What does a schizophrenic episode look like

Symptoms - Schizophrenia - NHS

Schizophrenia changes how a person thinks and behaves.

The condition may develop slowly. The first signs can be hard to identify as they often develop during the teenage years. 

Symptoms such as becoming socially withdrawn and unresponsive or changes in sleeping patterns can be mistaken for an adolescent "phase".

People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no symptoms. This is known as acute schizophrenia.

Positive and negative symptoms

The symptoms of schizophrenia are usually classified into:

  • positive symptoms – any change in behaviour or thoughts, such as hallucinations or delusions
  • negative symptoms – where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat


Hallucinations are where someone sees, hears, smells, tastes or feels things that do not exist outside their mind. The most common hallucination is hearing voices.

Hallucinations are very real to the person experiencing them, even though people around them cannot hear the voices or experience the sensations.

Research using brain-scanning equipment shows changes in the speech area in the brains of people with schizophrenia when they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices.

Some people describe the voices they hear as friendly and pleasant, but more often they're rude, critical, abusive or annoying.

The voices might describe activities taking place, discuss the hearer's thoughts and behaviour, give instructions, or talk directly to the person. Voices may come from different places or 1 place, such as the television.


A delusion is a belief held with complete conviction, even though it's based on a mistaken, strange or unrealistic view. It may affect the way the person behaves. Delusions can begin suddenly or may develop over weeks or months.

Some people develop a delusional idea to explain a hallucination they're having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions.

Someone experiencing a paranoid delusion may believe they're being harassed or persecuted. They may believe they're being chased, followed, watched, plotted against or poisoned, often by a family member or friend.

Some people who experience delusions find different meanings in everyday events or occurrences.

They may believe people on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing on the street.

Confused thoughts (thought disorder)

People experiencing psychosis often have trouble keeping track of their thoughts and conversations.

Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme.

People sometimes describe their thoughts as "misty" or "hazy" when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand.

Changes in behaviour and thoughts

A person's behaviour may become more disorganised and unpredictable.

Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else.

Another feeling is that thoughts are disappearing, as though someone is removing them from their mind.

Some people feel their body is being taken over and someone else is directing their movements and actions.

Negative symptoms of schizophrenia

The negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode.

These initial negative symptoms are often referred to as the prodromal period of schizophrenia.

Symptoms during the prodromal period usually appear gradually and slowly get worse.

They include the person becoming more socially withdrawn and increasingly not caring about their appearance and personal hygiene.

It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else.

Negative symptoms experienced by people living with schizophrenia include:

  • losing interest and motivation in life and activities, including relationships and sex
  • lack of concentration, not wanting to leave the house, and changes in sleeping patterns
  • being less likely to initiate conversations and feeling uncomfortable with people, or feeling there's nothing to say

The negative symptoms of schizophrenia can often lead to relationship problems with friends and family as they can sometimes be mistaken for deliberate laziness or rudeness.


Schizophrenia is often described by doctors as a type of psychosis.

A first acute episode of psychosis can be very difficult to cope with, both for the person who is ill and for their family and friends.

Drastic changes in behaviour may occur, and the person can become upset, anxious, confused, angry or suspicious of those around them.

They may not think they need help, and it can be hard to persuade them to visit a doctor.

Read more about understanding psychotic experiences.

Definition, Symptoms, Causes, Diagnosis, Treatment

Written by WebMD Editorial Contributors

Schizophrenia is a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. Though schizophrenia isn’t as common as other major mental illnesses, it can be the most chronic and disabling.

People with schizophrenia often have problems doing well in society, at work, at school, and in relationships. They might feel frightened and withdrawn, and could appear to have lost touch with reality. This lifelong disease can’t be cured but can be controlled with proper treatment.

Contrary to popular belief, schizophrenia is not a split or multiple personality. Schizophrenia involves a psychosis, a type of mental illness in which a person can’t tell what’s real from what’s imagined. At times, people with psychotic disorders lose touch with reality. The world may seem like a jumble of confusing thoughts, images, and sounds. Their behavior may be very strange and even shocking. A sudden change in personality and behavior, which happens when people who have it lose touch with reality, is called a psychotic episode.

