Phases of a Schizophrenic Episode

Schizophrenia is a chronic psychiatric disorder characterized by episodes of acute symptoms. When someone is experiencing a schizophrenic episode, they often have some psychotic symptoms that are very frightening, especially when it is the first time they experience the symptoms.

There are three phases of a schizophrenic episode

  • Prodromal
  • Active
  • Residual

Each of the phases is characterized by different types and severities of symptoms. Helping someone who is experiencing a schizophrenic episode can be difficult, but there are things you can do to better understand the disease and help them through it.

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Prodromal Phase

The symptoms of the prodromal phase often start with subtle changes to the individual’s personality and behaviors. In this phase, the symptoms often aren’t recognized as a part of schizophrenia until after they have progressed into the active phase.

Symptoms of the prodromal phase could include:

  • Withdrawing from social activities
  • Self-isolation
  • Increased anxiety
  • Difficulty concentrating and poor memory
  • Lack of motivation, interests, or energy
  • Changes to their normal routine
  • Poor hygiene
  • Changes in sleep
  • Increased irritability

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

These symptoms are often mistaken for other conditions or overlooked as a normal part of adolescence. Two of the common conditions are commonly diagnosed during this time include anxiety and depression.

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

Active Phase

During the second phase, 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 may be present.

There are three major categories for the symptoms of schizophrenia:

Positive Symptoms

A positive symptom is the addition of an experience or behavior.

Visual, auditory (hearing), or tactile (physical) hallucinations are common during the active phase of schizophrenia. It involves hearing voices, seeing people or things, or feeling movements on the skin or inside the body that are not present.

Delusions are strong beliefs that are based on illogical thinking and not based on actual events. Common delusions include beliefs that there are secret messages being sent to them; belief they are being watched or followed; and other fantasies.

Disorganized Symptoms

These are a subtype of positive symptoms that involve:

  • Disorganized thoughts: This can lead to cognitive deficits, like difficulty concentrating, poor memory, and problems with attention.
  • Disorganized speech: This presents as jumbled sentences that often jump between topics or words without any logic or order. It makes it difficult to communicate effectively with them and often doesn’t make sense
  • Disorganized behaviors and movements: This can happen as well, including unpredictable agitation and aggressive behaviors, disorganization, slowed movements, and difficulty performing everyday activities.

Negative Symptoms

Negative symptom is the removal or absence of behaviors or experiences. These symptoms present as:

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

The active phase is often the most alarming for friends and family members because of the bizarre behaviors that are present. It’s important to get the individual displaying symptoms to a doctor to be diagnosed and treated. This will help them gain access to resources to help with treating and managing their condition to reduce the risk of harm to themselves or others.

Residual Phase

The residual phase of schizophrenia is used to describe the period of time after symptoms become less severe and the active phase begins to resolve. 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.

This phase is also referred to as the recovery phase because some of the delusions or hallucinations of the active phase may be less severe but still present.

Symptoms of residual phase include:

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


The most effective treatment options for schizophrenia uses a combined treatment plan of:

  • Medication management
  • Psychological treatment
  • Social support

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

Even if remission is obtained, relapses can happen, so it is important to monitor for early signs to help prevent a more severe schizophrenic episode.

In severe cases, individuals with schizophrenia may require hospitalization during the active phase to regain control over their symptoms and prevent harm to themselves or others.

Suicide Help

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Tips for safely helping someone with active schizophrenic symptoms:

  • Avoid arguing. Instead, ask 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
  • 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
  • Call 911 for help if you are concerned the person will harm themselves or someone else
  • Attempt to move the person away from the cause of their fear, turn off the TV or radio
  • Calmly explain everything you are going to do before you do it
  • Encourage them to seek help if they will be receptive to it, but some individuals with active symptoms may fear seeking help and this could make them suspicious of you.
  • Try to discuss their symptoms and fears when they are not experiencing active symptoms. Ask them how you can help during times they are experiences symptoms, strategies to avoid triggers when possible, and early signs to look for to encourage early interventions.

A Word From Verywell

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

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Article Sources
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  1. George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS. Understanding the schizophrenia prodrome. Indian J Psychiatry. 2017;59(4):505-509. doi:10.4103/psychiatry.IndianJPsychiatry_464_17.

  2. Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treatment. 2012;2012. doi:10.1155/2012/916198.

  3. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. Updated June 2016.

  4. Larson MK, Walker EF, Compton MT. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders. Expert Rev Neurother. 2010;10(8):1347-1359. doi:10.1586/ern.10.93.

  5. American Family Physician. Schizophrenia. Updated December 2014.