Schizophrenia is a complex mental health condition characterized by psychotic symptoms hallucinations, delusions, disorganized thinking and can impair perception of reality. Mental Health First Aid (MHFA) guidelines equip laypeople to provide initial support until professional help is available.
Although schizophrenia is not as common as other severe mental disorders, it can be extremely disabling and chronic. Since it disrupts the way in which a person’s brain works, people with schizophrenia struggle in numerous aspects of their daily activities.
When schizophrenia is left untreated, it can tarnish your romantic, social, and professional relationships. It makes it difficult for one to organize their thoughts, causing them to behave in a manner that makes them more susceptible to injuries or other conditions or illnesses.
Causes
There isn’t just a single cause related to schizophrenia. Medical experts believe that it could happen due to different reasons. These include:
- Problems in brain development that take place before birth.
- An imbalance in the chemical signals used by the brain for cell-to-cell communication.
- When there is a loss of connection between the various areas of the brain.
Types of Schizophrenia
Schizophrenia can be divided into the following types:
Paranoid Schizophrenia
Paranoid schizophrenia is the most common type of schizophrenia, usually shown in all forms of media. The symptoms of it are:
- Auditory hallucinations
- Preoccupation with one or multiple delusions
Hebephrenic Schizophrenia
Hebephrenic schizophrenia is also known as disorganized schizophrenia, and the symptoms of it include:
- Disorganized behavior
- Difficulty in communication
- Walking or pacing in circles
- Disorganized speech
- Misplacing or forgetting things
- Social withdrawal
- Lacking impulse control
- Displaying childlike behavior
- Placing words in the wrong order or misusing them
- Repeating the same things again and again
- Not making eye contact
- Not being able to finish tasks
- Experiencing difficulty in understanding things
- Not giving related answers to the questions that are asked
- Not being able to keep a logical connection between different thoughts
- Not having proper emotional reactions
- Being unable to stick to everyday tasks
Residual Schizophrenia
Someone affected by residual schizophrenia doesn’t experience:
- Hallucinations
- Prominent delusions
- Highly disorganized behavior
- Disorganized speech
Instead, they experience negative symptoms and/or the milder form of the diagnostic symptoms of schizophrenia, including:
Social withdrawal
- Odd beliefs
- Unusual perceptions
- Difficulty expressing emotions
Catatonic Schizophrenia
Catatonic schizophrenia is when a person’s behavior, as well as speech, gets affected, and it is characterized either by decreased or excessive movement. The symptoms of catatonic schizophrenia are as follows:
- Not being responsive to most stimuli
- Lack of speech
- Repeating what others around them are saying
- Rigid muscles
- Imitating the movement of people around them
- Repetitive and involuntary physical movements
- Taking on bizarre or inappropriate postures voluntarily
- Displaying weird expressions, usually out of disapproval, disgust, or pain
Undifferentiated Schizophrenia
Undifferentiated schizophrenia does not have any specific symptoms but rather a wide variety of symptoms that don’t fulfill the full criteria for a certain subtype. The symptoms are as follows:
- Agitation
- Social withdrawal
- Abnormal movements
- Neglecting personal hygiene
- Paranoia
- Delusions
- Having difficulty making plans
- Hallucinations
- Experiencing trouble with logical thinking
- Difficulty with emotional expression
- Lack of sleep or excessive sleeping
- Disorganized or unusual speech
The other disorders related to schizophrenia include:
- Delusional Disorder
- Schizoaffective Disorder
- Schizophreniform Disorder
- Brief Psychotic Disorder
- Schizotypal Personality Disorder
Symptoms of Schizophrenia
The symptoms of schizophrenia can be divided into various categories, and they are as follows:
Early symptoms
The early symptoms appear during the early 20s or a person’s teenage years. These include:
- Anxiety
- Having odd ideas
- Sleep issues
- Being vaguely suspicious
- Irritability
- Changing social groups or friends
- Isolating oneself from their loved ones
- Performing poorly in academics