How severe schizophrenia is varies from person to person. Some people have only one psychotic episode, while others have many episodes during a lifetime but lead relatively normal lives in between. Still others may have more trouble functioning over time, with little improvement between full-blown psychotic episodes. Schizophrenia symptoms seem to worsen and improve in cycles known as relapses and remissions.

What Are the Early Symptoms of Schizophrenia?

The condition usually shows its first signs in men in their late teens or early 20s. It mostly affects women in their early 20s and 30s. The period when symptoms first start and before full psychosis is called the prodromal period. It can last days, weeks, or even years. It can be hard to spot because there’s usually no specific trigger. You might only notice subtle behavioral changes, especially in teens. This includes:

  • A change in grades
  • Social withdrawal
  • Trouble concentrating
  • Temper flares
  • Difficulty sleeping

Positive Symptoms of Schizophrenia

In this case, the word positive doesn’t mean good. It refers to added thoughts or actions that aren’t based in reality. They’re sometimes called psychotic symptoms and can include:

  • Delusions: These are false, mixed, and sometimes strange beliefs that aren’t based in reality and that the person refuses to give up, even when shown the facts. For example, a person with delusions may believe that people can hear their thoughts, that they are God or the devil, or that people are putting thoughts into their head or plotting against them.
  • Hallucinations: These involve sensations that aren't real. Hearing voices is the most common hallucination in people with schizophrenia. The voices may comment on the person's behavior, insult them, or give commands. Less common types include seeing things that aren't there, smelling strange odors, having a funny taste in your mouth, and feeling sensations on your skin even though nothing is touching your body.
  • Catatonia: In this condition, the person may stop speaking, and their body may be fixed in a single position for a very long time.

Disorganized Symptoms of Schizophrenia

These are positive symptoms that show that the person can’t think clearly or respond as expected. Examples include:

  • Talking in sentences that don’t make sense or using nonsense words, making it difficult for the person to communicate or hold a conversation
  • Shifting quickly from one thought to the next without obvious or logical connections between them
  • Moving slowly
  • Being unable to make decisions
  • Writing excessively but without meaning
  • Forgetting or losing things
  • Repeating movements or gestures, like pacing or walking in circles
  • Having problems making sense of everyday sights, sounds, and feelings

Cognitive Symptoms of Schizophrenia

The person will have trouble:

  • Understanding information and using it to make decisions (a doctor might call this poor executive functioning)
  • Focusing or paying attention
  • Using their information immediately after learning it (this is called working memory)
  • Recognizing that they have any of these problems

Negative Symptoms of Schizophrenia

The word "negative" here doesn’t mean "bad. " It notes the absence of normal behaviors in people with schizophrenia. Negative symptoms of schizophrenia include:

  • Lack of emotion or a limited range of emotions
  • Withdrawal from family, friends, and social activities
  • Less energy
  • Speaking less
  • Lack of motivation
  • Loss of pleasure or interest in life
  • Poor hygiene and grooming habits

What Causes Schizophrenia?

The exact cause of schizophrenia isn’t known. But like cancer and diabetes, schizophrenia is a real illness with a biological basis. Researchers have uncovered a number of things that appear to make someone more likely to get schizophrenia, including:

  • Genetics (heredity): Schizophrenia can run in families, which means a greater likelihood to have schizophrenia may be passed on from parents to their children.
  • Brain chemistry and circuits: People with schizophrenia may not be able to regulate brain chemicals called neurotransmitters that control certain pathways, or "circuits," of nerve cells that affect thinking and behavior.
  • Brain abnormality: Research has found abnormal brain structure in people with schizophrenia. But this doesn’t apply to all people with schizophrenia. It can affect people without the disease.
  • Environment: Things like viral infections, exposure to toxins like marijuana, or highly stressful situations may trigger schizophrenia in people whose genes make them more likely to get the disorder. Schizophrenia more often surfaces when the body is having hormonal and physical changes, like those that happen during the teen and young adult years.

Who Gets Schizophrenia?

