Acute phase of schizophrenia

What Are the Phases of Schizophrenia?

Written by Paul Frysh

Schizophrenia is a mental illness whose symptoms usually occur in phases. Phase 1, when they start to show up, is called prodromal. In phase 2, the active stage, your symptoms are most noticeable. The last stage is the residual phase of schizophrenia. In this phase, you're starting to recover, but still have some symptoms.

What Are the Symptoms?

Schizophrenia is a type of psychosis. That means you can’t always tell the difference between what's real and what's a thought inside your head. Its symptoms can include:

Hallucinations: You see or hear things that don’t exist
Delusions: Beliefs that aren’t based in reality
Muddled thoughts based on hallucinations or delusions
Problems speaking clearly
Lack of goal-oriented behavior
Trouble thinking through information or paying attention
Loss of interest in daily life
Bad hygiene
Desire to avoid people, even friends and family

Often, you don’t realize that your thoughts have become misleading or paranoid. Friends, loved ones, or your doctor must point it out and try to lead you toward treatment.

The First 2 Phases of Schizophrenia

Schizophrenia tends to happen in episodes, in which you cycle through all three stages in order. These cycles are hard to stop without help from a doctor.

In the first, prodromal phase, friends and family might notice strange behavior. You might want to be alone much of the time and may start to talk only about certain topics, such as religion, the government, or a particular public figure.

This phase can last from weeks to years. Some people with schizophrenia never go past this point, but most do.

The active phase (sometimes called “acute”), can be the most alarming to friends and family. It causes symptoms of psychosis like delusions, hallucinations, and jumbled speech and thoughts. Sometimes, this phase appears suddenly without a prodromal stage.

The Residual Phase of Schizophrenia

Doctors sometimes call this the “recovery” phase. In many ways, it mirrors the prodromal phase. The more intense symptoms, like hallucinations, start to fade. But you may still have some strange beliefs. You're also likely to withdraw into yourself and talk less.

You might have trouble concentrating or keeping your thoughts straight. You can become depressed as you become aware of the episode.

The Importance of Treatment

The residual symptoms tend to get more and more serious after each new active stage. Some people have residual symptoms that don't go away. Always follow the treatment program your doctors prescribe, so you can avoid another episode of the disease.

Early treatment, with consistent follow-up, works well for many people with schizophrenia. Some people have just one or two active episodes in their lives. A combination of medication, talk therapy, and other support can greatly improve mental health and quality of life.

Talk to your doctor if you suspect symptoms of schizophrenia in yourself or a loved one.

Explaining the Phases of Schizophrenia: Symptoms, Treatment & More

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:

withdrawal from social life or family activities
isolation
increased anxiety
difficulty concentrating or paying attention

lack of motivation
struggling to make decisions
changes to normal routine
forgetting or neglecting personal hygiene
sleep disturbances
increased irritability

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:
Schizophrenia and Related Disorders Alliance of America
Mental Health America
Substance Abuse and Mental Health Services Administration Hotline: 1-800-662-HELP (4357)

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:
Dial 911 or your local emergency number
Visit a hospital or emergency department
Call the National Suicide Prevention Hotline at 800-273-8255 24/7
Text NAMI or HOME to the Crisis Text Line at 741741

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.

Three stages of schizophrenia — treatment of schizophrenia at the Allianz Central Medical Health Center

Doctors say that severe physical illnesses occur in three stages:

The first organism mobilizes all resources.
On the second, balance occurs, the body adapts to the disease.
On the third, exhaustion sets in, the diseased organ (or the whole organism) ceases to cope with the "work".

Schizophrenia should be diagnosed and treated by an experienced psychiatrist.

The course of schizophrenia resembles the course of serious illnesses of the body. There are three stages of schizophrenia: mastery, adaptation and degradation. The severity and duration of these stages vary significantly.

First stage of schizophrenia: mastery

From the familiar, predictable real world, the patient moves into a distorted, phantasmagoric world of visions, hallucinations, unusual colors and unusual proportions. Not only his world is changing, he is also changing. With a stormy course of schizophrenia, in their eyes, a person becomes a hero or an outcast, a savior of the universe or a victim of the universe.

If changes occur gradually, the first stage of schizophrenia may be dominated by anxiety, confusion and fear: something is clearly happening to the outside world, people's motives are not clear, but they do not promise anything good - you need to prepare either for defense or for flight.

The first stage of schizophrenia can be called a period of discovery and insight. It seems to the patient that he sees the essence of things and the true meaning of events. In this phase, there is no place for routine and calmness.

