What are the three phases of schizophrenia?

Research has identified schizophrenia to have three phases, these are as follows:

• Prodromal
• Acute / active
• Residual

It may sometimes seem as though schizophrenia suddenly develops out of nowhere, this, however, is not the case. There is no such thing as waking up one morning and have bouts of full-blown psychosis. The disease instead consists of psychotic symptoms that slowly start to appear, and the sufferer begins to show a way of thinking that is distorted and has difficulty relating to others.

The phases can be explained accordingly:

1. Prodromal Stage

This is the first stage and refers to the period of a year before the illness begins to manifest. The term ‘prodrome’, which is derived from ‘prodromos’ – a Greek term which means something that appears before an event, signalling the occurrence of the event. Medically, ‘prodrome’ refers to the initial symptoms of a condition, those that typically appear before the characterised symptoms begin to show.

People in this stage of schizophrenia tend to isolate themselves from others, they will often stay in their rooms, sleep most of the day and not want to see friends or family. Their work or school performance can often take a turn for the worst due to their motivation being decreased as well as a loss of interest in things they once found joy in.

The signs of this stage are not only specific to schizophrenia. They may also be linked to depression among other issues. This is the reason why doctors are unable to identify the first stage until the person has reached the active phase and this can then be done in retrospect. Psychotic symptoms usually need to be experienced in order for the doctor to diagnose schizophrenia at this stage.

In this stage, close friends and family are able to feel as though something is wrong with the person developing schizophrenia. They may suspect the changes in personality being due to increased drug or alcohol intake, or just because they are in a bad mood.

An interesting fact is that early signs of the prodromal stage of schizophrenia have been seen and identified in children. A study was done that examined video footage of the schizophrenic adults as children. The researchers, without knowing who had the condition, noted that the majority of the children who developed schizophrenia as adults, were often excessively awkward and clumsy and by observing the footage could accurately point out which children were likely to be diagnosed with schizophrenia later in life. Although clumsiness is not purely a sign of schizophrenia, as it is often common in children and adults alike, it is an early sign that may hold a link to the condition – therefore it can be said that certain signs of the condition may be identified in childhood.

2. Acute Stage

The acute or active stage describes the period when someone is starting to show symptoms of schizophrenia that are psychotic in nature. These include delusions, hallucinations and/or extremely disorganised behaviour. This stage represents the full development of schizophrenia – and it can be said that the disorder has ‘activated’.

This is where diagnosis due to psychosis is possible. The best thing to do when you notice these symptoms is to get the person displaying them to a doctor for diagnosis and treatment. This first assessment will involve trying to determine when and how the symptoms began, questioning the patient and their family. This also allows for other conditions to be ruled out. The behaviour of the patient may have become serious enough to require hospitalisation.

When treated, many of the symptoms of schizophrenia can disappear. If this stage is not treated, the symptoms can last from several weeks to months, or even indefinitely. For many people with schizophrenia, this stage is characterised by symptoms that are positive for schizophrenia i.e adding to the person’s personality.

Just to recap, these are:

• Hallucinations
• Delusions
• Disorganised speech/thinking
• Abnormal and disorganised behaviour

3. Residual Stage

This is known as the final stage of schizophrenia. These symptoms are very similar to those of the prodromal stage. Patients in this stage are often not seen to be psychotic, but their symptoms shift from positive to negative (i.e. they take something away from the person). These symptoms are:

• Lack of enthusiasm, energy or interest, experiencing extreme apathetic emotions.
• Withdrawing socially.
• Lacking initiative and drive.

Although the symptoms in this stage may not be psychotic, the person suffering from schizophrenia may still express beliefs that are strange. An example of someone in going through the stages can be explained as follows:

Nina starts to act out, sleep more and isolates herself from her friends (prodromal stage), some of her family and friends think that maybe she is just going through a bad patch or is moody. She then starts to believe that her lecturer at university is making a secret television show about her. As humorous as her friends think it is, she whole-heartedly believes it to be the truth and becomes quite traumatised by it and these thoughts do not pass. At times, she seems normal but then goes off on a tangent about how her lecturer watches her and the story is sometimes hard to follow.  Her mom then notices that she may need help and takes her to see a doctor. He then diagnoses her with schizophrenia after hearing about her bizarre beliefs (acute/active stage).

Nina then gets the treatment she needs, her symptoms are managed and she is somewhat able to return to a normal life. She now only believes that the lecturer does not like her and not that he is making a television show about her (residual stage).

The phases and recovery of schizophrenia

Recovery from psychotic episodes is not something that can be predicted. Some people may only experience one psychotic episode that is full-blown. Others have several different episodes. Some people may recover completely, however it is recommended that patients continue with lifelong treatment and support so as to avoid relapsing.