Phases of Schizophrenia: What Do They Mean?
Mental Health ConditionsSchizophrenia

Phases of Schizophrenia: Prodromal Phase, Active Phase, and Residual Phase

Here’s what you should know about the 3 phases of schizophrenia and the symptoms of each.
Phases of Schizophrenia: Prodromal Phase, Active Phase, and Residual Phase
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Published on November 11, 2024
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Schizophrenia is a rare but serious mental health condition that causes symptoms like hallucinations, delusions, cognitive problems, and disorganized thinking, speech, and behavior. Schizophrenia often occurs in three different phases: prodromal, active, and residual.

“The journey through these phases varies for each person and may cycle, depending on the response to treatment and external stressors,” says Michael Kane, MD, a psychiatrist and the chief medical officer at Indiana Center for Recovery.

Here’s what to know about each phase of schizophrenia.

Prodromal Phase of Schizophrenia

The prodromal phase is the first phase of schizophrenia. Mild symptoms may appear during the prodromal phase. “The prodromal phase is the early stage, where the signs are subtle, often confused with general mood or behavioral changes,” says Dr. Kane.

“The prodromal phase can be difficult to recognize in oneself, and it's usually family members who might notice a change first,” says Bruce Bassi, MD, a psychiatrist based in Chicago.

Signs and symptoms of the prodromal phase can include the following:

  • Mood changes, such as depression, anxiety, mood swings, irritability, anger, sleep problems, or suicidal thoughts
  • Social withdrawal
  • Decreased school performance or school refusal
  • Memory issues
  • Attention problems
  • Difficulty concentrating
The prodromal phase typically happens between ages 15 and 25, and lasts an average of about 21 months.

“Recognizing the signs in the prodromal phase and getting help before the active phase fully develops can reduce the intensity of symptoms and improve the person’s quality of life in the long term,” says Kane. But “it’s a bit tricky to diagnose [schizophrenia] at this stage since the signs are not as clear. In my opinion, families should be particularly observant here, because these early signs often get missed.”

Bassi agrees, adding that these symptoms can overlap significantly with those of other conditions. Research suggests other mental health conditions like major depression or post-traumatic stress disorder, for instance, may prompt similar symptoms.

Active Phase of Schizophrenia

The active phase of schizophrenia comes next and often involves psychosis — a group of symptoms that cause a loss of touch with reality. “In the active phase, symptoms get progressively more severe,” says Bassi. Many people in this phase don’t understand what’s happening to them and may need hospitalization for initial treatment, Bassi adds.

Schizophrenia diagnosis often happens during the active phase because symptoms are often the most pronounced during this phase. The active phase typically appears between ages 16 and 30, and men may show symptoms at an earlier age than women. How long the active phase lasts varies from person to person and often depends on when they receive an effective treatment.

In this phase, you may notice several different types of schizophrenia symptoms.

Positive Symptoms

One group of symptoms you may notice during the active phase are called “positive” symptoms. These are unusual changes in thoughts or behaviors, and can include:

  • Hallucinations This is when you see, hear, smell, taste, or feel something that isn’t actually there. People with schizophrenia most often have auditory hallucinations (meaning they hear voices or other sounds that aren’t there), but hallucinations can affect any of the five senses.
  • Delusions This means you hold a very strong belief based on untrue information or a strange perception of a situation. For example, someone experiencing a delusion may believe without evidence that someone who lets them go first in a line wants to follow them home. Individuals experiencing delusions may also believe without evidence that they’re being persecuted, harassed, or poisoned by a loved one or someone else, or that someone on TV is communicating hidden messages to them alone.

Negative Symptoms

Another group of symptoms you may notice are called “negative’ symptoms. They involve an absence of usual and expected ways that one typically interacts with their surroundings. Although negative symptoms can occur during the active phase, the presence of positive symptoms may make the negative symptoms seem less apparent. Negative symptoms can include:

  • Social withdrawal
  • Speaking little, even when forced to interact
  • Limited facial expression
  • Speaking with a monotonous or dull voice
  • Lack of interest or pleasure in daily activities
  • Extreme lack of energy
  • Declines in hygiene or physical appearance
  • Trouble concentrating or paying attention

Disorganized Symptoms

During the active phase, people with schizophrenia may experience disorganized thoughts, speech, or behaviors. Disorganized symptoms can make it difficult to finish a sentence, task, or thought without your mind interrupting you. These symptoms can cause you to start several sentences without finishing any, to make up words that have no meaning (sometimes known as “word salad”), or to move your body in strange ways.

Residual Phase of Schizophrenia

Once you receive treatment and it begins working, you may enter the residual phase of schizophrenia.

“In the residual phase, positive symptoms are more well-controlled, and the negative symptoms might be more obvious now,” says Bassi.

 Negative symptoms in the residual phase may look similar to prodromal symptoms, adds Kane. These may include the following:
  • Low motivation
  • Decreased interest in daily activities or hobbies
  • Social withdrawal
  • Emotional flatness
  • Difficulty planning and following through
  • Speaking in a dull voice
  • Very low energy

“The residual phase also tends to develop slowly as symptoms become less intense, though they may never completely go away,” says Kane.

How long this phase lasts may vary from person to person and often depends on treatment. If your treatment is effective, you can remain in the residual phase for a long time. But it’s possible to cycle back to the active phase. This is known as a relapse.

You’re at an increased risk of relapse if you have another co-occurring mental health condition, if you don’t take your treatment consistently or as directed, if you’ve been in treatment for five years or less, or if you’re experiencing a stressful life event.

The Takeaway

  • Schizophrenia is typically experienced in three phases: prodromal, active, and residual.
  • The prodromal and residual phases may include more negative symptoms like social withdrawal or lack of interest in usual activities, whereas the active phase prompts positive symptoms like hallucinations and delusions.
  • No matter which phase you’re in, medical treatment under the care of a healthcare professional can help you manage symptoms.

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Angela D. Harper, MD

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Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adul...

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