Recognizing Early Signs of Schizophrenia

What is Schizophrenia?

Schizophrenia is a serious mental health disorder that affects how a person behaves, feels, and thinks. The psychosis (symptoms affecting the mind) caused by schizophrenia include delusions, hallucinations, disordered thinking and behavior, catatonia (a range of abnormal behaviors, often involving disturbances in movement, speech, and responsiveness), and negative symptoms such as a lack of motivation, reduced emotional expression, and social withdrawal.

Worldwide, schizophrenia affects approximately 24 million people. Schizophrenia can affect every aspect of a patient’s life. It can lead to employment difficulties and strain on relationships and social life. Thankfully, effective treatments are available. The treatment plan may include talk therapy and antipsychotic medications. Most people with this condition require lifelong treatment.

What Are Usually The First Signs of Schizophrenia?

The early signs and symptoms of schizophrenia are called the prodromal stage, and can include:

Emotional Changes

Many patients with schizophrenia will display subtle signs, such as frequent mood swings, before they receive a formal diagnosis.

Social withdrawal

Social withdrawal or disconnection from family members and friends is another early sign of schizophrenia. Patients can become increasingly isolated and preoccupied or lost in their own world.

Lack of Focus

One of the early signs of schizophrenia can be a lack of focus and motivation. For example, the patient may neglect schoolwork or job responsibilities. They may offer strange or irrational explanations for missed appointments or incomplete tasks as their mind begins to lose touch with reality.

Symptoms of Schizophrenia Spectrum Disorders

Schizophrenia is described as having ‘positive symptoms’ and ‘negative symptoms.’ Positive symptoms are experienced that affect the patient’s perception of reality. Negative symptoms refer to thoughts and behaviors the patient had before developing schizophrenia. Negative symptoms can last from a few weeks to a few years before the psychotic symptoms consistent with active schizophrenia develop.

Positive Symptoms of Schizophrenia

Positive symptoms of schizophrenia and related psychotic disorders include:

Hallucinations

Hallucinations involve seeing, hearing, smelling, touching, or feeling things that are not present or observable by others. The most common hallucinations in schizophrenia patients include auditory hallucinations (hearing voices). Visual hallucinations (seeing things) are the second most common. Find out what medications may cause hallucinations as a side effect.

Delusions

Delusional beliefs are fixed false beliefs about things that aren’t true. A person with schizophrenia can have persistent delusions despite evidence to the contrary. For example, they may feel they are the target of harassment or that someone is out to harm them. Or that they are famous and have exceptional abilities. Or that a major disaster is about to occur.

Disordered Thinking and Behavior

People with schizophrenia find it hard to interact with others due to disorganized thinking, behavior, and communication. For example, they may give irrelevant answers to questions or have difficulty following instructions. Or they may jumble up unrelated words and be difficult to understand (this is sometimes referred to as “word salad”). They can also display highly disorganized behavior, such as doing bizarre things, behaving inappropriately in social settings, and having incoherent speech or inappropriate emotional responses.

Motor Symptoms

Other symptoms in people with schizophrenia include motor symptoms that can range from childlike behavior to extreme agitation and violent behavior, unusual postures, or catatonic behavior (slowed movements or not moving at all).

Negative Symptoms of Schizophrenia

A person experiencing schizophrenia symptoms may have negative symptoms such as a lack of eye contact, speaking in a monotone or flat voice, rigid body language, inability to show emotions, and social withdrawal. They may also neglect self-care and personal hygiene. Negative symptoms are often among the earliest signs of schizophrenia, with up to 70 percent of patients experiencing them before the onset of any positive symptoms.

What Are The First-Order Symptoms of Schizophrenia?

The first-order symptoms of Schizophrenia, also called Schneider’s First Rank Symptoms (FRS), are include:

Auditory hallucinations (hearing voices or hearing your thoughts outside your head)
Thought withdrawal, insertion, and interruption (the person’s thoughts are under the control of an outside agency)
Thought broadcasting (the person’s thoughts filter out of their head, and everyone can pick them up)
Somatic hallucinations (hallucinations involving physical experiences, such as something crawling over the person)
Delusional perception (false beliefs, such as traffic lights turning red means Martians are about to land on Earth)
Feelings or actions as made or influenced by external agents (certainty that actions are controlled by someone else, for example, the CIA is controlling my mind).

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What Is The Age of Onset For Schizophrenia?

Schizophrenia can begin at any age. The typical age of onset is the late teens or early 20s in men or people assigned male at birth and the late 20s or early 30s in women or people assigned female at birth. (Women tend to develop schizophrenia at an older age).

Early-Onset vs. Late-Onset Schizophrenia

Early-onset schizophrenia is diagnosed when the condition manifests before age 18. Developing schizophrenia before age 13 is extremely rare.

Late-onset schizophrenia refers to a diagnosis of schizophrenia after age 40. The onset of schizophrenia after age 60 is called very late-onset schizophrenia-like psychosis.

Identifying Schizophrenia Across Different Age Groups

What Are the Early Signs of Schizophrenia in Children?

