Schizophrenia is a chronic (long-term) mental illness that affects the way you think, feel, and act. It’s a complex brain disorder that can significantly impact both your life and the lives of your loved ones. Before the full symptoms of schizophrenia develop, many people experience subtle changes in thoughts, emotions, and behaviors. These early symptoms are part of what’s called the prodromal phase of schizophrenia.

For most people, the prodromal stage lasts about one to two years before they receive a diagnosis of schizophrenia. About 80 percent to 90 percent of people diagnosed with schizophrenia experience prodromal symptoms before the illness progresses to its active phase.

In this article, we’ll explore the early warning signs of schizophrenia, what to expect during the prodromal phase, and ways to manage symptoms or seek treatment early.

What Are the Three Stages of Schizophrenia?

Health experts classify schizophrenia into three stages based on how symptoms progress over time. Schizophrenia is associated with changes in brain structure and function, including the loss of gray matter (a type of brain tissue involved in processing information). Each stage reflects increasing changes in thinking, emotions, and behavior.

• Prodromal stage — Subtle changes in thoughts, emotions, or behavior emerge, suggesting the onset of psychosis, but they aren’t severe enough for a schizophrenia diagnosis.
• The first episode (acute stage) — Severe psychotic symptoms, such as hallucinations or delusions, emerge.
• Chronic stage — Ongoing phase that includes periods of remission (symptom improvement), relapse (return of symptoms), and persistent illness.

Mood changes may occur during the prodromal phase. These may include depression, anxiety, or irritability.

Identifying symptoms of prodromal schizophrenia can be challenging, as they are often mild or vague. However, seeking treatment before the first episode can improve long-term outcomes and help manage symptoms more effectively.

What Happens in the Prodromal Stage? 4 Signs

The prodromal stage of schizophrenia, also called schizophrenia prodrome, involves noticeable changes in thinking, emotions, and behavior. However, these early symptoms may not be immediately recognized as signs of schizophrenia.

Common prodromal symptoms can include:

• Unusual or extreme beliefs
• Auditory hallucinations (hearing sounds or voices that others don’t)
• Increased suspicion or guardedness
• Changes in memory, concentration, and attention
• Mood changes, such as increased anxiety or depression

The symptoms aren’t easy to define, but you or others might notice changes in how you think or behave. You might mistake them for signs of a mood disorder, personality disorder, or substance abuse disorder.

You may experience hallucinations, delusions, or distortions as prodromal schizophrenia symptoms.

Recognizing how these symptoms affect your thoughts and daily life is an important first step in seeking help and managing early schizophrenia symptoms.

1. Changes in Academic or Work Performance

As the prodromal phase begins, you may find it harder to manage daily responsibilities. These challenges may lead to noticeable declines in academic or work performance. Tasks that once felt easy may become difficult, and you might seem less motivated or engaged in your school or job-related activities.

Difficulties with problem-solving, organization, or focus can cause you to miss deadlines, fall behind on assignments, or struggle to complete tasks efficiently.

This decline in functioning can have a major impact on daily life, leading to:

• Decreased productivity at work or school
• Missed academic or career opportunities
• Financial difficulties
• Strained relationships with co-workers, classmates, or supervisors

2. Mood Changes

One of the early symptoms of the prodromal phase of schizophrenia is a noticeable decrease in emotional expression. This is considered a negative symptom of schizophrenia, meaning it reflects a loss of typical behaviors or abilities. It may include:

• Disinterest in activities you once enjoyed
• Lack of motivation
• Anhedonia (reduced ability to experience pleasure)

Other mood changes may also occur during the prodromal phase, such as:

• Depression — Intense sadness, hopelessness, or loss of interest in life
• Anxiety — Constant worry, fear, or nervousness
• Irritability — Easily triggered agitation or anger

These mood changes can be distressing and significantly impact daily life.

Because these symptoms overlap with depression or other mental health conditions, they may not immediately suggest schizophrenia. However, when combined with other prodromal symptoms, they can serve as an early warning sign of the disorder.

3. Hallucinations, Delusions, and Distortions

During the early stages of schizophrenia, some people may experience changes in perception, thinking, or beliefs that are associated with psychosis.

Psychotic symptoms (also known as positive symptoms) may include:

• Hallucinations — Seeing, hearing, or feeling things that aren’t there
• Delusions — Strongly held false beliefs that persist despite evidence to the contrary
• Distortions — Difficulty thinking clearly, organizing thoughts, or accurately interpreting information

During the prodromal stage, these symptoms may appear in a milder form, known as attenuated positive symptoms.

