Phases of Schizophrenia

Schizophrenia is a chronic psychiatric disorder characterized by phases. The most noticeable phase involves active, acute symptoms. Each phase is defined by certain symptoms, with a range in the severity of symptoms during each phase.

Phases of schizophrenia are:

• Prodromal
• Active or acute episodes
• Residual

When someone is experiencing an acute schizophrenic episode, active psychotic symptoms can be frightening. It can be challenging to help someone you care about when they are experiencing an acute schizophrenic episode, but there are things you can do to better understand the disease and help them through it.

Prodromal Phase

Signs of the prodromal phase often start with subtle personality and behavioral changes. During this phase, the symptoms often aren’t recognized as being part of schizophrenia until after the condition is diagnosed—usually during the active phase.

Symptoms of the prodromal phase could include:

• Withdrawing from social activities
• Self-isolation
• Increased anxiety
• Difficulty concentrating and impaired memory
• Lack of motivation, interests, or energy
• Changes to a person's normal routine
• Diminished hygiene
• Changes in sleep
• Increased irritability

These symptoms are often mistaken for other conditions or can be overlooked as a normal part of adolescence. Sometimes anxiety or depression might be diagnosed several years before the diagnosis of schizophrenia is apparent.

On average, men typically experience an earlier onset of symptoms than women. The average age of onset for men is 18 to 25. For women, the disease most commonly develops during two identified age ranges: between 25 to 35 years or over 40 years old.

The prodromal phase can last several months or years before progressing into the next phase.

Active Phase

During the second phase, which is the active phase, the symptoms of schizophrenia become more severe and more obvious. The active phase is recognized as the full development of schizophrenia, and symptoms of psychosis are present.

Episodes of acute psychosis can occur, or symptoms of psychosis can be constant.

There are three major types of symptoms that occur during the active phase of schizophrenia:

Positive Symptoms

A positive symptom is a change in thoughts or perceptions caused by the condition and includes hallucinations and delusions.

• Visual, auditory (hearing), or tactile (touch) hallucinations are common during the active phase of schizophrenia. Hallucinations involve hearing voices, seeing people or things, or feeling movements on the skin or inside the body that are not present.
• Delusions are fixed, false beliefs that are based on illogical thinking and not based on actual events. Common delusions include beliefs about secret messages, being watched or followed, and other fears.

Disorganized Symptoms

Disorganized symptoms can be confusing to others.

Disorganized symptoms include:

• Disorganized thoughts: This can lead to cognitive deficits, like difficulty concentrating, impaired memory, and problems with attention.
• Disorganized speech: This presents as jumbled sentences that often jump between topics or words without a clear logic or order.
• Disorganized behaviors and movements: This can include unpredictable agitation and aggressive behaviors, disorganization, slowed movements, and difficulty performing everyday activities.

Negative Symptoms

Negative symptoms involve an absence of normal interactions and functioning.

Negative symptoms include:

• Difficulty speaking
• Lack of normal expression of emotion
• Loss of desire for social interaction
• Decreased engagement in daily activities.

Residual Phase

The residual phase of schizophrenia is the period of time when the active phase begins to resolve, and it may be referred to as the recovery phase. During this phase, the individual tends to have lower energy and less motivation.

Some of the positive symptoms of the active phase may remain, but the symptoms begin to resemble the prodromal phase. Sometimes delusions or hallucinations of the active phase may still be present, but less severe.

Symptoms of residual phase include:

• Lack of energy, interest, or enthusiasm
• Withdrawing socially
• Illogical thinking
• Lack of emotion

Treatment

The most effective treatment for schizophrenia combines:

• Medication
• Psychological treatment
• Social support

With treatment, some people with schizophrenia can experience remission and can have no symptoms, or only mild symptoms, and sometimes without interruptions in their daily lives.

Even after remission, however, relapses can happen—so it is important to monitor for symptoms to help prevent a recurrence of an acute schizophrenic episode.

In severe cases, individuals with schizophrenia may require hospitalization during an acute episode to regain control over symptoms and potentially to prevent harm to themselves or others.

Tips for safely helping someone with active schizophrenic symptoms:

• Call 911 for help if you are concerned the person will harm themselves or someone else.
• Give them personal space. If they feel trapped, they may feel they need to use aggressive actions. Try to remain at least an arm reach away to avoid being hit.
• Focus on what is real, without being argumentative.
• Avoid arguing. Instead, ask gentle questions about their fears if they are receptive.
• Reassure them that no harm will come to them and use simple directions to help calm them.
• Attempt to remove the cause of their fear—for example, turn off the TV or radio.
• Calmly explain everything you are going to do before you do it.
• Encourage them to seek help.

Try to discuss their symptoms and fears when they are not experiencing active symptoms. Ask them how you can help during times they are experiencing symptoms, talk about strategies to avoid triggers, and discuss early signs so you can get early interventions.

A Word From Verywell

Schizophrenia can be a frightening condition for those experiencing it and for their loved ones. With a proper treatment plan, the disease and its symptoms can be managed. Many people with schizophrenia are able to manage their symptoms and are able to have relatively normal lives if consistent treatment is followed.