Stages of schizophrenia

Schizophrenia is a psychotic disorder that disrupts one’s ability to distinguish between reality and what is perceived as reality. There are three stages of schizophrenia: prodromal, active, and residual. Each of these schizophrenia stages has different features with varying levels of symptoms.^[1]

What are the three stages of schizophrenia?

Schizophrenia is a chronic mental illness, yet how it affects people changes over time. These changes often occur in a sequence of three stages, including prodromal, active, and residual. These three phases of schizophrenia usually appear in order, and they repeat themselves.^[2]

As with any mental illness, the particular way these phases of schizophrenia play out is highly individualized. Where one person might have a lengthy prodromal stage, another might experience a very short prodromal stage and a prolonged active phase.

Despite these individual differences, each person experiences the same phases of schizophrenia. More details about each of these stages are outlined below.

Stage 1: Prodromal

The early stages of schizophrenia are referred to as the prodromal stage. This is when the first signs of mental illness begin to emerge. During this time the symptoms typically present as more general symptoms that can be associated with other mental illnesses, making the identification of schizophrenia at this stage very difficult.

Generally speaking, the behaviors exhibited during the early stages of schizophrenia fall into one of several categories: mood symptoms (e.g., anxiety), cognitive symptoms (e.g., difficulty concentrating), social withdrawal, and positive symptoms (e.g., mild hallucinations). Also common are erratic or obsessive behaviors, dysphoria, and superstitiousness.^[3]

Another component of the prodromal phase is a loss of interest in once-enjoyed activities. This may or may not be paired with a withdrawal from loved ones. In either case, these behaviors typically indicate depression and other mood disorders ^[4], which can “mask” the true nature of the symptoms as something other than schizophrenia.

Adding to the difficulty of identifying schizophrenia in its earliest stages is that, for many people, these changes and symptoms happen gradually. For some, it might be a process of months or years during which these symptoms worsen. However, this stage usually occurs in males aged 15-25 and females aged 25-35.^[1] Eventually, most people with schizophrenia exit the prodromal stage and enter the next of the three phases of schizophrenia: the active stage.

Stage 2: Active

The active stage of schizophrenia is when classic psychotic symptoms emerge. As noted earlier, many people gradually get to this point. Others, though, experience psychosis much more quickly. In either case, this is the most troublesome of the schizophrenia stages because the symptoms are severe, frequent, and numerous. These symptoms include:^[5]

• Hallucinations include seeing, hearing, or smelling things that no one else is aware of. People with schizophrenia often hear voices that might be critical, threatening, or both.
• Delusions are strongly heldyet false beliefs that a person continues believing even in the face of evidence that their beliefs are incorrect.
• Disorganized thinking typically involves the inability to complete tasks, concentrate, or remember things. Some people in the active stage also have anosognosia, which describes a person who is entirely unaware that they have schizophrenia.
• Negative symptoms reduce a person’s ability to communicate and connect with others. This might include labored, disconnected speech, an inability to take an interest in life activities, or having a flat affect.

Again, like in the early stages of schizophrenia, the symptoms of the active stage can sometimes be mistaken for another mental illness, particularly other forms of psychosis. In particular, negative symptoms can make it seem like someone in the active stage of schizophrenia is in a major depressive episode.

Stage 3: Residual

During the residual stage of schizophrenia, patients experience fewer symptoms and less severe symptoms, not unlike the prodromal stage.^[2] The severe symptoms of psychosis, like hallucinations and delusions, gradually disappear, but other, less severe symptoms usually persist, including the following:

• Disinterest in life activities and general social withdrawal
• Trouble planning activities or participating in activities with loved ones
• Difficulty concentrating
• Minimized facial expressions
• Low verbal expressivity 

Some patients might have one or two cycles of these schizophrenia stages in their lifetime. Others might have far more than that. It’s not entirely understood why this is, but it is known that with more cycles of the three stages of schizophrenia, the symptoms in the residual stage increase. This can lead to a marked decrease in a person’s ability to function independently.^[1]

When to seek treatment for schizophrenia

Though schizophrenia is a severe, chronic mental illness, treatment can be highly effective. However, treatment is most effective when it’s undertaken during the earliest signs of schizophrenia. The sooner treatment begins, the less likely a patient is to experience another active phase of the disorder and the less likely they are to experience increasingly severe residual symptoms.^[2]

There are many options available to treat schizophrenia. Some of the most common are outlined below:

• First-generation antipsychotic medications like Chlorpromazine, Haloperidol, and Pimozideblock dopamine transmission in the brain, which reduces some schizophrenia symptoms. These drugs have a higher risk of side effects and are less popular than second-generation antipsychotics.
• Second-generation antipsychotic medications like Clozapine, Olanzapine, and Risperidone are almost always the first line of treatment for schizophrenia because of their efficacy in reducing symptoms and the reduced number and severity of side effects compared to first-generation antipsychotics.
• Psychotherapy helps reduce the symptoms of schizophrenia and improves daily functioning. It also addresses other concerns, like anxiety, depression, and stress. Psychotherapeutic interventions are also helpful in enhancing psychosocial skills, supporting employment, and improving self-care.^[6]
• Cognitive-behavioral therapy, which is a specific type of psychotherapy,helps patients gain insights into their thinking and how it affects their behavior. It also helps manage the effects of psychosis and treats less severe symptoms like anxiety and stress.^[2]
• Electroconvulsive therapy (ECT) effectively reduces schizophrenia symptoms when medication doesn’t achieve the desired result. It’s also helpful in addressing the severe depression some people with schizophrenia experience during the residual phase.^[2] 
• Family therapy is often beneficial in building more robust support for someone with schizophrenia by educating the family about schizophrenia, improving communication, and building coping skills.