In short
The first signs of schizophrenia most often appear gradually, in adolescence or young adulthood: the person drifts away from friends and family, loses interest in school or work, stops taking care of themselves, becomes suspicious, says strange things, sleeps poorly, and becomes absorbed in unusual ideas. Psychotic symptoms may follow: voices, delusions of persecution, and disorganized speech. No single sign means schizophrenia, but a combination of persistent changes in behavior is a reason to have the person seen by a psychiatrist. Early treatment noticeably improves the outlook.
Key points in one minute
- Schizophrenia often begins with a prodromal period: gradual changes in behavior months or years before psychosis.
- Warning signs include withdrawal, falling grades, self-neglect, suspiciousness, strange ideas, and sleep problems.
- Psychotic symptoms such as voices, delusions, and confused speech call for seeing a psychiatrist as soon as possible.
- Cannabis and stimulants can provoke psychosis and worsen the course of illness in predisposed people.
- The earlier treatment of a first episode begins, the better the outlook and the more likely studies, work, and relationships are preserved.
What Schizophrenia Is
Schizophrenia is a chronic mental health disorder that disrupts thinking, perception, emotions, and behavior. In ICD-10 it is coded F20; in ICD-11 it belongs to the group “schizophrenia or other primary psychotic disorders.” Key symptoms for the diagnosis include delusions, hallucinations (most often auditory, or “voices”), disorganized thinking and speech, and so-called negative symptoms: emotional flatness, reduced motivation, and social withdrawal.
The disorder usually begins between the late teens and age 30, on average somewhat earlier in men. Its development involves hereditary predisposition, features of brain development, and external factors such as severe stress and the use of cannabis and stimulants in adolescence. Schizophrenia is not caused by upbringing and does not mean a “split personality”; that is a widespread myth.
Myths About Schizophrenia
Common beliefs hold that people with schizophrenia are dangerous, unable to work, and cannot be treated. In reality, most of them are not aggressive and are far more often victims themselves. With timely treatment, many live independently, study, and work. Stigma is one of the main reasons families put off seeing a doctor for years.
Which Early Signs of Schizophrenia Should Raise Concern
Before the first obvious psychosis, many people go through a prodromal period lasting from several months to several years. During this time the changes are nonspecific and easily put down to adolescence, stress, or laziness. The person becomes withdrawn, loses friends, stops caring about former hobbies, their grades drop, and they become indifferent to their appearance and hygiene. Sleep may be disrupted, and anxiety, irritability, and low mood may appear.
Changes in thinking and perception are more specific. The person becomes absorbed in strange ideas, such as mysticism or philosophical constructs that others find hard to follow, and says that everything around them has acquired special meaning, that they are being watched, or that they hear their name or whispering. Their speech becomes evasive, with unexpected jumps. Individually, these signs can occur in other conditions too, but if several persist for weeks and get worse, that is a serious reason to see a psychiatrist.
- Abrupt withdrawal from socializing, loss of friends, isolating in their room
- A drop in school performance or ability to work for no clear reason
- Self-neglect: stops washing, changing clothes, or keeping things tidy
- Suspiciousness, a feeling of being watched, mistrust of family members
- Strange ideas, an unusual interest in mysticism or “hidden meanings”
- Hears voices or sounds that are not there, reacts to them, talks to themselves
- Inappropriate emotions: laughing in a sad situation, or indifference to everything
- Sleep disturbances: staying awake at night, a reversed day-night cycle
| Feature | More likely within the normal range | A reason to see a psychiatrist |
|---|---|---|
| Socializing | Has a new group of friends, spends more time with them | Isolates from everyone, including friends |
| School and activities | A temporary slump during stress | A persistent decline for no reason, gives up on everything |
| Appearance | Experiments with style | Stops washing and taking care of themselves |
| Ideas and interests | Hobbies that others can understand | Strange, incomprehensible constructs and “special meanings” |
| Perception | Normal | Hears voices, feels watched |
| Sleep | Goes to bed late on weekends | Stays awake at night, reversed day-night cycle |
What a First Psychotic Episode Looks Like
Psychosis is a state in which a person loses the ability to distinguish their own experiences from reality. In a first episode of schizophrenia, delusional ideas appear: most often of persecution (“I’m being followed, they want to harm me”), reference (“they’re talking about me on TV”), or control (“thoughts are being put into my head”). Hallucinations are most often auditory: voices comment on the person’s actions, argue, or give orders. The person is usually convinced that all of this is really happening.