The discovery of a new world can be wonderful (for example, when feeling omnipotent) or terrible (when realizing the insidious plans of enemies who supposedly poison the patient, kill him with rays or read his thoughts), but it is impossible to calmly survive the changes.

It happens that after experiencing a bright, stormy phase of mastery, the patient returns completely to normal life. And with an unfavorable course of schizophrenia, short, almost imperceptible periods of mastery and adaptation are quickly replaced by a long phase of degradation.

Second stage of schizophrenia: adaptation

The patient gets used to the changes. The sense of novelty is lost. At the second stage of schizophrenia, delusions, hallucinations and other manifestations of the disease become commonplace. The illusory world no longer obscures reality. Two realities more or peacefully coexist in the mind of man.

Important

This stage of schizophrenia is characterized by the so-called "double orientation": the patient can see in a neighbor an evil alien and, at the same time, a well-known Uncle Misha.

Regardless of the variant of the course of schizophrenia, the result of therapy largely depends on what the patient chooses: the real world or the world of illusions. If nothing keeps a person in the real world, he simply does not need to return to reality.

In addition, this stage of schizophrenia is accompanied by the repetition of the same words, gestures and facial expressions that are not related to the current situation, stereotypical behavior - the patient walks in circles around the room, sits and sways with lamentations. The more severe the course of schizophrenia, the more stereotypical behavior becomes.

Third stage of schizophrenia: degradation

In this phase, emotional dullness comes to the fore. The time of onset of the third stage depends on the form and on the course of schizophrenia. Signs of emotional and then intellectual degradation develop rapidly in hebephrenic and simple forms of the disease.

Patients with a catatonic and paranoid form, especially with a favorable course of schizophrenia, can remain emotionally and intellectually intact for a long time.

At the third stage, the patient seems to burn out from the inside: hallucinations fade, the expression of emotions becomes even more stereotyped. Space and time lose their significance.

With any type of course of schizophrenia, the third phase is unfavorable in terms of prognosis. However, thoughtful rehabilitation gives patients the opportunity to exist in society. In some cases (usually after severe emotional upheavals), a short-term or steady return to normal life is possible.

Schizophrenia: clinical picture

Schizophrenia can manifest itself in different ways. It depends on the personality of the person, the stage of the disease. Information about the stages of development of schizophrenia can help you choose the right approach to treatment.

In this section:

Stages of development of the disease ^1-2

Schizophrenia does not develop according to a strictly prescribed algorithm. But three main phases of the disease can be distinguished - these are the prodromal, acute and residual stages ^1.2 .
The concept of "prodromal" characterizes the period preceding the first psychotic episode. The phase can last from a few days to 18 months. At this time, the first signs of schizophrenia begin to appear: a person’s behavior changes, his actions become incomprehensible to others, memory problems arise, concentration of attention is disturbed, isolation appears, the desire to communicate and do something disappears.
The period of exacerbation or the acute phase follows the prodromal period. Positive symptoms appear: hallucinations, delirium. A person needs medical help: pharmacotherapy and psychological support. However, after the positive symptoms are relieved, the negative symptoms of schizophrenia may persist. They are expressed in a decrease in interest in ongoing events, apathy. This condition often persists for several years. This is the stabilization stage of schizophrenia ² .
Treatment is necessary throughout the life of a person with schizophrenia, therapy allows control of symptoms and enables a person to be active and productive.

Progression of schizophrenia (adapted from Lieberman and First, 2018)

Course of illness

^1-2

It may seem that schizophrenia is a disease with a predictable course. But, unfortunately, each person has an individual picture of the disease, there are various symptoms, their combinations. In some people, an acute episode with predominantly positive symptoms can last a few days, in others it can last several years. A number of patients do not have a pronounced prodromal period, schizophrenia immediately manifests as acute psychosis ² .
In the infographic below, you can see patterns in the course of schizophrenia.
So:

every 5th patient after the first acute attack of the disease no longer experiences any symptoms;

in 4 out of 5 people, schizophrenia progresses and psychotic episodes become more pronounced.

There are many options. At the same time, relapses of schizophrenia can develop according to a unique “scenario” each time, they cannot be predicted, it is impossible to calculate the time interval between attacks.

Sources:

AIPC Overview of Schizophrenia. https://www.aipc.net.au/articles/an-overview-of-schizophrenia/ [Accessed July 2019]
CPA Schizophrenia: A journey to recovery. https://www.schizophrenia.ca/docs/RoadtoRecoveryschzhioph-web.pdf [Accessed July 2019]
Lieberman and First. N Engl J Med.
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