Schizophrenia can occur after the age of 30


schizophrenia (schizophrenic psychosis): Schizophrenias are characterized by serious disorders of thinking, perception and the world of emotions. The relationship to real life is severely disturbed, while intellectual abilities such as B. Retention or spatial imagination remain unimpaired. Central symptoms of schizophrenia are delusions (delusions) and hallucinations (hallucinations). Despite the severity of the disease, two out of three patients today have a good chance of leading a stable and self-determined life. About 1% of the population is affected by schizophrenia, the incidence rate is almost constant worldwide. Men and women get sick equally often. The age of the first illness is typically between the ages of 20 and 30, with men falling ill a little earlier than women.

Leading complaints

Positive complaints. Occur in the acute phase of the disease:

  • Illusions: Typically acoustic hallucinations such as hearing voices commenting on the patient's actions or giving instructions to the patient.
  • Mind deprivation: The sick believe that their thoughts, intentions, actions and feelings are known to others and are controlled by them.
  • Delusions: The patient does not recognize symptoms such as hallucinations as part of his illness, but actually experiences them. In order to explain what has been experienced, the patient builds up a delusion. The sick often know that they have delusions and find them extremely frightening and shameful. This is why they often try to keep the delusions a secret.
  • Thinking disorders: It is impossible to distinguish between important and unimportant, minor details come to the fore. Thinking becomes very associative, a logical “red thread” is no longer recognizable. In terms of communication, the sick are erratic and confused. They suddenly change the subject or wander widely.
  • Paradoxical affectivity: feelings do not correspond to the situation. Patients are cheerful when it is appropriate to mourn. Or they cry for a trivial reason.
  • Increased activity: The patients are overexcited, restless and restless.

Immobility: This 48-year-old schizophrenia patient maintained a certain arm position for many minutes and was not responsive during this time. Catatonia, as this frozen motionlessness is called, could only be overcome with psychotropic drugs.
Georg Thieme Verlag, Stuttgart

Negative complaints. Usually kick first to the acute phase of the disease on:

  • Affect flattening: The patient's emotional life appears strangely flat and undifferentiated.
  • Reduced drive: The sick person feels easily exhausted and physically weak.
  • Immobility: The patient seems frozen, sometimes he remains in grotesque postures.
  • Self-absorption: the patient isolates himself from reality. He lives in his own world without taking any interest in his surroundings.
  • Social withdrawal: The sick person is suspicious of others - this also as a result of the uncertainty and the felt social rejection.
  • Many schizophrenics are also very afraid or react to the changed experience with depressive symptoms.

When to the doctor

Immediately if the symptoms appear for the first time or worsen, the patient no longer wants to take his medication because of the side effects or the patient endangers himself or others.

Schizophrenic sufferers include always into the expert treatment of a psychiatrist.

The illness

For many people, schizophrenia is the symbol of “madness” or “madness”. Prejudices and reservations when dealing with patients are correspondingly high. Contrary to popular belief, however, those affected are no more involved in violent crimes than the population average. Rather, they are rather shy, very sensitive people who often have an extraordinarily good feeling for the feelings of others.

Too much stress (over-stimulation) and too little stimulation (under-stimulation) can trigger acute schizophrenia.
Georg Thieme Verlag, Stuttgart

For all that is known, heredity plays a central role in schizophrenia. Children of schizophrenic mothers or fathers have a 20 times higher risk of disease than the population average. In identical twins, 50% of the siblings of an affected twin become ill. For the disease to break out acutely, however, other stressful factors such as family or interpersonal problems, separations or experiences of loss must also be added.

The disease usually breaks out in early adulthood, initial illnesses in later stages of life are rare. The disorder can set in acutely with severe symptoms, but it can also develop gradually over the course of several years. After the acute symptoms have subsided, there may be a postschizophrenic depression come - this is associated with a particularly high risk of suicide. It then changes to a phase with few symptoms, in which the patients are initially very exhausted, but then partially recover until they are free of symptoms and can regain their old performance.

Course. The following factors favorably influence the course of schizophrenia:

  • Female gender
  • Stable social relationships
  • Acute, abrupt initial illness (i.e. no creeping beginning)
  • Good social adaptation (school leaving certificate, vocational training, friendships) before the onset of the illness
  • Therapy started early and followed consistently.

The doctor does that

The diagnosis arises from the main complaints delusions and hallucinations, the careful psychopathological findings and - especially in unclear early stages - from observation of the patient.

The “golden” bridge has to be found: the interplay of therapeutic measures to overcome schizophrenic positive and negative symptoms.
Georg Thieme Verlag, Stuttgart

Treating schizophrenics requires patience, experience, knowledge, and commitment. A combination of drug therapy, psychotherapeutic procedures and Sociotherapy, which means the support in coping with life and everyday life so that the sick person can fill his various roles again, which he takes on in the family, in partnership and in the workplace.

