Schizophrenic Episodes: Symptoms, Causes, and Treatment - Verywell Mind

What Is a Schizophrenic Episode?

Schizophrenia is a chronic brain disorder. It is a mental illness characterized by psychosis, which is when people have trouble distinguishing between what is real and what is imagined.

Symptoms of psychosis can include hallucinations, delusions, paranoia, and incoherence, says Deepak D'Souza, MD, a psychiatry professor at Yale School of Medicine.

A schizophrenic episode, also known as a psychotic episode or acute schizophrenia, describes a time when the person's symptoms are particularly active, says D'Souza. Depending on the severity of the schizophrenic episode, the person may lose touch with reality, and the world can seem like a confusing jumble of sights, sounds, and information.

A schizophrenic episode can last days or weeks—in rare cases, even months, says D'Souza. Some people may experience only one or two schizophrenic episodes in their lifetime, whereas for others, the episodes may come and go in phases. 

Symptoms of Schizophrenic Episodes

The symptoms of schizophrenic episodes are broadly classified into three categories:

  • Positive symptoms, which include delusions, hallucinations, paranoia, and psychotic behaviors that are not seen in those without schizophrenia.
  • Negative symptoms, which are emotional and behavioral symptoms, such as social withdrawal, lack of interest or motivation, and depression. These symptoms may appear years before the person has their first schizophrenic episode and gradually get worse over time. They can be harder to diagnose than positive symptoms, but are associated with higher rates of suicidal behavior and morbidity.
  • Cognitive symptoms, which can include difficulty concentrating and disorganized thoughts, speech, and behavior.

These are some of the symptoms of schizophrenic episodes:

  • Hallucinations: The person may see, hear, taste, smell, or feel things that are not real. The most common form of hallucinations is auditory, and they include hearing voices that nobody else can hear, even when no one is around, says D'Souza. The voices may be friendly, threatening, abusive, critical, or annoying. They may talk to the person, have discussions with them, or give them instructions. Hallucinations can be very real to the person experiencing them.
  • Delusions: Delusions are false beliefs that are not based on real facts, but the person may believe them with absolute conviction, despite being shown evidence to the contrary. For instance, the person may believe that their thoughts are being controlled by space aliens, that they are on a special mission, or that they have special powers, says D'Souza. Delusions may appear suddenly or develop over weeks or months. They can affect the way the person behaves.
  • Paranoia: Paranoia is an irrational feeling of suspicion and mistrust. The person may believe they are being followed and watched when that is not the case, says D'Souza. "Sometimes paranoia can cause the person to feel very unsafe."
  • Disorganized thoughts and behaviors: The person's speech may be incoherent and their behaviors may not make sense, says D'Souza. Their thoughts may be jumbled and confused. They may struggle to hold on to a thought or make sense of their surroundings. They may also feel like their thoughts are blocked.
  • Behavioral changes: The person's behavior may change in unpredictable ways and they may behave in a manner that is inappropriate to the situation. They may feel like their body has been taken over and their thoughts and actions are being controlled by someone else. 
  • Lack of interest: The person may lose interest in their work, studies, relationships, and other activities. They may not have the motivation to pursue any interests or to initiate conversations or connections with others.
  • Social withdrawal: The person may become socially withdrawn and cut themselves off from friends, family, work, and their community. They may not be able to function at work or school and may not want to leave their house. The may struggle with chores or other activities and become very inactive.
  • Depression: The person may become depressed or experience mood swings. Their emotions may feel dulled or they may have difficulty empathizing.

These symptoms can make it difficult for a person to function on a daily basis. People with mild episodes may be able to understand some parts of reality and lead a somewhat normal life. 

However, severe episodes can cause the person to disconnect from reality and compromise their ability to eat, maintain personal hygiene, work, and get around. The person may not be able to take care of their basic needs during these episodes, says D'Souza.

Causes of Schizophrenic Episodes

These are some of the factors that can cause or exacerbate schizophrenic episodes, according to D'Souza:

  • Stress
  • Substances (such as alcohol, cannabis, or cocaine)
  • Loss (such as a break-up, the death of a loved one, or the loss of a job)
  • Lack of sleep
  • Stopping one's antipsychotic medication

Treating Schizophrenic Episodes

Schizophrenia cannot be permanently cured; however, treatment can help eliminate the symptoms and reduce the occurrence of episodes.

A combination of therapy and antipsychotic medications are key to treating episodes of psychosis and schizophrenia in general, says D'Souza. 

Treatment may be able to:

  • Help the person distinguish between what's real and what isn't
  • Stop or reduce hallucinations
  • Stop or reduce delusions
  • Reduce feelings of confusion
  • Aid in clear thinking
  • Help the person resume their everyday activities 

In some cases, a schizophrenic episode may warrant hospitalization in a safe, secure, and predictable environment if the person is unable to care for themselves or has become a danger to themselves or others, says D'Souza.

Coping With Schizophrenic Episodes

These are some steps that can help you cope with a schizophrenic episode, according to D'Souza:

  • Be in a safe, secure, and predictable environment
  • Seek the support of family members and friends
  • Take medication regularly
  • Attend therapy sessions
  • Find ways to limit and manage stress
  • Avoid substances such as alcohol, cannabis, or cocaine
  • Stay engaged with work or school and your community

A Word From Verywell

Schizophrenic episodes can be difficult to cope with, for the person as well as their loved ones. It can be difficult to watch someone you love go through the experience, especially the first time.

People with schizophrenia often have difficulty realizing they have a mental illness, so it can be hard to persuade them to seek treatment. However, it's important to help them get treatment in order to reduce symptoms, prevent schizophrenic episodes, and manage the condition.

By Sanjana Gupta
Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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