Early Signs and Symptoms of Schizophrenia

Schizophrenia is a chronic psychiatric disorder that affects how a person thinks, feels, and behaves. Common early signs of schizophrenia vary by age group and include:

• Young children: Delayed development
• Older kids and teens: Depression, isolation, behavioral problems (e.g., stealing) or changes (e.g., bizarre or unusual thoughts or actions), and trouble focusing
• Adults: Restlessness, anxiety, low energy, not taking care of one's self (e.g., personal hygiene), decrease in work performance, suicidal thoughts, and social withdrawal

Schizophrenia usually develops slowly, with early warning signs developing before the first severe episode (psychosis). That is when what are known as positive symptoms—those not generally seen in healthy people, such as hallucinations and delusions—are experienced for the first time.

Early diagnosis and treatment of schizophrenia increase the chances of a successful recovery. Knowing the early warning signs can be important in identifying the onset of schizophrenia and getting the care that's needed.

Early Warning Signs of Schizophrenia

The period in which early warning signs are experienced is called the prodromal stage. The onset of schizophrenia can last from months to several years, and the first signs differ depending on at what age the disorder develops.

The age at which someone develops schizophrenia is thought to have an impact on the symptoms that person will experience. Even though men and women have roughly similar rates of schizophrenia, they tend to develop the condition at slightly different ages.

In Young Children

People who are diagnosed with schizophrenia in childhood have more developmental issues than those diagnosed later in life. 

Very early developmental warning signs include:

• Delayed motor development: Such as not walking until over 18 months old 
• Delayed speech and/or language development: Such as not speaking meaningful two- or three- word phrases until over 36 months old
• Impaired social development at an early age: Such as not using gestures to communicate or failing to regulate facial expressions 

It is important to note that these issues are not necessarily indicative of schizophrenia and may instead be related to something completely different.

In Teenagers

Prior to the onset of schizophrenia, adolescents often develop changes in behavior. This can lead to them struggling in school, one of the most common issues reported in teens diagnosed with schizophrenia. 

Early warning signs include:

• Difficulty concentrating and paying attention
• Unexplained functional decline
• Increased introversion
• Loneliness
• Depression
• Aggression
• Suicidal ideation
• Theft
• Bizarre behaviors

It is hard to diagnose schizophrenia in adolescents because many of the features of the condition are common during normal childhood development. For example, a normal part of childhood is having vivid imaginations and fantasies. However, these can be misunderstood to be hallucinations, a symptom of schizophrenia.

Those developing the disorder at a young age are more likely to go on to experience certain symptoms compared to those who develop it later.

It is also thought that children may be less likely to experience paranoid delusions, which is the belief that others are out to harm you, than people who develop schizophrenia at an older age.

In Early Adulthood

Schizophrenia typically develops during early adulthood. Its onset is characterized by changes in behavior and a deterioration in functioning in daily life. 

The most common earliest signs are:

• Nervousness and/or restlessness
• Depression
• Anxiety
• Difficulty in thinking clearly or concentrating
• Worrying
• Lack of self-confidence
• Lack of energy and/or slowness
• A worrying drop in grades or job performance
• Social withdrawal and/or or uneasiness around other people

Not everyone will experience these early warning signs at the same time in their lives. According to some studies, these prodromal symptoms can be present for years.

While the exact cause of the disorder is unknown, schizophrenia has a strong genetic component and is highly heritable. Having a family member with schizophrenia increases your risk of developing the disease. 

These risk factors will be taken into account regarding a diagnosis if you are thought to be experiencing these early warning signs of schizophrenia.

Over the Age of 45

The majority of early warning signs for this age group are the same as for people who develop schizophrenia at early adulthood. However, there are some differences. 

A study has reported that men who develop schizophrenia over the age of 35 tend to have fewer negative symptoms during the early warning stage. Specifically, the study found that they were less likely to experience social isolation and difficulties with concentration.

Some scientists think that those who develop schizophrenia later in life will experience less disorganized thinking and negative symptoms.

When Schizophrenia Symptoms Start

Symptoms usually start to develop in early adulthood, between late adolescence and the early 30s. The disorder typically becomes evident slightly earlier in men than in women. Symptoms often emerge between late adolescence and the early 20s in men and between the early 20s and the early 30s in women.

Early Onset Schizophrenia

If the disease is diagnosed prior to the age of 18, it is referred to as early onset schizophrenia (EOS). EOS is rare, with an estimated prevalence of 0.23%. Rarer still, the disease can develop in very young children. This is called childhood-onset schizophrenia (COS), when the disease is diagnosed before the age of 13.

According to the National Institute of Mental Health, approximately one in 40,000 children will have COS. It is thought to be extremely uncommon that COS develops before the age of 10. 

Late-Onset Schizophrenia

Although schizophrenia most commonly presents between late adolescence and the early 30s, it is estimated that up to 20% of patients first develop symptoms after the age of 40 years old. Some scientists have identified this as a subtype of schizophrenia called late-onset schizophrenia (LOS).

Women are more likely to be in this group than men. Symptoms typically develop in menopause, between ages 44 and 49 years old. However, even for women, it is still more common for schizophrenia to develop in early adulthood than at this age.

Complications

In the early stages of schizophrenia, the disorder can be confused with others, including depression. This is because the majority of the most common early warning signs for schizophrenia are also the most common initial symptoms for moderate to severe depression.

It is not until positive symptoms (such as hallucinations, delusions, and disorganized thoughts and speech) are experienced that schizophrenia can be more easily distinguished from mood disorders such as depression.

People with schizophrenia may experience suicidal thoughts. The risk of suicide for those with schizophrenia is higher for men and for those that develop the disease at a young age.

Depression has been identified as a major risk factor for suicide among those with schizophrenia. Having other disorders that are highly prevalent among those with schizophrenia, such as substance use disorder, also increase the risk of suicide.

Substance abuse, in general, is linked to poor outcomes in terms of recovery. For those affected, a comprehensive plan that includes treatment for the substance use disorder along with the schizophrenia is important.

When to See a Healthcare Provider

As schizophrenia usually develops gradually, it can be difficult to pinpoint when changes in behavior start or know whether they are something to worry about. Identifying that you are experiencing a pattern of concerning behaviors can be a sign you should consult with a professional. 

Symptoms may intensify in the run-up to an acute episode of psychosis in schizophrenia. The warning signs include:

• A worrying drop in grades or job performance
• New difficulty thinking clearly or concentrating
• Suspiciousness of or uneasiness with others
• Withdrawing socially, spending a lot more time alone than usual
• Unusual, overly intense new ideas, strange feelings, or having no feelings at all
• Decline in self-care or personal hygiene
• Difficulty telling reality from fantasy
• Confused speech or trouble communicating

While these changes might not be concerning by themselves, if you or a loved one are experiencing a number of these symptoms, you should contact a mental health professional. It can be difficult for those with schizophrenia to want to get help, especially if they are experiencing symptoms such as paranoia. 

A Word From Verywell

Getting help as early as possible increases your chances for a successful recovery. You should speak to your healthcare provider, or your loved one's healthcare provider, if you are concerned about any changes in behavior. The early warning signs highlighted above do not necessarily point to schizophrenia and might instead be related to something else, but they still may warrant medical intervention.

This is especially true for children. Because schizophrenia is very rare for this age group, it is likely that, even if they are experiencing the early warning signs highlighted above, your child doesn't have this disorder.

If you, or a loved one, do receive a diagnosis of schizophrenia, know that there are effective treatments available that can help manage symptoms well.