Schizophrenia is a chronic psychotic disorder involving hallucinations, delusions, disorganized thinking and negative symptoms such as withdrawal and low motivation. It is treated with antipsychotic medication (risperidone, aripiprazole, paliperidone and others, including long-acting injections), with clozapine for treatment-resistant cases, plus psychosocial support. With consistent treatment many people live stable, meaningful lives.
Stedfast Psychiatry provides outpatient care for people with schizophrenia and psychotic disorders at all 13 offices: careful medication management including long-acting injectables and clozapine, metabolic monitoring, coordination with families, therapists and case managers, and support for the practical goals that matter, from staying out of the hospital to returning to work or school.
Symptoms of schizophrenia
- Hearing voices or other hallucinations
- Fixed false beliefs such as being watched, followed or controlled
- Disorganized or hard-to-follow speech
- Confused thinking or difficulty making sense of information
- Flat or reduced emotional expression
- Loss of motivation and neglect of hygiene or responsibilities
- Social withdrawal and loss of interest in relationships
- Trouble with attention, memory and planning
- Unusual or agitated behavior
- Lack of awareness that anything is wrong
Causes and risk factors
Schizophrenia is highly heritable, with about 80 percent of risk attributed to genetics involving hundreds of common variants and some rare ones, but most people with schizophrenia have no affected relative. Environmental factors that add risk include prenatal infection or malnutrition, birth complications, growing up in an urban environment, migration, childhood adversity and heavy cannabis use in adolescence, particularly high-potency products. The disorder involves altered dopamine signaling in striatal pathways (the target of antipsychotics), glutamate dysfunction, and changes in brain development and connectivity that typically unfold through adolescence. Onset is usually between the late teens and early thirties, earlier in men than in women.
Schizophrenia affects an estimated 0.25 to 0.64 percent of US adults, and roughly 24 million people worldwide.
Source: NIMH; World Health Organization
Schizophrenia is among the top 15 leading causes of disability worldwide.
Source: Global Burden of Disease Study, cited by NIMH
About 5 percent of people with schizophrenia die by suicide, with the highest risk in the first years after diagnosis.
Source: American Psychiatric Association Practice Guideline for Schizophrenia (2020)
Long-acting injectable antipsychotics reduce the risk of relapse and rehospitalization by roughly 20 to 30 percent compared with oral medication in real-world studies.
Source: Kishimoto et al., Lancet Psychiatry, 2021 meta-analysis
How we diagnose it at Stedfast Psychiatry
Diagnosing a psychotic disorder requires a thorough evaluation, usually with input from family. We take a detailed history of symptom onset, prior episodes, hospitalizations, medications and response, substance use, and functioning at school, work and home. We use the PANSS or BPRS to rate symptom severity and track change. A first episode of psychosis always calls for a medical workup to exclude other causes: a metabolic panel, thyroid tests, complete blood count, vitamin B12, HIV and syphilis screening, a urine drug screen, and brain imaging when the presentation is atypical or there are neurological signs. We distinguish schizophrenia from bipolar disorder with psychotic features, schizoaffective disorder, major depression with psychosis, substance-induced psychosis, delusional disorder and, in older adults, dementia or delirium. We assess safety, insight and the support system before building a treatment plan.
Treatment options
Medication management
Antipsychotic medication is the foundation of treatment. Second-generation agents such as risperidone, aripiprazole, paliperidone, olanzapine, quetiapine, ziprasidone, lurasidone and cariprazine are typical first choices, selected by side-effect profile: weight and metabolic effects are lowest with aripiprazole, ziprasidone and lurasidone, and sedation and metabolic burden highest with olanzapine and quetiapine. Positive symptoms usually improve within two to six weeks. Long-acting injectable formulations (paliperidone monthly, every three months or every six months; aripiprazole monthly or every two months; risperidone) remove the daily pill and roughly halve relapse and rehospitalization rates; we offer them early rather than as a last resort. Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia and for reducing suicide risk, and we prescribe it with the required blood count monitoring. We monitor weight, waist, blood pressure, fasting glucose or A1c, and lipids at baseline, three months and annually, screen for movement side effects, and treat them. Antidepressants or mood stabilizers are added in schizoaffective disorder.
