Schizophrenia

Understanding Schizophrenia: Insights from Our Psychiatrists

Schizophrenia is a complex psychiatric condition that our nurse practitioners, doctors and psychiatrists diagnose and treat, marked by disturbances in thinking, perception, and behavior—such as hallucinations, delusions, disorganized thoughts, and unusual behaviors.

Positive Symptoms of Schizophrenia

Positive symptoms of schizophrenia are typically linked to excessive dopamine activity in the brain’s mesolimbic pathway. These symptoms add experiences that are not part of typical mental functioning, such as hallucinations, delusions, and disorganized thinking or behavior.

• Hallucinations: Perceptions that seem real to the person but are not, such as hearing voices, seeing images, or experiencing smells, tastes, or sensations that others do not. For example, someone hearing a voice may turn toward it and respond as if it were present.
• Delusions: Fixed, false, and idiosyncratic thoughts that a person with schizophrenia may develop, which may (in their mind) explain feelings of suspicion or paranoia that their illness inflicts them with, or may explain other phenomenon (such as hallucinations) that they experience. An example, would be the delusion that others can hear their thoughts (Audible thoughts), steal their thoughts (thought withdrawal), or plant thoughts into their minds (thought insertion). Additional common delusions occurring in schizophrenia include thought broadcasting (the belief that one’s thoughts are being broadcast (over radio waves for example) and delusional perceptions (assigning an illogical meaning, to a true perception). An example of a delusional perception, would be a person seeing a car’s license plate number, and internalizing it as evidence that they are being monitored.
• Disorganized thoughts or behaviors: Individuals may have trouble organizing their thoughts or behaviors, resulting in jumbled speech, a train of thought that is difficult to follow, or an inability to speak coherently. Examples of disorganized behaviors would include unusual movements that one might not expect, such as saluting repetitively, turning for no clear reason, or not moving at all (for example: standing still in a crowded area for extended periods of time).

Negative Symptoms

Negative symptoms of schizophrenia, are thought to be linked to reduced dopamine in the brain’s mesocortical pathway, involve a loss or reduction of typical abilities and behaviors. These symptoms can significantly affect daily functioning, relationships, and overall quality of life, making treatment from a nurse practitioner, doctor or psychiatrist experienced in schizophrenia treatment essential.

• Affect Flattening: Limited or absent emotional expression.
• Alogia: Minimal speech output
• Avolition: Lack of drive to begin or sustain purposeful activities.
• Anhedonia: Reduced ability to experience pleasure.
• Cognitive Deficits: Problems with memory, decision-making, or attention, which can worsen over time.

Negative symptoms can make it more difficult for individuals with schizophrenia to engage with others socially and/or romantically, function in the academic or work environment, and maintain independence. Medications that target “Positive Symptoms” such as hallucinations and delusions, and decrease dopamine, can worsen negative symptoms. This is why working with an experienced clinician is important, and why multiple medication trials may be necessary when establishing a patient’s treatment regimen.

Schizoaffective Disorder

Schizoaffective disorder combines features of schizophrenia with mood disorders such as major depression or bipolar disorder. Diagnosis requires psychotic symptoms to occur even when mood symptoms are not present. Our psychiatrists and other providers who treat schizophrenia can help distinguish between these conditions and create tailored treatment plans.

To make the diagnosis of Schizoaffective disorder, a patient must exhibit psychosis outside of the context of mood episodes. For example, if an individual only hears voices, or experiences delusions when they are either manic or depressed, then they do NOT meet criteria for schizo-affective disorder (and rather, they likely have major depressive disorder or bipolar affective disorder, with psychosis.

How Common is Schizophrenia?

Schizophrenia affects approximately 1% of the US population. Schizophrenia affects men and women in roughly equal numbers.

Course of Illness for Schizophrenia – Why to Get Help Early

For men, symptoms most often appear between ages 15-25; for women, onset is typically between 25-35. About 20% of diagnoses occur after age 40, and while schizophrenia is rare in children, it can develop at younger ages.

Early treatment is essential. Research shows that prompt intervention and reducing the number and severity of psychotic episodes can help improve long-term outcomes and quality of life.

