Onset: The Early Warning Signs

The earliest symptoms of schizophrenia, such as apathy and withdrawal from others, often are overlooked by family and friends. Later, after a diagnosis is made, a psychiatrist may refer to this as the prodromal phase of the disease. Since patients may start avoiding social situations during this stage, it is easy to see how this could be interpreted as simply needing or wanting time alone.

At this point in the development of the disease, there may be no way to know that a young person is not experiencing a phase of moodiness unless you are familiar with the early warning signs of mental illness and the first signs of schizophrenia in particular.

Possible Hints of Trouble to Come

The American Psychiatric Association provides a list of some changes that could indicate the beginning of a potentially serious mental illness. Not all of these signs have to be present. You might notice just one sign at first or you might see several.

Warning Signs of Mental Illness

  • Marked personality change

  • Inability to cope with problems and daily activities

  • Strange ideas or delusions

  • Irrational fears

  • Prolonged feelings of sadness

  • Marked changes in eating or sleeping patterns

  • Thinking or talking about suicide

  • Extreme highs and lows

  • Abuse of alcohol or drugs

  • Excessive anger, hostility, or anxiety

  • Violent behavior

Source: The American Psychiatric Association

Becoming aware of a pattern of potential warning signs may help you guide someone to much-needed psychiatric care. You also should not hesitate to seek help if you suspect trouble. It is better to be reassured than to miss early signs of mental illness. The stakes are very high.

Prodromal Symptoms of Psychotic Disorders

Prodromal symptoms are traits, behaviors, and preferences appearing in children or young adults that may indicate developing psychosis. For some, the symptoms subside or remain subtle and no treatment is necessary. For others, they are the first signs of a developing, potentially serious disease. Recognized and treated early, these symptoms can lead to more effective treatment and better outcome.

Changes in Behavior or Performance that Might Signal Schizophrenia

  • Social withdrawal or isolation. Little interest in speaking or being with others. Preference for spending time alone.

  • Sleep disturbance.

  • Little motivation, energy, or ambition. Little interest in previously enjoyable pastimes, hobbies, sports, or other activities.

  • Easily distracted. Reduced concentration, difficulty paying attention or remembering things.

  • Deterioration of grooming, self-care, or personal hygiene habits.

  • Problems performing or functioning in school, at work, or at home. Difficulty understanding what others say or what one is reading.

  • Lack of emotional display. Little facial expression. Flat, monotone speech.

  • Inability to organize speech.

  • Conversation includes statements irrelevant to the topic, inappropriate choice of words, unconnected flow of speech.

Adapted from the CARE program at the University of San Diego, California; the Center of Prevention and Evaluation, Columbia University Department of Psychiatry/ New York State Psychiatric Institute; and the Centre for Addiction and Mental Health, University of Toronto.

Children in the process of developing the disease also undergo changes in the way they see and think about things. Some of these changes will be obvious to someone who knows the child. Other changes, such as unusual perceptions, are not apparent to others.

Changes in Feelings or Thoughts that Might Signal Schizophrenia

  • Unusual perceptions. Strange sensations: Things look or sound different. Hearing voices, seeing things that are not there, or imagining things. A feeling that something strange is happening even with familiar events and objects. Misinterpreting sounds for voices. The perception of objects is exaggerated, dulled, or otherwise changed. Greater sensitivity to taste, sounds, smells, or sights.

  • Unwarranted suspiciousness. Misinterpretation of events. Uncertain if being followed, watched, or the subject of plots.

  • Developing unusual pattern of thinking with odd, strange, or eccentric behavior, ideas, or beliefs. Seeing special meaning or threats in commonplace events. Difficulty telling the real from the imaginary. Déjà vu experiences more often than usual. Suspicion that others can hear thoughts, read minds, or control behavior. Preoccupation with mystical ideas, religion, or superstitions.

  • Grandiose ideas leading to feelings of superiority. Exaggerated belief in talent, fame, power, importance, status, or abilities.

  • Anxiety or irritability.

  • Muddled or disorganized thinking. Mental confusion. Thoughts seem sped up or slowed down.

Adapted from the CARE program at the University of San Diego, California; the Center of Prevention and Evaluation, Columbia University Department of Psychiatry/ New York State Psychiatric Institute; and the Centre for Addiction and Mental Health, University of Toronto.

Are there any signs that someone is about to become psychotic?

Sometimes, early symptoms of schizophrenia produce significant changes in behavior that can be very disturbing for family members and friends. In other cases, changes may be subtle. Some secondary problems related to the onset of schizophrenia can provide a hint that psychosis may be present or developing. Look for evidence of disturbed sleep, anxious behavior or agitation, and avoidance of social situations.

Trust Your Intuition

If your gut feeling indicates that something is not right with someone you know, investigate the source of these feelings. Keep on the case until you are convinced the changes you sensed or observed were fleeting and you can no longer see any evidence of change. Ask other people if they detect any changes.

Take their impressions into consideration, but rely on your intuition so you don't ignore any warning signs you think might be significant. The sooner a person gets help for a mental disorder, the better chances she has of experiencing a less severe illness that responds better to medication and psychotherapy.

When secondary features of schizophrenia such as agitation, disturbed sleep, and a disinclination to socialize is combined with a decline in cognitive abilities or a loss in intellectual sharpness, you have a clear indication that something potentially very serious is developing.

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