What are the signs and symptoms of schizophrenia?

Many people have heard of schizophrenia, but not many fully understand its symptoms and how it impacts people. Schizophrenia is a lifelong mental health condition that causes serious problems, altering the way a person sees reality and how they think and feel. This can be confusing and overwhelming for anyone who has the disorder—but also for the people around them.

Schizophrenia is a severe mental health condition that leads to episodes of psychosis. Psychosis is when a person has hallucinations or delusional ideas, making it difficult for them to differentiate between what is real and what is not. Hallucinations include hearing voices without anyone speaking and seeing or smelling things that aren’t there, while delusions are firmly held beliefs not supported by facts, such as believing that the television is sending out special messages only you can hear or that others are out to get you. During these episodes, people with schizophrenia may not realize they are unwell, which can be challenging for doctors trying to diagnose and treat the condition. Though the exact cause of schizophrenia is unknown, it's more common in people with a family history. It may also be caused by problems with chemicals in the brain called neurotransmitters, such as dopamine and glutamate. There may also be neurons or nerve cells in the brain that are involved.

People are most commonly diagnosed with schizophrenia in their 20s and 30s, but the diagnosis can also occur during the adolescent years, between 13 and 18. While younger children can develop schizophrenia, it is very rare.

It can be tricky to notice the early signs of schizophrenia, as these are often subtle changes that may be mistaken for more common conditions, such as depression or anxiety. Early symptoms of schizophrenia include:

• Strange thoughts, ideas or statements
• Moodiness or irritability
• Issues or changes in relationships
• Disrupted sleep
• Out-of-character behavior, such as dropping out of school or making an unexpected career change

People who experience early symptoms of schizophrenia are often unaware that anything is wrong, and so they don’t seek help.

The symptoms of schizophrenia can vary by age, gender and environmental factors. People with schizophrenia may appear to lose touch with reality and have impaired thinking or behavior. There is a range of other signs associated with schizophrenia, which can be categorized as positive, negative or disorganized.

Positive symptoms

These are behaviors and thoughts that healthy individuals don't have. Positive symptoms are thought to be caused by having too much of the chemical dopamine in the brain and include:

• Hallucinations (sights, sounds, smells, etc. that are not real)
• Delusions (false beliefs that are often paranoid in nature)

These symptoms generally mean that someone experiences the world in a distorted way, with a loss of contact with reality. This can result in feelings of paranoia, where people with schizophrenia can become unreasonably suspicious of others around them, such as neighbors, friends and doctors. Positive symptoms are usually vivid and other people may notice them, so they're easier to identify than negative symptoms.

Negative symptoms

These signs are the absence of characteristics found in most healthy people, including:

• Being emotionally “flat” and having difficulty expressing emotions
• Social withdrawal
• Inability to complete everyday tasks
• Speaking in a disconnected way
• Experiencing little pleasure in daily life

These symptoms affect normal functioning and can cause apathy or a lack of interest or concern about the world around the individual, which can make everyday tasks like personal hygiene, sleep and socializing hard for people with schizophrenia.

Disordered symptoms

Schizophrenia can also cause cognitive difficulties that are considered disorganized symptoms, including:

• Disordered thoughts and speech
• Agitated movement (also known as movement disorders)
• Trouble concentrating
• Difficulty retaining information
• Difficulty processing information

While childhood schizophrenia is very uncommon, and even more uncommon for those younger than 13, the symptoms for children are similar to those for adults.

Early signs in children can be misdiagnosed or missed because they can be present in many other disorders, such as autism, anxiety or other developmental delays. Correct diagnosis requires a thorough history by a practitioner specially trained in this area.

Children and adolescents with schizophrenia may be more likely to show negative symptoms, such as lack of emotions or lack of interest in everyday activities. The symptoms are often difficult to spot in teenagers because of their typical behavior, including withdrawal from friends and family, and can make diagnosis challenging. Teens can also lack motivation, be irritable or have issues with school performance and sleep, all without having any psychiatric problems.

Hallucinations are much more common than delusions in youth with schizophrenia as compared to adults; however, they may be less likely to be reported. 

Symptoms of schizophrenia are similar for males and females. The only major difference is that men are typically diagnosed in their early to mid-20s, while women usually find out they have the condition in their late 20s. Late-onset schizophrenia occurs after the age of 45, producing symptoms similar to those affecting younger adults.

Although schizophrenia may be difficult to navigate, people can manage symptoms and psychotic episodes through medication and regular evaluation by mental health professionals.

 Schizophrenia requires lifelong treatment, so it's important to seek medical and professional advice. With compliance, therapy and the support of loved ones, people with schizophrenia can get help.

Clinically reviewed and updated by Julie McDaniel, MSN, RN, CRNI October 2023.