Anyone can get schizophrenia. It affects people all over the world, from all races and cultures. While it can happen at any age, schizophrenia typically first appears in the teenage years or early 20s. The disorder affects men and women equally, although symptoms generally appear earlier in men. The earlier the symptoms start, the more severe the illness tends to be. Children over the age of 5 can have schizophrenia, but it’s rare before adolescence.

How Is Schizophrenia Diagnosed?

If symptoms of schizophrenia are present, the doctor will perform a complete medical history and sometimes a physical exam. While there are no laboratory tests to specifically diagnose schizophrenia, the doctor may use various tests, and possibly blood tests or brain imaging studies, to rule out another physical illness or intoxication (substance-induced psychosis) as the cause of the symptoms.

If the doctor finds no other physical reason for the schizophrenia symptoms, they may refer the person to a psychiatrist or psychologist, mental health professionals trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interviews and assessment tools to evaluate a person for a psychotic disorder. The therapist bases their diagnosis on the person's and family's report of symptoms and their observation of the person's attitude and behavior.

A person is diagnosed with schizophrenia if they have at least two of these symptoms for at least 6 months:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
  • Negative symptoms

One of the symptoms has to be

  • Delusions
  • Hallucinations
  • Disorganized speech

During the 6 months, the person must have a month of active symptoms. (It can be less with successful treatment.) Symptoms should negatively affect them socially or at work, and can’t be caused by any other condition.

How Is Schizophrenia Treated?

The goal of schizophrenia treatment is to ease the symptoms and to cut the chances of a relapse, or return of symptoms. Treatment for schizophrenia may include:

  • Medications: The primary medications used to treat schizophrenia are called antipsychotics. These drugs don’t cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations, and thinking problems.
    • Older (commonly referred to as "first-generation") antipsychotic medications used include:
      • Chlorpromazine (Thorazine)
      • Fluphenazine (Prolixin)
      • Haloperidol (Haldol)
      • Loxapine HCL (Loxapine)
      • Perphenazine (Trilafon)
      • Thiothixene (Navane)
      • Trifluoperazine (Stelazine)
    • Newer ("atypical" or second-generation) drugs used to treat schizophrenia include:
      • Aripiprazole (Abilify)
      • Aripiprazole Lauroxil (Aristada)
      • Asenapine (Saphris)
      • Brexpiprazole (Rexulti)
      • Cariprazine (Vraylar)
      • Clozapine (Clozaril)
      • Iloperidone (Fanapt)
      • Lumateperone (Caplyta)
      • Lurasidone (Latuda)
      • Olanzapine (Zyprexa)
      • Olanzapine/samidorphan (Lybalvi)
      • Paliperidone (Invega Sustenna)
      • Paliperidone (Invega Trinza)
      • Quetiapine (Seroquel)
      • Risperidone (Risperdal)
      • Ziprasidone (Geodon)

Note: Clozapine is the only FDA-approved medication for treating schizophrenia that is resistant to other treatments. It’s also used to lessen suicidal behaviors in those with schizophrenia who are at risk.

