What Happens

Symptoms of schizophrenia usually start in the late teens to mid-20s for men and the late 20s to 30s for women. The symptoms may start suddenly or happen gradually.

Childhood schizophrenia is rare.

There are four stages of schizophrenia: prodromal phase, active or acute phase, remission, and relapse.

Prodromal phase

Schizophrenia usually starts with this phase, when symptoms are vague and easy to miss. They are often the same as symptoms of other mental health problems, such as depression or other anxiety disorders. They may not seem unusual for teens or young adults. In fact, schizophrenia is rarely diagnosed at this time.

Symptoms are sometimes triggered by stress or changes, such as going away to school, starting to use drugs or alcohol, or going through a severe illness or a death in the family.

These first symptoms often include negative symptoms, outbursts of anger, or odd behavior. For more information, see Symptoms.

This phase can last for days, months, or years before positive symptoms appear.

Active, or acute, phase

At some point you start to have positive symptoms, such as hallucinations.

These symptoms may appear suddenly or slowly over time. They can be severe and can cause a psychotic episode, which means you can't tell the difference between what is real and what isn't real.

You may need to go to the hospital. You probably won't be able to make many decisions about your care.

This phase usually lasts 4 to 8 weeks. This is when schizophrenia usually is diagnosed.

Remission and relapse

After an active phase, positive symptoms get better, especially with treatment, and life may be more "normal." This is called remission. But symptoms may get worse again, which is called a relapse. You may have this cycle of symptoms that get severe and then improve.

In each cycle, the positive symptoms may become less intense, but the negative symptoms may get worse. You may have few or many cycles before you are able to stay in remission.

Within 5 to 10 years, you may develop a unique pattern of illness that often stays the same throughout your life. It also is possible that you will have fewer relapses as you get older and may even not have symptoms.

Tips for avoiding relapse

• Learn how to recognize the first signs of relapse, such as not wanting to do things with others, and have a plan to deal with it and get help right away.
• If you need help deciding whether to see your doctor, read about some of the reasons people don't get help and how to overcome them.
• Take your medicine, even if you're feeling better. This makes a relapse less likely.¹ Learn some ways to help you remember to take your medicine.
• If side effects are making your life hard, talk with your doctor to see whether you can try a different medicine.
• Treat health problems that may occur along with or because of schizophrenia. These include obesity, substance abuse, type 2 diabetes, and heart and lung problems.
• Stay in counseling or therapy, and continue with your recovery plan.

Special concerns

Watch these areas for problems:

• Thoughts of suicide or thoughts about harming yourself or others. If you think about these things, call your doctor or right away. Tell family and friends how to recognize the warning signs of suicide, such as threatening to harm yourself and being preoccupied with death or suicide, and warning signs of violence toward others, such as thinking or talking about harming someone or becoming aggressive.
• Social concerns, such as other people's attitudes. People who don't understand schizophrenia or other mental health problems may treat you differently. Find family and friends who want to support you and help you with relationships. Help them understand schizophrenia.
• Smoking. Many people who have schizophrenia smoke cigarettes. This may be because smoking helps with some of the symptoms. But smoking makes other illnesses, such as cancer and heart disease, more likely.
• Having a baby. If you have schizophrenia and want to have a baby, talk to your doctor. Medicines that you take for schizophrenia can cause birth defects, and not taking your medicine puts you at risk for a relapse. Your doctor can help you plan your pregnancy so there will be as little risk as possible to you and your baby.
• Substance abuse. Many people who have schizophrenia abuse alcohol or drugs. When you have schizophrenia and a substance abuse problem, it's called a dual diagnosis. Talk with your doctor or another trusted person about getting help for substance abuse.