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Symptoms of schizophrenia typically begin with the emergence of negative and/or depressive symptoms, soon followed by cognitive and social impairment. Some years later, psychotic symptoms emerge. The level of social development attained at the first sign of psychosis strongly predicts the severity and course of schizophrenia with the later age of onset improving the prognosis. Most patients experience some impairment throughout their lives with varying levels of residual symptoms while others may go into remission late in life.

Negative and cognitive symptoms tend to be stable over the course of illness but are associated with significant functional impairment. Psychotic symptoms, on the other hand, tend to be episodic (they come and go) and, when they are present or when they intensify, are associated with the patient being a risk to themselves and to others. Some patients may need to be hospitalized.

Schizophrenia is characterized by stages, which include:

• Premorbid stage
• Prodromal stage
• Psychotic stage
• Recovery stage

Premorbid Stage

During this stage, function is still normal and there is no indication of disease onset. However, the genetic and/or environmental predisposition exists and the patient is vulnerable to developing schizophrenia.

Prodromal Stage

The prodromal stage is the period when the disease process has started but it is not yet clinically obvious. The American Psychiatric Association (APA) notes that this period between first signs of functional impairment may continue for 2-5 years although it may be only weeks or months for some other patients. During this period, which may coincide with the teenage/young adult years, the patient may experience other nonspecific symptoms as well such as:

• Drop in grades
• Sleep problems
• Irritability
• Behavioral problems
• Poor or deteriorating social relationships
• Social withdrawal
• Depressed moods
• Anxiety
• Poor concentration

During the prodromal period, the patient's educational career, independent functioning, vocational training, and social maturation are all disrupted. The earlier the age at which this disruption occurs, the more severe will be the difficulties reintegrating into the community later on. Because many of the nonspecific symptoms are typical behavior for normal teenagers, the recognition as the prodromal stage of schizophrenia may be missed or delayed and diagnosis may be established only when psychotic symptoms emerge. Late in the prodromal stage, positive symptoms may appear which signal imminent onset of a psychotic episode.

Psychotic Stage

The first episode of psychosis may come abruptly over a period of weeks or slowly over a period of years. The APA notes that it may be as long as 1-2 years from the onset of the psychotic stage until the patient is properly treated. It is crucial to seek treatment as quickly as possible for the psychotic patient. The psychotic stage is characterized by:

• Strong psychotic features, such as hallucinations, delusions, thought disorders, or disorganized thinking
• Increased severity of negative symptoms
• Difficulty for the patient to take care of themselves properly

Life can be turned upside down during this stage for the patient, their families, and friends. The patient may require hospitalization because they cannot take care of themselves or because they pose a danger to themselves or to others around them. Patients usually respond to treatment with antipsychotics during this stage and constant monitoring and follow-up with health professionals is essential.

Recovery Stage