicating clearly, or taking part in their usual activities. People may also feel disconnected from reality. This could be hallucinations (sensations that aren’t real, like voices) and delusions (strong beliefs that aren’t true, like having superpowers). Some people may also feel ‘flat’ or numb and experience changes in mood, motivation, and the ability to complete tasks.

Among those who develop schizophrenia, how the illness unfolds and the impact it has is unique for each person. Some people experience only one episode in their lifetime with periods of wellness while others may experience symptoms that last a long time. Some people experience psychosis without warning while others experience warning signs. No matter how someone experiences schizophrenia, researchers agree that early treatment can help reduce the impact of the illness.

Who does it affect?

Psychosis can affect anyone. A small percentage of Canadians – around 1% – are diagnosed with schizophrenia, which is considered a severe and persistent form of mental illness that, if left untreated, can have a serious negative impact on a person’s life.^[i] For schizophrenia specifically, symptoms of illness usually start in the teen years.

It is also thought that there is a continuum of psychotic experiences and illnesses across the general population. People who use substances, particularly amphetamines, cocaine, and cannabis, are at higher risk.^[ii] The incidence of psychosis is also higher among racialized people, newcomers, and women who have recently given birth. Researchers think this may be because of trauma, the chronic stresses of racism and poverty, and factors like sleep deprivation. The stresses of new motherhood, and hormonal changes can be triggers for psychosis.^[iii] This points to the ways that it’s not only genes and brain development that may play a factor in the development of a psychotic disorder, but also life events and social conditions.^[iv]

Substance use disorders are common among people who experience severe and persistent psychosis; around half of all people with schizophrenia will develop a substance use problem in their lifetime.^[v] Although many people will use substances to try and cope with distressing symptoms of psychosis, substance use can worsen psychotic symptoms and is associated with other health problems that can negatively impact a person’s quality of life.^[vi]

What can I do about it?

Psychotic disorders often respond well to medication, and many people who experience psychosis can manage their symptoms and are able to return to good health. In addition to taking medication as prescribed, managing symptoms may require learning new coping strategies, working around challenges, getting extra supports, and prioritizing sleep, exercise, and other factors that promote wellness. Most people use some combination of treatments and supports.

Self-care is important for everyone. Small steps like eating well, getting regular exercise, building healthy sleep habits, spending time on activities you enjoy, spirituality, and connecting with loved ones can make a big difference.

Medication

Medications called antipsychotics may help reduce the severity of symptoms like hallucinations and delusions and may eliminate these symptoms altogether. There are many antipsychotic medications, so it may take time and patience to find the best one for you.

All medications can cause side effects—some of which can be uncomfortable or difficult. It’s best to have ongoing, open conversations about medication with a doctor so that they understand how a medication is affecting you, what can be done, and what other options you may have.

Counselling and supports

Counselling can help with many problems like low mood, anxiety, and relationships. You can learn helpful skills like problem-solving and setting goals. There are also therapies to help reduce the impact of delusions and hallucinations. Schizophrenia can affect people’s goals around education, work, and independent living. Professionals like occupational therapists and social workers can help with daily living, social skills, employment or volunteer training, and community activities. They can also connect you with community supports like home care, housing, and income assistance.

Substance use treatment can be an important part of symptom management and a return to wellness. Psychosocial interventions like cognitive behavioural therapy (CBT), contingency management (CT), assertive community treatment (ACT) and group therapy have been shown to improve symptoms and how a person functions.^[vii]

A big part of managing schizophrenia and psychotic disorders is symptom management. You can learn what might trigger psychosis and learn to recognize early warning signs. The goal is to learn when to seek extra supports, which may help reduce the impact of the symptoms.

If you experience severe psychosis, you may need to receive treatment in hospital. Care providers there should help you map out the service providers (like doctors, counsellors, and social workers) who will be involved in your care after your hospital stay. Having a care team in the community is important.

Psychotic disorders and schizophrenia can leave people feeling very isolated and alone. At times, many people who experience symptoms of these illnesses feel uncomfortable around others and may also worry what others will think of them. That’s in part because schizophrenia and psychosis are very stigmatized in our society. Supportive friends and loved ones can be very healing. Support groups and peer supporters can also help. Your local CMHA may be able to connect you.