Psychotherapy and psychosocial support
Medication controls symptoms; psychosocial treatment restores function. CBT for psychosis helps people reduce the distress of voices and beliefs and improve coping. Family psychoeducation lowers relapse rates by helping relatives understand the illness and reduce conflict. Social skills training, supported employment and education, and cognitive remediation address the negative and cognitive symptoms that medication reaches less well. For first-episode psychosis, coordinated specialty care programs that bundle these elements produce the best long-term outcomes, and we connect patients with those programs where they exist in Florida and South Carolina. We coordinate with community mental health centers, case managers, ACT teams and residential programs as needed.
What to expect
The first visit is a 60-minute evaluation, in person at any of our offices or by video, and we encourage a family member to attend if you agree. We review the history, order any needed labs, and agree on a medication plan and a safety plan. Follow-ups are every two to four weeks while medication is adjusted, then monthly or every three months when stable. Long-acting injections are given in the office on a fixed schedule. Telehealth follow-ups are available in Florida and South Carolina and help many patients stay engaged between in-person visits.
When to seek help
Seek evaluation promptly for new hallucinations, paranoid beliefs, disorganized speech or a sharp decline in functioning, especially in a teenager or young adult. The time between the first symptoms and the first treatment strongly predicts long-term outcome, so early care matters. If someone is a danger to themselves or others, is unable to care for basic needs, or is severely agitated, call 911 or go to the nearest emergency room; in Florida and South Carolina, involuntary evaluation is available when needed. If you or someone you love is having thoughts of suicide, call or text 988. Suicide risk is elevated in schizophrenia, particularly early in the illness.
The psychotic disorders
Schizophrenia requires six months of symptoms including at least one month of active psychosis. Schizophreniform disorder is the same picture lasting one to six months. Schizoaffective disorder involves psychosis together with major depressive or manic episodes, with psychosis persisting for at least two weeks without mood symptoms, and is treated with an antipsychotic plus a mood stabilizer or antidepressant. Delusional disorder involves fixed false beliefs without the other features of schizophrenia and often preserved functioning. Brief psychotic disorder lasts less than a month, often after a major stressor. Substance-induced psychosis from methamphetamine, cannabis, hallucinogens or alcohol withdrawal can look identical to schizophrenia and may or may not resolve with abstinence; a sizable fraction of people with cannabis-induced psychosis go on to develop schizophrenia. Psychosis in major depression or bipolar disorder is treated as part of the mood disorder.
The phases of schizophrenia
A prodromal phase of subtle changes (withdrawal, declining performance, unusual thoughts) often precedes the first episode by a year or more. The active phase brings full psychotic symptoms. With treatment, most people enter a residual phase where positive symptoms are reduced and negative and cognitive symptoms remain the main challenge. The course varies widely: some people have one episode and recover, many have a relapsing course that stabilizes with consistent treatment, and a minority have persistent symptoms. Each relapse carries a risk of lost function, which is why relapse prevention is the central goal of maintenance treatment.
Physical health
People with schizophrenia die on average 15 to 20 years earlier than the general population, mostly from cardiovascular disease, diabetes and smoking-related illness rather than from the psychiatric condition itself. Antipsychotics contribute to weight gain and metabolic risk, and smoking rates are three times the general rate. Our monitoring protocol tracks weight, blood pressure, glucose and lipids, and we treat or refer for what we find. Metformin can limit antipsychotic weight gain, and smoking cessation support, including varenicline and Deep TMS for smoking cessation (FDA-cleared in 2020), is part of care. We coordinate with primary care because that coordination is often what is missing.
Supporting someone with schizophrenia
Families carry much of the load. The practices that help most are calm, low-criticism communication, a predictable routine, help with medication and appointments without taking over, and attention to early warning signs of relapse (sleep changes, withdrawal, suspiciousness) with a plan to act. NAMI chapters throughout Florida and South Carolina offer free family education and support groups. Avoiding cannabis and other substances is one of the most important protective factors a person with schizophrenia controls.
