by Scholten A

Symptoms tend to start between the late teens and mid-30s. It can happen in children, but it is rare. They may be noticed by the person who has problems or those close to them. They often vague but can follow a pattern. The phases are:


There may be no symptoms at this stage. In those that have them, there may be:

  • Changes in behavior such as angry outbursts
  • Less grooming or hygiene
  • Trouble thinking clearly or remembering things
  • Trouble at work or school
  • Less interest in social life, activities, or hobbies
  • Sleep problems
  • Depression
  • Anxiety

Symptoms build slowly and worsen over time. They are different for each person. People may have symptoms from one or all of the next phases:


These are psychotic symptoms. People in this phase lose touch with reality. They may have:

  • Delusions—False personal beliefs that are held onto even though it is clearly not true. They are often strange and do not make sense. There are different types of delusions based on what the person thinks is happening.
  • Hallucinations—Seeing, hearing, touching, tasting, or smelling things that are not there. Hearing voices that other people do not hear is the most common type. Voices may describe the person’s activities, carry on a conversation, warn of impending dangers, or even issue orders.
  • Disorganized thinking and speech—Thoughts may come and go rapidly. They be easily distracted or unable to focus. Their thoughts are often fragmented and do not make sense. When speaking, the words may be made up or repeated. It may be impossible to follow a conversation.
  • Movements that seem agitated or tense for no reason.
  • Catatonia—Slow or absent movement. People can stay still for hours. They may also resist being changed into another position. Some can have repeated odd movements.


Negative symptoms are what is lost in normal emotion or behavior. They may have:

  • Flat affect—Lack of expression or emotion in the face or voice. There also may be very little or no eye contact.
  • Little pleasure in daily life
  • Lack of interest or care.
  • Lack of drive or ambition
  • Reduced speaking
  • Social withdrawal


These change how the brain works. People may not be able to:

  • Understand information and use it to make a decision
  • Use information right after learning it
  • Focus or pay attention
  • Speak or think clearly


Holder SD, Wayhs A. Schizophrenia. Am Fam Physician. 2014;90(11):775-782.

Schizophrenia. EBSCO DynaMed website. Available at: . Updated November 29, 2018. Accessed August 15, 2019.

Schizophrenia. Mental Health America website. Available at: Accessed August 15, 2019.

Schizophrenia. National Institute of Mental Health website. Available at: Updated February 2016. Accessed August 15, 2019.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrian Preda, MD
  • Review Date: 12/2018
  • Update Date: 08/15/2019