Behavior becomes unpredictable: the person may lock themselves in at home, cover the windows, refuse food for fear of being poisoned, run away from home, or suddenly become anxious or aggressive in response to their experiences. As a rule, they lack insight into their condition and do not consider themselves ill, so persuading them to see a doctor can be difficult. In this situation, it is important for loved ones not to argue with the delusions and to call a specialist.
Psychosis and Substance Use
Psychotic symptoms can occur with alcohol poisoning and withdrawal and with the use of stimulants, synthetic cannabinoids, and hallucinogens. Sometimes the psychosis goes away after the body has been cleared of the substance, and sometimes the substance becomes the trigger for schizophrenia in a predisposed person. Only a doctor can sort this out, so it is important to be honest about any substance use.
Other Causes of Psychosis
Similar symptoms occur with severe depression or mania, certain neurological and endocrine diseases, infections, brain tumors, and side effects of medications. That is why, with a first episode, the doctor orders tests: lab work, an MRI if needed, and a neurologist’s consultation. Schizophrenia is diagnosed only after other causes have been ruled out and when symptoms have lasted for a certain length of time.
Why You Should Not Put Off Seeing a Psychiatrist
The time between the appearance of psychotic symptoms and the start of treatment is called the duration of untreated psychosis. It is well established in psychiatry that the shorter it is, the better the response to treatment, the milder the residual symptoms, and the greater the chances of keeping one’s studies, job, and relationships. Waiting for it all to pass on its own, or for the person to “grow out of it,” robs them of the most favorable time for treatment.
Many families delay a visit out of fear of the diagnosis and of being put on the state psychiatric registry. In Kazakhstan, information about seeing a psychiatrist is protected by medical confidentiality under the Code “On Public Health and the Healthcare System,” and a consultation at a private clinic can be obtained anonymously. You can start with a conversation between family members and a specialist: the doctor will help assess the situation and advise on how to talk to the person.
How Schizophrenia Is Treated
Treatment is based on antipsychotics, medications that reduce delusions, hallucinations, and disorganized thinking. The specific medication and form (tablets or long-acting injections) are chosen by the psychiatrist, taking into account the symptoms, tolerability, and the patient’s preferences. The first improvements are often noticeable within a few weeks, and maintenance therapy after a first episode usually continues for a long time to reduce the risk of another psychosis.
Medication is only part of the help. Psychoeducation for the patient and family, cognitive behavioral therapy for psychosis, social skills training, and help returning to school and work significantly improve outcomes. Family interventions reduce the frequency of relapses. It is important to avoid alcohol and drugs: they worsen the course of the illness, provoke relapses, and interfere with treatment.
- A consultation with a psychiatrist and tests to rule out other causes
- Selection of antipsychotic therapy and monitoring of side effects
- Inpatient care for acute psychosis with a risk to the person or others
- Psychoeducation for the patient and family, and an action plan for deterioration
- Cognitive behavioral therapy for psychosis and social rehabilitation
- Avoiding alcohol and drugs, and help from an addiction specialist if there is addiction
How to Talk to a Loved One and How Narcology 24 Can Help
If you notice worrying changes in a loved one, speak calmly and talk about your observations and feelings rather than a diagnosis: “I can see you’re hardly sleeping and you’re very anxious. I’m worried about you.” Do not argue with delusional ideas or go along with them; acknowledge the emotions (“you’re scared”) but not the content. Suggest talking to a specialist as someone who can help with sleep, anxiety, or tension.
At the Narcology 24 clinic, a psychiatrist can consult family members, examine the person at home if they refuse to go out, and arrange hospitalization if necessary. If there is also alcohol or drug use, an addiction specialist joins the treatment. The online format is suitable for an initial consultation with family members, but if psychosis is suspected, an in-person examination is needed.