  • Coordinated specialty care (CSC): This is a team approach toward treating schizophrenia when the first symptoms appear. It combines medicine and therapy with social services, employment, and educational interventions. The family is involved as much as possible. Early treatment is key to helping patients lead a normal life.
  • Psychosocial therapy: While medication may help relieve symptoms of schizophrenia, various psychosocial treatments can help with the behavioral, psychological, social, and occupational problems that go with the illness. Through therapy, patients also can learn to manage their symptoms, identify early warning signs of relapse, and come up with a relapse prevention plan. Psychosocial therapies include:
    • Rehabilitation, which focuses on social skills and job training to help people with schizophrenia function in the community and live as independently as possible
    • Cognitive remediation, which involves learning techniques to make up for problems with information processing. It often uses drills, coaching, and computer-based exercises to strengthen mental skills that involve attention, memory, planning, and organization.
    • Individual psychotherapy, which can help the person better understand their illness, and learn coping and problem-solving skills
    • Family therapy, which can help families deal with a loved one who has schizophrenia, enabling them to better help their loved one
    • Group therapy/support groups, which can provide continuing mutual support
  • Hospitalization: Many people with schizophrenia may be treated as outpatients. But hospitalization may be the best option for people:
    • With severe symptoms
    • Who might harm themselves or others
    • Who can’t take care of themselves at home
  • Electroconvulsive therapy (ECT): In this procedure, electrodes are attached to the person's scalp. While they’re asleep under general anesthesia, doctors send a small electric shock to the brain. A course of ECT therapy usually involves 2-3 treatments per week for several weeks. Each shock treatment causes a controlled seizure. A series of treatments over time leads to improvement in mood and thinking. Scientists don’t fully understand exactly how ECT and the controlled seizures it causes help, but some researchers think ECT-induced seizures may affect the release of neurotransmitters in the brain. ECT is less well-proven to help with schizophrenia than depression or bipolar disorder, so it isn’t used very often when mood symptoms are absent. It can help when medications no longer work, or if severe depression or catatonia makes treating the illness difficult.
  • Research: Researchers are looking at a procedure called deep brain stimulation (DBS) to treat schizophrenia. Doctors surgically implant electrodes that stimulate certain brain areas believed to control thinking and perception. DBS is an established treatment for severe Parkinson's disease and essential tremor, but it’s still experimental for the treatment of psychiatric disorders.

Are People With Schizophrenia Dangerous?

Popular books and movies often depict people with schizophrenia and other mental illnesses as dangerous and violent. This usually isn’t true. Most people with schizophrenia are not violent. More typically, they prefer to withdraw and be left alone. When people with mental illness do take part in dangerous or violent behaviors, it’s generally a result of their psychosis and the fear that they’re being threatened in some way by their surroundings. Drug or alcohol use can make it worse.

On the other hand, people with schizophrenia can be a danger to themselves. Suicide is the top cause of premature death among people with schizophrenia.

What Is the Outlook for People With Schizophrenia?

With proper treatment, most people with schizophrenia can lead productive and fulfilling lives. Depending on how severe the condition is and how well they get and stick with treatment, they should be able to live with their families or in community settings rather than in long-term psychiatric hospitals.

Ongoing research on the brain and how brain disorders happen will likely lead to more effective medicines with fewer side effects.

Can Schizophrenia Be Prevented?

There’s no known way to prevent schizophrenia. But early diagnosis and treatment can help avoid or ease frequent relapses and hospitalizations, and help cut the disruption to the person's life, family, and relationships.

"I hid for ten years that I was suffering from psychosis." The story of a man with hallucinations

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Photo copyright, Luke Watkin

Photo caption,

Luke Watkin first experienced hallucinations at the age of 12

Luke Watkin was in high school when it happened. He was walking along an empty school corridor and suddenly heard a strange sound.

"It seemed to me that there was a screech of train brakes, and then a metallic clang. For me it was a complete surprise, I just did not understand what happened. And then I got scared," he says.

This was his first encounter with mental illness. He was then 12 years old.

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The auditory hallucinations grew - he heard single words, his own name, and at the end - whole phrases, as if someone was trying to talk to him.

This is one of the main signs of psychosis - hallucinations and delusions, and they can be caused by a specific disease - schizophrenia, bipolar disorder or acute depression.

Stress, trauma, drugs, alcohol, drug exposure, or a brain tumor can also cause these phenomena.

The invisible enemy

Psychosis is not as common as depression - it affects less than one person in a hundred. Experts say that for the successful treatment of psychosis, it is important to recognize and diagnose it as soon as possible.

Psychotic people are much more likely to commit suicide or cause physical injury to themselves.

According to psychiatrists, more than half of the patients admit that it was difficult for them to notice the initial symptoms of psychosis.

Most often, these symptoms appear in the age group of 18-24 years, and psychiatrists believe that a lack of knowledge in this area leads to the fact that young people do not receive timely help.

There are also more hidden signs that indicate mental ill-being and the approach of a psychotic state - growing self-isolation, a tendency to strange views and ideas, sharp mood swings and confusion in thoughts.

