Early Signs and Symptoms of Schizophrenia

Schizophrenia is a chronic psychiatric disorder that affects how a person thinks, feels, and behaves. Common early signs of schizophrenia vary by age group and include:

• Young children: Delayed development
• Older kids and teens: Depression, isolation, behavioral problems (e.g., stealing) or changes (e.g., bizarre or unusual thoughts or actions), and trouble focusing
• Adults: Restlessness, anxiety, low energy, not taking care of oneself (e.g., personal hygiene), decrease in work performance, suicidal thoughts, and social withdrawal

Schizophrenia usually develops slowly, with early warning signs starting before the first severe episode. Knowing these warning signs can help a healthcare provider diagnose schizophrenia sooner and make sure that a person living with the condition gets the care and support that they need.

Early Warning Signs of Schizophrenia

The time during which the early warning signs of schizophrenia are experienced is called the prodromal stage. The onset of schizophrenia can last from months to years. The first signs of schizophrenia can be different depending on how old a person is when the disorder develops. 

The age at which someone develops schizophrenia is thought to influence the symptoms they will have. Even though men and women have roughly similar rates of schizophrenia, they tend to develop the condition at slightly different ages.

Positive Signs

Positive symptoms can be the first signs that someone is living with schizophrenia. It’s important to know that when used to talk about a mental health condition, “positive” does not mean “good.” Instead, it’s helpful to think of “positive” as meaning “present.”

For example, symptoms like hallucinations would be present (positive) in someone with schizophrenia but would not be present in someone who does not have the condition.

The early positive symptoms of schizophrenia may get worse in the run-up to an acute episode of psychosis. The warning signs include:

• Confusing speech
• Strange and/or intense thoughts and feelings
• New difficulty thinking clearly or concentrating
• Suspiciousness of or uneasiness with others (paranoia)
• Trouble telling reality from fantasy, seeing and/or hearing things that are not there (delusions/hallucinations)

While these can be some of the early warning signs of schizophrenia, they can continue and may get worse (especially if someone is not diagnosed with and treated for the condition).

Negative Signs

Negative symptoms of schizophrenia develop later. “Negative” does not mean “bad,” bur rather “absent” or “reduced.” These are traits or behaviors that are typical and expected in people who do not have schizophrenia but would be absent or barely present in someone who does have the condition.

People living with schizophrenia have fewer of these traits, or may not have them at all. For example, a person with schizophrenia may not feel pleasure in things and may not talk a lot (if at all).

Examples of negative signs include:

• Limited talking or no talking
• Having no feelings (flat affect)
• Spending a lot more time alone than usual (withdrawing socially)
• Lack of initiative (for example, not completing tasks at home, work, or school)
• Decline in self-care or personal hygiene
• Being unable to feel pleasure

Schizophrenia Warning Signs by Age

Schizophrenia can look and feel a little different for each person, as not everyone will have all of the positive and/or negative symptoms. Schizophrenia can also look and feel a little different depending on the age at which it develops.

In Young Children

People who are diagnosed with schizophrenia in childhood have more developmental delays than people who are diagnosed later in life. 

Very early developmental warning signs of schizophrenia include:

• Delayed motor development (such as not walking until over 18 months old)
• Delayed speech and/or language development (such as not speaking meaningful two- or three-word phrases until over 36 months old)
• Impaired social development at an early age (such as not using gestures to communicate or failing to regulate facial expressions)

It is important to note that these delays are not always a sign of schizophrenia. There are also other reasons a child may have delays, so it’s important to have them evaluated by their provider. 

In Teenagers

Before the onset of schizophrenia, adolescents often develop changes in behavior. They are likely to end up struggling in school—one of the most common issues reported in teens diagnosed with schizophrenia. 

Early warning signs of schizophrenia in teens include:

• Difficulty concentrating and paying attention
• Unexplained functional decline
• Increased introversion
• Loneliness
• Depression
• Aggression
• Suicidal ideation
• Theft
• Bizarre behaviors

It is hard to diagnose schizophrenia in adolescents because many of the features of the condition are also common during normal childhood development. For example, a normal part of childhood is having vivid imaginations and fantasies. However, these can be misunderstood to be hallucinations—a symptom of schizophrenia.

It is thought that children might be less likely to have paranoid delusions (the belief that others are out to harm them) than people who develop schizophrenia at an older age.

In Early Adulthood

Schizophrenia typically develops during early adulthood. Its onset is characterized by changes in behavior and a deterioration in functioning in daily life. 