4. Sleep Problems

Sleep disturbances are common during the prodromal phase of schizophrenia. These can include:

• Having difficulty falling asleep
• Waking up frequently during the night
• Waking up too early and being unable to fall back asleep

Practice good sleep hygiene to counter sleep disturbances from prodromal schizophrenia.

Poor sleep can lead to daytime fatigue, trouble concentrating, and difficulty managing daily responsibilities. It can also worsen other prodromal symptoms, such as anxiety and social withdrawal, and make it harder to cope with everyday life.

Management and Treatment for Prodromal Schizophrenia

Diagnosing schizophrenia is complex and requires a pattern of symptoms lasting six months or more. However, recognizing and addressing symptoms early — during the prodromal phase — can lead to better long-term outcomes and improve quality of life. Sometimes, a loved one might notice changes before you do.

Speaking With a Mental Health Professional

Early intervention often includes regular psychotherapy, such as cognitive behavioral therapy (CBT). CBT can help you identify unhelpful thought patterns, develop coping strategies, and improve problem-solving skills. Working with a mental health professional allows you to openly discuss changes in your thoughts, emotions, and behaviors while receiving guidance on managing symptoms. If you or a loved one notice signs of the prodromal phase, seeking professional support as soon as possible can make a meaningful difference in long-term outcomes.

Managing Medications

If you show signs of schizophrenia prodrome, your psychiatrist may prescribe treatment options such as antipsychotic medication, antidepressants, or anti-anxiety medications. Early intervention with medication can sometimes improve long-term treatment outcomes.

If your psychiatrist recommends antipsychotic treatment, ask about:

• Possible side effects and how to manage them
• How long it may take for the medication to start working
• Alternative options if you have trouble tolerating or affording your treatment

If you experience side effects or difficulty managing your medication, talk to your doctor about adjusting your treatment plan to find the best balance between effectiveness and tolerability.

Improving Sleep Hygiene

Sleep problems create a vicious cycle with schizophrenia, as poor sleep may worsen symptoms like anxiety, difficulty concentrating, and mood changes. Practicing good sleep hygiene can help promote better-quality sleep and overall well-being. Helpful strategies include:

• Creating a calming environment for yourself around bedtime — Establish a relaxing pre-sleep ritual, such as reading or listening to soft music.
• Avoiding late-night screen time — Blue light from phones, tablets, and TVs can interfere with melatonin production, making it harder to fall asleep.
• Limiting caffeine use prior to sleep — Reduce intake of coffee, tea, energy drinks, and other stimulants several hours before bedtime.

Avoiding Substances

Use and abuse of drugs and other substances are common among people with schizophrenia, and this can be particularly problematic during the prodromal phase of schizophrenia. A person may turn to substances as a way to cope with the prodromal symptoms they are experiencing. Substance misuse can make the symptoms of schizophrenia worse and may even lead to the development of substance use disorders.

It’s important to seek help if you or a loved one is struggling with substance use while experiencing prodromal schizophrenia symptoms. Treatment can help manage symptoms and prevent more severe problems from developing.

Maintaining Relationships

Going through the prodromal phase of schizophrenia can feel overwhelming, but you are not alone. If you feel comfortable, consider sharing your experiences with trusted family members or close friends. — they can offer emotional support and practical help as you manage your condition.

For example, remembering to take medication daily can be challenging. A loved one can:

• Remind you to take your medications
• Help you stay accountable with your treatment plan

• Offer encouragement and reduce feelings of isolation

Schizophrenia symptoms can sometimes make socializing feel difficult or isolating. Seeking support from others can be an important part of coping. Consider joining a schizophrenia support group, where you can connect with peers who understand your experiences. Talking to others who share similar symptoms, treatment side effects, or life challenges can provide encouragement and reassurance.

Seek Help Early for the Best Outcomes

Recognizing the early signs of schizophrenia can be challenging, but seeking help during the prodromal phase can make a significant difference. If you or a loved one notice changes in thinking, mood, or behavior, reaching out to a mental health professional is an important first step. Early intervention can help manage symptoms and improve long-term outcomes. You don’t have to navigate this alone: Support from healthcare providers, family, and peers can make a meaningful impact on your journey to wellness.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and related mental health conditions (like schizophrenia) and their loved ones. On MyDepressionTeam, more than 150,000 members come together to ask questions, give advice, and share their stories with others who understand life with different mental health conditions.

Have you experienced the prodromal symptoms of schizophrenia? How have you dealt with these symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.