Childhood schizophrenia is essentially the same as adult schizophrenia, except that it begins earlier in life, typically in the teenage years. Generally speaking, children and teenagers with schizophrenia are less likely to experience delusions and more likely to suffer from visual hallucinations (seeing things) and auditory hallucinations (hearing voices). As mentioned, the diagnosis of childhood-onset schizophrenia before age 13 is very rare.

What Are Schizophrenia Symptoms in Teenagers?

The early signs of schizophrenia in teenagers can be mistaken for typical adolescent problems or other mental health conditions. The abuse of drugs such as marijuana, methamphetamine, or cocaine can cause symptoms similar to those of psychosis.

A school or college may be the first to send a teenager or young adult for evaluation and treatment due to bizarre or erratic behaviors or a drug overdose. A severe psychotic episode or first-episode psychosis can ultimately lead to a diagnosis of schizophrenia.

Early signs and symptoms of schizophrenia in children and teens may include:

Disorganized Thinking

Bizarre ideas
Problems with reasoning
Believing dreams or things seen on television are reality

Changes in Behavior

Lack of motivation (for instance, falling grades or new academic problems)
Social withdrawal from friends and family members
Sleep difficulties
Lack of self-care and personal hygiene (for example, not bathing or dressing)
Odd, eccentric, bizarre, aggressive, or violent behavior
Smoking or recreational drug abuse

Emotional Symptoms

Extreme moodiness
Personality changes
Irritability
Depression
Unusual anxieties or fears
Flat affect (lack of emotion)
Inappropriate emotions
Excessive suspiciousness of others (paranoia)
Social isolation or withdrawal
Problems getting along with peers

Recognizing Symptoms in Young Adults

Signs and symptoms of schizophrenia in young adults can gradually increase. They may begin with subtle signs and changes in the patient's thoughts and behaviors. Over time, the patient can develop more typical symptoms of disorganized speech and withdrawal.

What Are The Warning Signs of Late-Onset Schizophrenia?

A diagnosis of schizophrenia between ages 40 and 60 is referred to as late-onset schizophrenia. Compared to younger people, patients with late-onset schizophrenia tend to have:

Fewer and less severe positive symptoms
Fewer negative symptoms
Less severe neurocognitive impairments
Requirement for lower daily doses of antipsychotics

The onset of schizophrenia after age 60, known as very late-onset schizophrenia-like psychosis, is more common in women than in men. In the case of an elderly patient with psychotic symptoms, organic causes should always be ruled out, such as neurodegenerative disorders (e.g., Alzheimer's disease, Parkinson's disease), delirium, cerebrovascular events such as a stroke, infections, such as urinary tract infections or pneumonia, metabolic disturbances, such as electrolyte imbalances or thyroid dysfunction, and medication side effects.

What Are the Causes of Schizophrenia?

Researchers have not identified the exact cause of schizophrenia but believe it is a combination of genetic and environmental factors. Changes in brain chemistry (the levels of naturally occurring brain chemicals or neurotransmitters called dopamine and glutamate) are thought to play a role. Brain imaging studies show that there are structural changes in the central nervous system of people with schizophrenia.

Anyone can develop schizophrenia, but some people are at a higher risk. Risk factors for developing schizophrenia include:

Family history of schizophrenia.
Stressful life experiences, for example, living in dangerous places or in poverty.
Use of psychoactive or psychotropic drugs (mind-altering drugs) during the teenage or young adult years.
Problems during childbirth or viral infections during pregnancy may also contribute to the development of the disease.

How is Schizophrenia Diagnosed?

Mental health care professionals diagnose schizophrenia based on guidelines in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition (DSM-5).

The DSM-5 criteria for schizophrenia diagnosis are as follows:

Symptoms

At least two of the following symptoms must be present for at least one month:

Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms, such as diminished emotional expression

Symptom Duration

The disturbance must persist for at least six months. This period must include at least one month of active symptoms.

Social or Occupational Deterioration

The patient must be experiencing social or occupational difficulties over a significant period of time.

Other Conditions

The problems must not be attributable to another mental health condition.

Note: A schizophreniform disorder is a mental health condition that causes symptoms similar to schizophrenia, including delusions, hallucinations, and disorganized speech and behavior. However, the symptoms last less than 6 months.

What Should You Do If You Notice Schizophrenia Symptoms?

If you suspect a loved one has early warning signs of schizophrenia, you should start by talking to their healthcare provider. Their primary care physician can make a referral to a mental health professional who can perform a thorough evaluation. Diagnosis of schizophrenia involves excluding other potential causes for the psychotic symptoms, including drug use. A mental health professional can also evaluate for other conditions that cause similar symptoms, such as obsessive-compulsive disorder, bipolar disorder, schizoaffective disorder, or dissociative identity disorder (split personality).

If a diagnosis is made, the healthcare provider will discuss treatment options and their side effects. Treatment of schizophrenia is lifelong and consists of psychotherapy and psychiatric medications (antipsychotic medications) to reduce symptoms and improve functioning in daily life.

Note: Anosognosia is a condition where your brain can’t recognize the health conditions that you have. It is described as a “lack of insight” or “denial of deficit” and is common in people with conditions such as schizophrenia or Alzheimer’s disease. For this reason, it is important to seek care for a loved one with early signs of schizophrenia, as they may be unable to recognize the condition themselves.