What You Need to Know About Prodromal Schizophrenia

Symptoms of prodromal schizophrenia can be subtle or easily attributed to another condition, like anxiety or even normal changes in adolescence. While the hallmark symptoms of schizophrenia include hallucinations and a disconnect from reality, it can take years for these more advanced symptoms to appear.

Prodromal schizophrenia is the earliest stage of brain degeneration, though not everyone exhibits the same symptoms. During this phase, people begin experiencing pre-psychotic mild or moderate changes in perceptions and behavior, but don't yet have delusions and more serious difficulties. 

This article discusses the symptoms of prodromal schizophrenia and how it is diagnosed and treated. It will help you to better identify and understand these symptoms.

What Is Schizophrenia Prodrome?

Schizophrenia prodrome, or the prodromal phase, is the earliest phase. As such, it’s commonly diagnosed only after a person has entered the active schizophrenia phase. One estimate suggests that 75% of the patients with schizophrenia may pass through the stages of prodromal symptoms.

During the active (acute) phase, symptoms are most noticeable and potentially damaging to a person’s life. Friends and family will notice marked differences in their loved one, but the person may not be able to recognize or acknowledge the changes. 

The residual phase occurs after active schizophrenia. In this phase, symptoms are much less obvious and may even be in remission but could still be present to some degree. Entering this phase doesn’t mean you’ll never enter an active phase again, though.

What Are the Symptoms of Prodromal Schizophrenia?

Prodromal symptoms are generally seen as nonspecific symptoms of schizophrenia (those involving an absence of normal interactions and functioning) that evolve over time.

Symptoms can fluctuate in intensity, severity, and length of time. They can begin in adolescence and the teenage years, although they may not be recognized and understood until a schizophrenia diagnosis is made later in life (a retrospective diagnosis).

Common early signs and symptoms of schizophrenia include:

• Nervousness and/or restlessness
• Depression
• Anxiety
• Thinking or concentration difficulties
• Worrying
• Lack of self-confidence
• Lack of energy and/or slowness
• Significant drop in grades or job performance
• Social isolation or uneasiness around other people
• Lack of attention to or care for personal hygiene 

Some of the prodromal signs, such as a significant change in personal hygiene and a worrisome drop in grades or job performance, can also be early warning signs of other issues, including psychosis or detachment from reality.

Types of Prodrome

There are two main patterns the prodrome takes. Again, you likely won’t know for sure which type is applicable until later schizophrenia phases. These two types are:

• Pattern 1 prodrome, characterized by certain nonspecific changes (e.g., sleep disturbances that could be signs of other mental illness), followed by specific pre-psychotic symptoms (early warning signs of schizophrenia) and then eventually leading to psychosis.
• Pattern 2 prodrome, characterized by early, specific changes associated with schizophrenia, followed by neurotic symptoms like anxiety and irritability in response to changes, and then psychosis.

These symptom patterns were later divided into five more patterns of disturbances (areas of most difficulty), including disturbances in:

• Attention
• Perception
• Speech production
• Motor function
• Thinking (e.g., thought blocks)

Prodrome phase can also be categorized in three different ways:

• Category 1 means the patient should have at least one of the following symptoms: False beliefs that random events in the world directly relate to them, odd beliefs, or magical thinking; visual disturbance; odd thinking and speech; paranoid ideation; and odd behavior or appearance.
• Category 2 includes patients who have experienced psychotic symptoms that come and go, which have spontaneously resolved within a week.
• Category 3 includes a combination of genetic risk (i.e., being the first-degree relative of an individual with a diagnosis of schizophrenia) with substantial changes in personal daily functioning in the previous year. 

What Are the Risk Factors?

There's still much to know about the underlying causes of schizophrenia, but its risk factors include:

• A family history, with genetics contributing to the possibility of diagnosis
• Stress and other lifestyle factors
• Environment, including lead exposure in childhood
• Infectious exposures, including viruses and parasites

Keep in mind that risk factors do not necessarily indicate a cause of schizophrenia, which is a complex mental health condition. It's also important to remember that prodromal schizophrenia is hard to identify because it lacks the characteristic symptoms of schizophrenia.

For example, a person may be diagnosed with a mood disorder but later develop active schizophrenia without going through a prodromal phase, which further complicates getting an accurate diagnosis. 

The fact that prodromal schizophrenia co-occurs with other mental illnesses or substance use disorders, or arises during the hormonal changes of adolescence, adds to the complexities.

Diagnosis

Researchers have been working on ways to diagnose prodromal schizophrenia earlier on, rather than retrospectively. Earlier detection means minimizing the time between when the illness starts and first psychosis. It also offers more room for the prevention of psychological and social disruptions (work, school, friendships, etc.) associated with active schizophrenia.

Generally, someone in the prodromal stage will have two or more symptoms (like odd beliefs) in a milder form for at least six months.

Some diagnostic tools that have been used to assess for schizophrenia include:

• Comprehensive Assessment of At-Risk Mental States (CAARMS) includes assessment of symptom intensity, frequency, and duration as well as decline in functioning. 
• Structured Interview for Prodromal Syndromes (SIPS) was developed by the Prevention through Risk Identification, Management, and Education (PRIME) prodromal research team at Yale University. It includes minor differences and is used interchangeably with the others. 
• Bonn Scale for the Assessment of Basic Symptoms (BSABS), which has proven especially useful in diagnosis during prodromal phases.

Treatment

Schizophrenia is treated with medications that target symptoms ranging from psychotic symptoms (treated with antipsychotics), to depressive and anxiety-related symptoms that are treated with antidepressants and anti-anxiety medications.

Therapy with a trained professional can help a person develop healthier coping skills, manage substance use disorders, and work on their relationships with others. 

Many factors can interfere with someone’s treatment plan and outlook or prognosis. With prodromal schizophrenia, the outlook is negatively influenced by the following:

• Lower cognitive functioning (lower IQ or thinking, problem solving, and comprehension impairments)
• Lower social skills
• History of substance abuse
• Comorbid disorders (disorders that happen at the same time as others)
• Lack of social or community support 

Substance use disorders are among the most common comorbid illnesses affecting the outlook for people with prodromal schizophrenia. Psychoactive substances like cannabis can also influence the onset of psychosis and are a known risk factor for schizophrenia, although the cause-and-effect is unclear and findings are not always consistent.

Seeking help for psychiatric symptoms before they begin to create personal, interpersonal, and professional problems is always the best-case scenario for an outlook when it comes to mental illness. Staying the course of treatment will also be a major factor in overall outlook and outcome. 

Summary

Prodromal schizophrenia is the earliest stage of schizophrenia. Not all people with schizophrenia experience this phase. Hallmark symptoms of the prodromal stage include nervousness, anxiety, depression, difficulty concentrating, excessive worrying, and more.

Prodromal schizophrenia can be especially hard to identify because these symptoms are related to many other conditions. There are very small differences between diagnoses that may not seem major, but they can mean a lot when it comes to getting the right diagnosis and treatment.

Early detection can make a big difference for patients with schizophrenia. If you or a loved one are experiencing symptoms, seek help from a medical professional. Be sure to tell your healthcare providers about any substance use, as it's essential information for getting the right assistance.