Recognizing the Prodromal Symptoms of Schizophrenia

Schizophrenia is a severe and disabling mental health disorder. The prodromal symptoms of schizophrenia mark its initial appearance, and when they intensify a psychotic break could be near. The sooner treatment is sought the better, and treatment that begins during the prodromal phrase can prevent schizophrenia from ever developing.

The word ‘prodrome’ is used to describe the earliest signs of schizophrenia and other psychotic disorders, and also as a label for the period between the onset of those symptoms and the development of actual psychosis. Prodromal symptoms are similar to those experienced during an actual schizophrenic episode, although they usually appear in a more muted form.

Based on the specifics of the symptoms observed, one of three types of prodromal schizophrenia may be diagnosed by mental health professionals:

• Attenuate positive symptom prodromal syndrome (APS). This diagnosis is reserved for those who’ve been experiencing pre-schizophrenic symptoms regularly for at least a year.
• Brief intermittent psychosis prodromal syndrome (BIPS). Prodromal symptoms of psychosis are experienced for several months or more, but on a semi-irregular or intermittent basis.
• Genetic risk and deterioration prodromal syndrome (GRDS). If one or more family members have manifested psychosis in the past and prodromal symptoms are worsening, GRDS could be the diagnosis.

The majority of those who manifest prodromal symptoms are young, ranging in age from their late teens to their early 20s. This is not an ironclad rule, however, and schizophrenia (and its precursor symptoms) can develop at just about any age.

Prodromal schizophrenia is a serious mental health condition on its own, capable of interfering with ordinary functioning and causing notable life disruptions. But prodromal symptoms also function as an early warning system for psychiatrists and psychologists, who understand how schizophrenia develops and know how treatment plans should be designed to halt its progress.

Most people who manifest the symptoms of schizophrenia prodrome will eventually be diagnosed with schizophrenia (up to 75 percent according to some studies). One reason the conversion is not universal is because some people in the prodromal stage receive treatment for their symptoms. This can be enough to prevent the onset of true schizophrenia completely if the treatment is comprehensive and provided by highly skilled mental health experts.

Prodromal symptoms of schizophrenia are partially distinct from those experienced during fully developed versions of the disorder. They overlap with a broad range of mental health conditions and require a discriminating eye to identify as specifically belonging in the early-onset schizophrenia category.

Research indicates that prodromal symptoms of schizophrenia inhibit performance or cause aberrations in five domains: attention, perception, speech production, motor functioning, and thinking. Over time, the manifestations of schizophrenia prodrome will increase in intensity and are unlikely to subside on their own if treatment is not provided. This will be the case even if prodromal symptoms of schizophrenia never give way to schizophrenia itself.

Common symptoms of schizophrenia prodrome covering the five domains include:

• Chronic anxiety
• Frequent mood swings
• Insomnia
• Memory problems
• Difficulties with concentration and focus
• Social isolation or withdrawal
• Inability to perform job duties or fulfill personal responsibilities
• Strange, seemingly illogical behavior
• Decline in hygiene and self-care skills
• Lack of emotional expressiveness
• Low energy and a lack of interest in previously enjoyable activities
• Odd speech patterns, marked by too many or too few words, or an indirect and imprecise form of self-expression
• Unusual or clearly irrational beliefs, bordering on (or crossing into) the delusional
• Reports of strange perceptions, possibly indicating the presence of mild hallucinations

The prodromal symptoms of schizophrenia will tend to escalate in both intensity and number over time. Nevertheless, there is no clear and definitive time frame that indicates how long the schizophrenia prodrome will last before schizophrenia develops. A prodromal period of between several months and up to two years is typical, although some people have only been diagnosed with schizophrenia several years after they first started noticing prodromal symptoms.

Psychotic disorders share certain risk factors, all of which may contribute to the onset of prodromal schizophrenia symptoms. They include:

• Genetic predisposition. Someone who has a parent diagnosed with schizophrenia is 10 times more likely to develop the disorder than a person with no such history.
• Exposure to childhood trauma. People who were physically, sexually, or emotionally abused during childhood are highly vulnerable to mental illness of all types.
• Abnormalities in brain structure, volume, and function. Neurologists studying the brains of people with psychotic disorders have discovered many indications of malfunction or malformation, which could have predictive value in some instances.
• Chronic stress responses. Research shows that people who are at high risk for schizophrenia react more strongly to minor and moderate stress than those who are low risk.
• Complications in pregnancy or after birth. Some of the prominent risk factors for later-life psychosis include low birth weight, exposure to toxins or viruses before birth, and oxygen deprivation during the birth process.
• Substance abuse and addiction. Psychotic symptoms and disorders can develop when drugs of any type are misused for a prolonged period, with the risks especially significant for those who use drugs during adolescence or in young adulthood.

Risk factors are not a perfect predictor of schizophrenia. They increase the likelihood of it developing, but many who become schizophrenic, or demonstrate prodromal symptoms, would not fit neatly into any high-risk category.

Recognizing the symptoms of prodromal schizophrenia is not always easy, since they can mimic the side effects of other conditions. Knowing about the risk factors can make it much easier to do so, and families who are educated about the disorder and its potential causes are in a good position to react quickly when signs of trouble first become evident.

Early intervention is known to produce good results in people who have psychotic disorders. It is the nature of these conditions to worsen over time, and while they are still amenable to treatment at any stage, their progression can be halted if intervention comes early.

This is especially important with prodromal schizophrenia. This disorder itself is not usually disabling, but it signals the impending development of a serious, life-altering condition. If it is assumed that a person who manifests prodromal signs is likely to develop schizophrenia eventually, it is logical to offer treatment before this extreme result is experienced.

Mental illness is challenging to overcome, but it is also challenging to accept. If someone in your family is showing disturbing signs of emotional or psychological struggle, denial may be your initial response. You may credit the symptoms to a less severe disorder, such as mild depression or anxiety, or refuse to accept the existence of the problem altogether.

But the prodromal symptoms of schizophrenia indicate something far more serious is taking place, and your ability to correctly interpret them could be crucial for your loved one’s long-term prognosis. The appearance of pre-schizophrenic behavioral patterns is in fact a powerful signal that expert assistance is required—and quickly.

You may not suspect that your loved one’s problems are an indicator of early-onset schizophrenia. Or you might suspect that if there is a history of psychosis in your family. Either way, the time to get treatment for schizophrenia is during the prodromal stage, when the combination of medication, psychotherapy, and complementary wellness practices offer the best possibility for comprehensive healing.

Residential treatment and other intensive recovery programs for prodromal schizophrenia provide the kind of comprehensive care that can prevent further issues with psychosis from arising. The prodromal symptoms of schizophrenia should never be ignored, and if you respond to their appearance rapidly and proactively you could save your partner, parent, sibling, or close friend from a frightening encounter with a highly disruptive mental health disorder.

If you’re concerned about a loved one and believe they may need residential care, we can help. BrightQuest offers long-term treatment for people struggling with complex mental illnesses. Contact us to learn more about our renowned program and how we can help you or your loved one start the journey toward recovery.

Prodromal Schizophrenia at BrightQuest