- Feeling different from the ones around them
- Agitation
- Altered levels of concentration and focus
Positive symptoms
Positive symptoms of schizophrenia refer to added actions or thoughts that aren’t connected to reality. These symptoms are as follows:
- Delusions
- Hallucinations
- Paranoia
Negative symptoms
The negative symptoms of schizophrenia refer to the ones that interrupt an individual’s typical behaviors, abilities, and emotions. These are:
- Social isolation
- Lack of expressions or emotions
- Losing interest in life
- Difficulty in executing daily activities
- Not speaking much
- Having difficulty feeling pleasure
- Responding oddly to circumstances
- Having difficulty following through with plans
Cognitive symptoms
Cognitive symptoms are named so since they impair certain mental or cognitive functions of a person. These symptoms are as follows:
Trouble with learning information and implementing it
- Forgetfulness
- Not being able to understand information and using it to make decisions
- Disorganized thinking
- Disorganized speech
When to Seek Professional Help
Activate emergency services if the person:
- Is threatening harm to self or others, or has acted on harmful impulses
- Exhibits severe confusion, unresponsiveness, or catatonia
- Shows self‐injurious behaviour or suicidal ideation
- Has not regained baseline mental state after a prolonged psychotic episode
First Aid Steps (ALGEE Action Plan)
Mental Health First Aid uses the ALGEE framework—Approach, Listen, Give support, Encourage professional help, Encourage self‐help:
- Approach and Assess
- Ensure a safe environment; remove sharp objects or potential weapons.
- Check if the person is risking harm to self/others; if so, call EMS.
- Listen Non-Judgmentally
- Use calm, simple language; allow the person to share feelings and fears without interruption.
- Acknowledge emotions (e.g., “I can see this is frightening for you”).
- Give Reassurance and Information
- Validate their experience: “What you’re going through is real for you.”
- Offer clear facts about available support: crisis lines, mental health hotlines, crisis teams.
- Encourage Professional Help
- Suggest contacting a mental health professional (psychiatrist, psychologist, community mental health service).
- Offer to help make calls or accompany them to appointments.
- Encourage Self-Help and Other Support
- Promote social connection: friends, family, peer support groups.
- Recommend coping strategies: grounding techniques (“name five things you can see”), relaxation exercises, structured daily routine.
Do’s and Don’ts
| Do | Don’t |
|---|---|
| Approach calmly, introduce yourself, and ask how you can help | Confront delusions directly or challenge beliefs loudly |
| Listen actively, validate feelings, and maintain eye contact | Rush them or force them to speak before they’re ready |
| Offer simple grounding tasks (e.g., breathing exercises) | Touch the person without consent or invade personal space |
| Keep emergency contacts and crisis helpline numbers ready | Ignore signs of escalating distress or self‐harm risk |
| Reassure confidentiality and your ongoing support | Promise to “fix” them or minimize the seriousness of symptoms |
Communication Tips
- Maintain a calm demeanour; sudden movements or raised voices can heighten paranoia.
- Use concrete, straightforward language—avoid metaphors or idioms.
- Respect personal space; allow physical distance if the person seems suspicious.
- Avoid arguing about delusional beliefs; focus on emotions rather than content of thoughts.
REFERENCES
- Mental Health First Aid International. Guidelines for Psychosis. mhfainternational.org/guidelines/
- Robyn L. Langlands, Anthony F. Jorm, Claire M. Kelly, Betty A. Kitchener, First Aid Recommendations for Psychosis: Using the Delphi Method to Gain Consensus Between Mental Health Consumers, Carers, and Clinicians, Schizophrenia Bulletin, Volume 34, Issue 3, May 2008, Pages 435–443, https://doi.org/10.1093/schbul/sbm099
- John Furst, First Aid for Free. First Aid for Schizophrenia. Updated December 14, 2023, https://www.firstaidforfree.com/first-aid-for-schizophrenia/
- Read J., Ross A., et al. Offering mental health first aid to a person experiencing psychosis: a Delphi study. BMC Psychology (2021)
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
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