Phases of Schizophrenia
Schizophrenia involves more than just experiencing hallucinations and delusions, as its symptoms often come in phases.
Living with schizophrenia means that psychotic symptoms, which involve a detachment from reality, are a part of the diagnosis.
However, these symptoms do not occur every day, as schizophrenia consists of three stages that typically cycle in a certain order.
Living with schizophrenia does not necessarily mean experiencing constant hallucinations. Instead, it can involve going through a phase of changes in behavior or a phase of clarity mixed with depression.
Prodromal phase
The first phase of schizophrenia is known as the prodromal phase or beginning stage.
Symptoms during this stage can be subtle and may include changes in social activity and ideology, which may be perceived as natural shifts in one’s personality.
Symptoms of the prodromal phase may include:
- social withdrawal
- increase in suspicious thinking
- changes in previous ideologies
- trouble concentrating
- memory lapses
- decline in work or school performance
- irritability
- anxiety or paranoia
- change of social circle
- difficulty sleeping
- inappropriate affect (reactions without a proper stimulus, like laughing for no reason)
- changes in diet
- skewed interpretation of events
In the early phase of schizophrenia, changes in one’s thoughts and behaviors may be subtle, and those around them may notice minor shifts.
Due to the onset of schizophrenia typically occurring during late adolescence or early adulthood, some symptoms may be mistaken for “growing up” and not recognized as a mental health condition.
Even when seeking help from a mental healthcare provider, the symptoms of this initial phase can overlap with those of other mental health conditions.
Schizophrenia may not be immediately noticeable because the prodromal phase can persist for months or even years before progressing to the second phase of the disorder.
Symptoms can develop gradually and slowly during this phase, but some individuals may experience sudden onset of more severe symptoms that affect their daily life.
This does not necessarily mean the prodromal phase was skipped, but rather that it may have been too subtle to notice or brief in duration.
Active phase
The acute stage, also known as the active phase, is when schizophrenia is typically diagnosed as symptoms become more prominent.
During this phase, individuals may experience a significant change in behavior, and those around them may notice.
This is when symptoms of psychosis, such as hallucinations and delusions, may become more apparent.
During the active phase of schizophrenia, you may experience three primary types of symptoms:
- Positive symptoms of schizophrenia are those that involve the presence of something that is not normally present. These can include hallucinations, delusions, disordered thinking and speech, and abnormal motor behavior.
- Negative symptoms: There are also negative symptoms that you may experience during the active phase of schizophrenia. These symptoms may cause a decline in your overall function, including cognitive decline, social withdrawal, or loss of emotional expression.
- Disorganized symptoms: Disorganized symptoms, which involve disorganized speech, thoughts, or unpredictable movements, may appear to others as nonsensical.
The length of the active phase of schizophrenia can vary from weeks to years and is influenced by how soon treatment is sought. Seeking treatment early can have a significant impact on the duration of this phase.
According to a 2018 systematic review of cognitive-behavioral combination therapy, over 52% of individuals saw a decrease in positive symptoms with treatment.
Residual phase
The residual phase, which is also referred to as the recovery phase, marks a period of reduced symptoms following the active phase of schizophrenia.
As the symptoms of the active phase begin to subside, you may gain a better understanding of the thoughts and behaviors that occurred during the previous phases.
This could lead to a resurgence of emotional distress as you come to terms with the impact of schizophrenia on your life. Additionally, symptoms that persist during this phase may gradually worsen with each subsequent active phase.
Based on research, negative symptoms are known to persist during the residual phase of schizophrenia. Some of the symptoms that may occur during this phase include social withdrawal, fatigue, disorganized thoughts and behavior, cognitive disturbance, and a lack of emotion or expression.
The duration of the residual stage in schizophrenia can be affected by treatment, similar to the active stage. It is important to note that having multiple major episodes of schizophrenia is not a given.
Successful treatment can help individuals remain in the residual phase for an extended period of time or even indefinitely.
A 2021 cross-sectional study found that high rates of schizophrenia relapse are linked to several factors. These include a short duration of treatment, not adhering to medication, and having an additional mental health condition.
Causes
The progression of schizophrenia through its stages is not fully understood, as there is no known specific trigger for transitions between phases.
However, prompt and continuous treatment can help delay the progression of the condition.
Experts suggest that schizophrenia is influenced by a complex interplay of factors, such as genetic predisposition, environmental exposures, and neurological abnormalities, and that each individual may have a distinct combination of these factors that contribute to the development of the disorder.
It is important to keep in mind that having any of these contributing factors does not guarantee that someone will develop schizophrenia.
Diagnosis
The prodromal phase of schizophrenia can be challenging to diagnose because the symptoms can be nonspecific.
Diagnosis typically occurs during the active phase when the symptoms start to affect daily functioning significantly.
To achieve a schizophrenia diagnosis, the DSM-5 states the following guidelines must be met:
- Significant presence of at least 2 of the following symptoms during a 1-month period (or less with successful treatment):
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms
- One of the present symptoms for diagnosis must be delusions, hallucinations, or disorganized speech.
- Since the onset of symptoms, major functioning impairment has been seen for the majority of the experience.
- Symptoms persist for at least 6 months, continuously, and include at least 1 month of active phase symptoms.
- Other mental health disorders, such as or bipolar disorder with psychotic features, have been ruled out.
- Symptoms aren’t linked to substance use.
- Delusions or hallucinations must be present for 1 month in children with autism spectrum disorder or a communication disorder for a schizophrenia diagnosis to be considered.
If, after 1 year, symptoms persist, you may be given a specifier on your diagnosis to indicate the severity and recurrence of your symptoms.
These specifiers include:
- first episode, currently in acute episode
- first episode, currently in partial remission
- first episode, currently in full remission
- multiple episodes, currently in acute episode
- multiple episodes, currently in partial remission
- multiple episodes, currently in full remission
- continuous
- unspecified
- with catatonia
Treatment
The symptoms of schizophrenia can be daunting, particularly if you’ve felt disconnected from reality.
However, this mental health disorder is considered highly treatable, and many people have long-term success with treatment.
A combination of therapy and antipsychotic medications is often considered the most effective approach for managing symptoms of schizophrenia in many individuals.
Recap
To manage symptoms of schizophrenia, it’s essential to understand that the condition has three distinct phases, each with its own set of symptoms.
Seeking prompt treatment is crucial to manage these symptoms effectively.
With treatment, you can experience longer periods between active phases or even avoid experiencing an active phase again.
If you or a person you know may be experiencing this condition, you can speak to someone immediately by calling the SAMHSA National Helpline at 800-662-4357 (HELP).
If this is an emergency, you can receive immediate assistance by calling 911.
10 sources
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