Psychotropic drugs. The therapy of first choice is always neuroleptics. With neuroleptic medication, the acute symptoms subside within a few days. Usually, however, an inpatient treatment period is required until the dose and active ingredient are precisely set. The average length of stay in the acute ward of psychiatry is now around three to four weeks for schizophrenia.

To prevent relapses and to stabilize the patient, neuroleptics are usually prescribed over a longer period of time even after the hospital stay. The resident psychiatrist controls the dosage and type of medication as well as their side effects. How long the medication has to be taken depends on the individual course. As a rule, if there are no new symptoms within a year, the patient can try reducing the medication. To do this, however, the patient must be seen regularly by the psychiatrist so that any deterioration can be responded to immediately.

Psychotherapy. Psychoeducation is offered in the clinic, in which patients are informed about the disease, its treatment, how to use medication and how to prevent relapses. Relatives should definitely be included. Expressive methods such as B. Art therapy additionally stabilize the patient and support their healthy, creative side.

After the stay in the clinic, outpatient psychotherapy has proven its worth. The patients learn to improve their social skills, to cope with fears, to deal better with stress (stress management) and - last but not least - to be able to process the consequences of the illness.


Schizophrenia is also a very serious disease prognostically:

  • At least a third of schizophrenic patients largely recover, remain socially integrated and, if conditions are good, also able to work, but have to live with impairments.
  • In a further third of the patients, the course is unfavorable, the symptoms worsen and move into a chronic stage: employment is hardly possible anymore, and the family environment, if it ever existed, is often broken by the disease. Often no household can be run either, so that long-term residential accommodation is the only alternative. However, due to intensive treatment of the acute phase, these cases are becoming increasingly rare.
  • 10% of people with schizophrenia commit suicide.
Drug and alcohol consumption (including “soft” drugs such as cannabis) greatly increases the risk of relapse.

Your pharmacy recommends

Find the right doctor.

A stable, trusting relationship with the doctor makes it easier to identify and avoid crises at an early stage. There is nothing wrong with changing psychiatrists once or twice, there has to be an actual relationship of trust. But then the patient should stay with his psychiatrist or psychotherapist, because the better he knows him, the better he can help the person affected and feel when they need more help and when they need more independence. There are also other contact points that offer support: self-help groups, meeting points and events for patients and their relatives. Information is available from the social psychiatric services, health authorities and health insurance companies. The treating psychiatrist can also arrange contacts.

Stick with the therapy.

Long-term studies have shown that patients are less likely to have relapses if they continue to take their medication after an initial illness. Additional treatment measures (psychoeducation, psychotherapy) reduce the risk of relapse even more. For the success of the therapy, it is crucial that the person concerned works together with their doctors and relatives and adheres to an agreed treatment concept. This includes regularly taking the prescribed medication in the right dose and at the right time, as well as keeping appointments with the doctor or in the hospital.

Recognize another flare-up of schizophrenia.

Back in everyday life, sick people and relatives should pay particular attention to early warning symptoms that precede a new flare-up. Typical early warning symptoms are:

  • Persistent changes in mood, especially diffuse anxiety
  • Changes in the sleep-wake cycle
  • Decrease or increase in appetite
  • Changes in social contact behavior, such as frequent hurt and sensitive withdrawal from conversations or relationships.

Prepare contingency plan.

It is advisable for those affected and their families to think about help in the event of a relapse as early as possible and to work out a personal "crisis plan" together with the doctor or therapist. This also applies to longer trips or spa stays.

Dose stress factors

. The daily stress should only be gradually allowed to approach the sick person again and always be in the right proportion to their current condition. This is the only way to avoid the patient becoming overwhelmed on the way back to a self-determined life.

Knowledge of the disease.

The better the patient is informed about schizophrenia and the more precisely he knows what is good for him and what is not, the easier he can organize his everyday life in such a way that a life with quality of life is possible despite the illness.

Further information

  • - Informative website of the Schizophrenia Competence Network, Düsseldorf, funded by the Federal Ministry of Education and Research (BMBF).
  • - Website of the BASTA (Alliance for Mentally Ill People), Munich: Offers tips, information and a discussion forum.
  • - Website of the Federal Association of Mentally Ill People (BApK), Bonn: Offers valuable information material and addresses of local self-help groups.
  • - Website of the Federal Association of Psychiatry Experienced e. V. (BPE), Bochum: Offers inter alia Addresses of self-help groups.
  • H. Häfner: The riddle of schizophrenia. A disease is being deciphered. C.H. Beck, 2005. Informative book on all aspects of the disease; the author is a doctor and schizophrenia researcher.
  • W. Kissling; G. Pitschel-Walz: Living with schizophrenia. Information for patients and relatives. Schattauer, 2003. Information about illness and therapy, questions of lifestyle, leisure activities, professional integration and financial aid.
  • M. Kruse: In the conflict of the soul. Experience with an endogenous psychosis. Frieling, 2004. The author impressively describes the course of his illness and healing.


Gisela Finke, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 14:35

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.