What Are The Stages Of Schizophrenia In Mental Health?

Schizophrenia is a complex brain disorder that can significantly impact those living with the condition. The condition is characterized by stages, presenting symptoms differently in each phase. To understand the schizophrenia spectrum, exploring these areas and how they can present for different people may be helpful.  

What is schizophrenia?

According to clinical practice guidelines, schizophrenia is a mental illness characterized by phases or stages. Those experiencing certain stages of schizophrenia may not recognize their symptoms, but others may. Symptoms could include the following: 

1. Delusions: Delusions are persistent false beliefs despite evidence to the contrary. For example, one might believe their thoughts or actions are controlled by another person or organization. 
2. Hallucinations: Sensory perceptions of non-existent stimuli may occur, such as seeing things or hearing voices that are not there.  
3. Disorganized or incoherent speech: People with schizophrenia often have difficulty organizing thoughts while speaking, resulting in unclear expression or difficulty staying on topic.
4. Unusual movements or behaviors: This symptom may involve actions that deviate from a person’s typical behavior, including random or no movement. 
5. Negative symptoms: Negative symptoms can include reduced or absent facial expression, lack of motivation, or disorganized speech.

As a result of these symptoms, people with schizophrenia may become suspicious, paranoid, or afraid. They may neglect their personal hygiene and appearance and experience depression, anxiety, and suicidal thoughts. Additionally, people with schizophrenia are more likely to use substances like alcohol or drugs to attempt to alleviate symptoms.

If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Understanding the stages of schizophrenia

Schizophrenia is characterized by three distinct stages referred to as the prodromal, active, and residual phases: 

Three stages of schizophrenia

• Prodromal phase: Prodromal symptoms may be subtle and easily overlooked, resembling those of other conditions like depression. They can include withdrawal from social activities, increased anxiety, and difficulty concentrating.
• Active phase: During active episodes, symptoms become more pronounced, with hallucinations, paranoid delusions, and disordered thoughts being prominent. This phase may follow years of subtle prodromal symptoms.
• Residual phase: Although no longer a formal diagnostic term, residual symptoms can still be observed. They include reduced emotional expression, social withdrawal, and low energy levels, often with lingering elements of the active phase.

The active and residual phases of schizophrenia are considered the primary phases. However, each of the three phases presents unique symptoms that may or may not be noticeable to the individual experiencing them or those around them. 

The prodromal stage

The prodromal stage, also called the schizophrenia prodrome, is the earliest stage of schizophrenia or before repeating episodes. This stage is characterized by mild to moderate changes in behavior and perception and can last from several weeks to several years. 

These initial signs and symptoms of schizophrenia often mimic those of other mental health conditions, such as depression or bipolar disorder. Though this early phase marks the onset of schizophrenia, it often goes overlooked, as symptoms are typically non-specific and may overlap with those of other conditions. 

Signs of prodromal schizophrenia may include:

• Social isolation
• Lack of motivation
• Anxiety
• Irritability
• Difficulty concentrating
• Changes in routine
• Sleep disturbances
• Neglect of personal hygiene
• Erratic behavior
• Mild or vague hallucinations

According to a 2018 review, up to 73% of individuals with schizophrenia experience the prodromal stage before developing more severe symptoms. However, identifying individuals in the prodromal stage can remain challenging. For some people, recognition and diagnosis of the prodromal phase only occur after schizophrenia has progressed to the active phase.

The active phase

The active stage of schizophrenia often involves noticeable symptoms. In this phase, telltale symptoms like hearing voices, having unusual thoughts, or having visual hallucinations can become intense and challenging to manage. During the active phase, the individual with schizophrenia may not recognize their own symptoms, but people around them may.  

While these symptoms could seem to manifest suddenly, research indicates that individuals may have been displaying symptoms of prodromal schizophrenia for around two years by the time they reach this phase.

Symptoms during the active phase

• Hallucinations, such as hearing sounds or feeling sensations that don’t exist
• Paranoid delusions
• Confusion and disorganization of thoughts
• Disordered speech
• Changes in motor behavior, such as excessive or purposeless movements
• Reduced eye contact
• Blunted emotional expression

Supporting individuals during acute episodes can be challenging, but awareness of the phases and their associated symptoms can help provide understanding and assistance.

The residual phase

Although not included in current diagnostic criteria, the residual phase is considered to come after the active phase, and some clinicians may still refer to this phase when discussing schizophrenia symptoms and progression.

Symptoms during this phase can mirror those of the initial phase. They are marked by reduced energy and motivation, yet some aspects of the active phase persist. Though this phase may also be considered a “recovery phase,” some individuals may relapse into the active phase.

Symptoms of the residual stage

• Diminished emotional expression
• Withdrawal from social interactions
• Persistent low energy
• Eccentric behavior
• Illogical thinking
• Difficulty thinking clearly
• Vocalizing direct or unfiltered statements

While symptoms in this phase might not be as severe, they can linger. People in this phase may continue to experience minor effects of active schizophrenia, like disorganized thinking and lack of motivation. 

What causes the stages of schizophrenia?

The causes behind the development of schizophrenia and the pace at which individuals progress through its stages are unclear. Researchers suggest that contributing factors to the development of schizophrenia may also influence the timing and speed of progression through the phases.

Contributing factors to symptoms of schizophrenia

These potential contributors include:

• Genetics: Having a family history of schizophrenia increases the likelihood of developing it, although it doesn't guarantee its onset.
• Hormonal changes: Researchers speculate that hormonal fluctuations and physical changes during adolescence and early adulthood may play a role. Symptoms often emerge during this period, with men typically exhibiting signs in their late teens to early 20s and women showing symptoms later, typically in their mid-20s to early 30s.
• Biological factors: Disruptions in neurotransmitters, which transmit signals between brain cells, may contribute to the disorder.
• Structural changes: Alterations in brain shape or structure could impede neurotransmitter-cell communication.
• Environmental influences: Exposure to certain viruses in early life or lifestyle choices, such as substance misuse, may elevate the risk of developing schizophrenia.

Explore schizophrenia symptoms in therapy

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Symptoms of psychosis and mental health: The benefits of treatment

Schizophrenia is a manageable condition with various options available for managing symptoms. Antipsychotic medications are commonly prescribed to help clients manage hallucinations, delusions, and other symptoms. Additionally, therapeutic approaches, such as cognitive-behavioral therapy (CBT), can help individuals comprehend and cope with their symptoms while addressing underlying issues. Supportive therapies, including family or group therapy, offer additional resources and support networks.

Online therapy for mental health treatment and symptoms of psychosis 

In recent years, online therapy through platforms like BetterHelp has emerged as a convenient and accessible option for individuals living with mental health challenges. While further research can be beneficial to determine its effectiveness in treating schizophrenia, virtual therapy provides the opportunity to access support remotely, which can be helpful for individuals facing barriers to attending in-person sessions. In addition, online therapy allows clients to choose between phone, video, or live chat sessions. 

Studies show that online therapy may be effective for individuals experiencing first-episode psychosis. A recent study found that online therapy reduced symptoms in those experiencing first-episode psychosis, with results similar to studies on face-to-face treatment.