Many people experience a prodrome before their first psychotic episode. This early phase can last months or even years and may involve subtle changes such as social withdrawal, loss of interest in activities, decreased motivation, reduced emotional expression, concentration problems, or early perceptual changes. Recognizing and addressing these warning signs can lead to earlier intervention and a better prognosis.

The course of schizophrenia varies: about one-third of individuals have a chronic, progressive illness, one-third have ongoing symptoms without progression, and one-third experience significant improvement or recovery. With the right support from a schizophrenia psychiatrist, many people can manage symptoms effectively and lead fulfilling lives.

Risk Factors for Schizophrenia and Psychosis

Several factors can increase the risk of developing schizophrenia, including:

• Heavy or daily marijuana use during adolescence (linked to up to 30% of preventable cases)
• Family history of schizophrenia or other psychotic disorders
• Pregnancy or birth complications
• Being born in the winter months, possibly due to prenatal exposure to seasonal illnesses
• Urban living or poverty
• Traumatic brain injury
• Other genetic and environmental influences

When to See a Doctor or Psychiatrist for Schizophrenia

If you or someone you care about may be experiencing symptoms of schizophrenia, schizoaffective disorder, or psychosis, it’s important to seek evaluation promptly. Early diagnosis and treatment can help reduce relapses, improve function, and support long-term stability.

In some cases – such as recent hospitalization, suicidal behavior, or new-onset psychosis – patients may require specialized programs with hospital privileges and 24/7 emergency coverage. Your doctor can help determine the most appropriate level of care. Rittenhouse Psychiatric Associates does not have some of these additional resources and our providers typically continue care for patients after they have been stabilized and only if they are open to medication management. For new onset cases of schizophrenia, we typically refer out to local academic hospitals or providers with 24-7 emergency coverage.

Early treatment, and a reduction in total psychotic episodes, may decrease the severity of the patient’s illness and improve their long-term prognosis and outcome. 

*Please see recommended Schizophrenia and Psychosis Programs, in the disclaimer at the bottom of this page.

Treatment Options for Schizophrenia

Effective treatment for schizophrenia is highly individualized and may include:

• Medication management: First- and second-generation antipsychotics, including long-acting injectables for improved adherence
• Psychotherapy and behavioral activation: Support to enhance daily functioning, social skills, and treatment compliance
• Ongoing monitoring: Regular follow-up with a psychiatrist who treats schizophrenia to adjust treatment as needed

At Rittenhouse Psychiatric Associates, our nurse practitioners, doctors and psychiatrists who treat schizophrenia combine clinical expertise with a compassionate approach to care. Many of our providers have taught at leading academic institutions such as Johns Hopkins and the University of Pennsylvania. Our team includes board-certified psychiatrists, psychiatric nurse practitioners, and licensed therapists who are experienced in managing schizophrenia and co-occurring mental health conditions.

Why Choose Rittenhouse Psychiatric Associates?

Our team offers specialized, compassionate care for individuals living with schizophrenia and other psychiatric conditions. We combine academic expertise with a patient-centered approach, ensuring that every treatment plan is informed by the latest research and tailored to each patient’s needs.

• Board-certified psychiatrists and psychiatric nurse practitioners with extensive experience in diagnosing and treating schizophrenia
• Licensed therapists and doctoral-level psychologists providing therapy and supportive care
• Academically oriented providers, many of whom have taught at leading institutions such as Johns Hopkins Hospital and the University of Pennsylvania
• Timely access to care, with appointments for schizophrenia treatment generally available within two weeks
• Flexible scheduling, offering both in-office and secure virtual appointment options
• Expertise in co-occurring psychiatric conditions, allowing for integrated, whole-person treatment
• Welcoming, inclusive environment for individuals from all backgrounds and identities

Disclaimer: Our schizophrenia doctors and nurse practitioners provide ongoing outpatient care but do not offer 24/7 emergency coverage or hospital admitting privileges. For individuals with new-onset psychosis, recent hospitalizations, suicide attempts, or severe illness, larger health systems and specialized programs such as Penn’s PERC or Johns Hopkins’ EPIC are better equipped. Our practice is best suited for patients with an established diagnosis who are stable, engaged in treatment, and seeking long-term care from experienced schizophrenia doctors.