The three phases of schizophrenia are the prodromal, active, and residual phases. Symptoms of schizophrenia can depend on the phase.

Early symptoms of schizophrenia may be similar to other conditions. You may not receive a diagnosis until it reaches the active stage.

Read on to learn more about the phases of schizophrenia, including their symptoms, causes, treatment options, and more.

What are the phases of schizophrenia?

There are three phases of schizophrenia: prodromal, active, and residual.

Prodromal schizophrenia: This early phase can be difficult to distinguish from other conditions. Symptoms in this phase usually develop slowly.
Active schizophrenia: Also known as acute schizophrenia, this phase is the most visible. People will show the telltale symptoms of psychosis, including hallucinations, suspiciousness, and delusions.
Residual schizophrenia: Residual schizophrenia was in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), but it’s not in the 5th edition (DSM-5). However, some people may still use this term to describe a time when individuals with schizophrenia have fewer obvious symptoms, but some symptoms are still present.

What are the symptoms of each phase?

Each phase of schizophrenia has symptoms that help classify it.

Although symptoms of active schizophrenia may seem to come on suddenly, the condition can take several years to develop into psychosis.

Prodromal schizophrenia symptoms

In the early prodromal phase, symptoms aren’t always obvious.

The first signs and symptoms of schizophrenia may be overlooked because they’re common to many other conditions, such as depression. These symptoms of schizophrenia may be called “negative symptoms.”

Symptoms in this phase may include:

anhedonia, or withdrawal from social life or family activities
isolation
increased anxiety
difficulty concentrating or paying attention
lack of motivation
having trouble making decisions
changes to usual routine
forgetting or neglecting personal hygiene
sleep disturbances
increased irritability

Learn about recognizing the early signs of schizophrenia.

Active schizophrenia symptoms

At this phase of schizophrenia, the symptoms may be the most obvious. Some people call these “positive symptoms.”

Symptoms can include:

hallucinations or seeing people or things no one
else does
paranoid delusions
confused and disorganized thoughts
disordered speech
changes to motor behavior (such as useless or
excessive movement)
lack of eye contact
flat affect

Residual schizophrenia symptoms

While no longer a term recognized by the DSM-5 or used in diagnosis, some clinicians may still describe this phase when discussing symptoms and the progression of schizophrenia.

Symptoms in this phase of the illness resemble symptoms in the first phase. They’re characterized by low energy and lack of motivation, but some elements of the active phase remain. Some people may relapse back to the active phase.

Symptoms of the residual phase are said to include:

lack of emotion
social withdrawal
constant low energy levels
eccentric behavior
illogical thinking
conceptual disorganization
frank vocalizations

Learn more about schizophrenia symptoms.

What causes the phases of schizophrenia?

It’s unclear why individuals develop schizophrenia. Likewise, it’s unclear exactly how or why a person moves through the stages at the pace they do.

Researchers believe a combination of factors set off chemical and structural changes in the brain. Ultimately, these changes lead to schizophrenia. Those same factors may influence when or how quickly a person progresses from one phase to another.

Researchers believe these factors may contribute to developing schizophrenia:

Genetics: If you have a family history of the illness, you’re more likely to develop it. However, having a family history doesn’t mean you certainly will have the illness.
Hormonal changes: Researchers believe that hormones and physical changes in the body may be a factor. Symptoms of the illness often begin in young adulthood, during a time of major change. On average, people assigned male at birth show first signs in their late teens and early 20s. People assigned female at birth develop the illness later, typically when they’re in their mid-20s to early 30s.
Neurotransmitters: Neurotransmitters relay signals between cells in the brain, and chemical changes may damage or impair them. This could lead to the illness.
Structure: Changes to the shape or structure of the brain could interfere with communication between neurotransmitters and cells, too.
Environmental: Researchers believe exposure to some viruses could lead to schizophrenia. Some drug and alcohol use may also increase the risk of schizophrenia.

Learn more about possible causes of schizophrenia.

How do doctors diagnose schizophrenia?

You are more likely to receive a diagnosis of schizophrenia when it is in the active stage. This is when symptoms become most obvious. In general, symptoms must have been present for at least 6 months.

To assist with reaching an accurate diagnosis, the doctor will review all symptoms and your psychiatric history. They’ll also likely take steps to rule out other possible causes of symptoms before confirming a schizophrenia diagnosis.

Once a diagnosis is made, a doctor will also be able to determine when the active phase is over based on symptoms and behaviors.

Learn more about diagnosing schizophrenia.

Where to find help

Advocacy organizations can help you find immediate help. They can also connect you with local resources that can help you find sustained, long-term treatment. These mental health resources include:

Schizophrenia and Related Disorders Alliance of America

Mental Health America

Substance Abuse and Mental Health Services Administration (SAMHSA) Hotline: 1-800-662-HELP (4357)

What are the treatments for schizophrenia?

Treatments for schizophrenia are usually the same for each phase, particularly as most people do not receive a diagnosis until the active phase.

Treatments a doctor may recommend include:

Medication: Antipsychotic medications may be able to influence the level of chemicals and neurotransmitters in the brain. This could reduce symptoms. It might also help a person avoid relapses or worsening symptoms.
Therapy: A doctor may refer a person with schizophrenia to a psychologist or psychiatrist. These mental health experts can help people learn to work through disordered thought patterns. They can also help recognize signs of a possible relapse.
Hospitalization: This emergency treatment is for an individual in immediate danger. Suicidal thoughts or hallucinations may pose a risk to the person’s safety, or even to people around them.

Learn more about treatments for managing schizophrenia.

Where to seek emergency care

If you or a loved one experience suicidal thoughts or dangerous behaviors, seek emergency care:

Dial 911 or your local emergency number.

Visit a hospital or emergency department.

Call the National Suicide Prevention Lifeline at 988.

Text HOME to the Crisis Text Line at 741741.

The bottom line

Schizophrenia is a mental health disorder that causes a variety of symptoms. The earliest symptoms, in the prodromal phase, are similar to other conditions. You may not receive a diagnosis until the condition is in the active phase.

The final stage, residual schizophrenia, still causes symptoms, but not as many. However, this phase is no longer a diagnosable phase.

It’s important to contact a doctor as soon as you have concerns about schizophrenia. They can confirm the diagnosis or rule out other possible causes for your symptoms.

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Schizophrenia. (n.d.). https://www.nimh.nih.gov/health/statistics/schizophrenia
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