Guidance for Families on Recognizing Early Indicators of Schizophrenia

Schizophrenia is a complicated, serious, and chronic mental illness that interferes significantly with an individual’s ability to function normally. Schizophrenia occurs in between 0.25 percent and 0.64 percent of the population. It causes a person to interpret reality, to think, and to relate to others in abnormal ways.

Schizophrenia causes hallucinations, delusions, disordered thinking, and abnormal behaviors that can be severe enough to be disabling. Although it is chronic and lifelong, early and ongoing treatment can be effective in managing symptoms and improving function.

Most people with a diagnosis of schizophrenia first show signs of the illness in their teens or 20s. Late adolescence is the typical age of onset, but some people develop schizophrenia even earlier. In extremely rare cases, the symptoms may even appear in childhood.

Regardless of the age of onset, most people diagnosed with schizophrenia will exhibit early signs. These aren’t easy to detect, especially because most families never assume their children will have this terrible illness.

It is important, however, to take early signs of psychosis and schizophrenia seriously. They’re too often mistaken for teenage moodiness or even clinical depression, but recognizing the symptoms as early schizophrenia can lead to earlier and more effective treatment.

As with most kinds of illnesses, early treatment results in better outcomes. Studies have found that early interventions for schizophrenia, including antipsychotic medications and therapy, can actually delay the onset of psychotic episodes.

Schizophrenia doesn’t simply come out of nowhere and remain the same forever. Like many other mental illnesses, it appears in phases and cycles of early, active, and residual symptoms. The phases of schizophrenia include:

1. Prodromal. This is the early stage of schizophrenia with symptoms that hint at psychosis but that are not always obvious. Because it so often occurs in adolescence and is similar to depression, many families miss the signs or mistake prodromal schizophrenia for typical moodiness or a less serious mental illness. Symptoms include withdrawal, mood swings, neglected hygiene, and changes in sleep patterns.
2. Active. The full onset of symptoms occurs in the active phase. These include hallucinations, delusions, disordered speech, confused thoughts, changes in movements and behaviors, and flat emotional affect.
3. Residual. Active schizophrenia usually winds down into a residual phase with symptoms similar to the prodrome. This may include withdrawal and subdued emotions, low energy, illogical thinking, disorganization, and unusual behaviors, but not full-blown psychosis.

Schizophrenia is so disruptive to a normal life. Treatments help, but they cannot cure this illness. The best way to help someone with schizophrenia is to catch it early, to get a diagnosis as soon as possible, and to begin treatment right away.

For families of a young person, or even someone in their 20s, the prodromal symptoms can seem subtle. They often seem like depression or a reaction to life changes and stressful circumstances. It is essential for families, especially those with risk factors or a history of psychosis, to know and watch for the signs of prodromal schizophrenia:

• Depression and anxiety
• Withdrawal from family and friends as well as normal activities, social isolation
• Suspicion of others and extreme reactions or hostility toward others
• Loss of interest in personal hygiene
• Changes in normal routine
• Loss of emotional affect, flat expressions or reactions to things that would normally trigger an emotional response
• Inappropriate emotional responses
• Insomnia or sleeping more than normal
• Difficulty concentrating, forgetfulness
• Irrational, unusual statements or thought patterns
• Lack of motivation, apathy
• Unusual behaviors

Prodromal schizophrenia may last a few weeks or a few years. It’s common for someone in the early phase to have co-occurring mental illnesses as well, further complicating diagnosis.

Most parents and families never imagine their child or loved one will develop a psychotic mental illness, so they don’t know to look for early signs. All families should take unusual symptoms and behavioral changes seriously, but those with risk factors should be especially careful. Risk factors include:

• A family history of schizophrenia or another form of psychosis
• Major life stresses or trauma, such as homelessness, abuse, or assault
• Use of hallucinogenic drugs
• Certain pregnancy complications such as malnutrition or exposure to viruses, especially in the first and second trimesters

Schizophrenia does not have a single cause or a gene that triggers its onset, although it does tend to run in families. Most likely, schizophrenia occurs when there is a combination of genetic factors and environmental triggers that culminate in symptoms.

Studies have shown that managing and lowering stress in the prodromal phase is helpful in delaying active symptoms of psychosis. Lifestyle changes for stress management are useful, but most patients in this stage need stronger interventions such as anti-anxiety medications, antidepressants, and mood stabilizers.

Also proven to be useful in reducing symptoms is a low dose of an antipsychotic medication along with behavioral therapies or psychotherapy. This combination in one study reduced the conversion of prodromal to active schizophrenia from 36 percent to 9 percent.

Dietary supplementation is useful during the early phases of schizophrenia. Although the mechanism isn’t fully understood, adding omega-3 fatty acids to the diet can reduce the onset of full psychosis. Patients receiving the dietary supplement have fewer symptoms and function better overall.

In addition to therapy, medications, and diet, psychoeducation at this early phase can teach young patients how to live with schizophrenia. Psychoeducation programs include the family as well and help everyone understand the illness and how to manage it over many years.