When to see a doctor
- Over several months, the person has become withdrawn, dropped out of school or work, and stopped taking care of themselves
- Suspiciousness has appeared, along with a conviction that they are being watched or that someone wants to harm them
- They talk to themselves, listen intently, and react to things others cannot hear
- Their speech has become confused, it is hard to understand what they are talking about, and their thoughts break off
- Changes in behavior appeared after using cannabis, stimulants, or “bath salts” (synthetic cathinones)
- There have been cases of schizophrenia or psychosis in the family, and a loved one has shown worrying changes
When urgent help is needed
Call 103 or 112 immediately if the person hears voices ordering them to cause harm, threatens themselves or others, talks about suicide, has stopped eating and drinking, or is severely agitated. You can also request a psychiatrist’s home visit. Teenagers and young people can get help from the free helpline 150.
How Narcology 24 can help
Round-the-clock home visits, inpatient care and detox, coding, rehab and online consultations with an addiction doctor or psychiatrist. Confidential, with no registry entry.
- Schizophrenia treatmentfrom 15 000 ₸ · Online 24/7
- Acute psychosis: urgent helpfrom 15 000 ₸ · Online 24/7
- Psychiatrist home visitfrom 15 000 ₸ · Online 24/7
Questions and answers
What does schizophrenia look like at the beginning?
Most often it develops gradually: withdrawal, loss of interests, falling grades, self-neglect, sleep problems, suspiciousness, and strange ideas. This prodromal period can last for months. Then psychotic symptoms appear: voices, delusions, and confused speech. Sometimes the onset is acute, with sudden psychosis triggered by stress.
At what age does schizophrenia begin?
Usually in the late teens and young adulthood, roughly between 16 and 30, on average slightly earlier in men than in women. Less often, the disorder begins in childhood or after age 40. That is exactly why it is important to pay close attention to persistent behavior changes in teenagers and students.
Can schizophrenia be cured?
Schizophrenia is a chronic disorder, but treatment makes it possible to manage psychotic symptoms, prevent relapses, and lead a full life. Some people go into long-term remission after a first episode. The outlook is much better if treatment begins early and is carried out consistently.
Can weed cause schizophrenia?
Cannabis use, especially in adolescence, when regular, and with a high concentration of the active ingredient, is associated with an increased risk of psychosis and can trigger schizophrenia in predisposed people. Synthetic cannabinoids are particularly dangerous. If strange behavior appears after use, a psychiatric consultation is needed.
What should I do if my loved one refuses to see a psychiatrist?
Do not argue with the delusions or make threats. Talk about what is bothering them (sleep, anxiety, tension) and offer help with exactly that. You can start with a consultation for family members; at Narcology 24, a psychiatrist will advise you on how to talk to your loved one and can make a home visit. If there is a danger to life, call 103.
Can someone be hospitalized without their consent?
In Kazakhstan, involuntary admission to a psychiatric hospital is possible only in the cases and according to the procedure provided for by the Code “On Public Health and the Healthcare System”: as a rule, when there is an immediate danger to the person or others, when the person is helpless, or when there is a threat of serious harm to their health without help. The decision is subject to judicial review.
Is schizophrenia hereditary?
Heredity increases the risk, especially if parents, brothers, or sisters are affected, but what is passed on is a predisposition, not the illness itself. Most people with schizophrenia in the family never develop it. Whether the predisposition is realized is also influenced by external factors, including the use of psychoactive substances.
Sources and methodology
- ICD-10, category F20 “Schizophrenia,” WHO
- ICD-11, Chapter 6, section “Schizophrenia or other primary psychotic disorders,” WHO
- DSM-5, American Psychiatric Association
- NICE guideline CG178 “Psychosis and schizophrenia in adults: prevention and management”
- APA Practice Guideline for the Treatment of Patients With Schizophrenia
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
This article was prepared by the Narcology 24 medical editorial team and reviewed by a doctor. It is for reference only and does not replace a specialist consultation. Editorial policy
Medically reviewed by
Arman Magzhanov, MDPsychiatrist · experience 24 yearsSchizophrenia, bipolar disorder and acute psychosis, including substance-induced psychosis; psychiatrist home visits.
