Editing Schizophrenia (section)

===Onset===
{{Further|Basic symptoms of schizophrenia}}
{{See also|Childhood schizophrenia|Adolescence#Changes in the brain}}
Onset typically occurs between the late teens and early 30s, with the peak incidence occurring in males in the early to mid-twenties, and in females in the late twenties.<ref name=NIH2022/><ref name=DSM5/><ref name=Ferri2019/> Onset before the age of 17 is known as early-onset,<ref>{{cite journal |vauthors=Bourgou Gaha S, Halayem Dhouib S, Amado I, Bouden A |title=[Neurological soft signs in early onset schizophrenia] |journal=L'Encephale |volume=41 |issue=3 |pages=209–214 |date=June 2015 |pmid=24854724 |doi=10.1016/j.encep.2014.01.005}}</ref> and before the age of 13, as can sometimes occur, is known as [[childhood schizophrenia]] or very early-onset.<ref name=DSM5 /><ref name=DaFonseca2018>{{cite journal |vauthors=Da Fonseca D, Fourneret P |title=[Very early onset schizophrenia] |journal=L'Encephale |volume=44 |issue=6S |pages=S8–S11 |date=December 2018 |pmid=30935493 |doi=10.1016/S0013-7006(19)30071-5|s2cid=150798223 }}</ref> Onset can occur between the ages of 40 and 60, known as late-onset schizophrenia.<ref name=Murante2017/> Onset over the age of 60, which may be difficult to differentiate as schizophrenia, is known as very-late-onset schizophrenia-like psychosis.<ref name=Murante2017/> Late onset has shown that a higher rate of females are affected; they have less severe symptoms and need lower doses of antipsychotics.<ref name=Murante2017/> The tendency for earlier onset in males is later seen to be balanced by a [[post-menopausal]] increase in the development in females. [[Estrogen]] produced pre-menopause has a dampening effect on dopamine receptors but its protection can be overridden by a genetic overload.<ref>{{cite journal |vauthors=Häfner H |title=From Onset and Prodromal Stage to a Life-Long Course of Schizophrenia and Its Symptom Dimensions: How Sex, Age, and Other Risk Factors Influence Incidence and Course of Illness |journal=Psychiatry Journal |volume=2019 |page=9804836 |date=2019 |pmid=31139639 |doi=10.1155/2019/9804836 |pmc=6500669 |doi-access=free }}</ref> There has been a dramatic increase in the numbers of older adults with schizophrenia.<ref>{{cite journal | vauthors = Cohen CI, Freeman K, Ghoneim D, Vengassery A, Ghezelaiagh B, Reinhardt MM | title = Advances in the Conceptualization and Study of Schizophrenia in Later Life | journal = The Psychiatric Clinics of North America | volume = 41 | issue = 1 | pages = 39–53 | date = March 2018 | pmid = 29412847 | doi = 10.1016/j.psc.2017.10.004 }}</ref>

Onset may happen suddenly or may occur after the slow and gradual development of a number of signs and symptoms, a period known as the [[Prodromal schizophrenia|prodromal stage]].<ref name=DSM5 /> Up to 75% of those with schizophrenia go through a prodromal stage.<ref name=George2017>{{cite journal |vauthors=George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS |title=Understanding the schizophrenia prodrome |journal=Indian Journal of Psychiatry |volume=59 |issue=4 |pages=505–509 |date=October 2017 |pmid=29497198 |doi=10.4103/psychiatry.IndianJPsychiatry_464_17|doi-broken-date=1 November 2024 |doi-access=free|pmc=5806335 }}</ref> The negative and cognitive symptoms in the prodrome stage can precede FEP (first episode psychosis) by many months and up to five years.<ref name=Hashimoto2019>{{cite journal |vauthors=Hashimoto K |s2cid=195814019 |title=Recent Advances in the Early Intervention in Schizophrenia: Future Direction from Preclinical Findings |journal=Current Psychiatry Reports |volume=21 |issue=8 |page=75 |date=5 July 2019 |pmid=31278495 |doi=10.1007/s11920-019-1063-7}}</ref><ref name=Conroy2018>{{cite journal |vauthors=Conroy S, Francis M, Hulvershorn LA |title=Identifying and treating the prodromal phases of bipolar disorder and schizophrenia |journal=Current Treatment Options in Psychiatry |volume=5 |issue=1 |pages=113–128 |date=March 2018 |pmid=30364516 |doi=10.1007/s40501-018-0138-0|pmc=6196741 }}</ref> The period from FEP and treatment is known as the duration of untreated psychosis (DUP) which is seen to be a factor in functional outcome. The prodromal stage is the high-risk stage for the development of psychosis.<ref name=Green2019/> Since the progression to first episode psychosis is not inevitable, an alternative term is often preferred of [[at risk mental state]].<ref name=Green2019/> Cognitive dysfunction at an early age impacts a young person's usual cognitive development.<ref>{{cite journal |vauthors=Lecardeur L, Meunier-Cussac S, Dollfus S |title=[Cognitive deficits in first episode psychosis patients and people at risk for psychosis: from diagnosis to treatment] |journal=L'Encephale |volume=39 |pages=S64-71 |date=May 2013 |issue=Suppl 1 |pmid=23528322 |doi=10.1016/j.encep.2012.10.011}}</ref> Recognition and early intervention at the prodromal stage would minimize the associated disruption to educational and social development and has been the focus of many studies.<ref name=Hashimoto2019/><ref name=Conroy2018/>