Schizophrenia: Understanding a Serious Mental Illness
This article is general information published by the practice of Dr. Sholeh Toobaei, Specialist Psychiatrist, Dubai. It has not yet been individually reviewed by a clinician and is not a substitute for personal medical advice. Published: 1 September 2026.
Scope: This article is general information about schizophrenia. It is not a diagnosis and cannot tell you whether someone has schizophrenia. Only a proper clinical assessment by a psychiatrist can do that.
What is schizophrenia, and what is it not?
Schizophrenia is a serious mental illness that affects how a person thinks, perceives reality, and behaves. It is not "split personality" (that is a different condition called dissociative identity disorder). The name comes from the Greek words for "split mind," but the modern understanding is that schizophrenia is not about splitting into separate personalities — it is about a fragmentation of thought, perception, and emotional response.
Schizophrenia affects approximately one percent of the population worldwide. It typically begins in the late teens to early thirties, most commonly in the early twenties for men and the late twenties for women. It affects men and women roughly equally, though men tend to develop it at an earlier age and often have a more severe course.
What are the symptoms?
Symptoms are grouped into three categories:
Positive symptoms are things that are added to normal experience. The most important are hallucinations (seeing, hearing, or feeling things that are not there — hearing voices is the most common) and delusions (fixed beliefs that are not true despite evidence to the contrary — for example, believing that the television is sending special messages just to you, or that people are conspiring against you).
Negative symptoms are things that are taken away from normal experience. These include reduced emotional expression (a flat face, reduced eye contact, a monotone voice), reduced motivation (not being lazy — this is a genuine neurological symptom), reduced ability to experience pleasure, social withdrawal, and reduced speech. Negative symptoms are often more disabling than positive symptoms and are harder to treat.
Cognitive symptoms include problems with attention, memory, executive function, and processing speed. A person with schizophrenia may have difficulty following a conversation, remembering instructions, planning ahead, or switching between tasks. These cognitive deficits are a major determinant of how well a person can function in daily life.
What causes schizophrenia?
The strongest risk factor is genetics. If a first-degree relative has schizophrenia, the risk is about ten percent — substantially higher than the one percent baseline, but still meaning that ninety percent of people with a family history do not develop the condition.
Brain biology matters too. Brain imaging studies show differences in the structure and chemistry of the brain in people with schizophrenia, particularly involving dopamine and glutamate systems. The exact cause of these differences is not fully understood, but they are real and measurable.
Environmental factors also play a role: prenatal complications (malnutrition, infection, hypoxia), childhood adversity, urban upbringing, migration, and cannabis use in adolescence (particularly heavy use) all increase risk. The most well-established environmental risk factor is cannabis use during the teenage years in people who are already genetically vulnerable.
The current model is a "stress-vulnerability" one: a person has a biological vulnerability (mostly genetic), and environmental stressors push them past the threshold where the brain can compensate. This is why schizophrenia often emerges in late adolescence or early adulthood — that is a period of massive brain reorganisation, and it is also when many people face significant life stressors (leaving home, starting university, entering the workforce).
What happens during a psychotic episode?
A psychotic episode is when positive symptoms become severe enough to significantly disrupt the person's life. The person may hear voices that are commanding, threatening, or commenting on their actions. They may develop delusions that feel utterly real — and from their perspective, they are. Telling someone "those voices are not real" is usually not helpful, because the experience of hearing a voice is subjectively indistinguishable from hearing a real person.
During a psychotic episode, the person may become disorganised in their thinking and speech — jumping between topics, using words in unusual ways, or becoming impossible to follow. They may become severely withdrawn, neglect personal care, or behave in ways that seem bizarre to others.
A psychotic episode is a medical crisis. It is not a personal failing. It is the brain in a state of acute dysregulation that requires professional intervention. Most people need hospitalisation during a first psychotic episode, both to ensure safety and to start treatment.
What treatment is available?
Antipsychotic medication is the cornerstone of treatment. These medicines work by modulating dopamine activity in the brain. First-generation (typical) antipsychotics like haloperidol were effective but had significant side effects, particularly movement problems. Second-generation (atypical) antipsychotics like risperidone, olanzapine, quetiapine, and aripiprazole are now first-line because they are generally better tolerated.
Side effects vary by medication and by person. Common ones include weight gain, sedation, metabolic changes (increased blood sugar and cholesterol), and in some cases, movement-related side effects. A good psychiatrist will work with the patient to find a medication that balances effectiveness with tolerable side effects. This is not always straightforward, and it may take trying several medications.
Psychosocial treatments are essential alongside medication. Cognitive behavioural therapy for psychosis helps the person develop a different relationship with their symptoms — not necessarily eliminating the voices or delusions but reducing their power and distress. Family therapy and education are crucial — families need to understand what is happening and how to support recovery. Supported employment and educational programmes help people with schizophrenia maintain or return to work and study.
What is the long-term outlook?
Schizophrenia is a chronic condition, like diabetes or hypertension, but it is treatable. Many people with schizophrenia, with consistent treatment and support, live meaningful lives, maintain relationships, and contribute to their communities. Some recover fully and do not need ongoing medication. Most need long-term treatment, and that is fine — they manage a chronic condition, just as someone manages any other chronic condition.
The single most important predictor of good outcome is early intervention. The longer a psychotic episode goes untreated, the worse the prognosis. First-episode psychosis services exist in many countries because they dramatically improve outcomes. In the UAE, awareness of schizophrenia and psychosis is limited, and people often delay seeking help because they do not recognise the symptoms as treatable medical conditions. This delay is understandable but costly in terms of outcome.
How can family members help?
Education is the most powerful tool. Understanding what schizophrenia is and is not reduces fear, shame, and blame. Learning to recognise early warning signs of relapse (sleep disruption, increased social withdrawal, changes in thinking) allows for early intervention before a full episode develops.
Communication matters. Speaking clearly and simply, not arguing with delusions, not mocking or dismissing symptoms, and showing genuine empathy for the person's experience — even when the content of that experience is unusual — builds trust and keeps the door open for help.
Taking care of yourself matters too. Caring for someone with schizophrenia is demanding. Family members need their own support, respite, and education. There is a strong evidence base for family interventions in schizophrenia, and families that engage with them have better outcomes for both themselves and the person they are supporting.
When should I seek help?
If you or someone you know is experiencing hallucinations (seeing or hearing things others do not), delusions (fixed beliefs that others find strange or untrue), disorganised thinking or speech, severe social withdrawal, or a significant decline in functioning that came on over weeks or months, seek a psychiatric assessment promptly. Early treatment of first-episode psychosis dramatically improves outcomes. Seek urgent help — call 999 (police) or 998 (ambulance) in the UAE, or go to the nearest emergency department — if the person is a danger to themselves or others, if they are severely disorganised and unable to care for themselves, or if they are experiencing a psychotic episode for the first time. For non-urgent enquiries, use the appointment request form on this website. This practice does not operate a monitored telephone line, and a message sent through the form may not be read straight away.