man leaning out window looks concerned

Schizophrenia is a widely misunderstood mental health disorder that can cause significant disruption in daily life, which means understand the early signs of schizophrenia are important – especially for people with a family history of schizophrenia or other risk factors associated with schizophrenia. While schizophrenia is not common – less than 1 percent of the population receive a clinical diagnosis – it’s one of the top 15 causes of disability worldwide.

That’s why recognizing the early signs of schizophrenia can help. Research shows the earlier a person receives an accurate diagnosis and evidence -based treatment, the better the outcome, which can reduce the severity of disruption and disability associated with the disorder.

What is Schizophrenia?

The Merck Manuals offer the following definition, based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5):

“Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking and behavior, reduced expression of emotions, diminished motivation, a decline in mental function (cognition), and problems in daily functioning, including work, social relationships, and self-care.”

Risk factors, i.e. things that increase the likelihood of developing schizophrenia, include:

  • Family history of schizophrenia
    • Presence of schizophrenia in parent or sibling increases risk by about 10%
    • Presence of schizophrenia in identical twin increases risk by about 50%
  • Neonatal complications, including:
    • Influenza during the 2nd trimester of pregnancy
    • Oxygen deprivation during delivery
    • Low birth weight
    • Mother/infant with incompatible blood types
  • Some brain pathologies/infections
  • Cannabis use/misuse during early adolescence

In most cases, schizophrenia appears during late adolescence or early adulthood. The most common age of onset is sometime during the 20s. In rare cases, it can appear as early as childhood or as late as middle age. Most cases of schizophrenia are preceded by a prodromal phase – meaning early or preceding – that includes symptoms that may mimic other mental health disorders, but eventually resolve to align with the symptoms of schizophrenia.

Schizophrenia: Symptoms and Early Signs

To understand why it’s essential to understand the early signs of schizophrenia, it’s helpful to know what the symptoms of full schizophrenia look like. Knowing where it can lead can foreground the value of knowing the early signs, which we’ll share after we review the primary symptoms.

Experts divide the symptoms of schizophrenia into four categories:

  • Positive symptoms:
    • Delusions: believing things that aren’t true
    • Hallucinations: perceiving things that aren’t there
  • Negative symptoms:
    • Little to no expression of emotion
    • Decreased speech/talking
    • Inability to experience pleasure
    • Little interest in forming relationships with others
  • Disorganization:
    • Disorganized thoughts/communication, reflected in rambling or incoherent speech
    • Atypical behavior, such as inappropriate appearance, childlike actions, or unexplained agitation
  • Cognitive Impairment
    • Problems with memory
    • Problems with concentration
    • Difficulty making decisions
    • Difficulty problem solving

These are the symptoms that cause major disruption in life and increase risk of significant disability. Next, we’ll take a look at behaviors the may precede the onset of schizophrenia.

The Early Signs of Schizophrenia

Early positive symptoms:

  • Atypical/strange/intense feelings and thoughts
  • Disorganized speech
  • Paranoia/suspicion of others
  • Problems separating what’s real and what’s not
    • Mild hallucinations/delusions

Early negative symptoms:

  • Little or no talking
  • Absence of expressed emotion
  • Withdrawing from friends and activities
  • Apathy, i.e. not completing typical daily tasks
    • At school, work, or home
  • Reduced ability to experience pleasure
  • Reduced interest in personal hygiene

If you or someone you know shows these signs, then it’s imperative to arrange for a full psychiatric assessment delivered by a mental health professional. Some of these symptoms precede mental health disorders like depression, bipolar disorder, anxiety, and others are related to psychotic disorders. In any case – whatever the ultimate diagnosis – an experienced clinician can refer a patient to treatment, and/or create a treatment plan that can help prevent escalation and begin the process of managing any disruptive, challenging, or uncomfortable symptoms.

Early Signs of Schizophrenia in Teens and Young Adults

While it is possible for schizophrenia to develop in childhood or middle age, the most common period for the onset of schizophrenia is between adolescence and adulthood, i.e. around age 14 to around age 30, with most cases developing in early adulthood. However, although most people who develop schizophrenia report a similar set of symptoms, the early signs of schizophrenia are slightly different for teens and young adults.

Early signs in teenagers often include:

  • Problems concentrating
  • Uncharacteristic abnormal behavior
  • Functional decline at school/work/home
  • Escalating withdrawal
  • Stealing
  • Suicidal ideation
  • Aggression

Early signs in young adults often include:

  • Depression
  • Anxiety
  • Nervousness
  • Restlessness
  • Reduced confidence
  • Withdrawal from social activities
  • Decline in academic or work performance
  • Low/reduced energy
  • Problems concentrating
  • Unclear thinking

We’ll repeat the advice we share above: if you or someone you know shows these signs – particularly in the presence any of the risk factors we discuss earlier – then it’s essential to arrange a full psychiatric evaluation administered by a qualified mental health professional.

Treatment For Schizophrenia

Treatment for schizophrenia most often includes a combination of medication, psychotherapy, within the context of an approach called coordinated specialty care (CSC).

Medication for schizophrenia may include typical or atypical antipsychotics, while psychotherapy may include:

  • Cognitive behavioral therapy (CBT).
  • Dialectical behavior therapy (DBT)
  • Acceptance and commitment therapy (ACT)

The CSC approach integrates the following components into a treatment plan for schizophrenia:

  • Family involvement and collaboration
  • Psychotherapy
  • Medication
  • Family therapy
  • Case management
  • Education
  • Peer and community support
  • Vocational and lifestyle support

Treatment for schizophrenia is the primary way people with the disorder learn to manage their symptoms and live a full and productive life, and reduce the disruption caused by the most severe and distressing symptoms.

Treatment and the Early Signs of Schizophrenia

Evidence shows that the earlier a person receives an accurate diagnosis and begins evidence-based treatment, outcomes improve. For patients who fully engage with and adhere to treatment, outcomes follow this general pattern:

  • ⅓ experience significant, long-term improvement
  • ⅓ experience moderate improvement, but may experience relapse and some disability
  • ⅓ experience severe, long-term disability

Patients who have problems achieving long-term improvement share the following characteristics:

  • Early onset
  • Family history of schizophrenia
  • Issues with social functioning appear before symptoms
  • More negative symptoms than positive
  • Long time gap between onset of symptoms and treatment

Patients who achieve long-term improvement share the following characteristics:

  • Rapid symptom onset
  • Later symptom onset
  • Significant level of life achievement before onset, i.e. finishing school, having stable relationships, having consistent employment
  • Few negative symptoms
  • Short time gap between onset of symptoms and treatment

Note the last bullet point in each of those two sets. An extended time gap between symptom onset and treatment is associated with a long-term difficulty, while a short gap between symptom onset and treatment is associated with long-term improvement. That’s why we need to reiterate this fact:

The earlier a person who needs treatment for schizophrenia gets the treatment they need, the better their chances of successful and sustainable recovery.

Finding Help: Resources

If you or someone you know needs professional treatment and support for schizophrenia, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources: