Schizophrenia - What Happens

What Happens

Symptoms of schizophrenia usually emerge in the late teens to mid-20s for men and the late 20s to 30s for women.² Symptoms can also develop in children and younger teens, although this is rare. The symptoms may either appear suddenly or evolve gradually. Men tend to have more severe symptoms and a more difficult time with the effects of schizophrenia than do women.⁷

There are three phases of disease progression: prodromal, active, and residual.^{6, 8}

Prodromal phase

• Negative symptoms (such as lack of emotion or motivation), which may appear suddenly or slowly over time
• Social withdrawal
• Poor hygiene, such as wearing dirty clothes or not bathing
• Loss of interest in school or work
• Outbursts of anger
• Unusual or out-of-character behavior
• Anxiety
• Confusion or confused speech
• Terror or unreasonable fear of something or someone
• Depression

The prodromal phase may last for days, months, or years before the active illness begins. At first the symptoms may be confused with depression or other anxiety disorders. Stressful events such as emotional trauma or substance abuse can trigger symptoms of schizophrenia in those who are at risk for developing the disease.⁷

Active or acute phase

• Positive symptoms (such as hallucinations or confused thinking or speaking) may appear either suddenly or slowly over time.
• Negative symptoms may also continue to occur during this phase.

During the active or acute phase of schizophrenia, symptoms may fluctuate between episodes of severe positive symptoms and periods of stabilized symptoms (remission).⁶ A person usually develops a unique pattern of illness within the first 5 to 10 years of the active phase of schizophrenia.

Residual phase

• Positive symptoms tend to become less intense.
• You may regain some social and job skills.
• The disease may become easier to manage, although people in this phase of schizophrenia may not fully recover from its effects on the quality of their lives.⁶

While the positive symptoms may become less intense as the disease progresses, the negative symptoms (such as lack of emotional response) may get worse. Even with treatment, up to 40% of people with schizophrenia will relapse within 2 years; but without treatment, up to 80% will have a relapse.⁷

Knowing how to recognize the first signs of relapse, such as social withdrawal, may help you get early treatment, which may help you recover more quickly.

Up to 30% of people with schizophrenia attempt suicide, and between 4% and 10% will die by suicide.^{7, 9} Continuous treatment is important. People with schizophrenia are also at risk for other problems, such as violence and polydipsia (drinking so much water that it leads to health problems).

Recovery rates vary between 29% and 83%, and about 20% to 30% of people with schizophrenia deteriorate rather than recover from symptoms even with treatment.⁷

People with schizophrenia are likely to develop other social and physical conditions (such as homelessness) or have additional disorders (such as substance abuse and depression).