Schizophrenia is a chronic mental illness. It affects about 1 percent of the population, although the condition’s exact prevalence is hard to obtain.

People with this condition experience:

  • hallucinations
  • disordered thoughts
  • unorganized speech
  • departures or breaks from reality

Schizophrenia is divided into stages, or phases. Each phase is marked by specific symptoms and signs.

phases of schizophrenia

The phases of schizophrenia include:

  • Prodromal. This early stage is often not recognized until after the illness has progressed.
  • Active. Also known as acute schizophrenia, this phase is the most visible. People will show the telltale symptoms of psychosis, including hallucinations, suspiciousness, and delusions.
  • Residual. Though not a recognized diagnosis in the DSM-5, this term may still be used to describe a time when individuals with schizophrenia have fewer obvious symptoms (the psychosis is muted). However some symptoms are still present.

Each phase of schizophrenia has symptoms that help classify it.

Though symptoms of active schizophrenia may seem to come on suddenly, the condition takes years to develop.

In the early prodromal phase, symptoms aren’t always obvious, as you’ll see when you read about this first phase.

Prodromal schizophrenia symptoms

The first signs and symptoms of schizophrenia may be overlooked because they’re common to many other conditions, such as depression.

It’s often not until schizophrenia has advanced to the active phase that the prodromal phase is recognized and diagnosed.

Symptoms in this phase may include:

Active schizophrenia symptoms

At this phase of schizophrenia, the symptoms may be the most obvious.

Yet research suggests by the time a person is at this phase, they may have been showing symptoms of prodromal schizophrenia for approximately 2 years.

Symptoms include:

  • hallucinations or seeing people or things no one else does
  • paranoid delusions
  • confused and disorganized thoughts
  • disordered speech
  • changes to motor behavior (such as useless or excessive movement)
  • lack of eye contact
  • flat affect

Residual schizophrenia symptoms

While no longer used in diagnosing, some clinicians may still describe this phase when discussing symptoms and the progression of schizophrenia.

Symptoms in this phase of the illness resemble symptoms in the first phase. They’re characterized by low energy and lack of motivation, but some elements of the active phase remain. Some people may relapse back to the active phase.

Symptoms of the residual phase are said to include:

  • lack of emotion
  • social withdrawal
  • constant low energy levels
  • eccentric behavior
  • illogical thinking
  • conceptual disorganization
  • frank vocalizations

It’s unclear why individuals develop schizophrenia. Likewise, it’s unclear exactly how or why a person moves through the stages at the pace they do.

Researchers believe a combination of factors set off chemical and structural changes in the brain. Ultimately, these changes lead to schizophrenia. Those same factors may influence when or how quickly a person progresses from one phase to another.

Researchers believe these factors may contribute to developing schizophrenia:

  • Genetics. If you have a family history of the illness, you’re more likely to develop it. However, having a family history doesn’t mean you certainly will have the illness.
  • Hormonal changes. Researchers believe that hormones and physical changes in the body may be a factor. Symptoms of the illness often begin in young adulthood, during a time of major change. On average, men show first signs in their late teens and early 20s. Women develop the illness later. For them, symptoms typically first appear in their mid 20s to early 30s.
  • Biological. Neurotransmitters relay signals between cells in the brain, and chemical changes may damage or impair them. This could lead to the illness.
  • Structure. Changes to the shape or structure of the brain could interfere with communication between neurotransmitters and cells, too.
  • Environmental. Researchers believe exposure to some viruses at an early age could lead to schizophrenia. Likewise, lifestyle choices may impact risk. These choices can include narcotic use or misuse.

A diagnosis for schizophrenia is often first made in the active stage. This is when symptoms become most obvious. Other people may recognize the disordered thoughts and behavior patterns for the first time.

At that point, a doctor may work with friends and family members to understand when early symptoms began. Symptoms of the first phase are often not recognized until a person is in the active phase.

Once a diagnosis is made, a doctor will also be able to determine when the active phase is over based on symptoms and behaviors.

Where to Find Help

Advocacy organizations can help you find immediate help. They can also connect you with local resources that can help you find sustained, long-term treatment. These mental health resources include:

Most people with schizophrenia aren’t diagnosed until the second phase, once symptoms worsen and become more obvious.

At this point, treatment options include:

  • Medicine. Antipsychotic medications may be able to influence the level of chemicals and neurotransmitters in the brain. This could reduce symptoms. It might also help a person avoid relapses or worsening symptoms.
    Therapy. A doctor may refer a person with schizophrenia to a psychologist or psychiatrist. These mental health experts can help people learn to work through disordered thought patterns. They can also help recognize signs of a possible relapse.
  • Hospitalization. This emergency treatment is for an individual in immediate danger. Suicidal thoughts or hallucinations may pose a risk to the person’s safety, or even to people around them.
Where to Seek Emergency Care

If you or a loved one is experiencing suicidal thoughts or dangerous behaviors, seek emergency care:

The first phase of schizophrenia can typically last around two years. However, it’s not always recognized or diagnosed until a person is in the active phase.

If the active phase is left untreated, symptoms can last for weeks, even months. Relapses may be more prevalent, as well.

In one manner or another, a person diagnosed with schizophrenia will be managing symptoms or working to prevent a relapse for the majority of their life.

Schizophrenia is a mental health disorder that causes a variety of symptoms. The earliest symptoms (schizophrenia prodrome) may go undetected until more severe symptoms develop in the active phase of the illness.

The final stage, residual schizophrenia, still causes symptoms. But these aren’t as severe or disordered as the active phase.

Treatment can help reduce symptoms and prevent relapses. As schizophrenia is a life-long condition, treatment will likely be necessary throughout life.