Early signs of schizophrenia, like changes in personality or behavior, can develop years before you experience psychosis. Doctors refer to this early phase as prodromal schizophrenia.
Schizophrenia is a complex mental health condition that affects how you perceive and interact with the world around you. It’s characterized by symptoms of psychosis, such as hallucinations and delusions. But it also features cognitive and behavioral changes, as well as losses in many areas of motor function.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), a clinical guidebook that helps identify and diagnose mental health disorders, some people living with schizophrenia experience an abrupt onset of psychosis, and others experience a more gradual development of symptoms.
The time of early warning signs before the first full episode of psychosis in schizophrenia is known as the prodromal period, and it can involve a variety of symptoms that affect personality, behavior, and thinking.
This article examines prodromal schizophrenia, including symptoms, causes, treatment, and outlook.
Prodromal schizophrenia isn’t a stand-alone diagnosis. It’s a phase of schizophrenia.
Schizophrenia is typically broken down into three phases:
- prodromal: early warning signs
- active or acute: symptoms of psychosis appear
- residual or chronic: symptoms improve, typically with treatment and management
Prodromal schizophrenia refers to the earliest phase of schizophrenia, where subtle changes in mood, behavior, and thinking develop before the first full episode of psychosis.
Psychosis is diagnosed when one or more psychotic symptoms are severe enough to affect your ability to function in reality. Symptoms of psychosis
- hallucinations
- delusions
- disorganized thinking
- disorganized motor function
- negative symptoms:
- alogia: a decrease in one’s ability to verbally express oneself
- anhedonia: an inability to feel pleasure in previously enjoyed activities
- asociality: preferring solitude and limited social interaction
- blunted affect: decreased ability to impart emotion through facial expressions, tone of voice, or body language
- avolition: lack of motivation or ability to do tasks or activities with an end goal, such as paying bills
For a diagnosis of schizophrenia under DSM-5-TR criteria, at least two symptoms of psychosis must be present or have been present for the majority of time during a one-month period.
While you only experience the prodromal period in schizophrenia once, it is possible to experience prodromal-like warning signs after a diagnosis when you’re shifting from a residual phase into another active phase.
Not everyone experiences a prodromal phase in schizophrenia, but most people do. According to a
Symptoms can vary, but may include:
- social withdrawal
- sleep disturbances
- poor concentration
- depressed mood
- mood swings
- trouble remembering
- decline in personal hygiene
- unusual beliefs or changes in beliefs
- paranoia
- skewed interpretation of events
- mild psychosis experiences that don’t affect function, like auditory hallucinations
Experts aren’t sure why some people experience a schizophrenia prodrome and others don’t.
Genetics, environmental exposures, and life stressors are all thought to affect how schizophrenia develops.
Some research suggests prodromal symptoms may be more significant among people living with early-onset schizophrenia (schizophrenia where psychosis occurs before the age of 18 years).
The first step in treating prodromal schizophrenia is identifying that your symptoms may be leading to an episode of psychosis. Doctors do this using assessment tools developed to determine when someone has an “ultra high risk (UHR)” of developing psychosis.
If you meet the criteria for UHR, treatment will depend on the severity of your symptoms and which areas of function have been affected.
You may receive the same types of treatments as someone who has been officially diagnosed with schizophrenia, including:
- antipsychotic medications
- mood stabilizers
- psychotherapy
- lifestyle modifications
- support services
Schizophrenia is a lifelong condition, but early treatment is associated with the best outcomes.
Treating schizophrenia as soon as possible can mean fewer and shorter active phases and may reduce how significantly schizophrenia affects your daily life long-term.
It’s unclear, however, if treating schizophrenia in the prodromal phase can prevent you from experiencing psychosis completely.
The prodromal phase is the first and earliest phase of symptom development in schizophrenia, before the first full episode of psychosis. It features changes in mood, personality, behavior, and thinking, and can last for months or years.
While it’s unclear if treating schizophrenia during the prodromal phase can prevent psychosis, early treatment is associated with the best outcomes.