“The media tends to play up the diagnosis as [individuals] who only hear voices and are talking to themselves,” says Abigale Johnson, LCSW. “This can be an aspect of schizophrenia, but not everyone presents the same way.” Stephen Geisler, M.D., staff psychiatrist at Brooklyn Minds, adds that people might experience hallucinations or delusions, but their thoughts can be completely logical and coherent. Because of this, schizophrenia can be sometimes be misdiagnosed and mistaken for another mental health disorder. Learn about the symptoms, similar diagnoses, and treatment options for acute schizophrenia.

Acute Schizophrenia Symptoms

According to Lawrence Greenberg MD, Chief Medical Officer at MindPath Care Centers, the main symptoms of acute schizophrenia, also recognized as active psychosis, include: 

Decreases in functional capacity: The inability to work on self-care, attend school, show up to work, or to socialize properly Delusions: False false notions or ideas that the individual believes Disorganized behavior: This can manifest in a variety of ways. It can include odd, bizarre behavior such as smiling, laughing, or talking to oneself, or being preoccupied/responding to internal stimuli. It can also include purposeless, ambivalent behavior, or movements. It may also involve catatonia, which is marked by a significant decrease in someone’s reactivity to their environment. This can involve stupor, mutism, negativism or motor rigidity, and even purposeless excitement. Disorganized thinking or speech: This is referred to as the “thought disorder” which often makes it difficult for these individuals to communicate clearly with others. Hallucinations: This includes auditory, visual, tactile, olfactory, and gustatory. The two most commonly diagnosed are auditory and visual.  Negative symptoms: Negative symptoms involve the absence of something and include the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships. This includes diminished emotional expressivity and is often considered a flat or constricted affect. 

“It is not uncommon to see symptoms suggestive of depression or strange behavior such as laughing in the absence of an appropriate stimuli,” says Dr. Geisler. “Patients frequently experience negative symptoms, that is diminished emotional expression and/or withdrawal from interpersonal, social, and occupational functioning,” To make a diagnosis of schizophrenia, Dr. Geisler says, symptoms have to be present continuously for at least a six-month period.

Mental health disorders are difficult to diagnose, and schizophrenia is no different. It is a very complex mental health condition and is accompanied by a wide range of symptoms, any one of which can lead to misdiagnosis. This is why it’s important to speak with a mental health professional about your or your loved one’s feelings, thoughts, and behaviors.  Other diagnoses that share similarities to schizophrenia include:

Bipolar disorder: Symptoms can range from talking excessively and behaving impulsively to feeling hopeless or sleeping excessively, depending on the type of disorder. With bipolar mania, possible symptoms include delusions or hallucinations which are also seen in schizophrenia.  Delirium: A neurological disorder, delirium can occur at any age. It can be caused by drug use, dehydration, or infection. Symptoms include impaired judgment, difficulty focusing, as well as hallucinations, delusions, or paranoia.  Dementia: This chronic disorder deals with cognitive impairment and can include symptoms such as personality changes, memory loss, and communication difficulties. Individuals with schizophrenia may be at a higher risk of developing dementia.  Paranoia: This can occur in acute schizophrenia, but individuals can experience paranoia and not have schizophrenia. Paranoia is a state of suspiciousness.  Schizotypal personality disorder: Acute schizophrenia can be misdiagnosed with this personality disorder in which paranoid ideation and strange behavior are considered the top symptoms. Individuals with this personality disorder often have difficulty interacting with others. Substance-induced psychosis: Hallucinations and delusions are the most common symptoms seen in medication- or substance-induced psychosis, but individuals might also present disordered thinking or negative symptoms. When diagnosing this disorder, it’s important to find out if these symptoms existed before drugs or alcohol were consumed or if they occurred as a result of them. 

Acute Schizophrenia Diagnosis

The sudden onset of severe psychotic symptoms may be considered “acute” schizophrenia, but not always. Onset can occur at any time, though typically individuals are diagnosed between their teen years and their early thirties. It is very rare for a diagnosis to be made earlier or later in one’s life. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by mental health professionals to diagnose mental health disorders and illnesses, states that an individual must exhibit two specific symptoms for more than six months to be diagnosed with schizophrenia.  “As an illness that requires a time component to make the diagnosis, it can take several months to reach a conclusive diagnosis from the time a family first begins to notice changes in behavior or cognition,” says Dr. Greenberg. “It is important, however, to make the diagnosis as soon as possible as there is evidence that earlier interventions can improve the longitudinal course of the illness.” In order to make an official diagnosis, medical professionals evaluate “the history told by the affected individual and the family, and [by] assessing the individual’s mental status,” says Dr. Geisler. He points out that no blood test or scan can be done to make the diagnosis. 

Acute Schizophrenia Treatment 

Schizophrenia is considered an incurable chronic illness. If you or a loved one has been diagnosed with acute schizophrenia, there are treatment options for minimizing and managing symptoms. 

Medication

“Medication is the first line of treatment that I’ve seen really work for patients,” says Dr. Johnson. “Medications typically target the symptoms of schizophrenia… [but] medications do not ‘cure’ schizophrenia.”  Medication options range from antipsychotic medications and adjunctive medications to electroconvulsive therapy (ECT) and somatic medications. Most commonly, individuals with active schizophrenia are given antipsychotic medications. Typically, medical professionals will work with the individual to determine the most effective medication at the lowest possible dose. Antipsychotic medications affect receptors in the brain that help manage the signs and symptoms present in active psychosis. There are two types of antipsychotic medications:

Typical antipsychotic medications, also called first-generation antipsychotic drugs)Atypical antipsychotic medications, or second-generation antipsychotic drugs, which tends to result in less severe side effects. 

No matter the type of medication or the side effects, studies show that antipsychotic medications can help manage symptoms, prevent relapse, and ultimately improve an individual’s quality of life. 

Individual and Group Psychotherapy

Though medication can benefit individuals with acute schizophrenia, psychotherapy can also help an individual process the diagnosis, manage medications, monitor changes in behavior and mood, and action. Other treatment options include psychosocial therapy, social skills training (SST), cognitive behavior treatment (CBT), mentalization-based treatment (MBT), and support groups which often complement medication or therapy. 

Coping With Acute Schizophrenia

Because the symptoms of acute schizophrenia are often sudden and severe, it is important to speak with a mental health professional as soon as possible. Individuals won’t receive a diagnosis until symptoms are reported for at least six months, so it’s important to notify a professional right away. If you’re unsure where to begin, you can start by speaking with your doctor and asking for a referral.  One of the best ways to cope with an acute schizophrenia diagnosis is to understand as much as possible through psychoeducation, explains Dr. Geisler.  “This can help families understand what their loved one is experiencing and to best know how to approach them and to help support their efforts in getting proper treatment,” says Dr. Geisler. “This can be done best by meeting with the individual’s psychiatrist and other mental health professionals.” 

A Word from Verywell

Symptoms of acute schizophrenia can be difficult and scary for both individuals and loved ones, especially when they present themselves suddenly. The best thing you can do is be patient, track your symptoms, and work with a reliable mental health professional to determine the best next steps.