The most common early warning signs of schizophrenia include:

• Nervousness and/or restlessness
• Depression
• Anxiety
• Difficulty in thinking clearly or concentrating
• Worrying
• Lack of self-confidence
• Lack of energy and/or slowness
• A worrying drop in grades or job performance
• Social withdrawal and/or uneasiness around other people

Over the Age of 45

Most early warning signs of schizophrenia for people over the age of 45 are the same as those for people who develop schizophrenia at a younger age.

Some scientists think that people who develop schizophrenia later in life will have fewer disorganized thinking and negative symptoms than people who develop it earlier.

In the past, studies suggested that people who develop schizophrenia later in life may not have the same symptoms as people diagnosed earlier. However, more recent research suggests that the key features of schizophrenia—like negative symptoms—are often similar for people who are diagnosed at an older age compared to those who are diagnosed younger.

When Schizophrenia Symptoms Start

Symptoms usually start to develop in early adulthood, between late adolescence and the early 30s. The disorder typically becomes evident slightly earlier in men than it does in women. The symptoms of schizophrenia often show up between late adolescence and the early 20s in men and between the early 20s and the early 30s in women.

Early Onset Schizophrenia

When the disorder is diagnosed before the age of 18, it is referred to as early onset schizophrenia (EOS). EOS is rare, with an estimated prevalence of 0.23%. Even more rarely, schizophrenia can develop in very young children. This is called childhood-onset schizophrenia (COS) and it is diagnosed before the age of 13.

According to the National Institute of Mental Health, approximately one in 40,000 children will have COS. It is thought to be extremely uncommon that COS will develop before the age of 10. 

Late-Onset Schizophrenia

Although schizophrenia most commonly starts between late adolescence and the early 30s, it is estimated that up to 20% of patients first have symptoms after the age of 40 years old. Some scientists have identified this as a subtype of schizophrenia called late-onset schizophrenia (LOS).

Women are more likely to be in this group than men. The symptoms typically develop in menopause, between ages 44 and 49 years old. However, it is still more common for schizophrenia to develop in early adulthood than at this time in life. 

Causes and Risk Factors

Since a lot of the early signs of schizophrenia can also be caused by other conditions (like depression and anxiety), it’s important to understand why some people develop schizophrenia. 

While the exact cause of schizophrenia is not known, there are a few risk factors that researchers think make a person more likely to develop it.

Schizophrenia has a strong genetic component and is highly heritable. Having a family member with schizophrenia increases your risk of developing the disease. 

These risk factors will be taken into account regarding a diagnosis if you are thought to be experiencing these early warning signs of schizophrenia.

For example, genetics, brain structure and function, and the environment a person grew up in (e.g., exposure to poverty, stress, viruses, and nutritional deficiencies) can all influence whether a person will be diagnosed with schizophrenia in their lifetime.

Complications

In the early stages of schizophrenia, the disorder can be confused with other common mental health conditions, like depression. It can be hard even for providers to tell them apart since most common early warning signs for schizophrenia are also among the most common initial symptoms for moderate to severe depression.

It is not until the positive symptoms (such as hallucinations, delusions, and disorganized thoughts and speech) of schizophrenia show up that it gets easier to tell apart from other mental health conditions.

Getting the correct diagnosis and connecting people with support and treatment is crucial to keep them safe and help them manage life with the condition. 

People are at risk for suicidal thoughts and may act on those thoughts. The risk of suicide for people living with schizophrenia is higher for men and people who were diagnosed at a young age.

Depression has been identified as a major risk factor for suicide among people living with schizophrenia. Having other mental health concerns, like substance use disorder, also increases the risk of suicide among people living with schizophrenia.

When to See a Healthcare Provider

Schizophrenia usually develops gradually, so it can be hard to pinpoint when changes in behavior start or whether they are something to worry about. In general, if you recognize that you’re having a pattern of concerning behaviors, take it as a sign that you need to talk to a provider about what you’re going through. 

If you are aware of the warning signs of schizophrenia at each age, you may be more likely to spot them early. While these changes might not be concerning by themselves, if you or a loved one are having several of them, talk to a mental health professional. Keep in mind that it can be difficult for people to get help—especially if they are experiencing symptoms such as paranoia. 

Summary

Early signs of schizophrenia like changes in behavior, social withdrawal, and seeing or hearing things that are not there can be frightening for a person and their loved ones to experience. It can also be confusing—even for healthcare providers—to tell if early symptoms are warning signs for schizophrenia or another common mental health condition like depression. 

Schizophrenia can be treated but the sooner a person can be diagnosed, the sooner they can get the support they need.