How can I help a loved one?

Supporting a loved one may be challenging. It can be difficult to understand what they are experiencing, and their behaviour may be confusing at times. Many people worry about their loved one’s future. The good news is that schizophrenia and other psychotic disorders are treatable—and love and support can go a long way. Here are some tips for helping a loved one:

• Learn more about schizophrenia and psychotic disorders so you have a better idea of what to expect and how you can help.
• Encourage your loved one to avoid substance use, particularly cannabis and stimulants, because these substances can make symptoms worse.
• Symptoms of schizophrenia and psychotic disorders can have a big impact on people’s ability to concentrate and make sense of information. Loved ones may not react to things in ways you expect or may struggle with tasks that seem simple to you. It’s okay to feel frustrated, but it isn’t anyone’s fault.
• If a loved one has trouble following conversations, choose a quiet space and try speaking calmly and clearly.
• It’s best to avoid disagreeing with a person’s delusions or hallucinations. A more helpful strategy is just to listen or to focus on the feelings that delusions or hallucinations bring up for the person.
• Ask your loved one how you can help. This may be a simple as helping with day-to-day tasks.
• When your loved one is feeling well, talk together about how you might help in a crisis or emergency and decide how you can contribute. Create a crisis plan and share it with their care team. This is also a good time to talk about behaviours you aren’t willing to accept.
• Learn more about support services that are available through your loved one’s care team, provincial or territorial health services, or community organizations.
• Depending on the barriers that your loved one experiences, planning for the future with tools like a Registered Disability Savings Plan can bring peace of mind.
• Set your own boundaries and seek support for yourself when you need it. Consider joining a support group for loved ones, finding a family peer supporter, and seeking counselling.

Need more help?

Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area. Find your local CMHA.

References

[i] Lecomte, Tania, Jean Addington, Chris Bowie, Martin Lepage, Stéphane Potvin, Jai Shah, Chris Summerville and Phil Tibbo, “The Canadian Network for Research in Schizophrenia and Psychoses: A Nationally Focused Approach to Psychosis and Schizophrenia Research,” Canadian Journal of Psychiatry 67.3 (2021): 172-75.

[ii] Leboyer, Marion, José Oliveira, Ryad Tamouza and Laurent Groc, “Is it time for immunopsychiatry in psychotic disorders?” Psychopharmocology 233 (2016): 1651-60.

[iii] Jones, Ian, “Postpartum psychosis: An important clue to the etiology of mental illness,” World Psychiatry 19.3 (2020).; Faber, Sonya C., Anjalika Khanna Roy, Timothy Michaels and Monnica T. Williams, “The weaponization of medicine: Early psychosis in the Black community and the need for racially informed mental healthcare,” Frontiers in Psychiatry 9.14 (2023).

[iv] DeRosse, Pamela and Katherine H. Karlsgodt,  “Examining the Psychosis Continuum,” Current Behavioral Neuroscience Rep 2(2015): 80-9.

[v] Cohen-Laroque, Julia Cohen, Inès Grangier, Natacha Perez, Matthias Kirschner, Stefan Kaiser and Michel Sabé, “Positive and negative symptoms in methamphetamine-induced psychosis compared to schizophrenia: A systematic review and meta-analysis,” Schizophrenia Research 267 (2024): 182-90; Khokhar, Jibran Y., Lucas Dwiel, Angela Henricks, Wilder T. Doucette, and Alan I Green, “The Link Between Schizophrenia and Substance Use Disorder: A Unifying Hypothesis,” Schizophrenia Research 14.194 (2017): 194-85.

[vi] Siddiqui, Salsabil, Dhvani Mehta, Alexandria Coles, Peter Selby, Marco Solmi and David Castle, “Psychosocial Interventions for Individuals with Comorbid Psychosis and Substance Use Disorders: Systematic Review and Meta-analysis of Randomized Studies,” Schizophrenia Bulletin 2024.

[vii] Siddiqui et al., 2024.