Prognosis
Schizophrenia is a serious illness, but the outlook is better than most people assume. With consistent treatment, a majority of people achieve substantial symptom control, and many work, study, maintain relationships and live independently. Early treatment, adherence (helped by long-acting injectables), avoiding substances, family involvement and the use of clozapine when needed all improve the course. Recovery in schizophrenia means a life defined by goals and relationships rather than symptoms, and that is a realistic aim.
Frequently asked questions
Can schizophrenia be treated on an outpatient basis?
Yes, and most care for schizophrenia happens in outpatient settings. Hospitalization is for acute crises: severe psychosis, danger to self or others, or inability to care for basic needs. Between and after those episodes, ongoing medication management, monitoring and psychosocial support in a clinic like ours is what keeps people stable. We coordinate with hospitals, community mental health centers and case managers so care continues across settings.
What is the best medication for schizophrenia?
No single antipsychotic is best for everyone except clozapine for treatment-resistant cases. First choices are usually second-generation agents such as aripiprazole, risperidone, paliperidone or lurasidone, chosen by side-effect profile and your history. If two antipsychotics have failed, clozapine is the next step and is underused. Long-acting injectables of the same medications are often the best way to prevent relapse.
What are long-acting injectable antipsychotics?
They are the same medications given as an injection every two weeks to every six months instead of a daily pill. Options include paliperidone (Invega Sustenna, Trinza, Hafyera), aripiprazole (Abilify Maintena, Aristada) and risperidone (Risperdal Consta, Perseris, Uzedy). They remove the daily decision to take medication, keep blood levels steady, and roughly halve relapse rates in some studies. We offer them to anyone who prefers fewer pills, not only to people who have struggled with adherence.
What is clozapine and why does it need blood tests?
Clozapine is the most effective antipsychotic available and the only one proven to work when others have failed; it also reduces suicide risk. It carries a small risk of severe neutropenia (a drop in infection-fighting white cells), so absolute neutrophil counts are checked weekly for six months, then every two weeks, then monthly. It also causes sedation, drooling, constipation and weight gain, which we manage. For the right patient, the benefit is substantial, and we prescribe it in our outpatient clinics.
Is schizophrenia treatment covered by insurance?
Yes. We accept most major insurance plans, Medicare and, at many locations, Medicaid; call to confirm for your office. Visits are billed as specialist psychiatric visits. Generic antipsychotics are inexpensive. Long-acting injectables and newer agents are covered with prior authorization, which we handle, and manufacturer programs can help with cost. Our self-pay evaluation rate is $185.
Can psychosis be treated through telehealth?
Partly. Follow-up visits, medication adjustments and family meetings work well by video for many stable patients, and telehealth helps people who have difficulty with transportation stay in care. The initial evaluation, injections, and visits during an acute episode are best done in person. We offer both across Florida and South Carolina and blend them to fit the patient.
My family member refuses treatment. What can we do?
Lack of insight is a symptom of the illness, not stubbornness. Approaches that help include focusing on the person's own goals (sleep, less stress, staying out of the hospital) rather than the diagnosis, offering a single low-pressure visit, and involving someone they trust. NAMI's Family-to-Family program teaches these skills. If the person is a danger to themselves or others or cannot care for basic needs, Florida's Baker Act and South Carolina's emergency admission process allow involuntary evaluation. We are glad to consult with families.
Can schizophrenia start in teenagers?
Yes. Early-onset schizophrenia before age 18 is uncommon but occurs, and the prodrome (social withdrawal, declining grades, odd beliefs, suspiciousness) often begins in the mid teens. Early intervention programs for young people at clinical high risk or in a first episode improve outcomes substantially. Our child and adolescent providers evaluate psychotic symptoms in teens, distinguish them from mood disorders, trauma and substance effects, and connect families with first-episode programs.
Where to get treatment for schizophrenia and psychotic disorders
Evaluation and treatment for schizophrenia and psychotic disorders is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.