Symptoms of psychosis:

  • Hallucinations, when it seems to a person that he sees, hears, feels something that does not exist in reality
  • Rapid continuous speech
  • Confused speech - for example, a quick transition from one topic to another in one phrase prevails
  • 0022
  • Sudden loss of train of thought, resulting in a sudden pause in conversation

Luke tried to talk about anxiety symptoms with the teacher, but he said he was given to understand that this should not be shared with everyone.

So he decided to stand firm and keep the secret to himself. Luke kept quiet about his illness until he had to drop out of his third year at university.

He admits now that even members of his family would find it difficult to notice that something was wrong with him.

"They thought I was quiet because that's how I dealt with problems. I rarely left my room and preferred not to talk to anyone. And my parents used to consider me a quiet and calm child," says Luke.

But when he became a student, it was difficult for him - it turned out to be impossible to hide his psychosis in the conditions of student life.

He dropped out of school without telling his parents, who didn't suspect anything.

image copyrightFamily photo

Image caption,

When Luke's father Steve found out about his son's illness, he was understanding and caring.

"When my illness got to the point, I just disappeared," says Luke. "I stopped keeping in touch with my parents."

"When the university told them that I had dropped out, they realized that something was happening to me, and this was the first step towards a cure. They showed complete understanding and care."

In Britain, psychiatrists advise anyone who shows signs of psychosis to contact their doctor immediately.

Psychosis is usually treated with a combination of medication, psychotherapy, and social and family support.

Attitudes of society are changing

Luke was treated - he was prescribed antipsychotic medication and was connected to an early intervention service.

"Now, when I remember my past, it seems incredible to me. I refused to complain about my condition - the very thought of it did not occur to me. Now I complain constantly, but then I was simply afraid to think about my illness without talking about talking about it with the doctor," recalls Luke.

Luke is now 26 years old. He became a volunteer and helps other young people cope with similar problems.

According to him, he sees how psychosis is transformed from a shameful topic into a subject of research and public attention.

"It seems to me that in the future people will not hide such a disease, because it is much easier to talk about it than to treat it as a taboo subject and hide it," he concludes.

Schizophrenia. A brief introduction” — review “The core of schizophrenia without the full picture” by apofatiki

This book could indeed be an introduction to another, more comprehensive work on schizophrenia, and for those familiar with such works, it is rather useless. This book gives a brief digression into the history of the study of schizophrenia, gives a digest of studies related to the study and treatment of schizophrenia, but mainly those theses are given that give the most typical and severe manifestations of this disease, namely, delusions of control and hallucinations. The authors devote separate chapters to how schizophrenia is associated with various factors - biological, social, drug, concluding that this disease, although it does not have a genetic marker, is associated with the characteristics of physical development and brain pathology, and not with the characteristics of education, communication problems and situations of high stress. The authors do not describe the course of schizophrenia, do not differentiate it into different types of anamnesis. Descriptions of the work of the intellect and emotional behavior are given in scant examples of how doctors describe patients or the patients themselves. This is not enough, and the cases are always typical and come down to dialogues with "voices". I think more details of how a schizophrenic feels can be obtained by looking at the public pages of those who consider themselves psychics, communicating with dead ancestors, magical spirits, or receiving messages from outer space. However, in my opinion, potentially any dreamer who seeks inspiration and avoids routine, any disloyal type who seeks space outside power control, anyone confident in a theory that typifies personality on opposite fronts, has schizophrenic episodes and is delirious.

A brief synopsis of this book gives the following picture: a typical schizophrenic episode is self-talk in the third person; the patient's average age is 24 years; drug therapy is effective in the case of schizophrenia, but social psychotherapy or psychoanalysis is not; there is no connection between the course of the disease and intellectual deficiency or hospitalization; statistics show that it is impossible to predict the propensity for antisocial behavior among schizophrenics; Difficulties also exist from the very diagnosis, which is difficult if it is not a nuclear symptomatology with the same delusion of control; volitional behavior of schizos is limited by a specific instruction for action, they are deprived of a creative approach to solving a problem. That is, it would be possible not to stretch it with references to studies and extensive illustrative material. It looks like a book for a schizophrenic who is not able to master something fundamental, or for a young reader.

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