Decompensation in schizophrenia refers to a period when the person’s mental state becomes unbalanced and symptoms return.

Schizophrenia is a serious psychiatric disorder characterized by disturbances in perception, behavior, and thought. It typically involves hallucinations and delusions. Current treatments and therapies can help a person with schizophrenia maintain a balance in their mental health.

However, a person living with schizophrenia may experience times when they become psychologically unbalanced. This is known as decompensation. It is a state when symptoms return, often due to a preceding event or trigger, issues with medication, or other factors.

Keep reading to learn more about decompensation in schizophrenia, signs of decompensation, treatment options, and more.

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Decompensation is a general medical term that doctors use to describe situations where a physical, psychological, or other type of condition becomes unstable, leading to new or worsening symptoms.

According to a 2022 paperTrusted Source, most experts agree that decompensation in schizophrenia and other mental health conditions refers to an acute worsening of a person’s symptoms that pose a significant increase to their short-term risk of serious harm or death.

It may occur due to a stressor or preceding traumatic event that causes an imbalance in the person’s mental health status due to failure of their in-place coping mechanisms to handle the new stressor.

Decompensation may also occur due to changes in medication, poor treatment adherence, or progression of schizophrenia. Experts considerTrusted Source nonadherence to medication to be one of the most common reasons for schizophrenia relapse.

Episodes of decompensation represent one of four criteria that the Social Security Administration (SSA) uses to help determine eligibility for Social Security Disability Insurance for individuals with mental health illnesses.

The SSA identifies possible causes as insufficient medication, the presence of stressors, or a combination of both. It recognizes that episodes of decompensation create issues that negatively affect several areas of a person’s overall well-being, including their ability to participate in daily life and social situations.

According to an older study from 2013Trusted Source, significant risk factors of schizophrenia relapse include:

  • caregiver criticism
  • nonadherence with medication
  • persistent substance use
  • poor premorbid adjustment

Premorbid adjustment is the ability of a person to make social and intimate relationships, and academic achievements before the onset of psychotic symptoms.

Decompensation in schizophrenia can present in different ways.

According to older research from 2015Trusted Source, acute psychosis is a common symptom of decompensation. It noted that early, nonspecific signs precede delirium in about 50% of cases.

Early signs may include:

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  • Ask the tough question: “Are you considering suicide?”
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Find more links and local resources.

Symptoms and signs of psychosis can includeTrusted Source:

  • paranoid ideas, uneasiness with others, or suspiciousness
  • difficulty with logical, clear thinking
  • sudden drop in job performance or grades
  • decline in self-care or personal hygiene
  • withdrawing socially and spending a lot more time alone
  • unusual or overly intense ideas, strange feelings, or a lack of feelings
  • trouble telling reality from fantasy
  • confused speech or trouble communicating
  • disruption of sleep, which may include trouble falling asleep and reduced sleep time

Along with these symptoms, a person may also experience:

  • anxiety
  • emotional disruption or distress
  • loss of motivation
  • trouble with overall functioning in daily activities

An earlier review from 2013Trusted Source also noted that once schizophrenia symptoms return, they tend to develop quickly back to their pre-treatment levels.

Decompensation in schizophrenia and relapses require quick identification and treatment to help improve outcomes.

In most cases, people experiencing decompensation in schizophrenia do well with the reintroduction of medication. Antipsychotics play an important roleTrusted Source in preventing psychosis and helping a person reduce their symptoms.

Psychological therapies, such as family counseling and cognitive behavioral therapy (CBT), can also help with reducing the symptoms of decompensation in schizophrenia.

Caregivers and people living with schizophrenia will likely benefit from taking steps to prevent relapses and a return of symptoms. According to a 2021 systematic reviewTrusted Source, factors that can help with preventing relapse include:

  • CBT
  • family interventions, such as therapy
  • family psychoeducation

Continuing medication also plays an important role in preventing the symptoms of schizophrenia from returning.

The following provides some answers to frequently asked questions about schizophrenia.

What is the last stage of schizophrenia?

The last stage of schizophrenia is the third stage, known as the residual phase. A person at this stage does not present with positive symptoms — such as delusions — and symptoms tend to be less severe than in the active stage.

It generally has an association with negative symptoms, such as low energy or depressed mood. However, it is important to note that the Diagnostic and Statistical Manual, Fifth Edition, Text RevisionTrusted Source no longer recognizes it as a phase for diagnosing purposes.

What is the life expectancy of a person with schizophrenia?

Evidence suggests that schizophrenia can reduce a person’s lifespan by about 15–20 yearsTrusted Source.

Decompensation in schizophrenia is an acute worsening of symptoms associated with the condition. It generally requires treatment with medication and psychotherapy to help a person reduce their symptoms.

A person can help prevent a relapse of symptoms through adherence to medications, family or caregiver counseling and education, and CBT.